Dauna Howerton, Ph.D. Behavioral Health Services Division October 8, New Mexico Human Services Department

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1 Dauna Howerton, Ph.D. Behavioral Health Services Division October 8, 2015 New Mexico Human Services Department

2 A new evidence based service delivered to members identified with Autism Spectrum Disorder (ASD) or identified as At-Risk for developing ASD. Research and evidence based approach to understanding behaviors in an environment. In practice, ABA uses techniques to bring about positive and meaningful changes in behaviors. Results in improved communication, learning, and social relationships. Increases participation in family and community activities. Source: Autism Speaks,

3 More members receiving services Wider age range up to 21 years of age Adds to the array of services CMS requires Service provided by staff trained in Applied Behavior Analysis with national board certification MCOs took the initiative to work together to implement MCOs working together on a common understanding of this new, layered service

4 Stage 1 Stage 2 Stage 3 Autism Evaluation Provider (AEP) Step 1 Screening to confirm the presence of Autism Spectrum Disorder Step 2 Stage 1 provider develops an Individualized Service Plan (ISP) ISP integrates ph and bh services needed. Behavior Analyst Step 1 Referral for services Step 2 Behavior Analytic Assessment is conducted Step 3 Based on assessment results, treatment plan for Stage 3 is developed. Behavioral Technicians ABA provider implements treatment plan Focused ages 1 to to 20 hours per week Comprehensive ages 1 to 5 Up to 40 hours per week Treatment is data driven and assessed for effectiveness and needed changes

5 Providers Location(s) Phone # Bridges Behavior Change Institute ABQ Santa Fe ABQ Roswell ext 106 Jumpstart ABQ Pacific Child and Family ABQ ENMRSH Clovis Apprendamos/Mariposa Autism Center Behavior Health Works, Stage 1 Provider in Las Cruces & UNM CDD Las Cruces Pending Approval 10/26/2015 5

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8 Centennial Care Update Enrolling More Individuals than Originally Projected: (enrollment as of Aug. 2015) Total in Medicaid 822,428 Total in Adult Expansion 226,783 Total in Centennial Care 642,047 Total in Long Term Care 46,359 Increasing Coordination of Services Total Members in Patient-Centered Medical Homes 200,840 Total Members in Higher Levels of Care Coordination 70,000 Total Members with Completed Health Risk Assessments 423,842 Total Members Accessing Community Benefit in ,331 Health Homes targeting Behavioral Health members launching 1/1/16 0

9 Supporting Provider Capacity Continuation of the PCP increase 1,982 providers receiving increased payments Expanding use of telehealth office visits and launching virtual physician visits, including with behavioral health providers. Increasing use of Community Health Workers: More than 100 directly employed by or contracted with MCOs; MCOs partnering with UNM to expand role of CHWs care coordination, health education, health literacy, translation and community supports linkages. 1

10 Implementing Payment Reform Projects MCO payment reform pilots build upon existing efforts to move away from volume-based payments, allow provider incentives and encourage shared risk. HSD approved 10 payment reform projects that launched in July 2015, including: Accountable Care Like Models performance-based model with partial payment paid as bonus for achieving quality outcomes; Bundled Payments for Episodes of Care bariatric surgery, diabetes and maternity; Patient-Centered Medical Home Share Savings built upon PCMH model by adding shared savings targets that reward achievement of utilization and quality targets. 2

11 State Innovation Model Grant NM received $2 million from CMS Partnering with DOH to test innovative health delivery and payment models that support the Triple Aim As part of the grant, HSD is leading planning efforts for an All Payer Claims Database (APCD) Can improve our understanding of the cost, quality and utilization of health care; help us evaluate the cost of care, utilization patterns, population health needs, and the impact of reform efforts, and help us identify gaps in access. 3

12 APCD Planning HSD is procuring a consultant to assist with the planning effort, which will include: Identifying and engaging stakeholders to be involved throughout the planning process Developing the state s APCD vision Recommending approaches to APCD governance Defining APCD infrastructure needs Outlining APCD funding considerations Delineating APCD data collection solutions for alignment and integration across health information systems Specifying next steps for APCD implementation Assisting with the development of an APCD concept paper and implementation plan 4

13 Engaging Members in their Care 40,000 members actively participating in the program Centennial Rewards Program allows members to earn points when completing healthy behaviors: Visiting dentist annually; Participating in a walking program, Step Up; Completing a Health Risk Assessment; Adhering to Asthma medication; Managing chronic conditions such as diabetes; Refilling Rx to manage bipolar disorder; and Joining the MCO prenatal program. 5

14 Continuing to Build Upon Early Successes MCOs reported an average of 39 ER visits per 1,000 member months in 2013 compared to an average of 35 ER visits in 2014; Two of the MCOs reduced non-emergent ER visits by 10% in 2014; Centennial Rewards program reported a 29% reduction in total hospital events for individuals with diabetes in 2014; and All MCOs increased telehealth visits with specialists by at least 15% in