“Why Should I Worry Now about Value-Based Purchasing to Keep My Organization Strong?”
There has not been a dull moment in the behavioral healthcare field for quite a while and there will not be one for a very long time, if ever.
Community-based providers continue to adjust to fee-for-service reimbursement while they brace themselves for the transition of mental health and substance use services from the Department of Human Services to the Department of Health. Meanwhile, the federal government continues debates about the Affordable Care Act and the Centers for Medicare and Medicaid Services is moving forward with implementing value-based purchasing.
With all the changes happening, you may be wondering, “Why should I worry about value-based purchasing now?”
The answer is: Because it is not a question of “if”; it is a question of “when”. And with emphasis on integrated care, it will happen sooner, rather than later.
To be in a strong position in the future, it is imperative that all providers begin preparing now for value-based purchasing. You need to get ahead of the game to be ready for this major change!
As part of our mission to help providers plan for the future, NJAMHAA will host a critical training event – Staying Ahead of the Game: Beyond Fee-For-Service Reimbursement – Roundtable Summit on Integration and Value-Based Purchasing – on October 3, 2017 from 9:00 a.m. to 4:00 p.m. at the Robert Wood Johnson Wellness Center, 3100 Quakerbridge Rd., Hamilton Township, NJ 08619.
Value-based purchasing calls for more mature relationships between health plan representatives and providers. This summit will provide the ingredients for developing relationships with payers and getting your organizations ready to deliver integrated services in the value-based purchasing system. It is important to remember that every value-based contract will be different – and this summit will help you prepare for operating under these contracts.
To help providers gain the most from this roundtable and to continue preparing for value-based purchasing, NJAMHAA will provide a FREE online provider-readiness tool to each individual who registers for this essential training event. If you were to hire a consultant to develop such a tool, you would pay 100’s – if not 1,000s – of dollars!
This survey is not transferable outside your organization and responses will be kept confidential. It is also proprietary; please do not share the link to it with others.
After the summit, we will send the aggregated results of the assessment tool responses, along with commentary from James Lape, MA, MBA, FACHE, Consultant and Former NJAMHAA Board President, who will be facilitating this event.
The transition of health care to value-based purchasing is inevitable! Providers must take action to bridge the gap from volume to value.
Click here to register today! Then, you will soon receive the link to the free provider-readiness tool!
NJAMHAA thanks our event sponsors: Aetna Better Health of New Jersey, Amerigroup Corporation, Beacon Health Options, Horizon NJ Health and Optum.
Showing posts with label Mental Health. Show all posts
Showing posts with label Mental Health. Show all posts
Wednesday, September 27, 2017
Tuesday, May 23, 2017
Blog
NJAMHAA Has Impact
and Depends on Members for Insights
“NJAMHAA’s role and
impact in the field of mental health has been tremendous and with the landscape
becoming more complex, it can only be more important moving into the future,”
said Anthony DiFabio, PsyD, Chief Executive Officer of Robins’ Nest and
long-time NJAMHAA member.
Changes are always happening – that’s the increasingly
complex landscape Dr. DiFabio refers to and it presents many challenges for
providers of not only mental health care, but also substance use and
developmental disabilities services.
Most notably and most concerning,
nowadays, are the transition to fee-for-service (FFS) reimbursement for providers
of mental health care and substance use treatment for children and adults. On
the federal level, the possible repeal and inadequate replacement of the
Affordable Care Act and proposed significant funding cuts to Medicaid.
To address these major issues and many others that affect
our members’ abilities to provide services to everyone in need, NJAMHAA
regularly meets and corresponds with State Legislators and key policymakers
(e.g., Departments of Human Services and Children & Families) and our
Congressional delegates. We demonstrate the value of our members’ life-saving
and life-enhancing services and reinforce the critical need to ensure access to
these services. We communicate this message even farther through traditional
and social media. We undertake these initiatives as part of our constant
pursuit of our mission:
To promote the value
of its members as the highest quality behavioral healthcare providers for the
residents of New Jersey through advocacy and professional development.
For professional development, we offer numerous training
opportunities throughout the year.
Our advocacy has had a significant impact and we are the
recognized leader in advocacy and achievement for New Jersey’s community mental
health, substance use and developmental disabilities system. Highlights of our
advocacy achievements include:
▪
Significant input into the FFS oversight
legislation, its passage and signing into law
▪
Increase of several FFS reimbursement rates for
mental health, substance use and Community Support Services (CSS), most notably
the doubling of medication monitoring rates▪ Option for transition dates for mental healthcare and CSS providers
▪ Substantial input that was used in the development of proposed legislation for safety net funding for mental health agencies transitioning to FFS on July 1, 2017, and expansion of screening centers and Early Intervention Support Services
▪ Preservation of funding for mental health and substance use services, including many children's behavioral health services, in the FY 2017 State Budget: All of the new funding proposed by the Governor was maintained.
▪ For the FY 2018 State Budget, Gov. Christie cited funding increases for mental health, addiction and developmental disabilities services, and we continue to advocate to help ensure State Legislators vote in favor of this funding.
On the federal level, our advocacy contributed to the
passage of the Comprehensive Addiction and Recovery Act and the 21st
Century Cures Act, which includes a $1 billion, two-year appropriation (almost
$12 million to New Jersey for two years) to fight the opioid crisis.
The effectiveness of our advocacy is a result, in large
part, to our members’ active involvement. They share their perceptions of and
experiences with changes in funding, regulations and laws, as well as their
clients’ success stories. We incorporate this invaluable information into our
advocacy, our communication with traditional media representatives and on
social media.
Please click here
to learn more about how NJAMHAA membership can reinforce your organization and
career, and how your involvement can help strengthen New Jersey’s mental
health, substance use and developmental disabilities system.
Wednesday, March 22, 2017
Advocacy and
Knowledge Building Are Always Critical for Providers and other Stakeholders
Join NJAMHAA at its
Annual Conference March 29-30, 2017 for Information, Insights & Inspiration
Now is the time to exercise your lungs and advocate against
the repeal and replacement of the Affordable Care Act as loudly as you can. If
the American Health Care Act is passed, hundreds of thousands of individuals
will lose coverage, which for many, was recently gained as a result of the
Medicaid expansion.
It is also a good time to take a breath and a refreshing
break – while continuing to reinforce your effectiveness as a behavioral health
provider and advocate. It is natural to feel overextended and stressed with so
many important issues to focus on, so NJAMHAA has a solution: Attend our Annual
Conference, Collaboration and Innovation:
A Formula for Success, on March 29 and 30, 2017 to take a rejuvenating, yet
still productive break from your highly demanding daily responsibilities.
The conference is not just something else to do. It is
designed to make everything you do even better. You and the individuals you
serve will benefit tremendously because you will not only get the latest
updates from Washington in real time, but also will gain a wealth of
information and insights that are timely and valuable for your ongoing work
with individuals who depend on your services to achieve a high quality of life.
You will not want to miss:
* Working with a New
Administration: In his keynote presentation on Day 1, Ron Manderscheid,
PhD, Executive Director of the National Association of County Behavioral Health
and Developmental Disability Directors, will provide his insights on the likely
impact of changes to national policy, including the Affordable Care Act,
Medicare and Medicaid. He will also share his perspective on the direction of
healthcare policy for the near and long term, as well as guidelines for
preparing for the coming changes.
* Five Pillars - The
Pathway to Improving the Delivery of Mental Health Services in Education: An
Interview with Amy Kennedy: In this plenary session, Amy Kennedy, MS,
Education Director for the Kennedy Forum, will share findings from her research
in early identification of and intervention for mental health concerns in
children, the use of brain fitness and mindfulness within school systems in
order to foster and improve mental wellness, and developing prevention programs
that utilize and promote students’ social and emotional learning.
* Innovation in
Behavioral Health Management, Reimbursement and Delivery: For the Day 2
keynote presentation, Brian Wheelan, MBA, Chief Strategy Officer and Executive
Vice President at Beacon Health Options, will share the successes and
challenges that have come from collaborations with provider organizations in
both risk and non-risk based arrangements.
* The Changing Role of
Hospitals: Leaders from Carrier Clinic, Hackensack, UMC Mountainside and
the Camden Coalition of Healthcare Providers will discuss their successes from
programs and changes they have implemented, as well as their current or planned
efforts to better serve those with mental health and/or substance use
disorders. They will also focus on the need for collaboration between hospitals
and community-based providers.
* Plus: Workshops
to meet every training need: Topics are organized by tracks – General
Clinical/Adult Mental Health; Substance Use Disorders and Treatment; Children
and Youth; and Organizational.
Get Even More
Inspired at the Courage & Compassion Awards
Reception
The best way to attract and retain staff is to make them
feel valued. We all know of the amazing work that frontline providers and
organizations’ leaders do every day and we are delighted to present Courage & Compassion Awards to
several of them at our annual awards and networking reception.
Please join us to honor providers, as well as state
legislators and media representatives who support the mental health, substance
use and developmental disabilities systems.
Your participation in the reception is included in your Day 1 conference registration.
Wednesday, February 22, 2017
Helpful Advice for Small Organizations Managing Huge Demands and Challenges
In small organizations, we get so busy – as evidenced by the several weeks since my last blog. I agree with Mary Gay Abbott-Young, a NJAMHAA Board member and CEO of the Rescue Mission of Trenton, that in smaller organizations, leaders and other staff wear so many hats, which makes it is difficult to get to many things. As a result, the expectations seem unrealistic. This leads to the question: What do small service provider organizations need to do to survive?
Most days, I would describe my role at NJAMHAA as being an octopus that also has to stand on its head to manage the multiple – and growing – demands. While this makes my career exciting and never boring, it becomes very challenging. In terms of advocating strongly and constantly on many issues; meeting regulatory standards; staying on top of what is happening in the behavioral health field, related industries and the state and federal governments that affects our members’ abilities to provide services; and keeping up with daily operations and serving members/clients, both the NJAMHAA staff and our members face a gargantuan task every day.
“Small” in the behavioral health field does not necessarily mean being as small as NJAMHAA’s staff. Small provider agencies in this environment could have budgets of $10 to $15 million. On our staff, we have fewer than five individuals delivering member services, advocating, and developing and presenting conferences and other training events to NJAMHAA’s 160 organizational members and their 61,000 employees. That’s a lot of demand on a few people! And the employees at our member provider agencies contend with similar challenges.
In this environment, as demands are increasing while resources are declining, here are some ideas from Mary Gay and Jim Lape, a Past NJAMHAA Board President who recently retired from his position as Trinitas Regional Medical Center’s Vice President of Behavioral Health and Senior Services:
Mary Gay poses the following questions for providers in small agencies to consider: Does your agency need to become larger to survive or is the key to partner with other provider organizations? Does “bigger” necessarily mean better services? How can we act as a community of providers?
According to Jim, agencies need to be bigger, but they do not necessarily need to merge with other organizations. However, there is pressure to consolidate in all sectors to achieve economies of scale. What is essential is their participation in larger networks.
Jim emphasized that smaller agencies must be as strong as they possibly can be in order to be attractive to networks and larger entities. To do this, they need to manage costs by being as lean as possible, especially on the administrative side, and explore opportunities to outsource some functions, such as information technology, human resources and billing. They also need to offer special valued services to maximize their revenues – perhaps by facilitating groups, especially around medication management, and specific types of groups that would meet the needs of their communities, such as trauma-focused and dialectical behavioral therapies.
Jim added that mental health providers need to focus on the broad range of mental health disorders, not just serious mental illnesses. In addition, since money will flow from the federal and state governments to health plans when Medicaid is managed – which will probably begin within the next year or two – it is also important for agencies to have relationships with health plans and provide solutions for populations that are being insured.
The many changes taking place can seem overwhelming, especially when they appear to be at odds with providers’ mission to serve everyone in need – a population that continues to grow. I hope this advice from long-time, expert providers of both mental health and substance use services brings encouragement to all of our members.
In small organizations, we get so busy – as evidenced by the several weeks since my last blog. I agree with Mary Gay Abbott-Young, a NJAMHAA Board member and CEO of the Rescue Mission of Trenton, that in smaller organizations, leaders and other staff wear so many hats, which makes it is difficult to get to many things. As a result, the expectations seem unrealistic. This leads to the question: What do small service provider organizations need to do to survive?
Most days, I would describe my role at NJAMHAA as being an octopus that also has to stand on its head to manage the multiple – and growing – demands. While this makes my career exciting and never boring, it becomes very challenging. In terms of advocating strongly and constantly on many issues; meeting regulatory standards; staying on top of what is happening in the behavioral health field, related industries and the state and federal governments that affects our members’ abilities to provide services; and keeping up with daily operations and serving members/clients, both the NJAMHAA staff and our members face a gargantuan task every day.
“Small” in the behavioral health field does not necessarily mean being as small as NJAMHAA’s staff. Small provider agencies in this environment could have budgets of $10 to $15 million. On our staff, we have fewer than five individuals delivering member services, advocating, and developing and presenting conferences and other training events to NJAMHAA’s 160 organizational members and their 61,000 employees. That’s a lot of demand on a few people! And the employees at our member provider agencies contend with similar challenges.
In this environment, as demands are increasing while resources are declining, here are some ideas from Mary Gay and Jim Lape, a Past NJAMHAA Board President who recently retired from his position as Trinitas Regional Medical Center’s Vice President of Behavioral Health and Senior Services:
Mary Gay poses the following questions for providers in small agencies to consider: Does your agency need to become larger to survive or is the key to partner with other provider organizations? Does “bigger” necessarily mean better services? How can we act as a community of providers?
According to Jim, agencies need to be bigger, but they do not necessarily need to merge with other organizations. However, there is pressure to consolidate in all sectors to achieve economies of scale. What is essential is their participation in larger networks.
Jim emphasized that smaller agencies must be as strong as they possibly can be in order to be attractive to networks and larger entities. To do this, they need to manage costs by being as lean as possible, especially on the administrative side, and explore opportunities to outsource some functions, such as information technology, human resources and billing. They also need to offer special valued services to maximize their revenues – perhaps by facilitating groups, especially around medication management, and specific types of groups that would meet the needs of their communities, such as trauma-focused and dialectical behavioral therapies.
Jim added that mental health providers need to focus on the broad range of mental health disorders, not just serious mental illnesses. In addition, since money will flow from the federal and state governments to health plans when Medicaid is managed – which will probably begin within the next year or two – it is also important for agencies to have relationships with health plans and provide solutions for populations that are being insured.
The many changes taking place can seem overwhelming, especially when they appear to be at odds with providers’ mission to serve everyone in need – a population that continues to grow. I hope this advice from long-time, expert providers of both mental health and substance use services brings encouragement to all of our members.
Wednesday, October 19, 2016
Lives Are at Stake; Changes Must Be Made
I’m going to Europe this fall and I’m always struck by the fact that throughout Europe and especially in France, they always have strikes and demonstrations. Since I joined NJAMHAA 21 ½ years ago, I’ve seen that while we agree it is effective to show what the mental health and substance community provides and how much it is depended on, there has never been a strike because providers are mission driven and would never hold back services even for a day from the children and adults who rely on them.
Community-based mental health providers are moving to a fee-for-service (FFS) reimbursement system with some rates that won’t work and the simultaneous removal of State contract dollars, as we have been demonstrating – without going on strike. Data from providers throughout New Jersey indicate that tens of thousands of individuals will lose services if FFS rates are not increased and if contract dollars are not continued while providers make the transition, which should be extended.
So, it is realistic – and frightening – to ask, “What if providers had to close their doors not for a day, but forever, because they were no longer viable?” This has been the experience in other states throughout the country, including Massachusetts, Michigan and Kansas. The move to Medicaid managed care and the concurrent termination of contracts with State dollars resulted in programs and even entire agencies closing, which led to individuals’ mental illnesses and substance use disorders becoming worse and requiring much more expensive treatment in emergency rooms and inpatient hospital units. If positive changes are not made for New Jersey’s FFS system, these same tragedies – which have been occurring due to the long history of insufficient funding – will inevitably occur to a greater degree. Such tragedies can and must be prevented.
Our member providers are so committed to those they serve that they are doing all they can as they face the multiple challenges inherent in the time frame in which FFS is being implemented. However, there is still a limit to what they can do with limited funds. It’s my hope that State legislators and policymakers will invest more State dollars in the community mental health and substance use system to ensure that all children and adults – whether they have Medicaid or they are underinsured or uninsured – so that even though providers refuse to quit, the FFS system won’t have such a devastating impact that it would seem as if providers had gone on indefinite strike.
As a good friend of mine, Randy Hall, eloquently stated, “People seldom change when they see the light; they only change when they feel the heat.” Our State leaders need to feel the heat, to know what’s at stake: people’s lives.
While the unquantifiable cost of people’s lives is certainly a compelling reason on its own, the quantifiable fiscal cost is also of great concern and cannot be ignored. The cost of community services must be viewed as an investment that yields a tremendous return. Community services cost hundreds of thousands of dollars less than hospital services and save the State millions of dollars every year in prevented emergency room visits, hospitalizations, homelessness and incarceration.
People’s lives and the State’s fiscal situation represent a lot of “heat” that should incite positive change to strengthen and maintain the safety net that is our community mental health and substance use system.
I’m going to Europe this fall and I’m always struck by the fact that throughout Europe and especially in France, they always have strikes and demonstrations. Since I joined NJAMHAA 21 ½ years ago, I’ve seen that while we agree it is effective to show what the mental health and substance community provides and how much it is depended on, there has never been a strike because providers are mission driven and would never hold back services even for a day from the children and adults who rely on them.
Community-based mental health providers are moving to a fee-for-service (FFS) reimbursement system with some rates that won’t work and the simultaneous removal of State contract dollars, as we have been demonstrating – without going on strike. Data from providers throughout New Jersey indicate that tens of thousands of individuals will lose services if FFS rates are not increased and if contract dollars are not continued while providers make the transition, which should be extended.
So, it is realistic – and frightening – to ask, “What if providers had to close their doors not for a day, but forever, because they were no longer viable?” This has been the experience in other states throughout the country, including Massachusetts, Michigan and Kansas. The move to Medicaid managed care and the concurrent termination of contracts with State dollars resulted in programs and even entire agencies closing, which led to individuals’ mental illnesses and substance use disorders becoming worse and requiring much more expensive treatment in emergency rooms and inpatient hospital units. If positive changes are not made for New Jersey’s FFS system, these same tragedies – which have been occurring due to the long history of insufficient funding – will inevitably occur to a greater degree. Such tragedies can and must be prevented.
Our member providers are so committed to those they serve that they are doing all they can as they face the multiple challenges inherent in the time frame in which FFS is being implemented. However, there is still a limit to what they can do with limited funds. It’s my hope that State legislators and policymakers will invest more State dollars in the community mental health and substance use system to ensure that all children and adults – whether they have Medicaid or they are underinsured or uninsured – so that even though providers refuse to quit, the FFS system won’t have such a devastating impact that it would seem as if providers had gone on indefinite strike.
As a good friend of mine, Randy Hall, eloquently stated, “People seldom change when they see the light; they only change when they feel the heat.” Our State leaders need to feel the heat, to know what’s at stake: people’s lives.
While the unquantifiable cost of people’s lives is certainly a compelling reason on its own, the quantifiable fiscal cost is also of great concern and cannot be ignored. The cost of community services must be viewed as an investment that yields a tremendous return. Community services cost hundreds of thousands of dollars less than hospital services and save the State millions of dollars every year in prevented emergency room visits, hospitalizations, homelessness and incarceration.
People’s lives and the State’s fiscal situation represent a lot of “heat” that should incite positive change to strengthen and maintain the safety net that is our community mental health and substance use system.
Thursday, October 6, 2016
Ensuring that Everyone who Needs Help Can Get Help
The summer passed so quickly and we jumped into fall at full speed as the transition to fee-for-service (FFS) had been and continues to be on everyone’s mind.
Ever since I began receiving feedback from members that some of the FFS rates won’t work, I’ve been asking myself every night, “What will it really take to ensure not only that no one loses services as we go through the system transformation, but also that we can expand services as there is so much unmet need?”
Of course, we are continuing to persevere in our advocacy and we are employing a variety of strategies, including recent videos, We Have a Potential Problem and The Number of People in Need Continues to Increase , on YouTube. The videos, as well as our press releases and letters to editors, have resulted in substantial media coverage. Highlights include a page 1 article in the Star-Ledger, several articles in NJ Spotlight, a feature in Mental Health Weekly and interviews on NJTV News. We have had some impact on FFS rates and the transition to FFS. We are also making significant strides toward eliminating stigma and discrimination.
The momentum keeps building. As others have been worrying along with me around the clock, which is evident by the nonstop communications, the potential loss of services for tens of thousands of individuals is of grave concern. This concern has prompted much positive action by our staff and members, including advocacy to legislators in writing and in person, a petition (click here to sign on before October 19th) and legislative breakfasts being held this month in Bergen and Essex Counties.
I fully support all of these efforts. They augment the advocacy that our staff and I do on behalf of all our members. I think there will be a solution and we will be heard if every individual at every member organization, as well as all clients and their family members, become actively engaged in advocacy. I believe that if we all join voices on this issue, leaders will know that services are needed and valuable.
We are glad the State Senate Health, Human Services and Senior Citizens Committee unanimously passed a bill for independent oversight of the FFS system operation and rates, and we anticipate an Assembly hearing on this legislation on November 14, 2016. We strongly encourage our members to make a strong showing at this hearing with clients and their family members. Stay tuned for details.
Debra L. Wentz, Ph.D.
President and CEO
New Jersey Association of Mental Health and Addiction Agencies, Inc. (NJAMHAA)
Ever since I began receiving feedback from members that some of the FFS rates won’t work, I’ve been asking myself every night, “What will it really take to ensure not only that no one loses services as we go through the system transformation, but also that we can expand services as there is so much unmet need?”
Of course, we are continuing to persevere in our advocacy and we are employing a variety of strategies, including recent videos, We Have a Potential Problem and The Number of People in Need Continues to Increase , on YouTube. The videos, as well as our press releases and letters to editors, have resulted in substantial media coverage. Highlights include a page 1 article in the Star-Ledger, several articles in NJ Spotlight, a feature in Mental Health Weekly and interviews on NJTV News. We have had some impact on FFS rates and the transition to FFS. We are also making significant strides toward eliminating stigma and discrimination.
The momentum keeps building. As others have been worrying along with me around the clock, which is evident by the nonstop communications, the potential loss of services for tens of thousands of individuals is of grave concern. This concern has prompted much positive action by our staff and members, including advocacy to legislators in writing and in person, a petition (click here to sign on before October 19th) and legislative breakfasts being held this month in Bergen and Essex Counties.
I fully support all of these efforts. They augment the advocacy that our staff and I do on behalf of all our members. I think there will be a solution and we will be heard if every individual at every member organization, as well as all clients and their family members, become actively engaged in advocacy. I believe that if we all join voices on this issue, leaders will know that services are needed and valuable.
We are glad the State Senate Health, Human Services and Senior Citizens Committee unanimously passed a bill for independent oversight of the FFS system operation and rates, and we anticipate an Assembly hearing on this legislation on November 14, 2016. We strongly encourage our members to make a strong showing at this hearing with clients and their family members. Stay tuned for details.
Debra L. Wentz, Ph.D.
President and CEO
New Jersey Association of Mental Health and Addiction Agencies, Inc. (NJAMHAA)
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