Virginia s Behavioral Health Services Administrator: Magellan Behavioral Health, Inc Promoting Wellness and Recovery Presented by Tom Lane, CRPS National Director Consumer and Recovery Services
About Magellan of Virginia Virginia s Behavioral Health Services Administrator, Magellan Behavioral Health, Inc is part of one of the country s leading behavioral health companies. Behavioral health means mental health or substance use disorders. Substance means drugs or alcohol. Magellan of Virginia is working with DMAS (Department of Medical Assisted Services) to improve access to quality behavioral health services and improve the value of behavioral health services. Magellan is administering a comprehensive care coordination model which is expected to increase service quality while embracing and establishing a culture of recovery & resiliency throughout the behavioral health care system. Magellan manages all Medicaid and FAMIS covered mental health and substance use treatment services for fee-for-service enrolled members. If you are a Medicaid and/or FAMIS member enrolled with one of the DMAS managed care organizations (MCO), Magellan will manage part of these benefits. 2
System Transformation Dedicated team of professionals focused on identifying system gaps and developing community based partnerships to enhance the system Collaborative approach, engage stakeholders via Governance Board, Quality Improvement Committees, learning collaborative, steering committee, stakeholder calls and member surveys Inclusion of recovery principles Magellan has a dedicated Recovery and Resiliency Manager In January 2014, DMAS and Magellan will began implementation of: Peer Bridger Demonstration Pilot Integrated Health with Non-traditional Services Learning Collaborative Children s Champion Project 3
Magellan s Core Principles 1. Demonstrate appreciation for the individuals and families we serve as well as for provider staff. 2. Be culturally and linguistically appropriate and ensure effective communication. 3. Engage and build on a full discovery about each person, including his or her goals, inner strengths, skills, culture, and external supports. 4. Think holistically about all areas of people s lives-physical health, behavioral health, culture, ethnicity, education, language, work social relationships, housing states, and spirituality, among others. 5. Focus on self-determined readiness. 6. Offer meaningful choices. 4
Magellan s Core Principles 7. Optimize peer and family support as well as natural supports. 8. Promote self-confidence of individuals who might have previous experiences that diminished their confidence. 9. Create opportunities for consumers and families to play major roles in planning, organizing and evaluating services. 10. Measure, monitor, and improve. 11. Celebrate and spread stories of success, especially those that foster hope and empowerment. 12. Model principles of recovery and resiliency that are reflective in our interactions, language choice and decisions. 5
We are here to help! Do you have questions about the behavioral health services that are covered in the Medicaid and FAMIS plans? Do you need help finding a provider in the Magellan network? Do you need a referral for care or help making an appointment? Do you have questions about any communication that you received from Magellan? Example: Member Handbook? Do you need these materials translated to another language? Do you have concerns or complaints about services that you are receiving with your provider or concerns or suggestions for Magellan? Do you need help finding a peer or family support organization? 6
How to Reach Us Centralized Call Center Call us any time at 1-800-424-4046 or TDD/TTY at 1-800-424-4048 Full level of service is provided 24 hours a day, 365 days a year We employ bilingual/multi-cultural staff that speak English and Spanish TTY access and interpreter services available. Visit Our Website at www.magellanofvirginia.com Find a provider Access Recovery & Resiliency Resources Sign up for our stakeholder email list Share your opinions and feedback via email by clicking on the Members Contact Us tab 7
Effective Care Coordination Care management coordination of care for members Ambulatory follow-up and discharge planning for all members in inpatient and/or residential settings under our management Coordination of care with the MCOs and PCPs (Managed Care Organizations and Primary Care Physicians) Magellan s MCO liaison works with the Medicaid MCOs to help coordinate services between plans for members with co-morbid mental health and medical needs. The liaison facilitates referrals into respective systems of care and also works with the MCOs to help smooth transitions between traditional inpatient and outpatient services and the non-traditional community mental health services 8
Collaborative Approach Coordination of care with the CSB s and other agencies Assignment of clinical liaisons to the CSB s to facilitate care coordination across the continuum of care Implementation of joint treatment planning for members who are not progressing in their recovery with CSB s and agencies Partnerships and collaboration with Virginia s peer support community Peer Support is an evidence-based practice that complements care coordination that reaches people who would like to develop their recovery and resiliency skills and become more engaged in a self-directed system of care. Unique opportunities to develop closer working relationships with peer and family organizations, support groups, etc. 9
10 Effective Care Coordination + Wellnessinformed Peer Support Services = Recovery, Increased Resiliency, and Better Quality of Life
Tools and Resources to Promote Education and Wellness
Magellan of Virginia Recovery Resources Our website is: www.magellanofvirginia.com A special area For Members can help you find a provider, prepare for your appointments, and provides other information about getting care. Recovery Resources e-guide E-learning Recovery & Resiliency Peer Support 12
Magellan s E-Learning Center www.magellanhealth.com/training Peer Support Whole Health and Wellness e-newsletters These quarterly e-newsletters offer articles, education and resources designed to help promote wellness and improved personal health outcomes. Health education/literacy materials These materials are literacy-level adjusted and address a range of topics selected to help promote increased knowledge of various health conditions. Online e-courses These provide education on a variety of subjects. Courses are free of charge and available on demand for learning at your convenience, including Recovery and Resiliency and Peer Support. 13
Magellan s E-Learning Center www.magellanhealth.com/training Continuing education Magellan's e-learning courses offer continuing education hours/ce credits. Please read the CE credit requirements or email us for additional information. Webinar archives View on-demand both CE-eligible and non-ce-eligible webinars. Resources Access a range of web-based organizations and resource centers. We regularly update our web resources links. A short description of each featured web resource is included with each link. 14
Wellness and Recovery Resources The Passport to Care is a 10-page how-to support guide for members, families, and peer supporters to work with medical and behavioral health providers and talk about steps to take to be healthy. It helps teach members and families about the importance of health care check-ups, talking to providers about medications, side effects, and other aspects of their wellness plan. (Coming Soon) Fast Facts: About Your Medicaid Behavioral Health Program is a single-page, double-sided information sheet that highlights: What Magellan of Virginia does How to get help Getting help in an emergency Cost of services How to contact Magellan 15
Magellan of Virginia Peer Bridger Demonstration Pilot
Peer Bridger Demonstration Pilot (PBDP) Project will focus on at least one community identified by consensus of the project steering committee and will build on the foundation of Virginia s robust network of peers providing a range of support, education, and training across the state. Peer Bridger services will focus on eligible members, 18 and older, transitioning out of acute in-patient settings not subject to the institution for mental disease (IMD) exclusion, who voluntarily agree to receive PB supports. The goal of Peer Bridger services is to make the transition back into the community a successful one and avoiding future inpatient stays. These voluntary services are designed to facilitate connections with local peer-run organizations, self-help groups, other natural supports, and appropriate community-based resources to improve the health of the individual and create a more cost efficient utilization of mental health services. 17
Implementation Plan Establish Steering Committee Identify pilot sites Data collection Training and education strategies Select peer organization(s) Deliver Peer Bridger services Monitoring - ongoing 2014 summary report 18
OUTCOMES We expect implementation of the Peer Bridger Program to have a positive impact on the individuals quality of life and reduce re-admissions to inpatient settings. The scope of services provided under the Peer Bridger program will include services in the home, community, and/or provider setting. Similar Magellan peer-driven programs focused on offering peer support to people discharged from inpatient settings include: Florida Peer Recovery Navigator program Maricopa s Peer Crisis Transition Navigators program Outcome data from both programs demonstrates an increase in successful community living rather than being in a hospital. 19
Wellness and Recovery Outcomes Peer Navigator Engagement increases community tenure Common outcomes achieved when utilizing peer support include: symptom reduction, improved functioning, quality of life, housing, employment, empowerment, autonomy, choice, and self-esteem 20
Small Group Exercise 1. What helped you first realize that recovery is possible? 2. What helps you feel accepted as a person living with substance use or mental health disorders? 3. What resources/tools have helped you in your recovery? 4. What has NOT helped you in your recovery? (barriers) 5. What services have helped you the most in your recovery? 6. If you could change one thing about the services that you receive, what would that be? 21
Questions
We are here to help Call us any time at 1-800-424-4046 or TDD/TTY at 1-800-424-4048. We can help you: Find the services you need; Get answers to your questions; Get a referral for care; Get help with making an appointment. (If you are enrolled in an MCO, we can refer you to your MCO for needed services.) In case of an emergency call 911 at once! You must act quickly to prevent serious health problems. You may have a mental health crisis or substance use treatment crisis. For example, you fear you may hurt yourself. Or you think a family member may harm themselves. Or your family member may harm another person. Cost of services: Some Medicaid members age 21 and older may have to help pay the provider for the cost of services they get. This is a small amount. It is called a copayment. 23
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