PROS of Tomorrow: Reshaping PROS
for Health Homes and Managed Care
Third Annual PROS Implementation Academy
Meeting the Challenge of Healthcare Reform: Developing the
Tools for Today and Tomorrow
Dganit Tal-Slor, Community Access, New York City
Alison Carroll, LCSW, Putnam Family & Community Services, Carmel
Paula Fries, LCAT, ATR-BC, CPRP, Clubhouse of Suffolk, Ronkonkoma
Peter Trout, MA, CRC, Behavioral Health Services North, Plattsburgh
Moderator: Edye Schwartz, DSW, LCSW-R, NYAPRS
Dganit Tal-Slor
Director of East Village Access PROS
Alison Carroll, LCSW-R
Associate Executive Director
Putnam Family & Community Services
1808 Route 6, Carmel, NY 10512
“Why Don’t You Just Tell Me What
You Want?”
What do we have to do to appeal to
Medicaid Managed Care and other
insurance companies, while still providing
services in a person-centered, recovery
format??
Basics
 Train
staff in all evidence based practices
WSM
WSM+
IDDT
Family Consultation
IPS
Motivational Interviewing
 Maximize
use of IR and ORS
 Clinic services – make sure it’s “all that it
can be”
Broadening Our Horizons
 Tracks/Specialty
Populations
Goal focused
 Finding a job
 Finding housing
Populations
 Veterans and their families
 First psychotic break (Open Dialogue Model)
 Forensics
 Dually Diagnosed
Broadening Our Horizons
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Time Limited
 Use IR to create 6-week track like Partial
Hospital
 Create time frames for certain tracks
 May appeal to private insurances as well
 Engagement
More mobile/off-site work
More peer support
Paula Fries, LCAT ATR-BC CPRP
Deputy Director
939 Johnson Avenue
Ronkonkoma, NY 11779
Carpe Diem!
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Simplification of Regulation
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What is really essential?
Still feeling “held hostage”
Let’s be person-centered, not “paper”-driven
Regs = Forms
 Get in the way of true care coordination
 Doesn’t fit well with normal flow of practice
 Good tools of practice become forms to “get
done”
 Recovery Planning – becomes just a
document:
 Loses the “ing” part of the process
Carpe Diem!
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Efficiency of Service Provision
◦ Quick access and admission
◦ A person-friendly assessment process
 What do we REALLY need to know initially?
 Needs/Risks
 Desires/Aspirations
 Any Barriers?
 First Steps = Goals
 Do we really need objectives?
 Lets design SIMPLE Plan
Carpe Diem!
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The Challenge?
◦ How to Achieve a Reasonable Balance
 Documentation is important
 BUT - Can be a barrier to fluid, creative, and
responsive practice
 Can stifle the rehab process – suffocating under
“paper” to justify reimbursement
 Want a flexible payment method linked to
identified outcomes
 By the person & with the provider
 How we get to the outcome is person-driven
Carpe Diem!

Charge the Barricades, Bring Down the Walls!
◦ Time to Go Electronic…
 One Integrated Plan
 Interoperability is non-negotiable
 Care Communication = Care Coordination
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Think Out of the Box
◦ Lessons Learned from Hurricane Sandy
 Importance of being flexible & adaptive
 Importance of being mobile – meet people
where they are at
 Importance of Community – a place to come
 Future - real time responsiveness to individual
needs
So, let us seize this day…
The Road Not Taken by Robert Frost
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I-I took the one less traveled by,
And that has made all the difference.
Designing your PROS MCO
Action Plan
Peter Trout, MPA,CRC
Chief of Services
Behavioral Health Services North
Plattsburgh NY
Leaders access and use
information to make change a
constant ingredient of their
organization.
~Bill Anthony, 2008
Managed Care wants….
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Access to care
Minimal delays for consumers transferring from
service to service
Administrative/clinical responsiveness
Decrease in avoidable hospitalizations
Use of problem-centered approaches
Positive practices profiles
◦ * coordinated care
◦ *person centered tx
◦ * peer support services
◦ *Outcome oriented
Culturally competent practices
Ability to arrange social supports
Designing your MCO Action Plan

Assess Current Position
◦ Strengths
◦ Limitations
◦ Opportunities
◦ Challenges
Data Collection
Describe your PROS population
 Analyze your PROS programming
_ Length of Pre-admission
◦ Length of stay
◦ Cost per episode
◦ Utilization of add-ons
◦ Cost of delivering add-ons
◦ Discharge status
◦ Outcomes
◦ Staff performance standards
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PROS Opportunity: H ealth
H ome
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Health Homes are charged with (among other
targets):
◦ Decreasing avoidable ER and hospital visits
◦ Engagement – Percent of participants that
retain outpatient visit in 7 and 30 days post
hospital
◦ Retention – Percent of participants that have
five outpatient visits within 90 days
Designing your MCO Action
Plan
Assess Current Position
 Develop Achievable Plan
◦ Establish goals and objectives
◦ Consider strategic alliances
◦ Develop alternative payment options
◦ Develop targets
◦ Involve staff and board
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Designing your MCO Action
Plan
Assess Current Position
 Develop Achievable Plan
 Implement Plan
◦ Assign responsibility
 Monitor Progress/Adjust Plan
 Advocate
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Adopt A Vision
“A vision is not reflective of what
we are currently achieving, but of
what we hope for and dream of
achieving….A vision begets not false
promises but a passion for what we
are doing”
(Anthony, Cohen, & Farkas, 2002)