docPlease click here to Mr. Seereiter`s 2015 TRC Symposium
download 
Report Transcription
Please click here to Mr. Seereiter`s 2015 TRC Symposium
A Perspective On System Transformation Michael Seereiter, President & CEO New York State Rehabilitation Association Resource Center Symposium June 2015 Agenda NYSRA: Who We Are Big Picture A Word About Who We Are • Statewide association of 80+ providers of services to people with varying disabilities representing those providers and individuals they serve • Members range from: • Very large to very small; • Exclusively DD employment service providers to agencies serving populations with disabilities, and well beyond, with any/all aspects of life (residential, education, specialty medical, etc.) • Decades of public policy work and advocacy - focus on employment • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Too Much & Too Fast -- To Do Well... • Massive policy changes underway • OPWDD Transformation Agenda • SW to SEMP/Pathway/Community Pre-Voc • ICF to IRA • Self-Direction • HCBS Community Rule • • • • DSRIP Pay for Performance Needs Assessments Care Coordination • Massive changes in how providers are paid/reimbursed underway • OPWDD Rate Rationalization • New HCBS OMH services • DSRIP • All of which is moving to managed care...??? Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus + Minimum Wage + OPWDD Rate Rationalization +… • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Bermuda Triangle For Providers? Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus Control Over Personnel, Regulations, Administrative Expenses • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Bermuda Triangle For Providers? Agenda NYSRA: Who We Are Big Picture ! e.g. Competitiveness with other sectors (min wage & Justice Center), Hyper-regulation, Executive Order #38 Control Over Personnel, Regulations, Administrative Expenses • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Bermuda Triangle For Providers? Agenda NYSRA: Who We Are Big Picture ! e.g. Competitiveness with other sectors (min wage & Justice Center), Hyper-regulation, Executive Order #38 Control Over Personnel, Regulations, Administrative Expenses • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus Bridging Policy, Practice, and Politics With Curricula, Conversations, and Connections • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Employment: What Makes It So Important? Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • • • • Non-monetary benefits outweigh monetary aspects Economic self-sufficiency brings about true independence and control Social determinant of health Saves money - Cornell MBI study • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Employment: Policy, Practice, Politics Policy Agenda • NYS moving to eliminate funding for supports in SWs and promote competitive, integrated employment – first OMH, now OPWDD • HCBS Community Rule • Governor’s Employment First Commission and Recommendations • US DOL’s Advisory Committee on Increasing Competitive Integrated Employment for Individuals with Disabilities (ACICIEID) NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers Practice • Employment rate for PWD hasn’t changed in decades • Stigma, discrimination, and lack of social acceptance continue to exist • 8000 PWDD continue to rely on SWs/Work Centers, and provide safety net for those trying CIE • Creating CIE opportunities for PWD has not been a policy priority for government • Providers asked to create new business alternatives to SW • New OPWDD SEMP and Pre-Voc rates make support of people pursuing CIE even more challenging Politics • CMS/OPWDD “relationship” driving some/part/all of the OPWDD changes NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Employment: Curricula Curricula: NYSRA Transformation Project • BIP-grant funded: Build capacity to increase integrated employment opportunities, primarily through TA – brings expertise that often does not exist in provider agencies currently • Through NYSRA RFI, twelve member agencies selected (T-12) to receive intensive, individualized training and consultant supports to develop one or more business plans as alternatives to SW • TA includes: • Agency self-assessment, used to target project resources • EHR and data management consultation • Accounting expertise • Linkage to local workforce development expertise • Assistance engaging individuals and the parents of individuals working in SWs • Business plan development and financial forecasting resources • Goal: Develop realistic, viable business plans • Sharing resources, expertise with rest of NYSRA membership, and then others statewide Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Employment: Curricula NYSRA T-12 Member Perspective Janelle Farris, COO, Brooklyn Community Services Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Employment: Conversations & Connections Conversations • Transformation Project creating community of learners, sharing experience and expertise with one another, and NYSRA membership as a whole • NYSRA’s Employment Council – ACCES-VR, OMH, OPWDD services • Generated letter DOH and OPWDD Commissioners pointing out discrepancy with OMH rates • “Compare notes” on new OPWDD SEMP/Pre-Voc rates – will inform advocacy efforts • NYSRA’s White Paper, “Getting The Job Done” – serving to educate policy makers at NYSDOL, REDC, ACICIEID http://nyrehab.org/uploads/GettingTheJobDone8_26_14.pdf Connections • Facilitating collaborative learning opportunities with new partners • NYATEP re: WIOA implementation • NYSRA co-leading Inclusive Workforce Alliance of 21 associations, actively engaged in dialogue about implementation of Governor’s Employment First Commission’s recommendations • Building relationship with DRNY, as they examine transition from SWs Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Health System Transformation Via Managed Care: Politics & Policy Politics • MRT recommended move to care management for all - part of Governor Cuomo’s legacy Policy • Care management for all. Seems it can work for MH population, but very limited evidence of potential success for DD population. • Health Homes show promise, but limited results in improving individual outcomes • OPWDD Transformation Panel Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Health System Transformation Via Managed Care: Practice Practice • Requires sophisticated use of outcome measures: LOTS of work to do! • Requires sophisticated technological tools, some of which have not yet been developed. Where they are developed, providers either don’t have the resources to invest or have competing interests (HARP, DSRIP, RHIO, DSRIP, FIDA) • OMH has been “practicing” for managed care implementation for more than 3 years, but many providers still very unprepared • OPWDD-only providers further from ready Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Health System Transformation Via Managed Care: Conversations, Connections, Curricula Conversations • NYSRA-NYSACRA co-hosted Community Integration Leadership Institute (CILI) 6/14 and 6/15. • NYSRA-NYSACRA Managed Care Council - begins later this month • Forum for sharing information/experiences • Identify member needs, including TA • Shape policy/advocacy positions for associations • NYSRA participation on OPWDD Transformation Panel. But, major pieces not yet clear: • MC will provide greater flexibility than 15 minute billing/documentation permits? • MC must include full carve in for DD habilitative supports? • How will optional enrollment achieve outcomes and savings from small cohort identified as better suited to different (less intensive and less expensive) supports? Connections Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes • Identifying expertise in managed care readiness • Building relationships with PPS leads Other (Related) Questions to Consider • NYSRA-NYSACRA exploring need for TA series on managed care readiness Recommendations for Providers Curricula Using Data to Drive Performance/Outcomes Agenda NYSRA: Who We Are If you’re not using data . . . or are unwilling to start… Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Using Data to Drive Performance/Outcomes: Politics, Policy, Practice Politics • Demands on government for increased accountability – and rightly so! As contractors for government, that demand translates to providers. Policy • Government funding, especially through managed care, will demand demonstration of value, derived from individual outcomes. Anecdotal evidence no longer acceptable for providers, or advocates. Practice • Recognition of need, but much work needed to define and make meaningful • Wide variability – small providers struggle to get started; large providers struggle with competing needs • Regardless of position, enormous resources required • Nascent stages of ability to quantify value of habilitative services on expenditures and utilization, let alone quality of life Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Using Data to Drive Performance/Outcomes: Curricula Curricula Agenda NYSRA: Who We Are Big Picture • Exploring creation of data warehouse and benchmarking/dashboard for habilitative supports • Too Much, Too Fast • Bermuda Triangle for Providers • Identifying technical expertise in data and analytics systems development for providers NYSRA’s Focus • NYSRA-NYSACRA seeking individual provider agency data from DOH on ER/IP utilization and expenditures for BH and DD populations, similar to data presented at 6/15 CILI by region. • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers June 2015 DD, BH, & General Population Medicaid FFS Claims and Spend Data – In-Patient Hospitalization 2014 IP Claims per Unique Patient (DD, BH, NYS General) 2014 IP Spend per Unique Patient (DD, BH, NYS General) Statewide Average Statewide Average Western Western Southern Tier Southern Tier North Country North Country New York City New York City Mohawk Valley Mohawk Valley Mid-Hudson Mid-Hudson Long Island Long Island Finger Lakes Finger Lakes Central Central Capital District Capital District 0.00 0.50 1.00 BH Claims per Unique Patient 1.50 2.00 2.50 3.00 3.50 4.00 4.50 General Population Claims per Unique Patient DD Claims per Unique Patient * Statewide averages do not include regional duplications 5.00 $- $2,000 BH Spend per Unique Patient DD Spend per Unique Patient $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 General Population Spend per Unique Patient June 2015 DD, BH, & General Population Medicaid FFS Claims and Spend Data – Emergency Room 2014 ER Claims per Unique Patient (DD, BH, NYS General) 2014 ER Spend per Unique Patient (DD, BH, NYS General) Statewide Average Statewide Average Western Western Southern Tier Southern Tier North Country North Country New York City New York City Mohawk Valley Mohawk Valley Mid-Hudson Mid-Hudson Long Island Long Island Finger Lakes Finger Lakes Central Central Capital District Capital District 0.00 0.50 BH Claims per Unique Patient 1.00 1.50 2.00 2.50 3.00 3.50 4.00 General Population Claims per Unique Patient DD Claims per Unique Patient * Statewide averages do not include regional duplications 4.50 $- $50 BH Spend per Unique Patient DD Spend per Unique Patient $100 $150 $200 $250 $300 $350 General Population Spend per Unique Patient Using Data to Drive Performance/Outcomes: Conversations & Connections Conversations • NYSRA-NYSACRA Data Workgroup/Council forming • Looking to create collaborative learning community on use of data and best practices • Improved data will greatly enhance ability to influence public policy makers Connections • Seeking opportunities for assisting providers with financial investment necessary • Connecting with others associations that created similar benchmarking/dashboard systems – avoid re-inventing the wheel Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Other (Related) Questions NYSRA is Considering… Provider Workforce Agenda NYSRA: Who We Are Big Picture • If the fast food industry gets a minimum wage increase, will providers be able to recruit/retain staff capable of providing supports to the level expected in value-based purchasing environment? Will state and local governments eliminate this disparity and pay rates/fees sufficient for providers to pay a new, higher minimum wage? • If the President’s new overtime rule takes effect, will federal and state governments pay higher rates/fees sufficient for providers to pay salaried staff under $50K/year overtime. • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Other (Related) Questions NYSRA is Considering… Provider stability/sustainability with new requirements • How long will providers continue to support individuals after policy/reimbursement changes make certain supports unsustainable? Agenda NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Are larger organizations better suited than smaller organizations to offer the highly personalized supports government is demanding? • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Other (Related) Questions NYSRA is Considering… Moving toward managed care and value-based purchasing Agenda NYSRA: Who We Are Big Picture • Will DSRIP provide sufficient incentive for providers to curtail referrals of people with disabilities to ER under Justice Center’s scrutiny? • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • How much additional Medicaid costs will be incurred if PWD are unable to continue working after state’s policy changes implemented? • Employment • Managed Care • Data/ Outcomes • Are we are embarking on the first failure of managed care, at least for DD? Other (Related) Questions to Consider Recommendations for Providers Recommendations for Providers Agenda • Communicate with one another – no one person can possibly find/retain all the information about varying systems changes taking place • Share with colleagues best practices and potholes/cliffs • Make data collection/analysis a core function of your operation and incorporate into everyday decision making • Act more like a business – identify unsustainable lines of business and focus on those that are viable and at which you excel • Act more like a business – rather than compete, it may be wiser to collaborate – may be the only way to survive. NYSRA: Who We Are Big Picture • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers Conversations, Connections, Collaboration: Let’s Keep Them Going! Agenda NYSRA: Who We Are Big Picture Michael Seereiter President/CEO NYSRA 518-449-2976 [email protected] www.nyrehab.org • Too Much, Too Fast • Bermuda Triangle for Providers NYSRA’s Focus • Employment • Managed Care • Data/ Outcomes Other (Related) Questions to Consider Recommendations for Providers
