Partner Spotlight Series: Coordinated Behavioral Care Partner Spotlight Series: Coordinated Behavioral Care

Partner Spotlight Detail

Partner Spotlight Series: Coordinated Behavioral Care

The staff at CBC works hard to engage with MSPPS to improve the lives of low-income New Yorkers.

Created by NYC behavioral health not-for-profit organizations in 2011, Coordinated Behavioral Care (CBC) operates care coordination services and innovative initiatives that help New Yorkers access quality treatment, housing, employment and other needed services. Today, CBC operates one of the largest health homes in New York State with over 50 member organizations.

CBC is a results-driven healthcare organization dedicated to realizing the opportunities under Medicaid redesign to improve the quality of care for Medicaid beneficiaries with serious mental illness, chronic health conditions and/or substance use disorders. CBC marshals the unique expertise of community-based partnerships to deliver integrated medical and behavioral healthcare that achieves the triple aim of federal health reform - improving people's health, providing a better healthcare experience and reducing costs. CBC is comprised of two related service entities: CBC Independent Practice Association (IPA) and the CBC Health Home (HH), both of which have a similar mission to provide patients with the highest quality of care.

The CBC IPA was established in 2014 to provide a NYC-wide integrated behavioral health (BH) provider delivery system with the infrastructure and ability to invest in value based care delivery interventions.Together the CBC IPA agencies have created a city-wide network with the geographic coverage and service diversity needed to effectively address behavioral service needs in community settings. This network includes Article 28, Article 31, and Article 32 clinics, Assertive Community Treatment (ACT) teams, supportive housing program beds, and outpatient treatment programs licensed by the New York State Office of Alcoholism and Substance Abuse Services (OASAS).

CBC recently launched Project Connect, a program connecting discharged individuals to health home services.

CBC currently operates one of the largest Health Homes in New York City, most recently expanding to serve children in December 2016. The Health Home is comprised of 50+ care management agencies (CMAs) throughout the five boroughs. According to Danika Mills, Executive Director of CBC HH and CBC IPA, "We support the administrative, quality, and technology functions for over 50 delegated CMAs that together have hundreds of care managers working with thousands of Medicaid recipients who have chronic conditions and are benefiting from care coordination." Since forming the Health Home in 2011, CBC and its partners have been refining their outreach strategies and patient engagement by addressing social determinants of health. Some examples include deploying health coaches for better patient engagement, as well as providing a targeted intervention-Pathway Home--for patients with mental illness who need assistance transitioning from hospital to the community. According to Mark Graham, CBC's Associate Executive Director of Operations, "Our organization is very proud of Pathway Home. Through a New York State (NYS) grant and most recently a contract with the NYS Office of Mental Health, the program now operates in four boroughs to shorten inpatient stays, improve community stability, and reduce readmissions and ER visits." CBC has built a quality platform from which assignments and workflows can be refined. Danika Mills said of the process, "We built the Health Home's quality platform over years of tooling and retooling. For example, our assignment workflows are not simply based on the how many individuals a care management agency wants to serve, but also the geography, expertise, languages spoken, and the provider's quality metrics. We ask ourselves, 'Are they performing on a level that would make us comfortable sending our own family members?"

CBC is actively participating in DSRIP to improve the lives of low-income New Yorkers through better access to quality of community-based health care. The organization believes it can achieve this goal in partnership with MSPPS. The gaps they currently see in their behavioral health work are with crisis care and care transition services. While CBC helps hundreds of people a year with Pathway Home and a few other care transition initiatives, the Health Home doesn't have the resources to provide large numbers of people with these services. The same is true when an individual has a crisis. CBC's network offers crisis services, but they are very limited because Medicaid funding currently is not supporting these services adequately. Danika Mills said, "Through DSRIP and partnerships with key managed care plans, we hope to play a significant role in developing new services to fill these gaps." CBC is working with MSPPS to address these gaps and improve the quality of care to people with BH disorders. CBC has a wealth of experience launching innovative initiatives. For example, they just launched a new program called Project Connect to connect Health Home-eligible individuals who are being discharged from jails and alternative-to-incarceration programs to Health Home care management. According to Mark Graham, "CBC can be most valuable to MSPPS as part of the planning process, so we can offer guidance as community providers and help the PPS as it rolls out projects to address any barriers to care." Due to CBC's services as a Health Home and IPA, they are already connected to many organizations. In fact, many of the agencies which comprise the Health Home are part of MSPPS and being a part of MSPPS has strengthened the already existing relationships with these organizations. Danika Mills said of this, "All of our providers are mission-driven to help our clients lead healthy, fulfilled lives. Our goals and the PPS population health goals are aligned, and we have the best chance of success working together."

CBC and CBC HH leadership from left to right: Bonnie Bellacera, Program Administrator, Mark Graham, and Danika Mills in their downtown Manhattan office.

Over the next few years, CBC HH plans to expand care management programs for its high-need Medicaid population, while the IPA intends to address gaps in crisis, substance abuse and transitional care. For more information on CBC, please click here