Think Tank | Fiscal Viability and Person-Centered Care: Thoughts from the PROS Academy

Another round of thanks goes out to NYAPRS (the New York Association of Psychiatric Rehabilitation Services) for putting together its fifth annual PROS Implementation Academy. I spoke earlier about the dedication and skill of the administrators, supervisors and direct care workers of today’s Personalized Recovery Oriented Services programs, and wanted to take some time today to go into a little more depth about the information shared over the course of the event, in particular the topic I presented with Edye Schwartz of NYAPRS, “Fiscal Viability in the Age of Managed Care,” as much of this applies to human service agencies in general.

PROS programs, like all of the NYS Behavioral Health Services, and indeed, all agencies providing services through integrated care models, seem to be in an endless cycle of flux these days, but the time is getting closer when this flux will settle into real change, and from this change we will find opportunity. Opportunity to redefine your agency’s strategies, opportunity to open new markets and serve new populations, opportunity to use new tools–and ultimately, opportunity to position your agency at the center of the service delivery world and contribute to the success of the new delivery system. At Foothold, we talk about these opportunities as ways agencies can “future-proof” themselves.

What is already clear at this point is that PROS programs, like others, are going to have to be flexible and adaptive. Many of you will be running programs under various sets of rules at the same time. At this point in time we know that a portion of your business, those individuals covered solely by Medicaid, will be defined by managed care companies; what that means is not fully clear and still ours to help define. Another portion of your business will be focused on the dual eligibles, Medicare/Medicaid covered population; these individuals will continue to be served for now under the existing PROS regulations.

What does this mean? Well, my take on the information coming from OMH, DOH and the managed care companies that spoke is that PROS is being given a real opportunity to define a role, that there appears to be a true commitment by OMH to the program. PROS programs will have an opportunity–not a guarantee, but the opportunity to not only survive but to thrive and lead, because they have what a managed care company operating in NY needs: a skilled, highly motivated and dedicated staff trained in recovery principles.

Lets start with the known. We know OMH is committed to giving PROS an opportunity; they spoke of possible regulatory change, guaranteed rates for two years, a place at the table to discuss modifications to make PROS more viable in a managed care environment, and the offer of new tools like the HCBS waiver services that can be used to enhance a PROS agency’s service delivery offerings. We also know that managed care companies are wanting to find services that enable them to achieve their goals. In some cases, these goals are the same, especially when they are held to life role achievement metrics. Also a shared goal is savings, which can only be achieved by keeping people well and thereby reducing their use of high-cost services like inpatient and emergency services. Both of these are areas in which PROS programs are designed to excel.

We also learned that for PROS programs, there are practices and lessons learned from each other that will help. Some critical next steps for providers to take to “future-proof” themselves:

• Embrace change as a positive. Use the opportunity to redefine yourself and strengthen your program.
• Get your house in order. Make sure everyone in the organization understands what he or she is accountable for and to whom.
• Look at your program as a business. Understand your cash flow and expenses, so at any point in time you know your fiscal health.
• Do not be isolated. Develop partnerships, collaborations, and in some cases, possible mergers.
• Look for ways to evolve. See how you could incorporate physical health services and new behavioral health services into your program or agency, and look for opportunities to serve new populations.
• Understand and incorporate evidence-based practices.
• Attest and have the capacity to deliver the HCBS waiver services.
• Become a “Recovery Machine” that is effective and efficient. As the system becomes increasingly value-based, be a value-based provider.
• Use your data strategically. Create the knowledge to make decisions from the information you create in your program and learn from others outside your program.
• Make sure you have rapid access to your data. If you’re on a paper system, go electronic. And if you’re using an electronic system but it doesn’t allow you to pull out the information you need in real time, change it. Do not get caught up in the mentality that “we invested so much in this system we can’t change”; if it doesn’t work, change it and use a system with the flexibility and support.
• Prepare to participate in Health Information Exchanges with your network of partners. In order to be a player and succeed in today’s service delivery world, your agency must have a data system with comprehensive interoperability capacity.

Most of this advice is not exclusive to PROS programs but also applies for all agencies providing services today. Indeed, the whole country is moving towards person-centered care through integrated care models. Rehabilitation and recovery programs have the opportunity to lead the way to a more recovery-focused, more efficient world of behavioral health service delivery by taking the next steps to embrace the changes.