Behavioral Health Integration Overview EDS Annual Workshop

1. Behavioral Health Integration OverviewEDS Annual Workshop Hoosier Healthwise October 22, 2009

2. Network Development • MDwise has selected Behavioral Health Management, Inc. (BHMI), an Indiana based provider organization to develop the MDwise Behavioral Health Provider Network. • Provider contracting • Provider credentialing • Effective October 2, 2009 MDwise Behavioral Health Network is closed.

3. MDwise Delivery Systems • MDwise utilizes a delivery system of care. MDwise members choose or are assigned to a Primary Medical Provider (PMP) in one of the MDwise networks or Delivery Systems (see quick contact sheet). For Behavioral Health, the MDwise Delivery Systems are responsible for: • Claims payment • Prior authorization of services • Case Management

4. How to check eligibility • The most accurate way to confirm eligibility is to use one of the EDS systems (e.g. Web InterChange, Omni, AVR) • Before providing services, it is necessary to confirm: • Is the member eligible for services today? • In what IHCP (Indiana Health Care Program) are they enrolled? (Hoosier Healthwise, Medicaid Select, Traditional Medicaid, HIP or Presumptive Eligibility) • If the member is in Hoosier Healthwise, what MCO are they assigned? (MDwise, Anthem, MHS) • If the member is enrolled in Hoosier Healthwise, what services are they eligible to receive? (Package A, B, C or P)* • If the member is with MDwise, what Delivery System are they assigned to? • Does the member have primary health insurance other than Medicaid (frequently seen with Package B moms)? • * Note: Package P does not include behavioral health

5. Outpatient Treatment Form (OTR) Prior Authorizations and Claims • Once you have determined what program the member is in and what MDwise Delivery System, use the Quick Reference Sheet to find: • Phone number & Fax number for prior authorization • Claims address or EDI number • Phone number & Fax number for Pharmacy prior authorization (PerformRx) • (See Quick Reference Sheet) • * This information can be found on the MDwise Web site at www.MDwise.org

6. Integration • Let’s talk about integration.

7. Let’s Talk Integration • Roger Kathol speaks of this situation as “Headless Health” • Head: BH/SUD System Body: PH System • Residential Inpatient • Inpatient Rehab • Partial Nursing Homes • IOP OP • OP Home Care • There is no or very little communication between the head and the body!

8. MDwise Integration Grant Project • When somebody tells you nothing is impossible, ask him to dribble a football.  ~Author Unknown • In cooperation with OMPP, MDwise has sponsored a grant project to support integrated care • Grant projects are innovative and put the “head” back on healthcare

9. Example -Midtown CMHC Medical Home Model • Members with mental illness will receive medical care where their medical home is the mental health setting • A physician and RN will be onsite at Midtown to provide for the medical needs of our members • Outcomes to be measured: access, ER use, member satisfaction, monitoring of metabolic issues • Outcomes of medical home model will be compared to non-medical home model

10. Example -Gallahue/Community Family Residency Program • Increase collaboration between family medicine and behavioral health • Behavioral health will be integrated into the family practice residency program of Community Hospital • Will implement a more systematic approach that will include routine mental health screenings for all new contacts, provide counseling within the primary care site if a brief therapy model is appropriate, more complex cases will be referred to Gallahue providers who will maintain regular communication with the medical provider

11. Integrated Care Means: • Local management of behavioral health services • Improved coordination and collaboration between medical and behavioral health providers ( A work in progress) • Utilization management and case management services are integrated at the delivery system level; medical and behavioral health managers work together to manage members’ needs

12. Integrated Care Means: • Building a “right sized” network of skilled providers, statewide • All providers work from the same contract and fee schedule • Delivery Systems assume risk for their members

13. Challenges Ahead • Taking down the silos that keep medical and behavioral health services apart • Location • Funding and payment systems • Information Technology • Old paradigms • Communication

14. Provider Information

15. Important Claims Information • Note: • Claims submission for Hoosier Healthwise Behavioral Health date of services 1/1/2009 should be submitted to MDwise Delivery System (see quick reference sheet) • Healthy Indiana Plan (HIP) Claims should go to: • MDwise (HIP) • P.O Box 33049 • Indianapolis, Indiana 46203 • Payor ID: MDWIS

16. Behavioral Health • Questions??