Enhancing Healthcare Partnerships in Indiana: A Collaborative Action Plan

1. Action Team A Team Leader: Aileen WehrenTeam Members: Shirley Arney*, Matt Burden*, Eric Crouse, Dana Frantz, Paul Kuczora, Laurie Nafziger, Sharyn Redding, Jerry Sheward, Tom Talbot*, Paul Wilson**Sub-committee Chair

2. Action Team Goals and Objectives • Goal #1: Develop Health Home and/or ACO Partnerships • Objective #1: Develop an inventory of state level associations and other organizations currently considering or developing a medical home or ACO concept in Indiana. Develop a communications plan that includes CMHCs as an essential component. • Objective #3: Identify the CMHC core business; improve access for the newly insured; consider changed relations and establish CMHC value; provide education re new clinical models. 2-9-11 ICCMHC Meeting

3. Action Team A Goals and Objective continued • Objective #4: Develop and implement a training curriculum for member centers and staff that defines and focuses on core competencies needed for leadership and direct care staff in the new health care delivery environment • Objective #5: Provide overview and training on the accreditation standards with exploration of issues and options depending on the CMHC role selected (e.g. partner versus become a medical home) 2-9-11 ICCMHC Meeting

4. Completed Deliverables • Developed a detailed action plan with owners and due dates for each of the assigned goals/objectives • Initial inventory of ACO and medical homes in the State • Initial review of state efforts (more comparison and detail required especially as more states look for savings in Medicaid and improved value for the investment) 2-9-11 ICCMHC Meeting

5. Inventory of ACO and Medical Home Efforts in Indiana • Strategy 1&2. Identify associations and provider organizations currently considering or development ACOs and/or health homes: • Hospitals and hospital systems • Franciscan Alliance: NW IN, Indianapolis, Carmel, and Shelbyville (added Major Hospital) • FQHCs: HealthLinc, Heart City, Indiana Health Centers, Vermillion Parke (Part of a Patient Centered Medical Home Demonstration), Raphael Health Center • Multi-specialty medical groups • They’ll affiliate, move toward health home as payment structure changes largely driven by large payers • Hospital-owned • Large payers • Aetna, Anthem/Wellpoint, Medicare/Medicaid Identify categories of associations 2-9-11 ICCMHC Meeting

6. Franciscan Alliance • St. Anthony Health - Crown Point • St. Anthony Health - Michigan City • St. Elizabeth Health - Crawfordsville • St. Francis Health, Beech Grove and Indianapolis; Mooresville, Indiana • St. Elizabeth Health, Lafayette • St. James Health, Chicago Heights and Olympia Fields, Illinois • St. Margaret Health, Hammond and Dyer, Indiana • Franciscan Physicians Hospital, Munster, Indiana • Also: Major Hospital, Shelbyville 2-9-11 ICCMHC Meeting

7. State Efforts regarding Medical Home or Payment Change Development • Current Status • Tennessee • Integrated managed care (no carve-out) • Washington • Contracting w/ specialized MCOs • North Carolina, Vermont • Primary care case management (e.g., behavioral health coordinator; behavioral health “flags” in EMR; team approach—nurse, health coach, etc.) • Iowa, Massachusetts, Arizona • Behavioral health organizations take SMI and contract primary and behavioral healthcare • Pennsylvania • Capitated behavioral health carve-out, shared savings program; collaborative care management Identify categories of associations 2-9-11 ICCMHC Meeting

8. State Efforts continued • Strategy 3. Researching other states’ efforts (cont.) • Missouri, Rhode Island • Health Homes • New York • Wisconsin Identify categories of associations 2-9-11 ICCMHC Meeting

9. How Do CMHCs add Value to Medical Service Delivery • Strategy 4. How behavioral health can add value to ACOs, health homes, payment delivery models, etc. • Addictions and dual diagnosis care delivery and management, long term gains • Brief intervention in ambulatory care settings • Chronic Care Management • Consultative and educational resource for care referral • Early Intervention with medical conditions to decrease longer term care demands and provide cost avoidance • Emergency Room Diversion • Family and community based support and case (care) management • Helping hospitals avoid disincentives (re-admissions) • Helping payers w/ wellness and prevention • Medication assisted treatment – training of PCPs , management • Responsibility for individuals with serious mental illness under health home model Identify categories of associations 2-9-11 ICCMHC Meeting

10. Other Considerations • Payment methodologies – Analysis and financial modeling to manage risk • Prevention and wellness – How do CMHCs establish a role • Integration and expansion of medical systems and purchases of medical practices • Elkhart and Memorial Hospital • Chronic care management and management of dual eligibles • Keeping kids in school, adults out of criminal justice system – system cost savings • Managing savings and penalties if funding changes are sequenced • Leveraging CMHC disease management expertise • If MRO remains not at risk these are dollars not in changed payment methodologies – leveraging this with providers 2-9-11 ICCMHC Meeting

11. Promising Payment Reforms 2-9-11 ICCMHC Meeting

12. Action Team A Goal 1 Objective 1: Develop an inventory of state level associations and other organizations currently considering or developing a medical home or ACO concept in Indiana. Develop a communications plan that includes CMHCs as an essential component of the ACO and medical home development and delivery system. 2-9-11 ICCMHC Meeting

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22. Action Team A Goal 1 Objective 3. Identify core business. Improve access for the newly insured. Consider changed relationships and establish value for behavioral health services. Provide education regarding the new clinical model(s). 2-9-11 ICCMHC Meeting

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28. Action Team A Goal 1 Objective 4. Develop and implement a training curriculum for member centers and staff that defines and focuses on core competencies needed for leadership and direct care staff in the new health care delivery environment. 2-9-11 ICCMHC Meeting

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35. Action Team A Goal 1 Objective 5. Provide overview and orientation/training regarding accreditation standards including Joint Commission, CARF and NCQA with exploration of options and issues based upon CMHC business choices, e.g. partnership versus becoming a medical home etc. 2-9-11 ICCMHC Meeting

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38. Action Plan • Develop template to distribute to membership for more details on local changes in healthcare environment so each CMHC can manage relations • Take list of ways in which we add value, transform into usable communication plan for contact and negotiations w/ local providers and payers • Getting success stories • Develop resources to gain expertise in understanding of different impacts of payment methodologies • How do we fit into shared risk model? Bundled payments? Evaluative pricing and negotiations? • Be part of change process w/ OMPP, DMH, DOH, others • Regional and state partnerships to talk w/ big payers 2-9-11 ICCMHC Meeting

39. Feedback Requested • As an entire group we need to determine overlap and which group will manage those specific items, including the possibility of creating additional workgroups or subcommittees for those items 2-9-11 ICCMHC Meeting