InvisALERT Solutions – ObservSMART

Beacon’s Unique Staffing to Facilitate System Reform in New York State

Since 1997, Beacon been a valued partner and thought leader for managed care plans, local and state agencies, and provider and consumer stakeholder groups in New York State, enabling Beacon to execute programming that achieves the intended goals of New York’s Medicaid Redesign Team.

Our partnership and development efforts in preparation for Qualified Medicaid Plans (QMP) and Health and Recovery Plans (HARP) began when Beacon partnered with Hudson Health Plan to develop the Westchester Cares Action Program (WCAP), a New York State Department of Health (DOH) funded Chronic Illness Demonstration Project beginning in 2009. This project focused on Medicaid FFS recipients having 2 or more chronic illnesses, both medical and Behavioral Health in nature, who had demonstrated poor engagement in preventive treatment and relied on the Emergency Department for Primary Care. WCAP was the only health plan-based demonstration project, and it used an innovative, field-based case management model featuring an interdisciplinary team comprised of nurses, Social Workers, and Peers. WCAP helped more than 250 recipients manage their chronic medical and Behavioral Health conditions; furthermore, WCAP promoted recovery goals by securing permanent housing, clothes, furnishings, employment and vocational training. In its first two years of operation, WCAP reduces inpatient hospitalizations by 55 percent for individuals who remained enrolled in the program. WCAP remains operational today as a Case Management Agency (CMA) for Health Homes. In 2011, Beacon participated in a Regional Behavioral Health Organization (RBHO) in Western New York. The purpose of the RBHO was to conduct Managed Care preparedness activities for Medicaid Fee-For-Service (FFS) providers. These activities included utilization review and care coordination initiatives designed to promote better treatment quality, comprehensive discharge planning, and improved outcomes through preventive, community-based treatment.

Beacon’s extensive collaboration through the years with the New York State DOH, Office of Mental Health (OMH), Office of Alcohol and Substance Abuse Services (OASAS), and Local Departments of Social Services (LDSS) on innovative initiatives like the RBHO and WCAP has sharpened our understanding of the critical components for success working with complex populations in New York’s fragmented service delivery system. As a result, Beacon has been successful in operating as the fully delegated behavioral health partner for ten (10) health plans who serve HARP members. Eight of these plans operate HARP and QMP plans, and the remaining two are HIV SNP plans with HARP eligible members. Beacon currently serves approximately 30% of the eligible Medicaid adults statewide and has been instrumental in ensuring the provision of Home and Community-Based Services (HCBS), designed to provide an individual with a specialized scope of recovery-oriented, person-centered support services not previously covered under the State Plan Medicaid services. These HCBS are designed to allow individuals to gain the motivation, functional skills, and personal improvement to be fully integrated into his or her community.

During the Medicaid redesign and transformation process and since QMP/HARP inception, Beacon has contributed thought leadership and close collaboration with our State partners and the many stakeholder and provider groups to design, operationalize, and implement the complex behavioral health service delivery system transformation as envisioned by NYS. Accordingly, since the implementation of and as a response to the creation of HARP, Beacon has created several unique staff positions that work with the provider community and assist/facilitate in these transformation activities; these positions include the Provider Clinical Liaison Specialists (PCLS) and the Manager, Provider Partnerships (MPP).

Provider Clinical Liaison Specialists (PCLS)

Beacon’s PCLS outreach, train, and support newly designated Home and Community-Based Services (HCBS) providers and work to support and oversee Health Home Care Coordinators in referring members to HCBS. In this role, PCLS have reached out to all New York City, Westchester, Rockland, Orange, Suffolk, and Nassau County HCBS providers and have developed training on all aspects of service delivery to ensure provider readiness. This includes connecting providers with internal and external resources to assist with the implementation of HCBS, maintaining ongoing communication with HCBS providers, and offering technical support and training, when needed. Additionally, responsibilities include:

  • Delivering trainings to Health Homes on the completion of members plans of care (POC) as well as a myriad of related topics tailored to the needs of the providers.
  • Updating and maintaining a list of active HCBS providers to assist Health Homes in the process of referring members to HCBS (per the HCBS workflow).
  • Developing quality measures to ensure effective service delivery of HCBS for members.
  • Regularly attending MCTAC, the Coalition of Behavioral Health Agencies, and Health Home Coalition meetings and trainings.
  • Providing in-person case consultations for members enrolled in Assertive Community Treatment (ACT) sites, per the request of partnered ACT providers. This streamlines the utilization review process for the ACT teams.
  • Collecting Follow-up after Hospitalization (FUH) Supplemental measures for ACT and Personalized Recovery Oriented Services (PROS) sites to ensure 7- and 30-day follow-ups have been met to comply with state HEDIS measures.
  • Attending Health Home calls to assist our plan partners in answering questions or responding to concerns related to HCBS.

To date, the PCLS have conducted multiple Provider Roundtables, having invited over 40 community-based providers to come to Beacon to discuss HCBS services and receive HCBS Education as well as conducting on-site visits and training to over 70 provider groups across the 5 boroughs, Long Island and Orange County. In 2016, PCLS convened 4 Provider Information Forums throughout New York State, delivering in person HCBS training to community-based providers who were invited to a breakfast meeting.

Manager, Provider Partnerships (MPP)

The mission of the Manager of Provider Partnerships (MPP) role is to build highly collaborative relationships with providers, drive provider performance improvement year-over-year through education and data, and identify top-performing providers for innovative programs/pilots. The Manager, Provider Partnerships (MPP) functions as a single point of contact for these providers, resolving provider issues through relationships with internal Beacon colleagues. The purpose of this unique service serves to decrease the provider and Beacon’s time on routine interactions, such as payment and authorization, and focus on clinical and quality initiatives. The MPP meets with their assigned providers at least quarterly to review key performance indicators that are benchmarked against regional averages. Opportunities for improvement are identified, and the MPP works with our regional leadership team and the providers to propose strategic initiatives to remedy any concerns around underperformance. The MPP role is intended to promote adoption of evidence-based practices, reflecting our philosophy that emphasizing treatment quality will yield desired outcome metrics. MPPs deliver aggregate data to providers to engage the provider in shared performance improvement goals. This data is gathered specifically for providers and highlights opportunities for Beacon to engage providers in shared goals to improve healthcare outcomes. Some of the measures include HEDIS rates, clinical outcomes (such as readmission and effective transitions of care), and cost, setting the stage for Value Based Payment.

In 2016, the MPPs completed 125 MPP-convened and lead meetings with key, strategic providers. The array of providers encompasses hospital systems, freestanding Psychiatric Hospitals, high volume Substance Use Disorder (SUD) providers, and Article 31 clinics. The MPPs have also been made efforts to reinforce trainings about workflows for HARP/QMP implementation.

Beacon remains committed to the State’s ongoing efforts at transforming the Behavioral Health system of care and is closely aligned with our health partners to ensure that our members live their lives to the fullest potential.

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