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The Impact of Billing and Third Payer Participation on Your Workforce: LessonsFrom the Pacesetter Award Process
John Morris, M.S.W.Wayne Dailey, PhDThe Annapolis Coalition
NIATx WebinarMay 10, 2011
Changes in the environment
Affordable Care Act: Accountable care homes
Changes in block grants Changes in state and local funding
strategies Changes in insurance…a resurgence of
capitation and population based models Pay-for-performance
Response of the Fieldre: Workforce Development
Typically - delayed & minimal Significant erosion in investment in
workforce development Universal problem irrespective of
setting, discipline, or specialty Only made worse by complications of
billing requirements, licensure, credentialing, etc.
What is The Annapolis Coalition?
A small not-for-profit Large “Coalition” Neutral convener of
stakeholders Source of information &
technical assistance Vehicle for strategic
planning, collective action, & public/private partnerships
Best known for…National Action Plan
Two years & 5,000 participants Federally funded Mental health & addictions Treatment & prevention Seeking to identify:
A core set of strategic goals & objectives
High priority ACTION items by stakeholder
A planning resource Call to action
Behavioral Health Pacesetter Award: Purpose
Discover and analyze emerging workforce best practices
Focus on: Community-based care Direct-care workers
Unlicensed Bachelor's degree or less
Hitachi and Annapolis
A partnership built on a focus on workforce
A concern about the front-line workforce as especially vulnerable
A desire to showcase ideas that demonstrate
Better Jobs Better Services Better Business
Who are these Direct-care Workers?
Estimated: 40% of Community Behavioral Health Workforce
What are their historical challenges?
Offered: Low pay Little training
and supervision Poorly defined
career path Little respect
from licensed behavioral health professionals
Scant access to information technologies
Asked to: Care for people
with the most complex conditions
Work in neighborhoods that lack resources
Take personal risks
What do they have to offer?
Role models for recovery
Understanding of mental illness and substance abuse
Connection with neighborhoods and diverse racial/cultural communities
Pacesetter Award: Objectives
Identify practices that have:
On the business/employer, AND On the lower wage employee, AND On the client
Five Selection Criteria
Effectiveness
Novelty
Significance
Durability
Transferability
Pacesetter Award: Process
Announcement (February 2010) “Call for Nominations” (March 31st) Applications due (May 15th) Review teams established (June) Eligibility determination (June) Teams conduct reviews (July-Sept) Initial sorting with The Hitachi Foundation
(October) Case study development (Oct-April) Announce Awards (April 2011) Dissemination of results (Spring/Summer
2011)
The National Winners!!
Thresholds in Chicago used “embedded consultants” and supportive supervision to advance careers of front-line mental health staff and implement Integrated Dual Disorders Treatment.
Stanley Street Treatment and Resources (SSTAR) in Fall River, MA
used “work-based learning” to change the competencies and educational aspirations of its behavioral health staff.
Family Services of Western Pennsylvania in Pittsburgh built university
and county government partnerships that transformed case management and promoted careers of front-line staff.
Borinquen Health Care Center in Miami prepared its multicultural
substance abuse and community outreach workers to battle the spread of HIV on the city’s streets.
Hartford Dispensary in Connecticut built a professional development
program that meets the challenges of direct-care staff as they provide effective treatment for heroin addiction.
Programs of Merit
Chesapeake Connections at Mosaic Community Services in Baltimore prepared a diverse staff group to provide assertive yet supportive services to people with severe mental illnesses.
People Acting to Help (PATH) in Philadelphia made thoughtful and
supportive supervision the heart of an effective psychosocial rehabilitation program
The impact of financing
Healthcare environment in influx Affordable Care Act - ACA Medicaid Block grants State and local budget cuts
Implications for workforce Recruitment Training Deployment
Thresholds, Chicago
Switch from grants to fee-for-service funding
Changes to internal agency operations:
Productivity goal setting and monitoring
Changes in training methods
Use of embedded consultants
Emphasis on technologies Financial incentives
Recruitment implications
Debbie Pavick Acting CEO
Dennis Crosby Team Leader at Irving Park “L”
station in Chicago
Mosaic’s Chesapeake Connections, Baltimore
Merger Mania Capitation Pilot Project
PM/PM rate Financial risk
Training implications “Anything it takes” Non-traditional
interventions Team, Team, Team
Recruitment Based on matching
staff with members
Former North Baltimore Center
Jeff Richardson, CEO Mosaic Community
Services
SSTAR - Fall River, MA Stanley Street Treatment and Resources
Few credentialed staff
Reduced volume of billable services &
less revenue
Limited accessto care &reduced
growth potential
Lower salaries & more staff recruitment
problems
Workforce with limited educational preparation
Workforce with limited educational preparation
Circular Dilemma
Staff Who Attained Certification as Addictions Counselors
0
5
10
15
20
25
30
1996 to2004
2005 2006 2007 2008 2009 2010 2011Projected
Cu
mu
lati
ve T
ota
l
Impact of Work-based Learning funded by Jobs to Careers Initiative
SSTAR - Fall River, MA Stanley Street Treatment and Resources
Lessons Learned
Payment type influenced selection, training and deployment of direct care workers
Biggest differences between:
Fee for Service Productivity and
efficiency Capitated program
Creativity, improved client outcomes and managing cost risk
Pacesetter Award Winning Programs
Used EBPs and maintained fidelity
Supported worker education and career aspirations
Provided competitive compensation
Established links with academic and research institutions
Provided supervision to staff on a frequent, regular basis
20112011
National WinnerNational Winner
Behavioral Health Behavioral Health Pacesetter AwardPacesetter Award
Annapolis Coalition on the Behavioral Health Workforce
John Morris, M.S.W. Executive [email protected]
Wayne F. Dailey, PhDProject Coordinator
www.annapoliscoalition.org
