1. 1 Collaborative undertaking by counties, providers and consumers, with support from OMH and project management by CCSI Shared goal of promoting recovery and conserving resources for the support of children with serious emotional disturbance and adults with serious mental illness. Formed in 2000, operational in mid-2002 – six western and central counties, including Chautauqua, Erie, Genesee, Monroe, Onondaga, Wyoming. Expanded in 2009 to include Westchester County. Implemented care coordination in diverse urban and rural counties. 2,800 enrollees at any one time

2. NYCCP Specialty Care Management Improves Outcomes and Costs 2 Better quality 46% decrease in emergency room visits per enrollee* 53% reduction in days spent in a hospital* 78% of enrollees report “dealing more effectively with problems” (2009 Enrollee Survey) Better outcomes 31% increase in gainful activity* 54% decrease in self harm among enrollees* 53% reduction in harm to others* Lower costs 2008 Medicaid mental health costs for Care Coordination populations in NYCCP vs. comparison counties: (OMH August 2010) 92% lower for inpatient services 42% lower for outpatient services 13% lower for community support Physical health savings would be additional. $5,541 lower average cost person * 2009 Periodic Reporting Form Analysis

3. 3 Of Erie and Monroe mental health users, the “top 10% in total cost” represent 63% of Medicaid hospital and residential spending… …yet only a quarter of the “top 10%” were enrolled in available Care Coordination programs ACT ICM SCM NYCCP has identified unmanaged populations as a driver of continuing high costs and refocused, community based, specialty care coordination as a component of the solution. Note: Analysis of all 2007 claims for Medicaid recipients 18 or over, with any mental health claim, excluding individuals with any OMRDD or nursing home claim.

4. NYCCP Keys to Success 4 Specialty care management grounded in understanding of complex needs of individuals with serious mental illness and co-occurring physical health conditions Continuous quality improvement and performance measurement Coordination of physical health, behavioral health and social support services Person-centered practices, planning, and services Culture change to a focus on Recovery

5. Recommendations: Specialty Health Homes 5 Specialty health homes should be a central component of any Medicaid managed care program, ensuring true integration of physical health, behavioral health and social services for people with serious mental illness. NYCCP is proposing a scalable model for specialty health homes for individuals with serious mental illness, based on the NYCCP keys to success. (Detailed proposal will be submitted.)

6. Recommended Requirements for Managed Care Organizations (Detailed proposal will be submitted) 6 Actively involve behavioral health providers, consumers, and family members in development and oversight of managed service systems. Maintain percentage level of financial support for behavioral health care to all populations. Assure that people with SMI have access to needed physical health services. Support formation of partnerships between physical health and behavioral health providers interested in providing health home services to persons with SMI. Collaborate with community behavioral health providers on person-centered assessment, service planning, coordination and monitoring of care. Work cooperatively with county mental health departments on local service planning, provider contracting, coordination of Medicaid and non-Medicaid funding of services for SED children and SMI adults.