1 / 13

Exposing Community Organizations to Value-Based Payment

Learn how Critical Time Intervention can help community-based organizations implement value-based payment arrangements and reduce avoidable hospitalizations among homeless individuals with Serious Mental Illness.

mminer
Télécharger la présentation

Exposing Community Organizations to Value-Based Payment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Critical Time Intervention as a Means of Exposing Community-Based Organizations to Value-Based Payment Arrangements April 28th 2017

  2. Bronx Partners for Healthy Communities • Our largest 7 primary care partners • Our DSRIP Goals: • Achieve the Triple Aim: Better Health, Better Patient Experience, Lower Cost • Reduce avoidable ED visits and hospital admissions by 25% by 2020 357,424 total attributed patients

  3. SMI, Homelessness & Hospitalization • Homelessness among people with Serious Mental Illness (SMI) is an important and unaddressed issue – contributes to avoidable hospitalization* • Traditional telephonic care-transitions programs rarely work for the precariously-housed with SMI • Recent data* has shown: • Psychiatric hospitalizations among these adults accounted for 26% of all psychiatric hospitalizations in NYC • ~33% of US homeless population includes individuals with SMI *Treatment Advocacy Center and National Coalition on the Homeless

  4. Critical Time Intervention (CTI) Model • Cost-effective, evidence-based practice proven to reduce recurrent homelessness • Developed in early 1980s in NYC, due to rise in homelessness among people with SMI • Supports clients in building community ties and ensuring continuity of care • Time-limited: 9 months, 3 phases • Phase 1: Transition • Phase 2: Try-Out • Phase 3: Transfer of Care

  5. BPHC’s Rationale For Selecting CTI • Bronx Community Needs Assessment, conducted in the DSRIP context, showed homeless New Yorkers tend to be: • Under utilizers of primary care and Health Homes • Frequent users of Emergency Departments • More pronounced amongst the SMI population.* • BPHC estimated ~400 patients with probable homelessness and 4+ visits to ED and/or inpatient setting (10/2013 – 10/2014). • SMI population requires community support to bridge the transition from facility to community and to ensure enduring linkages. • CTI bridges the gap by addressing transitional needs while the patient is still in the hospital, extending the reach of licensed community mental health providers. *National Coalition on the Homeless and NYCDOHMH data

  6. BPHC CTI Program Model • Eligibility Criteria • Diagnosis of a SMI • Hospital stay or ED visit in past 6 months • Eligible for Health Home (HH) • Precariously Housed • Locations of Client Identification • Psychiatric inpatient units • Medical inpatient units • Other programs (HHs, shelters, detox, etc.)

  7. BPHC CTI RFP and Provider Selection • RFP issued to network behavioral health providers • Incorporated value-based arrangement – downside risk tied to failure to achieve reduction in hospital use. • Four organizations selected to each enroll ~ 80 individuals in CTI program: • Coordinated Behavioral Care IPA (CBC) • Visiting Nurse Service of New York (VNSNY) • Riverdale Mental Health Association (RMHA) • SCO Family of Services (SCO) • Organizations hired caseworkers to perform the intervention – providing new job opportunities in the Bronx • Began enrolling patients in January 2017, will continue through end of the year.

  8. CTI and Health Home Collaboration • CTI extends intensive, high-touch care coordination into the community • Promotes successful transition • Complements the HH model during a critical period • Case workers are non-clinical coordinators supervised by a licensed professional • HH care coordinator is encouraged to collaborate with the CTI worker from the beginning. Interactions and billing for HH remains unchanged

  9. DSRIP P4P Measures CTI Can Impact P4P = Pay for Performance

  10. CTI Implementation – Early Challenges

  11. CTI as a Microcosm for VBP Challenges CTI

  12. Thank you!

  13. References • How Many People with Serious Mental Illness are Homeless? Retrieved from: http://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/2596-how-many-people-with-serious-mental-illness-are-homeless • Bronx Community Needs Assessment Report November, 2014 Retrieved from: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/st_barnabas_hosp_dba_sbh_health_system/3.4_st_barnabas_cna.pdf • Epi Data Brief. New York City Department of Health and Mental Hygiene. June 2016, No 71. Retrieved from: https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief71.pdf • Mental Illness and Homelessness. National Coalition for the Homeless, July 2009. Retrieved from: http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf • Homelessness and Housing Retrieved from: https://www.samhsa.gov/homelessness-housing. • Critical Time Intervention: Preventing Homelessness in the Transition from Institution to Community Retrieved from: https://www.criticaltime.org/wpcontent/uploads/2009/04/cti-handout4.pdf • CUCS Institute, Critical Time Intervention (CTI) Presentation Retrieved from: http://www.endhomelessness.org/page/-/files/Critical%20Time%20Intervention%20Presentation.pdf • CUCS Institute, Critical Time Intervention Overview Retrieved from: http://www.endhomelessness.org/page/-/files/Critical%20Time%20Intervention%20Overview.pdf

More Related