AG 2002 12 16 (Regular) - Laserfiche WebLink

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Piedmont Behavioral Healthcare Executive Summary: Vision and Goals of the Local Business Plan October l, 2002 Vision: The goal of the system reform initiative is to transform the current MH/DD/SA system of services from a supply driven model to a system driven by consumer and family priorities which is capable of making continual adjustments to meet the changing needs and choices of persons with behavioral health (Mental Health and Substance Abuse) problems and/or developmental disabilities. The system reform Will achieve movement of resources from large regional facilities to the local community in order to develop a continuum of care that will focus on services to Target Populations. These services and supports should be based on evidence based practices which support achievement of positive outcomes for people with needs in the areas of behavioral health and developmental disabilities. An infrastructure must be created that will provide the foundation for a system which is valued by people who use it and the community at large. Consumer empowerment and partnerships in system management must be achieved through this reform in order to ensure that the system develops and adjusts over time in concert with the needs and values of the people it serves. Community capaCity must be established which will reduce and redirect reliance on high cost institutional and facility care and offer a greater range of community supports. The system must rely on a Wide range of community partnerships and collaborations to creatively address needs of consumers and families. The LME, as local manager and implementer of the state's public policy, must develop the infrastructure and functional capacity to direct, coordinate and manage this transformation of the local system. This transformation will be accomplished in partnership with consumers, families, community stakeholders, and network providers to achieve an organized system of .care. The goals of the new system of care are to address the needs of targeted populations as well as the community as a whole, and provide comprehensive, efficient, cost effective services, that are responsive to the needs of individuals. Operational Model: In order to achieve this vision, Piedmont must develop the most advanced, strongest LME model practicable. This model is being designed to be replicable. This will require moving very quickly to develop the capacity to stand as a public sector manager capable of managing care for defined populations, managing defined benefit plans and carrying out functions of a regional manager of care including, network development, provider relations, rate setting, access to care, enrollee services, care coordination, authorization of services, utilization management (built on evidence based or expert consensus guidelines), claims adjudication and payment, management of medical/loss ratio, quality improvement targets, meeting established performance indicators and producing outcomes data. Additionally, the LME will be responsible for preparing and submitting in a timely manner, the management information reports required by the oversight entity at the state level. The LME will have as one of its major goals the alignment of incentives with public policy. Page1 F~[ Piedmont Local Business Plan Executive Summary