Status Report: December 2014 About Central Florida Cares Health System About Central Florida Cares Central Florida Cares Health System, Inc. (CFCHS) is a not-for-profit organization contracted by the Department of Children and Families to oversee state-funded mental health and substance abuse treatment services in Brevard, Orange, Osceola, and Seminole counties. Our Mission: Central Florida Cares Health System is a resource center that utilizes state, federal and innovative funding sources, promising practices, and/or pilot programs to support our providers as they address identified behavioral health needs of the community. Our Vision: Achieve a comprehensive and seamless behavioral health system promoting recovery and resiliency. Our Guiding Principles: To promote evidence-based practices in service delivery across the system of care To increase ease of access to all needed services To improve continuity of service provision and coordination of services across the system of care To reduce utilization of restrictive levels of care and use the resulting savings to enhance community-based recovery services To meet or exceed all outcome and performance requirements To work with the Department of Children and Families to integrate the CFCHS outcomes and its planning processes with the Department of Children and Families’ annual and long-range planning To adopt integrated approaches which afford access to primary and specialty medical care in concert with behavioral healthcare To always put the person served first in all aspects of its operations Our Values: The worth of every person served The principles of recovery — hope, trust, choice, personal satisfaction, interdependence, and community involvement The ability of every person to attain recovery and develop resiliency The need to focus on each person’s strengths and competencies The need for family-centered children’s services which build resiliency The need for each person for respect and dignity About this Report This Progress Report provides a snapshot of the progress made by Central Florida Cares Health System since its work began July 2, 2012. The organization remains highly committed to being efficient, innovative and nimble as it responds to an ever-changing state and federal landscape while remaining focused on the needs of the Judicial Circuits 9 and 18 (Brevard, Orange, Osceola and Seminole Counties). 2 Message from the CEO Dear Community Members, Central Florida Cares Health System is embarking on its third year of service in Brevard, Orange, Osceola and Seminole Counties and we are proud to share some of our accomplishments with the community. CFCHS staff members have worked together with our Board of Directors, providers and community stakeholders to make significant progress toward our vision of a comprehensive and seamless behavioral health system promoting recovery and resiliency for our community. Beginning in July of 2012, CFCHS successfully implemented numerous strategies to strengthen the ability to analyze our system of care, measure and improve our service outcomes and ensure strong financial stewardship. We launched a robust information system that provides CFCHS with the data necessary to manage and improve our network services, finances and contract management functions. We developed a needs assessment and strategic plan to improve the utilization of current and future resources. Through new policies, systems and automation, we formalized and improved client data reporting and integrity, service utilization, incident reporting, contract compliance and provider payment systems. We created strong partnerships with stakeholders to strengthen collaborative efforts and improve programs and services. We are excited about the challenges and opportunities the future holds and have built a strong foundation to guide our efforts. Central Florida Cares Health System will continue to commit significant energy towards strategies that will increase the quality, efficiency and effectiveness of our system of care. Thank you for your continued commitment and support. Sincerely, Maria Bledsoe Chief Executive Officer 3 Financial Progress Central Florida Cares Health System serves as the managing entity for Circuits 9 and 18 under a contract with Florida’s Department of Children and Families. Funds allocated to CFCHS include state, federal block grant and Temporary Assistance to Needy Families (TANF) funding. The approximate allocations for FY 12-13 were $56.6 million and $58 million in FY 13-14. CFCHS funding expenditures are divided into four primary program areas: Adult Mental Health (AMH), Adult Substance Abuse (ASA), Children's Mental Health (CMH), and Children's Substance Abuse (CSA). Table A. below shows expenditures, by program area, for FY 12-13 and FY 13-14. Table A. Expenditures by Program Area FY 12-13 and FY 13-14 $54,732,574 FY Total $55,642,373 $26,682,648 AMH $26,101,889 $12,919,395 ASA $14,708,504 $7,038,359 CMH $6,952,712 $8,092,172 CSA $7,879,269 $0 $10,000,000 $20,000,000 $30,000,000 FY 12-13 Table B. illustrates the percentage of total expenditures in each of the four primary program areas. The only major change in expenditures between FY 12-13 and FY 13-14 was the addition of a pregnant and post-partum expansion grant in Adult Substance Abuse for FY 13-14. $40,000,000 $50,000,000 $60,000,000 FY 13-14 Table B. Percentage of Expenditures by Program Area FY 12-13 and FY 13-14 Program AMH ASA CMH CSA FY Total FY 13-14 46.9% 26.4% 12.5% 14.2% 100.0% FY 12-13 48.8% 23.6% 12.9% 14.8% 100.0% 4 Within each of the four primary program areas there are major service types. Tables C.-F. below illustrate these expenditures for FY 12-13 and FY 13-14. Table C. Adult Mental Health Expenditures, Percentage of Total by Service Type* Table D. Adult Substance Abuse Expenditures, Percentage of Total by Service Type* FY 12-13 and FY 13-14 FY 12-13 and FY 13-14 FY 12-13 FY 13-14 FY 12-13 Amount ($000) AMH Service Type % Acute Outpatient FACT Teams Residential 44.9% 18.9% 12.5% 13.2% 45.3% 17.5% 13.6% 12.9% 11,811 4,580 3,559 3,355 PATH TANF Forensic Diversion Proviso Projects Prevention IDP 2.7% 2.5% 2.3% 2.8% 0.0% 0.3% 2.5% 2.4% 2.3% 2.2% 1.0% 0.3% 663 624 597 580 264 69 Total 100% 100% 26,102 % FY 13-14 Amount ($000) ASA Service Type % Detox Residential Outpatient 20.5% 39.2% 24.1% 28.2% 25.2% 16.7% 4,141 3,699 2,453 0.0% 11.5% 1,689 12.6% 2.1% 11.0% 4.3% 1,625 635 Prevention 1.6% 3.2% 466 Total 100% 100% 14,709 Pregnant Women (PPW) Proviso Projects TANF % Table E. Children’s Mental Health Expenditures, Percentage of Total by Service Type* Table F. Children’s Substance Abuse Expenditures, Percentage of Total by Service Type* FY 12-13 and FY 13-14 FY 12-13 and FY 13-14 FY 12-13 FY 12-13 FY 13-14 Amount ($000) CMH Service Type % Outpatient Crisis BNET PRTS 42.9% 35.0% 19.1% 2.7% 41.5% 36.6% 18.2% 2.6% 2,889 2,545 1,263 184 Prevention Residential 0.0% 0.2% 0.9% 0.1% 63 9 Total 100% 100% 6,953 % FY 13-14 Amount ($000) CSA Service Type % Residential Outpatient Detox Prevention 23.8% 37.4% 12.1% 18.1% 27.1% 29.3% 12.3% 21.0% 2,135 2,309 967 1,652 PPG TANF Approp'n 374 7.9% 0.6% 0.0% 7.8% 0.3% 2.2% 613 27 175 Total 100% 100% 7,879 % *Service Type Abbreviations: PATH: Projects for Assistance in Transition from Homelessness BNET: Behavioral Health Network Title XXI IDP: Indigent Drug Program PRTS: Purchase of Residential Treatment Services Appropriation 374: Informed Families Project 5 Service Progress Central Florida Cares Health System’s funding and contracted services are divided into four main program areas: Adult Mental Health (AMH), Adult Substance Abuse (ASA), Children's Mental Health (CMH), and Children’s Substance Abuse (CSA). Within each program area there are 3 main divisions or categories of services. These categories are displayed below in Table G. with a comparison of the number of individuals served in each category in FY 12-13 and FY 13-14 (duplicated figures, individuals may have been served in more than one category). Table G. Number Served in Major Program Catergories FY 13-14 and FY 12-13 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 AMH Residential AMH Ambulatory AMH Crisis ASA Residential ASA Ambulatory ASA Detox CMH Residential CMH Ambulatory CMH Crisis CSA Residential CSA Ambulatory CSA Detox FY 12-13 The overall numbers of individuals served in the four main program areas shown above illustrate an overall. This decrease is further highlighted by the table to the right. FY 13-14 Table C. Change in Number Served FY 12-13 to FY 13-14 Program Adult Mental Health (AMH) % Difference There was a 10.1% decline in the number served in the Adult Substance Abuse (ASA) AMH Ambulatory category which was due primarily to a Children's Mental Health (CMH) change in how a provider reported data. There was an Children's Substance Abuse (CSA) increase in the number of individuals served in three categories: ASA Residential (23.2%), ASA Detox (1.8%) and CSA Residential (14.8%). A FY 13-14 pregnant and post-partum expansion grant plays a role in the increase in the number served in ASA Residential Services. -9.0% -5.7% -19.4% -22.6% 6 Major Initiatives & Progress Behavioral Health Need Assessment and Strategic Plan CFCHS completed a comprehensive Behavioral Health Community Needs Assessment in spring of 2014 that examined community demographics, client demographics, service data, chronic disease and risk factor data and provider and consumer survey data. CFCHS used this report to develop a Strategic Plan for FY 14-15 that includes the following goals: Goal A: Research Service gaps and needs Goal B: Identify promising practices to implement to address needs Goal C: Inform all stakeholders how to use CFCHS resources Community Leadership CFCHS’s CEO was appointed by Orange County Mayor Teresa Jacobs to the Orange County Youth Mental Health Commission to serve on Implementation Team tasked with the development of a plan to prioritize and implement the Commission’s recommendations. Ms. Bledsoe was also appointed to serve on the Central Receiving Center (CRC) Governing Board by Orange County Commissioner Pete Clarke. Community Outreach and Education CFCHS staff participate in a wide variety of events in the community as part of the organization’s community outreach and education efforts. Recent events include a gathering of NAMI of Greater Orlando (Nation Alliance on Mental Illness) in May, the 2nd Annual Orange Fiesta sponsored by the Hispanic Heritage Committee of Greater Orlando in September and a Women’s Health event sponsored by Florida Hospital held in Sanford in November. Active Program Committee CFCHS facilitates an active, multi-agency Program Committee tasked with oversight of the system of care development and implementation, ensuring that the network has the capacity to effectively manage service delivery. This committee is responsible for the development of a Service Description Handbook created to define the different substance abuse and mental health services contracted by CFCHS and includes a list of network providers. A Consumer Handbook was also developed to assist consumers and family members in locating state funded services. Child Welfare Integration and Collaboration CFCHS works closely with the Department and Children and Families and Community Based Care agencies to ensure an integration of the two systems when serving the same families. CFCHS serves on the Local Review Team. As an active member of this team, CFCHS collaborates with local and statewide organizations to resolve case specific issues for children receiving services from multiple agencies. CFCHS staff also participates monthly in System of Care meetings to collaborate with other agencies to reduce barriers in coordinated services. CFCHS Staff Capacity and Expertise CFCHS’s Risk Manager received a certification in Health Care Risk Management from the University of South Florida and the Chief Operating Officer and both Contract Managers received their certification in Healthcare Compliance from the Compliance Certification Board. Six CFCHS staff are Six Sigma Yellow Belts and five are currently attending Six Sigma Green Belt training. CFCHS employs two licensed staff: one Licensed Clinical Social Worker and one Licensed Marriage and Family Therapist. 7 Client Information System CFCHS partnered with a software vendor to develop a robust data, financial, and contract management automated system that provides CFCHS leadership with up-to-date monthly client data that is used for strategic planning, financial forecasting and outcome evaluation. This new data system, Five Points, also allows providers to access their own client data monthly through a collection of customized reports. CFCHS’s Five Points system was intentionally designed to allow providers to submit their client data in a way that accommodates each provider’s specific technological capacity as they transitioned from the Department of Children and Families to the new system. Data Integrity CFCHS worked diligently to identify and address data integrity through the examination of data entry and submission practices and client coding issues. Through provider staff training and improved data validation processes within the Five Points system, CFCHS had increased the reliability of client and service delivery data. Provider Contract Compliance and Network Quality of Care Since July of 2012, CFCHS has concentrated effort on conducting a rigorous examination of its provider network to ensuring that providers were meeting contractual requirements, to improve the quality of care, and by conducting fraud, waste, and abuse prevention and detection activities. Significant improvements have been made to the system of care, including: Systematic invoicing errors identified and corrected Corrections made to data reporting practices, including previously incorrect conversion of service minutes to service units Identified and corrected SRT operations to align with standards Improved pre-authorization procedures for PRTS clients to ensure financial and clinical eligibility Implemented a new outreach policy to focus more funding into direct services Did not renew three contracts due to various reasons including under-utilization, financial instability, and poor performance. A related instance of possible Fraud, Waste and Abuse was reported. Risk Management, Quality Improvement and Utilization Management A variety of projects have been successfully implemented to improve the level of contract compliance, enhance provider engagement and increase the accountability of CFCHS’s provider network. An automated, confidential, HIPAA compliant incident reporting system (IRMS) was launched to make reporting more accurate, faster and easier to complete. This new system also provides summary reports back to each provider—a resource that was never previously available with the old reporting system. Two special Utilization Modules were launched as part of CFCHS’s Five Points data system. The Bed Count Module provides a daily “snapshot” of bed occupancy at inpatient/residential programs funded by CFCHS. The Waiting List Module, designed to comply with federal block grant requirements, keeps track of individuals placed on provider waiting lists. CFCHS also implemented a Fraud, Waste and Abuse (FWA) protocol that provides an avenue for reporting these types of concerns through a hotline, designated email account and web form on the CFCHS website. This protocol has equipped CFCHS with an additional tool to monitor its provider network. CFCHS has automated the DCF required Client Satisfaction Survey process with the addition of an Optical Imaging Recognition system that allows completed surveys to be scanned into the data system rather 8 than being mailed and data-entered. CFCHS is also providing feedback reports to network providers regarding their customer satisfaction data—information that was never before available to providers. Payment Automation for Validated Service Units CFCHS improved and automated the provider payment process to ensure that client service units are correctly reported by providers before they are paid for rendered services. Five Points’ data validation processes have been improved to reject client data uploaded or entered in the system that does not meet a variety of criteria. Providers are not paid for units until client data is correctly entered into the data system. Family Intervention Specialist (FIS) Program Redesign CFCHS led a multi-agency effort to redesign the FIS program model to improve the program’s efficiency and outcomes. FIS is an intervention model for families involved with the child welfare system and where substance abuse is suspected as a contributing factor to the abuse/neglect situation. The recommended changes to the program included: FIS caseloads reduced to 20 for a period of 60 days (longer depending on the needs of the family) to ensure engagement in treatment Development of a new FIS Tracking System FIS staff training on Motivational Interviewing Expanded access to FSFN (child welfare data system) Co-location of FIS staff with Community Based Care case managers Since the implementation of the program changes have taken place, the program waiting list has been eliminated, communication between the FIS staff and child welfare staff has been improved and quarterly meetings between key agencies are being held to further discuss the program model, successes and barriers. Statewide Inpatient Psychiatric Program (SIPP) CFCHS worked with other agency partners to modify the application process for SIPP, a service available to all Medicaid-eligible children with a psychiatric disorder who need intensive mental health services in a residential setting. Since those changes have been implemented, there has been a reduction in inappropriate or incomplete SIPP applications, families are receiving assistance in accessing community resources (so their children may be diverted from entering residential care) and the new electronic SIPP application has proven itself to be a much more efficient process. 9 Looking Forward Strategic Plan Activities CFCHS will be focused on the implementation of several activities in its FY 14-15 Strategic Plan in the coming year, including: Utilizing the Behavioral Health Assessment and stakeholder input, to identify one gap in service and seek funding to implement a promising practice to address the service need. Develop partnerships with at least one other stakeholder group capable of enhancing behavioral health in Circuits 9 and 18. Monthly Report Card/Dashboard CFCHS is currently developing a monthly “report card” report that will be sent to providers monthly by their contract managers. The report will provide agencies with continuous feedback on key areas of contract compliance including: Bed Count module Wait List module Incident reporting Client satisfaction surveys Spending Data submissions Required reports In addition to the reports sent to providers, summary information will be posted on the Dashboard section of the CFCHS website for the public. A new policy will also be enacted to place providers on Corrective Action if their contract compliance is repeatedly deficient. If non-compliance continues, the new policy will allow for financial penalties. Data Validation Processes An effort is already underway to identify the most common data errors identified in client data submitted by providers into the Five Points data system to improve the automated error reporting and data validation processes. Through data system enhancements and provider training, CFCHS expects to reduce the number of errors that providers must correct after their initial data submissions (saving provider staff time and effort) and improve the reliability of data in the system. Electronic Information Exchange CFCHS will be investing in software designed to facilitate the secure electronic exchange of consumer health information within the provider network. The Electronic Information Exchange (EIX) will enable better coordination of care for consumers, more timely access to care (through electronic referrals), and a reduction in duplicative services (such as assessments), leading to better care and cost savings which will allow the system of care to be more efficient. Quality Improvement and Utilization Management Projects Beginning this fiscal year, CFCHS is implementing a “secret shopper” program to ensure all network providers ae offering services that are accessible, courteous, timely and adhere to contract standards. The findings from these encounters will be shared with providers as part of their regular contract monitoring. 10 A Utilization Module in Five Points is currently under construction to help identify clients who repeatedly utilize a significant quantity of expensive provider services to allow CFCHS to work with providers to develop new strategies to serve this target population. Several CFCHS departments are collaborating on a Six Sigma Green Belt project to implement efforts to increase the integrity and quality of provider data in the Five Points system. Practice Improvement CFCHS is developing a new policy to standardize the financial eligibility practices of providers in their network to ensure that each provider’s documentation procedures for sliding scale, co-pay, and other elements of financial eligibility are uniform. Comprehensive Review of Providers’ Financial Systems CFCHS’s financial department will be enhancing their process of conducting in-depth reviews of the financial and accounting systems of their network of providers, including interim reviews of financial reports for CFCHS contracts. Special attention will be paid to cost allocation plans and the methods providers utilize to establish the cost-basis for various services. New Collaborative Service Model CFCHS staff, in partnership with Aspire Health Partners, DCF, and Community Based Care of Central Florida, meet bi-weekly to implement the Family Intensive Treatment (FIT) team model in Orange County. The program is designed to provide intensive team-based, family-focused, comprehensive services to families in the child welfare system with parental substance abuse. Mental Health First Aid Training Offered CFCHS plans to offer Mental Health First Aid trainings to the community through System of Care staff who are both certified instructors. Participants in the 8-hour course will learn how to offer initial help in a mental health crisis and connect persons to the appropriate professional and self-help care. The training also helps individuals identify, understand and respond to signs of mental illnesses and substance use disorders. 11 Acknowledgments The successes of Central Florida Cares Health System are only possible through a vibrant partnership of CFCHS staff, Board members, providers and community stakeholders working together to create a comprehensive and seamless behavioral health care system. Board of Directors Executive Committee Ken Peach, President and Chair, Health Council of East Central Florida Dick Jacobs, Board Immediate Past President, Aspire Health Partners Kristen Hughes, Vice President, Lassiter-Ware Insurance Charles Rogers, Treasurer & Finance Committee Chair, Centennial Bank Carol Wick, Secretary, Harbor House of Central Florida Members At-Large Richard Barlow, Park Place Behavioral Healthcare Chief Jeffrey Chudnow, Oviedo Police Department Ian Golden, Brevard County Housing & Human Services Robert Wayne Holmes, Community Advocate Tara Hormell, Children’s Home Society Belinda Johnson-Cornett, Osceola County Health Department Muriel Jones, Federation of Families of Central Florida, Inc. Elaine Kvitek, Orlando Health Behavioral Group Don Lusk, Brevard Workforce Joe Mendoza, Consumer Advocate Dr. Patricia Nellius, Brevard Family Partnership Debbie Owens, Seminole Prevention Coalition David Solomon, Innovation Committee Chair, Walt Disney World Myles Thoroughgood, Orange County Library System Children's Programs Lori Tomlin, Human Services Associates, Inc. Jim Whitaker, Circles of Care, Inc. Network Providers CFCHS currently contracts with community providers in the fourcounty area. The collaboration between CFCHS and this network of providers is the foundation of each of the successful and promising efforts noted in this report. CFCHS Staff Maria Bledsoe, Chief Executive Officer Anna Fedeles, Chief Operating Officer Claudia Mason, Chief Financial Officer Mike Lupton, Chief Information Officer Nikaury Muñoz, Consumer System of Care Manager Denise M. Williams, Administrative Assistant Sharon Ramsaran, Senior Accountant Trinity Schwab, Contract Manager Stephanie Turner, Contract Manager Christopher Chung, Data Specialist Valentina Melnichuk, Human Resources/IRAS Geovanna Dominguez, Risk Manager Miralys Camelo, Quality Specialist Anita Tulloch, Utilization Management Specialist Stephanie Smith, Consumer System of Care Specialist Elisa Bustamante, Support Specialist www.centralfloridacares.org 707 Mendham Blvd., Suite 104 Orlando, FL 32825 (407) 985-3560 12
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