If Only HOPSTOP Could Map Our Route to the Triple Aim

Health care reform is driving consumer focused, outcome-oriented change in New York and across the country. In the past decade we have come to look at health care differently and our technology-based tools have grown by leaps and bounds. Game changing opportunities are surfacing in supporting recovery and resiliency for people with the most serious mental illness or chemical dependencies, as well as new frontiers of collaborative care and viewing housing as healthcare. Behavioral health is on an incredible journey.

In an often used saying, when traveling one must know where you want to go. It is therefore critical that we select our final destination as the Triple Aim. The Triple Aim simply stated is a place where better care, better health at affordable costs is a reality. Striving toward the Triple Aim has meaning that connects with our non-profit roots and healthcare reform offers us new tools. The logical progression next takes us to the dreaded questions encountered on every family road trip “Are we there yet?” and “How do we get there?” This is where the journey to the Triple Aim becomes more challenging. Today when traveling around New York City we select our public transportation route using HOPSTOP. HOPSTOP is a savvy, decision-support tool offering multiple approaches to get to your destination. If only HOPSTOP could map our route to the Triple Aim.

Arriving at the Triple Aim is an inherently collaborative process. The mission of our agency, FEGS Health and Human Services, has remained constant for eight decades. To meet the needs of the Jewish and broader community through a diverse network of high quality, cost-efficient health and human services that help each person achieve greater independence at work, at home, at school and in the community, and meet the ever-changing needs of business and our society. The FEGS service delivery network includes: employment, career, and workforce development; help for individuals transitioning from welfare to work; behavioral health, developmental disabilities and rehabilitation programs; residential services; home care; services to individuals who are deaf or hard of hearing, older adults, refugees and immigrants, families in need, youth at risk, those with substance abuse problems, services for individuals facing life-limiting or end-of-life illness, and many others.

As we begin to chart our course towards the future, we can glean much from other States and healthcare arenas, even while the regulations are still being defined in negotiations between the State and Federal governments through task forces and committees. There are patterns of change that can guide behavioral health leaders, agencies and customers. The following are a sampling of key stops (HOPSTOPS) as we travel toward the Triple Aim.

  1. Value for the consumer. All of health care will soon be oriented around the right service or support in the right amount at the right time. This will be achieved with focus on engagement and new outcomes of improved health, stable housing and employment. Peer services, which have always been part of our fabric of care coordination and direct services, gains new priority in engaging clients, coordinating services and assuring responsiveness and quality.
  2. Integrated Health and Behavioral Health. In order to improve health, we must reach true integration between primary health care and behavioral health. The Collaborative Care model is an evidence-based approach for integrating physical and behavioral health services that can be implemented within a primary care practice. Over the past 15 years, more than 70 randomized control studies have documented a strong evidence base for this model. These trials have also specifically addressed the effectiveness of the model in ethnic minority groups, where it can be employed to reduce health care disparities.
  3. Partnerships. There is no “I” in success. Partners are essential to form care networks capable of achieving the Triple Aim. Formalized partnerships in many varieties set the stage for business arrangements that emphasize outcomes and can manage incentives for better performance. Partnerships mean more transparency and shared governance, including new roles for consumers. This is major change for providers.
  4. Technology. Technology advancement will play an ever-increasing role in behavioral health. The use of data analytics in decision-support is equally important to consumers and staff alike, especially for tailoring services and assuring performance quality. We are preparing for the creative use by consumers of iPads, direct access to personal health information, improved analytics and greater public accountability and transparency. In light of the transformative power of computer technology, FEGS established Center4, a venture in the creation of new technology solutions for health care.
  5. Workforce Development. Learning Communities. One economical way to build energy, new skills and collaboration is to engage staff in collectives to learn from the experience of others. Learning communities meet to study the lessons of other States and healthcare systems, Managed Care Organizations (MCOs) and other providers that are a few steps ahead in transforming their systems for integrated behavioral and health care.
  6. Diversified Funding and Risk Sharing. Redefining our operations to the new business models of the future will include both broadening our capacity to enter into risk and reward arrangements as well as joining networks serving those in Medicaid, Medicare, FIDA, Commercial, HARP, MLTC, etc.
  7. Innovation. Innovation in our definition of outcomes for health care in the future should focus on education, employment and housing. In practice, innovation in service delivery combines evidence informed and based practice coupled with ongoing performance improvement at the consumer, family, service and system levels.

New York’s non-profit’s have strong roots and are well positioned to leverage the many opportunities offered by Governor Cuomo’s Medicaid Redesign. Working together, we are on course to the Triple Aim and a bright future.

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