Continuing to Advance the Children’s Plan Vision in an Evolving World

1. Continuing to Advance the Children’s Plan Vision in an Evolving World Kristin Riley Deputy Commissioner, NYS OMH Division of Children and Families October 18, 2011

2. Why are vision AND “context” both important? • Vision has been consistent and clear Achieving the Promise Children Plan • World continues to change – health care policy, national health care debate, private insurers, Federal and State financial status and initiatives, family and youth expectations, research, outcome studies…

3. Medicaid Managed Care Benefit All: Inpatient 30 day/ Outpatient. Kids with SED access fee-for-service Medicaid without limits Parity between physical and mental health benefit Private Insurance Benefit Most: Inpatient,Outpatient with Co-Pay Medicaid FFS SED Services and Many Categories of Kids Underdeveloped Medicaid Managed Care, Child-Family Health Plus and Private insurance packages AND access to provider network, medical necessity and provider reimbursement issues remain Most children with BH issue seen in primary care. Undertreated - poor connection between primary care and BH and poor financial incentives 40% of kids in OMH Medicaid Case Management are not enrolled in Medicaid 25% of kids in OMH Waiver Program are eligible due to unique provision on income Historic reliance on Medicaid, State Aid and Philanthropy impactsfunding, models, systems

4. “NOW” BOX Stigma, knowledge, complexity, regulations and incentives create a BARRIER for kids between Primary Care and BH Specialty Care Orthopedic Specialty Care Private BH Providers Primary Care Public Behavioral Health Services and Safety Net Endocrinology Specialty Care Oncology Specialty Care

5. “NOW” BOX Medicaid FFS SED Services and Many Categories of Kids Stigma, knowledge, complexity, regulations and incentives create a BARRIER for kids between Primary Care and BH Specialty Care Private Insurance Benefit Most: Inpatient,Outpatient with Co-Pay Orthopedic Specialty Care Medicaid Managed Care Benefit All: Inpatient 30 day/ Outpatient. Kids with SED access fee-for-service Medicaid without limits Private BH Providers • Historic reliance on Medicaid, State Aid and Philanthropy based public MH system Provider Agency Mission and Fiscal Viability Primary Care Public Behavioral Health Services and Safety Net Endocrinology Specialty Care Oncology Specialty Care

6. Ex: State/Federal & Some Payers: Care Coordination, Family Support, Respite, Waiver Kids Behavioral Health Evolution Ex: State /Federal payer MH-JJ, Intermediate inpatient BH Wrap Around Services Private BH Providers Safety Net Behavioral Health Specialty Care Public Behavioral Health Services and Safety Net Ex: Multiple payers – Broad treatment continuum: Consultation/Clinic/Day Tx/Inpatient/Crisis/Residential

7. Family-driven, Youth Guided • Constancy of relationship with primary care provider • Early recognition of need for specialty care. • Referral and communication pathways (flow) • Access to specialty care and BH wrap around - right service at right time in the right amount • Care Coordination • Short and Long Term Outcomes • Accountability Ideal Box (from child/family view) Children’s Plan Vision-Values Orthopedic Specialty Care BH Wrap Around Services Safety Net Primary Care Behavioral Health Specialty Care Endocrinology Specialty Care Oncology Specialty Care

8. How do these tools help us in our roles – government, providers, families, advocates to advance the vision? Provider Networks and Affiliations Medicaid Managed Care Foster Care Model Medicaid Health Homes Medicaid BHO and/or SNP Access Points State and Federal Aid State Agency Regulations Safety Net Electronic Medical Records and RHIOs Outcome Metrics Commercial Insurance Plans Health Exchanges Primary Care Medical Home BH Wrap Around Services Primary Care Safety Net Behavioral Health Specialty Care

9. Our vision is still clear

10. …..like the pioneers of the 1800’s, on a very new frontier known as [managed care/health care reform/MRT.] Preparing for this journey will require each of us to leave what may be familiar ground, to learn new skills, to change your habits and to commit to journey that we know will be filled with cycles of remarkable progress and inevitable setbacks.

11. There is no single script or road map that will work universally. We don’t have a Santa Fe Trail but we do have a common vision. Actually it is the same as the pioneers vision that drove them forward….a better life, better opportunities for themselves and for the people for whom they were responsible.