Building a new model for care through Behavioral Health Care Collaboratives

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David Woodlock is CEO and president of Institute for Community Living. (Illustration by Zach Williams/ NYN Media)

Institute for Community Living has been given the opportunity to help launch what could be a game-changing model on behalf of children, adults and families across New York City. Our group’s proposal for an integrated network of health and human services agencies was recently chosen to receive a $5 million grant to improve the health and well-being of our clients.

The grant is part of Gov. Cuomo’s $60 million, three-year initiative to aid behavioral health providers during the transformation of New York’s Medicaid system. Through the initiative, providers will form Behavioral Health Care Collaboratives to participate in value-based payment arrangements – a financial incentive framework  that rewards improved health outcomes rather than volume-based care. Our BHCC was founded by six partner agencies – the Institute for Community Living, the Acacia Network, the New York Foundling, Leake and Watts, The Door, and Community Healthcare Network  – and is collectively known as “AsOne”.
All of us have been long committed to improving the health and well-being of the people we serve but also frustrated by the systemic barriers to making those improvements happen. Each agency that joined “AsOne” embraced the chance to form a unified team to deliver services in an innovative way over the lifespan of a family and community.

For years, the agencies in “AsOne” have shared the desire to overcome the regulatory and funding mazes that interfere with impactful, multigenerational, family-centered interventions. We cannot help people get healthier in the short-term while avoiding the long-term consequences of early childhood experiences and other social determinants of health such as a family’s economic, social and educational conditions. Determinants such as these are believed to effect some 70 percent of a person’s health and lead to long-term serious health conditions like diabetes and high blood pressure.”

As a BHCC, AsOne seeks to offer care that meets the needs of complex families, where “family” is broadly defined by the child or adult who is the identified client, and is grounded in an understanding of their life experiences. What is unique about “AsOne” is that it places family as the nexus for a single, unified network of services to meet both acute care and prevention needs and considers the impact of social determinants of health. We believe that considering the whole family as a unit of care will change the trajectory of future generations of children and adults.

The “AsOne” partners represent a broad spectrum of behavioral health, substance abuse, child and family treatment, and primary healthcare programs. We are building a large pool of additional organizations to meet the widest range of needs, including school-based services, domestic violence programs, and nutrition experts. Our goal is to offer comprehensive, culturally appropriate, person-centered, and multigenerational services. By working as an integrated team, we will keep children with social and emotional disorders on track to reach developmental milestones, reduce symptoms and treat the acute needs of adults with mental illness and substance abuse disorders, and support complex families in reaching their life cycle stages and tasks.

Collaboration is at the core of “AsOne.” Members will work in concert clinically and logistically through shared treatment plans and objectives instead of working in isolation. They will also partner with Managed Care Organizations to measure outcomes and enter into value-based contract relationships, a process made far easier when operating as a network of providers.

While clinical and funding integration is important to this approach, logistical integration between the agencies allows all of us to work off the same platform with the family at the center. So when ICL is treating a mom in a mental health clinic and gets a call that her child is sick and has to be picked up at school –  our partner working with the child can help the child so mom doesn’t have to cancel an important appointment.

The value-based payment model supports us in building this logistical platform.
It was not for lack of trying that providers could not make integration and collaboration happen sooner; we believe that VBP and the Behavioral Health Collaborative model is allowing us to break through historic siloes created by fee-for-service that has led to a disjointed experience for people being served.  Our network is determined to break through these artificial barriers to support people in addressing problems earlier and more effectively and ultimately preventing more serious and costly problems later in life.

This initiative also gives us the chance to really learn from experience – to look at data from a variety of perspectives and understand how people are using services in real time. We will be able to see what patterns such as their use of the emergency room or a rise in school absences suggest about their health. That information is vital and will allow us to work together to shift those patterns.

While the funding is critical, “AsOne” is about much more than money. Our group represents a fundamentally different approach to care. It offers the chance to make inroads in problems that have plagued families and communities for generations. This collaborative will allow us to move beyond theory to make real changes for distressed communities with enormous health disparities. With the proper support, these cycles can be broken. 

David Woodlock is CEO and president of Institute for Community Living, which serves some 10,000 New Yorkers each year through a range of supportive and transitional housing, counseling and rehabilitation services.

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