This is what progress on Medicaid and mental illness looks like....

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This is what progress on Medicaid and mental illness looks like....

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whynot_31
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Brooklyn Care Program Gets $14.8M Boost

Maimonides Medical Center last week was awarded a $14.8 million federal health care grant to create medical homes for psychiatric patients as part of the nation's effort to curb costs by treating illnesses outside hospitals.

Like most facilities, Maimonides finds inpatient admissions profitable under the current fee-for-service system of Medicaid reimbursement. But hospital Chief Executive Pamela Brier and colleagues are gambling that in the long run, keeping mentally ill patients out of the hospital will pay off.

She and the hospital's partners hope their new care program will reduce hospitalizations by 30% and save Medicaid $42 million over three years, compared with current payments.

The three-year award announced June 15 is one of 107 federal Health Care Innovation Challenge Grants awarded nationally. Maimonides will partner with health care providers, health care workers' union 1199 SEIU and other organizations.

The medical home will not be a bricks-and-mortal facility but an electronic network in which newly trained case managers and care navigators track the health of the estimated 7,500 psychiatric patients in 11 ZIP codes served by the hospital.

The new workers will be responsible for connecting directly not only with patients but with every place they seek care, whether it is a clinic, an emergency department or a specialist's office. The idea is to eliminate duplicative care, ensure that these patients are getting treatment for all their medical and mental health issues, and centralize their electronic medical records so that all caregivers are working with the same, up-to-date information.

New York is often criticized for overspending on Medicaid without improving patients' conditions, Ms. Brier said.

"Exhibit A is the example of the seriously ill mentally ill," she said, "These people are very expensive users of the health system with a lot of repetitive admissions."

Also involved in the project are Lutheran Medical Center and Lutheran Family Health Centers, the Institute for Community Living, and the 37-member Brooklyn Care Coordination Consortium.

http://www.crainsnewyork.com/article/20120619/PULSE/120619877#ixzz1yFAwU7ht

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
Jack Krohn
My Baby's Gone Shootin'
Joined: Dec '05
Posts: 1,075

Thanks for posting. I hope this works better than the current system, though I have my doubts. It seems that every few years the "establisment" trots out yet another new idea that winds up having little, if any, appreciable impact in the long run. The electronic records is an excellent idea for coordination - that alone would make it difficult to implement in some city hospitals that continue to operate in the dark ages by using paper records. I also wonder if uninsured and/or undocumented psychiatric patients would be eligible for this. Either way, I look forward to the results.

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
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Yes, the challenge is way too complex for one solution. I hope that this is part of an increased level of attention to the needs of the mentally ill.

The more intelligent, thoughtful, patient people that we have coming up with innovations and solutions, the better.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
The Psycho-ologist
big A little a Bouncing B the system may have got you but it won't get me.
Joined: Jan '08
Posts: 440

As a psychologist I see 4 things becoming of this:

1) more time wasted on frozen computers, slow data bases, and finding "missing charts" due to one incorrect keystroke which changes a name, DOB or Address.

2) A whole lot of potentially hackable, vulnerable and sensitive psychiatric data that could potentially get into the hands of prospective employers, friends etc, who have access to a few good people search engines.

3) A whole bunch of "fee for service" clinicians NOT being paid for: A) Work they can "take home" since its often subtly suggested that "Well, you can put it on a USB or access the mainframe from everywhere" therefore we will only pay you for actual "face to face time" and not any case management; and B)any travel time as when they are asked to go to all these facilities to "shadow" their patients or pick up stuff that cannot be electronically put through, (original consent forms, court papers, notarized things).

4) An increase in the number of clients a clinician is responsible for since its implied that electronics make everything sooo "easy" (forget about data entry of chart info and having to write your treatment notes), that you can do it in 5 minutes while you are sitting on the toilet at home.

Its a terrible time to be a PhD/PsyD or CSW

a teaspoon of kisses and a drop of glee

# Posted 12 mos ago
whynot_31
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I think the hospitals who get this funding will continue to provide more integrated care than the small clinics, which are completely unprepared and not funded to serve complex mental health needs.

...and often trying to make due with a group of fee for service LMSWs in their 30s, a LCSW to oversee them, and a per diem (once every two week) psychiatrist.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
The Psycho-ologist
big A little a Bouncing B the system may have got you but it won't get me.
Joined: Jan '08
Posts: 440

Hi Whynot.

I am in my 30's (I am 36) and I am a licensed clinical psychologist.

What's wrong with being in your 30's?

Also, many hospitals have outpatient mental health "clinic" services, that also have LMSW's etc. I think, the "comprehensive" will be eaten up by the volume versus staff, due to hospitals wanting to prove that this will be "cheaper" by cramming fee for service clinicians with more clients, when in fact this system probably will cost about the same (due to electronic data base maintenance, technical support, travel costs, wait times at various agencies while a patient is "shadowed").
Forget about all the unscrupulous folks I know in this industry who WILL take advantage of this "e-communication" system, to forge electronic data and claim they are shadowing folks when they are sitting on the beach.

a teaspoon of kisses and a drop of glee

# Posted 12 mos ago
whynot_31
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There is certainly nothing wrong with being in your 30s.

But there is certainly something "wrong" with being at the bottom of the mental health provider food chain as a LMSW, or just above them as a new psychologist. As you are aware, it is a place few people say for long. When I last checked, the going rate was $28 a session, and the fee for service (FFS) therapists weren't paid if the clients didn't show up. ...which is a lot of the time.

Being the Director of these folks in their 30s is no picnic either. Can you imagine staffing a clinic in which the majority are FFS workers, fresh out of graduate school?

Some are just there long enough to collect enough hours to get their ability to practice independently. Others have a real commitment to the population being served and their jobs, but fail to realize that no matter how much they complain and "advocate" on behalf of their clients, the Director doesn't have the magic wand that bestows resources and cures. ....please leave s/he alone while they write yet another Corrective Action Plan to one of the Medicaid HMOs that must be bowed to.

Think the new system will be even worse for therapists? I suspect you may be right, but don't agree with your reasoning. .

...You see, if you read the above article closely, you'll see Masters and Doctorate level therapists don't have much of a role it.

As the future arrives, Psychologists won't be able to blame the graduation standards of the area's half dozen MSW mills. Instead, they will bond with them against BA-level Patient Care Associates..... or, even cheaper, the dreaded Peer Counselor.

Make no mistake, this treatment plan has been written by those who fund Medicaid. They are desperately looking for ways to get its costs under control.

...as Jack points out, be careful, they just might improve care in the process.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
The Psycho-ologist
big A little a Bouncing B the system may have got you but it won't get me.
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1) you can't be a "new psychologist" if you are licensed
everyone in mental health knows that you need to have practiced at least two years post doctorate to even qualify for a license. That includes your PRE- dissertation one year minimum long "internship" and ANOTHER year's worth of hours you have to accrue AFTER you get your PhD, to sit for the license:

http://www.op.nysed.gov/prof/psych/psychlic.htm

Many of us, including myself, take longer than the year in the "internship phase" due to lingering over our dissertations, ABA is a term all to itself that is well known: "Anything/All but dissertation". Many of us like myself also spend more than 1 year also gearing up to sit for the license since it requires study of material that MAY not have been given while in school, which includes state ethics guidelines.

"{....One step above an LMSW.....}" that is an insult, and shows that you may know little about the field you are writing about. To be a "licensed psychologist" you MUST have a Ph.D. or Psy.D. and that is AT least 5 years of grad school. An MSW is one year of grad school. Psychologist also do testing, research and diagnostic exams.

2) 28 per hour, I don't know where you get that from, but no self respecting psychologist is working for that. I earned more than that before my licensing.

3)If you know the details of mental health like I do, the actual practice rather than the bullshit that is written in policy, you will know that a hell of a lot of case management and advocacy IS done by the MA and PhD level clinician's because many of the "caseworkers" don't' have the knowledge or training of the ethical/clinical standards, practice protocols, or compliance tools to ensure a chart that will pass auditing, or that a treatment diagnosis that will continue to meet billing guidelines etc.

I am NOT just a therapist, and nor are 99% of psychologist, that is why we chose PSYCHOLOGY. Many of us administer testing, do research, etc.

Let me give you a good example of what people who WORK in this field KNOW about clinician's ending up doing case management:
Example: A lot of CLINICAL legwork would have had to be done to get this person the service they needed:

A 51 year person walks. They need OPWDD services because they don't know how to read, write, or cannot carry out basic ADL's. They were taken care of by their mother who has passed away and now this person needs help finding supportive housing. They have no history of Mental Illness, and appear to be coherent and oriented to time and place, therefore OMH rejects them. They get tested and meet IQ/functional criterion for MR. They apply for OPWDD, but are rejected, because the person appeared to have no no longstanding IQ problems. We are forced due to this persons age to look for ancient data that may or may not be available. Testing data is often not available, because testing wasn't done on a widespread basis when that person was a child. So as clinicians, we sift through various pieces or archival medical data, school records etc that will bolster our case. Often times this takes someone with the clinical knowledge to know that a random report of a long standing infantile Thiamine deficiency may give us the DSM criterion we are looking for, due to our knowledge that it may impact IQ and cause epilepsy that when occurring in early childhood may also impact development.

The person I mentioned needs the service, but due to their messed up psycho-social history, their medical and school paperwork is long gone, and it takes a qualified clinician, to ask the right questions and look for the right tests, in that clients old hospital records to uncover and justify their need.

Yeah, the nuts and bolts are never in writing. They are in the practice.
Affordable healthcare should have nothing to do with screwing over credentialed people to get to the lowest cost denominator. I wonder about the allocation of the BULK of our federal resources in general to the military, which we don't have to depend on or use as much as we use health care. I also wonder about the overhead of these overpriced, drugs and medical tests.

yeah, but its better to shout at the little guy who is IN the trenches WITH the patient actually doing work, rather than moving numbers from one column to another then flying around in a jet as a fiscal manager for medicaid.

I would say the same thing about our teachers, and most in the trenches professionals who actually work for populations that NEED our help.

Medicaid should be better funded, rather than over analyzed for where we can scrape so called "waste" from the bone. I wish we were as stringent with military spending, space exploration and all sorts of ancillary, non immediately needed budgets as we are with the budgets that affect REAL PEOPLE every DAY.

a teaspoon of kisses and a drop of glee

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
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You are correct in stating that there is a qualitative difference between Psychologists and LMSWs, but I think you will agree with me that the line between them and the Case Management staff seems to blur everyday.

...their duties and their pay are what is making them similar, not their skill sets.

You accurately describe many of the skills needed to deliver quality care. However, as we both seem to agree (and the article alludes), the driving force behind this movement is cost savings.

If that fails, give them time ...they will also trot out terms like "independence".

How will they get less skilled, less educated workers to comply with the audit regulations and the complexities you describe?

They will create computer programs that make writing treatment plans similar to ordering a combo meal at McDonald's. The questions will constructed in a way that ensures every Dx and reimbursement criteria is met, and able to be completed by someone who will make between 30 and 36k.

The role of the psychologist? Well, as you know, less and less testing is done prior to diagnosis and treatment planning. Once the case management duties are stripped, the clinics may have treat them like the psychiatrist, and only be able to afford to have them appear once a week.

Prescription day with the MD: Tuesday

Testing day with the PsyD: Thursday

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
The Psycho-ologist
big A little a Bouncing B the system may have got you but it won't get me.
Joined: Jan '08
Posts: 440

" Create computer programs that make writing treatment plans similar to the ordering a combo meal at McDonald's. The questions will constructed in a way that ensures every dx and reimbursement criteria is met, and able to be completed by someone who will make between 30 and 36k."

Are you kidding. A human life with all the minutia and details of psycho-social and mental health can be boiled down to a boiler point template that can be generated by a computer? Don't you think that hasn't already been tried and FAILED abysmally.

I will give you a funny example.

At an agency where I worked we had a computer program, design a treatment plan that would automatically insert a referral to a nutritionist, group weight management counseling, and a screen for diabetes/cardiovascular problems when a Patient's BMI went up above a certain number. We implemented the system, because we had many obese patients who due to being on Zyprexa developed some glycemic issues.

Fast forward and we were audited again and sited for:

2 weight lifters who were repeatedly referred to nutritionists, weight management/obesity counseling, although they were in "perfect health". We wasted a whole lot of time and money on a convenient little computer system.

Deep Blue I hear plays good chess, and can win on Jeopardy but can he be a philosopher, poet or psychologist I doubt it?

a teaspoon of kisses and a drop of glee

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

You continue to focus on client care as a primary driver.

...there is no the primary driver.

Everyone has a stake:
Taxpayers who pay for services
Medicaid and HMO wonks
Directors
Providers
Patients

...some people just have stakes that are smaller than others.

Too many people with big stakes believe the present system isn't working for them, and they are going to impose something else.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
The Psycho-ologist
big A little a Bouncing B the system may have got you but it won't get me.
Joined: Jan '08
Posts: 440

The primary mission of most "public" hospitals, and Medicaid/care?
...drum roll......

: Patient care.

.. they say quality, but heh that's dubious.

HA!

I have to ask? What do you do for a living? I find myself fascinated by your posts/opinions/rants/ravings/

a teaspoon of kisses and a drop of glee

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
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For now, your mind should continue to wonder and wander.

As to the healthcare system, if we wanted it to deliver one thing, we could do it.

However, we want many things and do not agree on the definitions of what we want.

....nor the methods we will use to achieve them.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
Jack Krohn
My Baby's Gone Shootin'
Joined: Dec '05
Posts: 1,075

Wow, I go away for a few days and miss out on an interesting conversation! Good points on both sides. I agree with the Psychologist that being a "therapist" nowadays is more than just that, and typically involves a ton of case management, secretarial work (e.g. letters, phone calls, filing, xeroxing, faxing, etc.), and non-billable work like scheduling and rescheduling patients. At the end of the day, though, all management cares about is the number of patients that you have seen.

Just a quick correction: an MSW requires two, not one, years of graduate school. To be an LMSW, one has to pass a national licensing exam after graduation and to be an LCSW one has to log 2000 clincal hours and 100 hours of supervision over a three year period and pass two national licensing exams. To get the R psychotherapy privilege requires all of this plus an additional three years of practice. Your central point about PhD requiring more years and involving other skills like testing and research remains true, but I just wanted to dispel the notion that becoming a master's-level therapist requires but one year of grad school.

Lastly, I want to avoid turf battles. As a practicing LCSW, I respect all mental health disciplines (nursing, psycologist, psychiatry, social work, peers, etc.) and know from experience that a rich mix of all makes for a better clinic (regardless of the endless headaches posed by OMH regulations and pressure to increase revenue).

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

As the future arrives, only the largest settings will be able to hire full time people with specialized skills, the rest will be forced to simply hire per diem or FFS.

The system has nothing against (or for) those who spent more (or less) time getting the ability to bill, it simply makes economic sense to hire cheaper workers to do the lower paying work.

Whether they like it or not, those with licenses will be utilized as testing and diagnosis machines, allowing the clinics to stay open.

Yes, the risk is that Care provided by lots of people will result in no one knowing what what the other is doing, but the alternative (no care) might be worse.

While you may like to return to the idealized days of unlimited billing and face to face contact, that seems very unlikely to occur. Can't a program like EPIC help ?

http://en.m.wikipedia.org/wiki/Epic_Systems

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 12 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

Jack-
If you ever get tired of NY, this well written article that recently appeared in the NYT Magazine shows that NJ is quite similar:

http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-actually-lost-his-mind.html?_r=2&pagewanted=all

Computers aren't going to fix this mess, but they might help.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 11 mos ago
whynot_31
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CUNY rises to the occasion:

CUNY Certificate in Health Coaching & Care Coordination- Application Information Webinar on 6/27

Dear Friends and Colleagues,

Please join us on Wednesday, June 27th from 12:00PM-12:30PM for an informational webinar regarding the fall 2012 Certificate in Health Coaching and Care Coordination at CUNY. We encourage interested applicants to take advantage of this live session to learn more about the program, application and admissions process. Please find a flyer attached with detailed instructions for accessing the webinar.

This undergraduate certificate is offered by The John F. Kennedy, Jr. Institute, in association with Queensborough Community College, at no tuition cost to frontline workers in the health care, behavioral health and social services sectors who have a GED or High School Diploma, are residents of NYS, and are available to commit to completing a sequence of 5 courses (a college bridge course and 4 credited courses) through the fall 2013 semester. The application deadline is July 30, 2012. The fall 2012 application, which includes detailed program and eligibility information, can be downloaded from: http://www.cuny.edu/about/administration/offices/hhs/hps-program.html

Please share this with those in your network who may be interested in learning more about the program.

Sincerely,

Abigail

Abigail Nelson, CRC
Director of Disability Initiatives
Office of the University Dean for Health and Human Services and
John F. Kennedy, Jr. Institute
The City University of New York
101 West 31st Street, 14th Floor
New York, NY 10001
P: 212.652.2053
F: 646.344.7319
Abigail.Nelson@mail.cuny.edu

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 11 mos ago
whynot_31
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Joined: Mar '06
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New York Payer & Hospital Behavioral Health Collaboration Reduces Hospital Readmissions To Less Than 10%

Open Minds July 9, 2012

Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, http://www.openminds.com. All rights reserved.

In New York, a care coordination and case management collaboration between Samaritan Hospital’s clinical care team and the behavioral health operations of Capital District Physicians Health Plan, Inc. (CDPHP) has reduced behavioral health-related hospital readmissions to less than 10% between 2010 and 2012. The health plan estimates savings of at least $8,000 per avoided readmission.

During the second quarter of 2010, the behavioral health re-hospitalization rate was about 11%; by the third quarter of 2010 the readmission rate had dropped to 10%, and for each subsequent quarter has stayed below 10%. The behavioral health readmission rate was about 8% during the first quarter of 2012.

The partnership began in 2009 when CDPHP brought behavioral health management in-house; previously, CDPHP had contracted with United Behavioral Health to manage behavioral health benefits.

After a year of planning, in 2010, Samaritan Hospital and CDPHP launched the Readmission Avoidance Initiative in which a clinical care coordinator served as a liaison between the hospital and health plan medical director. In 2011, the health plan introduced case management services and a home visit program to the initiative to improve community linkages and care transitions.

Both CDPHP and Samaritan Hospital sought to decrease clinical and administrative burden related to pre-authorization and documentation, reach a high level of agreement on medical necessity and appropriate treatment, decrease denials, and improve outcomes for patients/members.

The initiative includes a care coordinator, weekly on-site length-of-stay rounds, weekly administrative meetings, and notification and clinical review prior to denial. The care coordinator functions as a primary clinical partner and liaison between Samaritan Hospital and CDPHP’s behavioral health medical director. The care coordinator reviews and determines medical necessity via remote access to patient medical records, telephonic consultation with professionals caring for the patient, information from the length of stay rounds, and participating in case review/conferences.

Together CDPHP’s director of behavioral health operations and a Samaritan Hospital clinical team outlined an acceptable utilization management process, launched an on-site care management presence, initiated open access to patient medical records, and identified clinical improvement opportunities to reduce avoidable hospital readmissions.

The collaboration extended through contract negotiations on sub-acute care reimbursement rates for a quality initiative—the Readmission Avoidance Initiative—a multidisciplinary approach to improve patient outcomes, enhance patient satisfaction, and reduce costs by avoiding preventable readmissions. Through the Readmission Avoidance Initiative, the partners implemented a readmission “audit tool” interview and experimented with clinical bundles that featured family involvement in care, timely discharge follow-up, post-discharge telephone contact, and primary care collaboration.

To further reduce readmissions, in 2011, CDPHP introduced a case manager and in-home visits. The case manager collaborated with Samaritan Hospital, directly contacted patients, and provided post-discharge follow-up via telephone outreach to identify members needing home visits. Hospital readmissions are now below five percent among patients who receive a home visit.

The collaboration was the topic of a presentation by Samaritan Hospital and CDPHP at the Healthcare Association of New York State’s (HANYS) first Behavioral Health Strategies, Weapons, and Tactics (SWAT) program, which took place on June 7, 2012. The event focused on tools and information to educate HANYS members serving behavioral health patients in a managed care environment. Other presentations at the event focused on providers’ general legal rights in managed care, managed care contracting for behavioral health provider organizations, and behavioral health revenue cycle management.

Robert Holtz, vice president of CDPHP Behavioral Health Services, and Scarlett Clement-Buffoline, assistant vice president of Behavioral Health Services at Samaritan Hospital in Troy, discussed the collaborative relationship between CDPHP and Samaritan Hospital. Their presentation emphasized that as a result of the collaboration, readmissions have been reduced, savings have been achieved, and patient response has been very positive.

As of mid-2012, the presenters said the home visit model is maturing, and they are identifying opportunities for collaboration related to chronic medical conditions. Mr. Holtz noted that CDPHP has learned that collaborating and building relationships with hospitals is the most effective way to conduct utilization management. Ms. Clement-Buffoline said Samaritan Hospital has learned that payers can be partners and that transparency drives accountability, but also that change takes time and requires reframing the relationship.

Samaritan Hospital, founded in 1989, is a 238-bed community hospital in Troy, New York. In October 2011, it became part of St. Peter's Health Partners as a result of merger of Northeast Health, St. Peter's Health Care Services and Seton Health. The hospital provides critical care, ambulatory surgery, maternity, cancer care, women's health, and behavioral health services. Founded in 1984, CDPHP and its affiliates serve nearly 390,000 people in 24 New York counties: Albany, Broome, Chenango, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgomery, Oneida, Orange, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Ulster, Warren, and Washington.

http://www.openminds.com/market-intelligence/premium/omol/2012/032612cs3.htm.

For more information, contact:

Ali Skinner: Public Relations Manager, Capital District Physicians Health Plan, Inc., Patroon Creek Corporate Center, 500 Patroon Creek Boulevard, Albany, New York 12206; 518-605-4497; E-mail: askinner@cdphp.com; Web site: http://www.cdphp.com/Commitment-To-Quality

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 11 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

Vera just published a report on one of the highest need, most expensive segments of the mental health population: Those who come into frequent contact with the criminal justice system.

fact sheet: http://www.vera.org/download?file=3545/closing-the-gap-fact-sheet-2.pdf

full report: http://www.vera.org/download?file=3544/closing-the-gap-report.pdf

They chose to study Washington DC, but I believe the findings to be be applicable to NYC.

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 10 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

New York Applies For Federal Waiver to ‘Transform’ Health Care

By Jessica Bakeman Gannett News Service August 6, 2012

New York today submitted an application to the federal government asking to reinvest into the state’s health care infrastructure $10 billion of savings created by Gov. Andrew Cuomo’s Medicaid Redesign Team.

Phase one of the team’s recommendations are estimated to save a total of $34 billion in Medicaid funds — about half to the state and half to to the federal government. The waiver application, touted by a slew of health-care industry stakeholders at a Capitol news conference on Monday, asks for $10 billion of the estimated $17.1 billion federal savings over five years to be reinvested into New York’s industry.

Cuomo assembled the Medicaid Redesign Team in January 2011 to identify potential cost savings in the state’s Medicaid program — the largest and most expensive in the nation.

State Health Commissioner Nirav Shah demonstrated no doubt that the federal government would provide the waiver.

“It will be approved, because all of New York state will be behind it,” he said at the conference. “And it makes sense.”

Calling the waiver “revenue-neutral,” he explained approving the application would not cost the federal government any more money. It will, in fact, cost less money, as the feds will still realize a savings of $7.1 billion.

Shah and Deputy Secretary for Health James Introne explained that the $10 billion would account for start-up costs necessary to update and modernize both the physical and organizational infrastructure of health care in New York. That investment will generate further cost savings, they said, assuring that the state would not be left with a multi-billion dollar commitment when the would-be five-year waiver runs out.

An example is a $750 million investment in supportive housing, included as one component in the 127-page waiver application. Providing housing and centrally located health services to the most vulnerable individuals will save money by preventing and shortening hospitalizations, officials said.

These individuals include patients being treated for substance abuse, psychiatric disorders, behavioral or developmental disabilities or chronic illnesses like HIV/AIDS. About 1 million New Yorkers fall into the “high-cost, high-needs” category, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services.

Ted Houghton, executive director of the Supportive Housing Network of NY, said at the conference that 20 percent of Medicaid members account for 80 percent of spending.

“For these people, housing is health care,” Houghton said. With housing support, “people that we really gave up on in previous generations are becoming success stories.”

Also touting both the waiver and the work of the Medicaid Redesign Team, Paloma Hernandez, president and CEO of the Bronx-based Urban Health Plan, Inc., said all stakeholders’ opinions were considered while developing the overhaul plan.

“When you try to improve a system,” she said at the conference, “you need to take what you do and not add to it but really transform it. And I think that’s what’s being proposed here.”

http://polhudson.lohudblogs.com/2012/08/06/new-york-applies-for-federal-waiver-to-transform-health-care/

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 10 mos ago
whynot_31
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Joined: Mar '06
Posts: 16,367

Psycho-ologist, I saw this and thought of you-

NYC REACH, the NYC Department of Health, and the New York City District Branches of the American Psychiatric Association invite you to the Behavioral Health EHR & Meaningful Use Seminar

Thursday, October 18th, 2012
6:30 – 9:00pm
Bellevue Hospital Center

462 First Avenue, The Rose Room, 12th Flr., Manhattan

Food and refreshments will be served.

At this free event, you will:

· Learn how your practice may be eligible to earn federal incentive payments of up to $63,750 for Medicaid or up to $44,000 for Medicare

· Receive tips on how to implement an EHR at your practice

· Network with other behavioral health providers

· Hear from local behavioral health professionals as they share their experiences on the successes and challenges in EHR use

· Connect with NYC REACH staff members to learn more about how we can help you

Register: http://behavioralhealthseminar_nycreach_apa.eventbrite.com/

Contact Outreach Specialist, Jessica Ohlssen at (347)396-4855 or johlssen@health.nyc.gov

NYC REACH is the federally designated regional extension center (REC) for NYC. The mission of the REC is to educate and support health care providers in becoming meaningful users of electronic health records (EHRs). NYC REACH is administered by the NYC Department of Health’s Primary Care Information Project (PCIP), a mayoral initiative focused on improving quality care in NYC through health information technology and funded under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Call: 347-396-4888 | Visit: http://www.nycreach.org | E-mail: pcip@health.nyc.gov

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 8 mos ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

Push to Downsize NY's Mental Hospitals Lauded, Called 'Overdue'

By Jessica Bakeman Gannett News Service December 3, 2012

ALBANY — Gov. Andrew Cuomo issued an executive order on Friday advancing the state’s efforts to place…disabled people in integrated, community-based settings rather than state institutions.

Cuomo’s order created a cabinet that will design a plan for how to implement federal law that aims to prevent disabled people from being segregated from the general population, both in where they live and how they spend their days.

The cabinet, which includes officials from state agencies dealing with the disability community as well as several of the governor’s top aides, will present a plan to Cuomo in May. Roger Bearden, who Cuomo last year appointed chair of the Commission on Quality of Care and Advocacy for Persons with Disabilities, will serve as the cabinet’s leader.

Developing a plan to integrate disabled people was one of Cuomo’s goals in his State of the State speech in January.

“The State of New York is committed to the principle that people with disabilities should have access to community-based services, accessible housing with appropriate supports, and employment opportunities that enable them to live productive lives in their communities,” Cuomo wrote in the executive order.

Disability advocates lauded Cuomo at a meeting Monday but lamented that they have been waiting years for the move.

“I’ve been sitting here for 10 years -- many of us have,” said Harvey Rosenthal, executive director of the state Association of Psychiatric Rehabilitation Services. “And frankly, we’ve been met with a lot of disappointment in terms of getting real measurable action, real progress.”

In 1999, the U.S. Supreme Court ruled that the Americans with Disabilities Act prohibits unjustified segregation of disabled people. The Olmstead decision, as it is referred, requires states to provide disabled people with necessary support and services “in the most integrated setting appropriate to their needs, considering available resources.”

In 2002, New York passed legislation to create the Most Integrated Setting Coordinating Council, a group that was tasked with designing an implementation plan. Little has been done since then, members said.

The council met Monday in Albany.

“It’s been a long series of stumbles and delays and apathy,” Rosenthal, who is an original council member, said later. “We never really had a real energy behind it -- and the energy for something like this has to come from the governor.”

Cuomo’s deputy secretary for health and human services, his counsel and his budget director will serve on the cabinet. That lineup represents the kind of administrative power that has been lacking in past attempts to comply with the law, Rosenthal said.

“That signals a real commitment we’ve never had,” he said.

DJ Jaffe, executive director of the Mental Illness Policy Organization, based in New York City, took issue, though, with the lack of representatives on the cabinet who have expertise in criminal justice. He said some of the New Yorkers with the most serious mental illnesses are behind bars.

“To improve treatment for the most seriously ill, the criminal justice system knows more than the mental health system and has to be at the table,” Jaffe said in an e-mail. “The lack of their participation is what has led to there being more mentally ill incarcerated than hospitalized in (New York).”

If the state does not comply with Olmstead requirements, it could face legal consequences from the federal government. The Obama administration has already sued several states for violations.

According to the federal law, the most segregated settings for people with disabilities would be state or private hospitals, adult homes or nursing homes, where residents would live only with others who have disabilities. The most integrated settings would be independent or supported apartments.

The law also addresses how people with disabilities spend their days. Rather than participating in a day program aimed at teaching independent living skills or holding a job in the community, some people with disabilities perform tedious tasks for below minimum wage.

Bruce Darling, executive director of the Center for Disability Rights, Inc., which has offices in Rochester, Geneva, Corning and Albany, addressed Bearden, the cabinet chair, at the Monday meeting.

“Make sure that the members of the cabinet are reaching out to the disability community and the disability-led organizations,” he said, “so that others don’t actually rule the day and that people who have disabilities have a real voice in this process.”

http://www.stargazette.com/apps/pbcs.dll/article?AID=2012312030045&nclick_check=1

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 6 mos ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

WNYC has begun thinking outloud that "the closure of Bellevue has put even more strain on an already struggling mental health system"

Um, yea, it did.

http://www.wnyc.org/articles/wnyc-news/2012/dec/11/bellevue-psychiatric-unit-temporarily-shut-mentally-ill-face-new-challenges/

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 6 mos ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

Research is beginning to be published re: Health Homes (a model of care provision for persons with high care utilization).

The results are not surprising to most of those who work in the field, and/or receive thier care via Medicaid.

http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261469&inactive=1#.UQKaL7d5mc1

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 4 mos ago
Jack Krohn
My Baby's Gone Shootin'
Joined: Dec '05
Posts: 1,075

Thanks for the link. As you said, the results are not surprising. I hope that with time this program will operate more smoothly, as I believe that outpatient care is the ideal form of treatment (more cost-effective, less intrusive/restrictive, and more humane). This is a very damaged system, though, so I suppose that some bumps are to be expected.

# Posted 3 mos ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

Jack-

NYAPRS released how the next round of cuts will be implemented, and I think it provides a pretty succinct view into just how complex the system is.

While I agree with you that outpatient care is ideal, the incentives and obstacles seem against us.

...A decade's of progress toward outpatient MH care is being nearly wiped out as a result of having to fix past overbilling by the folks at OPWDD.

one step forward, two steps back....

NYAPRS Note: In order to come up with sufficient savings and revenues to make up for a $1.1 billion loss in federal Medicaid funds connected with past OPWDD billing practices found excessive by CMS, the Cuomo Administration has released a plan that includes a number of items of particular interest to NYAPRS members, including

a. a $12.5m delay this year and next year in bringing up some Supportive Housing beds (doesn't harm the previously committed $75m in supportive housing)

b. a $1.5 million delay this year and the next in implementing the Managed Long Term Care ombudsman program (seems to be a $1 million a year temporary reduction)

* a 2 year delay in allocating the $15 million Health Homes Infrastructure grant

* a $2.02 reduction (down from $10 million) in funding Health Homes Plus enhancements for at risk individuals

* $7.5m reduction during this year and the next in implementing the Integration of Behavioral Health and Physical Care Clinic services (down from $15 million a year)

Last week, the Cuomo Administration released 30-day budget amendments that described a variety of budget actions and delays Today, they released more details about how the $1.1 billion budget gap created by the federal decreases and state billing changes will affect the budget.

Here are some highlights for savings identified for the current budget year and the one to follow:

2. $200 million in Last Year's Budget Savings To Pre-Pay 2013-4 Expenses

3. $24 million by Accelerating Medicaid Redesign Team initiatives ($70m in 2014-5) including (excerpts by NYAPRS):

a. $6.85m in Person Centered Medical Home savings ($3.43m next year)

b. $6.5m in Savings from Dual Medicaid/Medicare Demo (FIDA) ($27.5 m next year)

c. $3.25m by Accelerating Managed Long Term Care enrollment ($1.25m next year)

d. $12m next year by Accelerating Behavioral Health savings (converting supportive housing, state inpatient state funds to capitated federally supported managed care payments)

4. $100 million in 'Other Reforms' ($114m in 2014-5) including (excerpts by NYAPRS)

a. $25m by managed care plan improvements in reducing inpatient, ER et al costs ($25m next yr)

b. $50m from working providers to reduce liabilities owed to the state ($50m next year)

5. $56 million by delaying 2013-14 MRT Investments ($56 million also in 2014-5) including:

a. $12.5m in delaying some Supportive Housing beds (another $12.5 million in 2013-14)

b. $1.5 million delay in implementing Managed Long Term Care ombudsman program (another $1.5 million delay next year)

c. $15m in delaying Health Homes Infrastructure grant (another $15 million next year too)

d. $2.02 delayed in funding Health Homes Plus enhancements for at risk individuals

e. $7.5m delayed in implementing the Integration of Behavioral Health and Physical Care Clinic services (another $7.5 million delayed next y ear too)

6. OPWDD Providers: 6% Across the Board Rate Reduction "or Other Alternative Savings"

a. $120 million this year and $120m next year

7. Additional Federal Revenue Investments $600m this year and $455m next year

a. Federal revenue from additional emergency Medicaid claiming and other possible efforts: $250 million this year; $85m next year

b. New waiver amendment to invest in comprehensive OPWDD reform in a manner modeled on MRT $250m this year and $250m next year

c. Additional FMAP savings produced by the Affordable Care Act (ACA) $120m this year and $477m next year

d. Restore 2% Across the Board reduction* ($20m this year and $357m next year); *Restoration begins in the fourth quarter of FY 2013-14

TOTAL RESOURCES TO SOLVE FEDERAL REVENUE PROBLEM $1.1 billion this year; $815m next year

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 3 mos ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

Forward

Medicaid Emergency Care Costs Drop

Crain’s Health Pulse April 25, 2013

For years, health policy analysts have predicted that if patients had better access to primary care, they would make fewer visits to hospital emergency rooms. To the satisfaction of the Cuomo administration, using that strategy in redesigning care for the state's Medicaid patients appears to be working.

According to a state Department of Health analysis of Medicaid expenditures for April 2012 through February 2013, the state spent $32 million less on emergency room care than it had projected based on the prior year's spending. The total for the period was $452 million, compared with the $484 million projected.

"Managed care is having a real impact," a DOH spokesman said.

That includes moving patients into patient-centered medical homes, where patients with chronic conditions like diabetes or asthma are more carefully monitored. As of February, 75% of Medicaid patients in the state were in managed care plans, or 10.5% more than in March 2012.

"The most recent data supports our goal to provide appropriate care more effectively, which benefits patients and helps contain or reduce costs," the spokesman said.

The drop in Medicaid patients' ED visits was seen in every region of the state. In New York, emergency department spending dropped to $290 million for the period April 2012 to February 2013, from $364 million for the year-earlier period.

In addition, the average claim paid was less costly, at about $499 versus $565. On Long Island, ED spending for that period dropped to $22 million from $29 million and claim cost on average was $424, down from $464 for that period in the prior fiscal year.

http://www.crainsnewyork.com/article/20130425/PULSE/130429934#utm_source=Health%20Pulse%20Alert&utm_medium=alert-html&utm_campaign=Newsletters

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 1 mo ago
whynot_31
Former Lurker
Joined: Mar '06
Posts: 16,367

I love how these events are sort of a contest to see how many initials people think is ok to put after their name.

The NYAPRS Collective Presents
The 9th Annual Executive Seminar on Systems Transformation
Mastering the Opportunities in Healthcare, Olmstead and Budget Reforms in New York State

April 25-26, 2013

Tools for Today and Tomorrow: Inspiration, Innovation, Integration and Adaptation
Wilma Townsend, MSW, Acting Director for Consumer Affairs, Center for Substance Abuse Treatment, SAMHSA, Rockville, MD
Larry Fricks, Deputy Director, SAMHSA-HRSA, Center for Integrated Health Solutions, Cleveland, GA

Stanley Sacks, PhD, Director, Center for the Integration of Research & Practice National Development & Research Institutes, Inc. (NDRI), New York, NY
Monica Oss, MS, CEO and Senior Associate, Open Minds, Gettysburg, PA
Moderator: Richard Dougherty, PhD, CEO, DMA Health Strategies, Lexington, MA

Olmstead: Policies that Advance Full Community Integration
Samuel Bagenstos, JD, Professor of Law, University of Michigan Law School, Former Principal Deputy Assistant Attorney General, United States Department of Justice, Ann Arbor, MI
Kevin Huckshorn, PhD, RN, CADC, Director, Division of Substance Abuse and Mental Health, Delaware Health and Social Services, New Castle, DE

Roger Bearden, Special Council for Olmstead, Governor Andrew Cuomo, Albany, NY
Moderator: Harvey Rosenthal, Executive Director, NYAPRS, Albany, NY

Innovations in Peer Run Services
Larry Fricks, Deputy Director, SAMHSA-HRSA, Center for Integrated Health Solutions, Cleveland, GA
Mark Duffy, MSW, CPRP, Director of Operations, Collaborative Support Programs of New Jersey, Freehold, NJ
Joe Powell, LCDS, CAS, Executive Director, Association of Persons Affected by Addiction, Dallas, TX
Alan Rabideau, First Nations Behavioral Health Association, Kincheloe, MI
Steve Miccio, Executive Director, PEOPLe Inc., Poughkeepsie, NY
Moderator: Amy Colesante, Executive Director, Mental Health Empowerment Project, Albany, NY

Finding the Opportunities in Healthcare Reform: The Inside Track
Monica Oss, MS, CEO and Senior Associate, Open Minds, Gettysburg, PA

Managed Care Financed Innovations
Cheri Dolezal, RN, MBA, Executive Director, OptumHealth Pierce RSN, Tacoma, WA

Joe Powell, LCDC, CAS, Executive Director, Association of Persons Affected by Addiction, Dallas TX

Thomas Lane, CRPS, National Director Consumer & Recovery Services, Magellan Health Services, Ft. Pierce, FL

Moderator: Chacku Mathai, CPRP, Associate Executive Director, NYAPRS, Rochester, NY
Update on Medicaid/Medicare, Managed Long Term Care and Community First Choice Initiatives
Mark Kissinger, Long Term Care Division Director, NYS Department of Health, Albany, NY
Leah Farrell, MPA, Manager of Government Affairs, Center for Disability Rights, Albany, NY
Lindsay Miller, MPH, Deputy Director, New York Association on Independent Living, Albany, NY
Moderator: Harvey Rosenthal, Executive Director, NYAPRS, Albany, NY

Preparing Clinic Programs for Managed Care
Gary Weiskopf, MPA, Project Director, NYS Office of Mental Health, Albany, NY
Andrew Cleek, PsyD, Executive Officer, Senior Research Scientist, McSilver-Urban Institute for Behavioral Health, New York, NY
Carla Lisio, LCSW, Executive Vice President, Mental Health Association of Westchester, Tarrytown, NY
Moderator: Edye Schwartz, DSW, LCSW-R, Director, Systems Transformation, NYAPRS, Mahopac, NY
Rethinking the Mental Health System in Response to the Newtown Legacy
Paul S. Applebaum, MD, Professor of Psychiatry and Director, Division of Psychiatry, Law, and Ethics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
Ron Manderscheid, PhD, Executive Director, National Association of County Behavioral Health and Developmental
Disabilities Directors (NACBHDD), Washington, DC
Daniel B. Fisher, MD, PhD, Executive Director, National Empowerment Center, Lawrence, MA

Steve Coe, CEO, Community Access, New York, NY; Co-President, NYAPRS Board of Directors
Moderator: Harvey Rosenthal, Executive Director, NYAPRS, Albany, NY

Opportunities for Employment and Economic Self Sufficiency
John B. Allen, Jr., Special Assistant to the Commissioner, NYS Office of Mental Health, Albany, NY

Mark Duffy, MSW, CPRP, Director of Operations, Collaborative Support Programs of New Jersey, Freehold, NJ
Victor Luna, CFO, Collaborative Support Programs of New Jersey, Freehold, NJ

Maura Kelley, CPRP, WNY Independent Living Center, Buffalo, NY; Co-President, NYAPRS Board of Directors, Chair, Employment Committee

Moderator: Len Statham, MS, CBP, Employment and Economic Self-Sufficiency Specialist,
NYAPRS, Rochester, NY

Grounding Multicultural Competencies in Healthcare Reform Initiatives
Arthur C. Evans Jr., PhD, Commissioner, Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Philadelphia, PA

Jennifer L. Humensky, PhD, Research Director, NYS Psychiatric Institute, Center of Excellence for Cultural Competence, New York, NY
Lenora Reid Rose, MBA, Coordinated Care Services, Inc., Nathan Klein Center for Excellence in Cultural Competence, Rochester, NY
Moderator: Hextor Pabon, NYS Office of Mental Health, Bureau of Cultural Competence, Albany, NY

New Partnerships: Behavioral and Medical Health Innovations
Kameron Wells, ND, RN, VP Clinical Affairs, Community Health Care Association of NYS (CHCANYS), New York, NY
Bill Stackhouse, Ph.D, Director, Workforce Development Program, Community Health Care Association of NYS (CHCANYS), New York, NY
Peter Campanelli, PsyD, Founder, Institute for Community Living/Principal, Strategic Organizational Development, New York, NY
James Schuster, MD, MBA, Chief Medical Officer, Community Care Behavioral Health, Pittsburgh, PA
Moderator: Edye Schwartz, DSW, LCSW-R, Director, Systems Transformation, NYAPRS, Mahopac, NY

Addictions Treatment and Recovery Services under Managed Care
John Coppola, MSW, Executive Director, New York Association of Alcoholism & Substance Abuse Providers, Albany, NY
Sam Wiggins, Field Director, Friends of Recovery-New York, Albany, NY
Michael Chaple, PhD, Deputy Director, Center for the Integration of Research and Practice (CIRP) at National Development and Research Institutes (NDRI), New York, NY
Moderator: Chacku Mathai, CPRP, Associate Executive Director, NYAPRS, Rochester, NY

http://www.nyaprs.org/conferences/executive-seminars/index.cfm

For better or worse, the change on Nostrand is going to make the change on Franklin look minor.

# Posted 1 mo ago

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