Estimated Staff Time Effort, Costs, and Medicaid Revenues for Coordinated Specialty Care Clinics Serving Clients With First-Episode Psychosis

Smith, Thomas E.; Kurk, Margaret; Sawhney, Rishi; Bao, Yuhua; Nossel, Ilana; Cohen, Dana E.; Dixon, Lisa B.

doi:10.1176/appi.ps.201900039

Cited by 18 publications

(9 citation statements)

References 5 publications

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“…Moreover, because the earmarked funding is determined as a percentage of total MHBG funding to a state, as CSC capacities increase, the relatively fixed funding is divided among an increasing number of programs and client caseloads throughout the state, effectively reducing funding received by each program and compromising a program's ability to deliver high-fidelity CSC services. Insurance billing, on the other hand, is likely to cover only a small fraction of the operating costs of CSC programs (6), even under optimal billing as seen in New York State (7), where Medicaid provides coverage for supported employment and education (SEE) and peer services through the home and communitybased services provision, case or care management services, and clinical services, yet covers only 48% of CSC program costs. In addition to concern about financial viability, the patchwork approach seen in CSC financing (8,9) raises concerns about program fidelity, because the process of maximizing revenue from existing financing streams may not be aligned with best meeting client goals and needs.…”

Section: Highlightsmentioning

confidence: 99%

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Bao

Papp

Lee

et al. 2021

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The authors aimed to identify prominent financing approaches for coordinated specialty care (CSC) of patients with first-episode psychosis, alignment or misalignment of such approaches with sustained CSC implementation, and CSC provider perspectives on ideal payment models.Methods: Semistructured interviews were conducted with informants from CSC provider organizations. Purposeful sampling of CSC program directors, team leaders, and other administrators from a national e-mail Listserv was supplemented by snowball sampling via participant recommendations. Interview data from 19 CSC programs in 14 states were analyzed by using an integrated (inductive and deductive) approach to derive themes. Results:The results indicated that financing approaches to CSC were patchwork and highly varied. Three major sources of funding were cited: insurance billing (largely fee for service [FFS] to Medicaid and private insurance), set-aside funding from the federal Mental Health Block Grant (MHBG) program, and state funding. The findings revealed limited coverage and restrictive rules associated with FFS insurance billing that were misaligned with CSC implementation. The grant nature of MHBG and other public funding was seen as a threat to long-term CSC sustainability and deployment. CSC stakeholders endorsed a bundled-payment approach by public and private payers and supported tying payment to client outcomes to reflect CSC's recovery orientation.Conclusions: Reliance on FFS insurance billing and public funding is likely to be unsustainable. Additionally, FFS billing is misaligned with CSC goals. Because of the diversity in CSC programs, populations, and existing funding mechanisms and rules, payer-provider collaboration will be essential in designing a bundled-payment model that meets local needs.

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Section: Highlightsmentioning

confidence: 99%

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Bao

Papp

Lee

et al. 2021

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“…Through its participation as an EPINET regional hub, the OnTrackNY LHS will continue to innovate [18][19][20][21][22][23][24][25][26][27], while emphasizing and enhancing two critical foundational componentsproactively engaging stakeholders to optimize understanding of key problems and their solutions at every LHS phase and developing data systems with enhanced standardized data collection, informatics, and analytics. By including multilevel stakeholder input with shared leadership, we will continue to build the ongoing communication channels required for a highly effective LHS.…”

Section: Resultsmentioning

confidence: 99%

OnTrackNY’s learning healthcare system

Humensky

Bello

Malinovsky

et al. 2020

J. Clin. Trans. Sci.

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Worldwide, early intervention services for young people with recent-onset psychosis have been associated with improvements in outcomes, including reductions in hospitalization, symptoms, and improvements in treatment engagement and work/school participation. States have received federal mental health block grant funding to implement team-based, multi-element, evidence-based early intervention services, now called coordinated specialty care (CSC) in the USA. New York State’s CSC program, OnTrackNY, has grown into a 23-site, statewide network, serving over 1800 individuals since its 2013 inception. A state-supported intermediary organization, OnTrackCentral, has overseen the growth of OnTrackNY. OnTrackNY has been committed to quality improvement since its inception. In 2019, OnTrackNY was awarded a regional hub within the National Institute of Mental Health-sponsored Early Psychosis Intervention Network (EPINET). The participation in the national EPINET initiative reframes and expands OnTrackNY’s quality improvement activities. The national EPINET initiative aims to develop a learning healthcare system (LHS); OnTrackNY’s participation will facilitate the development of infrastructure, including a systematic approach to facilitating stakeholder input and enhancing the data and informatics infrastructure to promote quality improvement. Additionally, this infrastructure will support practice-based research to improve care. The investment of the EPINET network to build regional and national LHSs will accelerate innovations to improve quality of care.

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“…From a policy perspective, the beneficial role of psychosocial support following the end of FEP programs demonstrates an urgent need to provide sustainable funding sources for these traditionally nonreimbursable services both during and after first-episode care. At present, insurance reimburse-ments in the United States only cover ∼50% of CSC services, with the rest often being made up by grants specific to first-episode programs not avail-able elsewhere [34]. Sadly, while the evidence base for peer support and supported employment is well established, it has not resulted in investment in these practices.…”

Section: Discussionmentioning

confidence: 99%

What happens after early intervention in first-episode psychosis? Limitations of existing service models and an agenda for the future

Hyatt

Hasler

Wilner

2022

Current Opinion in Psychiatry

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Purpose of reviewEarly intervention in first-episode psychosis (FEP) improves symptomatic and functional outcomes while programs last. However, these gains may not be sustained over time and not all individuals benefit equally from such programs. This review examines the efficacy of FEP programs, as well as step-down practices and long-term outcomes to identify ways to extend the gains made in FEP programs. Recent findingsFEP programs improve outcomes while services last, but effects diminish over time.Step-down and discharge practices vary widely with little randomized evidence guiding practice. Extending the duration of FEP programs for all does not consistently improve outcomes, but there is some encouraging evidence that targeted psychosocial interventions after program end may extend symptomatic and functional benefits. Members of marginalized groups and individuals with poorer outcomes during the FEP period may benefit from further specialized intervention after FEP.

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Estimated Staff Time Effort, Costs, and Medicaid Revenues for Coordinated Specialty Care Clinics Serving Clients With First-Episode Psychosis

Cited by 18 publications

References 5 publications

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

OnTrackNY’s learning healthcare system

What happens after early intervention in first-episode psychosis? Limitations of existing service models and an agenda for the future

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