If you are a specialist organization operating today, payer preferences for community-based care and care coordination is changing the market landscape —and bringing with it new strategic challenges. Delivering “best practice” home- and community-based services requires collaborative, interdisciplinary teams capable of delivering services designed to support integration and inclusion.
While there are many discrete services being delivered in the community, there are fewer coordinated service programs—with longitudinal coordination across the medical/behavioral/social system. At our recent 2019 OPEN MINDS Management Best Practices Institute session, Community Integration & Consumer-Centered Care: Building A New Model For Community Living & Participation, we heard from executives of two organizations that are making this work. Jeffrey Friedman, Chief Executive Officer, CN Guidance and Counseling Services and Mark McHugh, President & Chief Executive Officer, Envision Unlimited shared their current models and their best practices for building a consumer-focused community-based program model. My takeaway— provider organization management teams need to focus on consumer-centered care models that can “meet consumers where they are.”
Mr. Friedman led off the session with a presentation of two programs of CN Guidance and Counseling Services—Nassau County’s first ever tech-powered mobile recovery unit and their Stability at Home Program—a intensive crisis management program designed as an alternative to hospitalization for mentally disabled adults.
The mobile recovery unit is a state-of-the-art drug recovery unit that travels over Nassau County to provide community-based services for consumers with addiction problems. Funding for the mobile unit is federal pass-through money in New York state, and a grant covered the cost of the van itself and the operating expenses of staffing. Fifty-five percent of the consumers are on Medicaid and roughly 30% of the funding comes from grants. (For a deeper dive into this service, check out Mobile Community-Based Care—The CN Guidance & Counseling Services Model.)
The grant-funded Stability at Home Program has since ended, and had provided crisis counseling, access to social services, housing, and long-term mental health treatment, focused on keeping consumers in the community, as well as hitting the triple aim: better consumer experience, improved health care, and reduced costs. After engaging 77% of the consumers 30-days post discharge, Mr. Friedman explained positive outcomes included:
- Number of psychiatric inpatient days dropped from 12.8 to 1.7 for “average” Medicaid service users
- Number of psychiatric inpatient days dropped from 24.2 to 1.3 for “high” Medicaid service users
- Costs for “average” Medicaid service users dropped from $10,688 to $1,420
- Costs for “high” Medicaid service users dropped from $21,100 to $1,086
What drove the development of these programs? Mr. Friedman explained:
We sat down and realized we couldn’t compete with the big hospital systems. They can buy or build anything they want. We didn’t have that luxury. We had to be sure of our direction, our value, and look at how we can move the needle for the health care we are supporting. And do it in a way that show results. Our Stability Home Program was a pilot project that ended, but served as a spring board/launching pad for a variety of other “beyond 4 wall/meeting consumers where they are at” programs,” that developed as a result of the learnings from this pilot.
At Envision Unlimited, Mr. McHugh explained that a challenging state market in Illinois with 11 years of disinvestment, payments below cost, a staffing crisis, and a high institutional population led the organization to develop a variety of community-based programs. The programs—which include short-term stabilization homes, independent living, host homes, and Community Hubs in place of congregate day settings—focus on shifting 75% of services to an integrated setting.
Mr. Friedman and Mr. McHugh’s advice on launching and maintaining community-based services? Focus on “partnerships, partnerships, partnerships.” Mr. Friedman explained that in a market that is driven by accountability, both provider organizations and the organizations they seek to partner with must build an ongoing positive relationship based on working very well together, exemplifying cultural competency, and bringing both mission and capacity that complements one another to the table. Mr. McHugh explained further, “I can’t say enough about how important partnerships are to create inclusion for consumers. You need to be a community asset that can include someone else’s work. Remember, reputation capital is currency. You don’t just build it up. You have to spend it.”
For more on community-based strategy and services, check out these resources from The OPEN MINDS Industry Library:
- The Old Is New In HCBS — An Update On Community-Based Care Rules & Regulations
- The Move To Care In The Community—The Trends & The Opportunities
- The Staffing Equation For Community-Based Services
- VBR Jumping From Hospital-Centric ACOs To Community-Based Players
- A Tale Of Two Community-Based Program Models
- What’s Holding Up Community-Based I/DD Services?
- Living In The Community—The Landscape For Adults With I/DD
- If 1 In 8 Community-Based Organizations Are Insolvent, The Answer Is?
- Options For Community-Based Services For Behavioral Health
- Home- & Community-Based Services: New Rules, New Trends
For more, join me on October 29 at The 2019 OPEN MINDS Technology & Informatics Institute for the session, Expanding Access Through Technology: Innovative Approaches For Improving Access To Care, featuring Jeremy Blair, MBA, LMFT, Chief Executive Officer, WellStone and Ellie Zuehlke, MPH, Director, Community Benefit & Engagement, Allina Health.