ValueOptions NorthSTAR Discussion of Adult Indigent Outpatient Concept

Defining the Problem and Moving Toward Sustainable Solutions

• The health and wellness of all NorthSTAR members is central to our shared mission.

• Models of care that are fragmented are costly to individuals and the system and do not promote recovery from a population perspective.

• Our system is now challenged to take on the process of system redesign that will reduce costs and improve quality outcomes.

NorthSTAR and Health Care Reform

• Demonstration projects nationwide from which to pull best practices

• Accountable Care Organizations• Medical Homes• Payment Structures

– Fee for service– Risk share– Bundled episodes of care– Shared savings– Capitation– Mixed models

Accountable Care Organizations

• The Centers for Medicare and Medicaid Services defines ACO as “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care [of those assigned]”.

• Core concepts: • Joint accountability• Measured quality improvements• Reductions in the rate of spending growth• Public confidence that savings are tied to quality

improvements

Potential ACO Scenario

What is Needed

• Clinical Protocols• Shared Communication• Data• Payment structures• Increasingly sophisticated quality measures• Legal agreements• Leadership from local providers in establishing

preferences that meet goals of members and community

Interim Steps

• Fully incorporate recovery orientation into our case rate model.

• Begin initiatives to develop collaborative pilots among specialty providers that promote quality outcomes.

• Promote movement through continuum of care via a cap on number of adult indigent members in service packages.

• Increase community stability with ongoing medication management and natural supports.

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Adult Indigent Outpatient Redesign Concept

Core Values

•Clinical Integrity

•Recovery Orientation

•Sustainable System of Care

•Good Stewards

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Financial Performance

Note: There has been a considerable loss of bed days in State Hospitals since 1999.

March 25, 2011 A Collaborative Review and Discussion of NorthSTAR Sytem Performance and Trending Data.

Note: This is based on cash payment from DSHS payment invoices and numbers of enrollees served, which is based on paid claims. Recent months are inflated due to claims lag.

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Average Monthly Cost Per EnrolleeServed

$423.17 $392.32 $387.44 $385.92 $403.36 $438.36

FY07-FY10 Monthly Avg

FY10 Monthly Avg Sep-10 Oct-10 Nov-10 Dec-10

FY00 FY10Change

FY00 to FY10 FY11 to date

Number of Enrollees Served (MH and SUD) 30,742 65,052 111.61% 47,649

Funding $78,787,143.71 $116,570,299.71 47.96% $70,879,951.46

Annual Cash Funding per Enrollee Served $2,562.85 $1,791.96 -30.08% $1487.54

Number Of Enrollees Served, Overall and By Service Category

Note: Data based on MH specific service and non MH specific service coupled with MH primary diagnosis on paid claims, OR Substance Use Disorder (SUD) specific service and non SUD specific service coupled with SUD primary diagnosis on paid claims.

March 25, 2011 A Collaborative Review and Discussion of NorthSTAR System Perforamnce and Trending Data.

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TOTAL Number of Enrollees Served 33752 39710 42390

Enrollees Served in Mental Health Related Services 31830 37659 40456

Enrollees Served in SUD Related Services 4132 4507 4331

FY07-FY10 Quarterly Avg FY10 Quarterly Avg Q1 FY11

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Key issues regarding NorthSTAR in the Public Mental Health System:

- Open Access

-Resiliency and Disease Management

- Continuum of Care Available

-Target Population

-Functional Impairment

Adult Indigent System Wide Placement Based on Clinical Need

Implementation• 1) SPNs develop internal management processes to continuously monitor for recovery and

movement through continuum of care • 2) Weekly reports are provided to each SPN with actual package distribution and allowable

package distribution of indigent adult members• 3) New clients are assessed to the package of care needed based on clinical presentation• 4) SPNs will have performance measures and incentives that promote this activity• 5) Members will be appropriately moved to medication management once stable and connected

with community supports– Medication management would only require annual UA for registration purposes

• 6) Reports will go out to SPNs notifying them of benefit change from Medicaid to Indigent group• 7) SPNs will be incentivized to maintain open slots while moving people through the continuum of

care • 8) Clinical/Quality audits will be conducted by VO Clinical staff to review for the following:

– a. Appropriate utilization of the continuum of outpatient care– b. Recovery orientation – c. Active connection with natural community based supports– d. Outlier Needs

Questions