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New York State
Behavioral Health
Value Based Payment
Readiness Program
Workplan and Budget Templates
February 8, 2018 2
Table of Contents
• Purpose
• Upcoming Dates
• Preliminary Workplan
• Organizational Structure
• Data Analytics
• Quality Oversight
• Clinical Integration
• Annual Budget
• Resources
February 8, 2018 3
Purpose• This funding opportunity aims to help prepare behavioral health
providers to engage in Value Based Payment arrangements.
• The final deliverable is to contract in a Level 2 or higher arrangement as a Level 1 provider network or as a contracted entity in a Level 2 or higher arrangement.
• A main goal is to improve the integration of physical and behavioral health.
• The funds are intended to be used to enhance quality care through clinical and financial integration and the use of community- based recovery support services.
• Funds will also allow the BHCC to collect, analyze, and respond to service data to improve behavioral and physical health outcomes.
February 8, 2018 4
Upcoming Dates
First Year One Payment: Upon contract signature
between BHCC lead entity and MCO partner*
Preliminary Workplan Due: March 22, 2018
Second Year One Payment: After preliminary
workplan approved
5
VBP Readiness
Preliminary Workplan
February 8, 2018 6
Major Workplan Areas
The BHCC preliminary workplan template includes
each of the four BHCC readiness areas:
• Organization Structure
• Data Analytics
• Quality Oversight
• Clinical Integration
February 8, 2018 7
Preliminary Workplan
• Release of BHCC Year One Second Payment,
and any subsequent funding is contingent upon
submission and approval of the preliminary
workplan.
• Submitted preliminary workplan must include a
timeline for each workplan area, which ties back
to the proposed budget.
8
Organizational Structure
February 8, 2018 9
Organizational Structure and Rules
1. Describe in detail BHCC Entity Type, i.e. IPA, independent network of providers, etc. (current or projected); and directional purpose of the BHCC
2. Describe and detail a plan, including a schedule and activities for communication and engagement activities
A. Within the BHCC
B. With the BHCC MCO partner -This must include a discussion about submission of: Quarterly summary status report and other means of engagement (e.g. phone call(s) if needed)
February 8, 2018 10
BHCC Network and Affiliate Providers
1. Update and submit the BHCC Member Submission Template (Excel) https://www.omh.ny.gov/omhweb/bho/bhcc_member_submission_template_09152017.xlsx
2. Submit initial organizational chart
3. Describe plan to:1. Address BHCC gaps, if any, in care continuum
2. Create BHCC Membership Standards
3. Create a process for Joining/Leaving/filing a grievance with the BHCC
February 8, 2018 11
Financial Structure
Plans and timelines to support:1. Bringing in the input of BHCC: OMH Art 31, OASAS Art 32, and
designated HCBS BHCC provider partners in decisions regarding funds allocation and for funds distribution to support BHCC activities in the four readiness areas
2. Collecting dues (if any)
3. Identifying funding sources beyond the BH VBP Readiness Program
4. Developing a Sustainability Plan
Submit proposed State-provided budgetBudget should include summary of items and activities for each readiness area as described, but not limited to those, in the budget template provided by the State.
12
Data Analytics
February 8, 2018 13
Data Management and Reporting
Plans and timelines to support:
1. Identifying, by MCO, total MMC enrollees served by
the BHCC
2. Identifying ongoing service utilization trends in
Physical Health, Behavioral Health, Medication
Assisted Treatment for Substance Use Disorders
(SUD), Social Determinants of Health, and BH
Home and Community Based Services
February 8, 2018 14
Data Analysis and Sharing
Plans and timelines to support:1. An Assessment of IT capability, including:
• Applications/software used (e.g. EMRs)
• Plan for sharing IT infrastructure
• Plan for addressing confidentiality and consent issues
• Data necessary for dashboard development, clinical data sharing, cost and quality reports for relevant stakeholders
2. Selection or design of a shared IT platform • Analysis should consider relationship to potential VBP contract
requirements and existing regional IT resources
3. Overcoming barriers to the above IT goals
February 8, 2018 15
Shared IT platforms and tools
• Ability to support internal and external:– Care coordination - Analytics
– Communication - Customizable
• NYS strongly encourages BHCCs to partner with
one another and/or other regional entities such as:- Performing Provider Systems -Medicaid managed care plans
- PSYCKES -Hospitals
- RHIOs -Primary Care Providers
February 8, 2018 16
Using data
Plans and timelines to support:1. Using data to develop a BH and support services gap
analysis for BHCC services areas
2. Implementing performance dashboards
3. Implementation and ongoing monitoring of care planning
4. Evaluating improvement opportunities and collaborate with MCOs
5. All data activity must be HIPAA and 42 CFR Part 2 compliant
February 8, 2018 17
PSYCKES
• PSYCKES has developed three utilization reports for VBP: 1. Payer Mix
2. Provider Network
3. Volume and Service Setting
• See recorded webinar and slide deck at: http://www.ctacny.org/training/psyckes-utilization-reports-webinar
February 8, 2018 18
PSYCKES Utilization Reports
1. Payer Mix– Which Managed Care Plans and product lines are my
clients enrolled in?
– Which plans and product lines should I focus on? WHY?
2. Provider Network– Which other providers do I share clients with, for what
service types? • For example, my mental health clinic clients use which SUD
services, medical ERs, or outpatient medical services?
– Who should I partner with?
February 8, 2018 19
PSYCKES Utilization Reports
3. Service Setting and Volume
– What services are my clients using? – from me
– from other providers?
– How many encounters per year, by service type (at
my agency, at other providers, and in total)?
– How can I use this volume data to model costs?
20
Quality Oversight
February 8, 2018 21
Quality Measurement and Reporting
1. Plans and timelines to support:A. Determining measures to use to monitor internal
performance for continuous quality improvement
B. Reporting collected metrics and outcomes to BHCC partners
2. A description of current VBP outcome and/or performance arrangements in the BHCC Member Submission Template
22
Clinical Integration
February 8, 2018 23
Clinical Integration Protocol and Standards
1. Plans and timelines to support:
A. Development of clinical practices, protocols and service
coordination activities that support care coordination and
clinical activity integration across the BHCC
B. Responding when access issues or quality indicators are
not being met among the BHCC providers
C. Monitoring individual programs for compliance with
BHCC quality expectations and for corrective action
when problems are identified among the BHCC providers
24
Annual VBP Budget
February 8, 2018 25
Release of Funds Program Year One:
• First Payment upon final contract between BHCC entity and the BHCC plan Partner.
• Second Payment upon submission, review and approval of preliminary workplan
Program Year Two and Three: Parallel the State Fiscal Year (4/1/xx –3/31/xx)
• Payments released at two points in program year (anticipated release at six month intervals)
• Payment release contingent upon submission, review and approval of updated workplans and deliverables.
Note: Unspent funds may be carried forward into the next program year
February 8, 2018 26
BHCC and Lead Agency Acceptance of
Funding Terms and Conditions
1. BHCC funds will be used only for approved readiness
activities. Funds will be distributed based on BHCC policy and
rules.
2. The lead agency, on behalf of the BHCC, will submit all required
program items to the designated MCO.
3. The State reserves the right to retroactively review work plan
activities and deliverables, and recoup BHCC funds from the lead
provider in the event it is determined it inaccurately represented
activity and/or progress.
February 8, 2018 27
BHCC and Lead Agency Acceptance of
Funding Terms and Conditions
Readiness Area : Organization
Items eligible for funding include but are not limited to:Connectivity with entities across and beyond the BHCC, Formation of committees within the BHCC to ensure compliance and consistency, Creating governance and decision-making structures, Developing plans to address network gaps, Dues payment including any arrangements for smaller agencies, Plans to manage BHCC member concerns and issues, and Contracting with legal/business consultants
Activities / Items (insert rows as necessary) SFY 2017-18 SFY 2018-19 SFY 2019-20 Total
Total for BHCC:
February 8, 2018 28
Organization
Items eligible for funding include but are not limited to:
• Connectivity with entities across and beyond the BHCC
• Formation of committees within the BHCC to ensure compliance and consistency
• Creating governance and decision-making structures
• Developing plans to address network gaps
• Dues payment including any arrangements for smaller agencies
• Plans to manage BHCC member concerns and issues, and
• Contracting with legal/business consultants
February 8, 2018 29
Data Analytics
Items eligible for funding include but are not limited to:
• Purchase of data analytics and warehousing software/hardware for
collaborating providers
• Training in data management and analytics
• Connections to RHIOs
• Fees for consultants or other entities with access to Medicaid data
that can provide analytics to the BHCC
• Data may inform dashboard development, clinical data sharing, cost,
and quality reports for relevant stakeholders
February 8, 2018 30
Quality Oversight
Items eligible for funding include but are not limited to:
• Identification and implementation of measures (VBP and others),
data collection tools, and systems to facilitate quality assurance and
oversight.
February 8, 2018 31
Clinical Integration
Items eligible for funding include but are not limited to:
• Consulting fees for care coordination training and protocol/policy development
• Costs for meetings to convene stakeholders/workgroups to develop protocols/policies
• Costs to support provider meetings related to care coordination practices
• Costs for training, implementing, and monitoring the delivery of evidence-based practices
• Costs for establishing co-occurring treatment practices including screening, treatment, and referral
32
Resources Available
February 8, 2018 33
Resources / Questions
• https://www.omh.ny.gov/omhweb/bho/bh-vbp.html– Field Offices
– PSYCKES Utilization Reports: http://www.ctacny.org/training/psyckes-utilization-reports-webinar
– PPS Partners
