MISSION & VISION

CMH Affiliation of Mid-Michigan

The Affiliation’s Vision and Values

 

A. Vision and Values: The Affiliation’s vision and values are central to its formation and day-to-day operation. The Affiliation’s formation, in fact, was driven by the similarity of values, among the Affiliation members. The Affiliation exists to ensure and promote:

·         Consumer choice and empowerment

·         Sound service and support provision; sound clinical operations

·         Best value in the services and supports that it provides, to consumers, as well as administrative and PHP services. Best value is defined as the highest quality services and supports at competitive costs.

·         Local community-driven, local control and responsiveness

·         Outcome and data based decision making

·         Fiscal soundness

·         Proven capacity to manage risk

·         Sound care management capabilities

·         Regulatory compliance

·         The public good, public equity, social justice

 

B. Structure and Methods Used to Carry out Vision and Values: The Affiliation carries out this vision, adheres to these values, and capitalizes on the strengths of its members (strengths honed over three decades of community-based practice) through a number of means:

 

1. The use of a locally-driven federation-style affiliation.  This model, virtually transparent to consumers and other stakeholders,  retains the longstanding relationship of each CMH with its community, strong local participation and decision making,  strong consumer and community stakeholder involvement,  ability to rapidly respond to local community need and variations, alignment of interests of provider and care manager via its integration in each Affiliate.

 

While CEI is the specialty PHP in the Affiliation, contracting, on behalf of the Affiliation’s members, directly with the Michigan Department of Community Health (DCH) for the provision and management of  Medicaid specialty services, each member of the Affiliation will carry out the administrative functions of the PHP, via contract with and under the supervision of CEI, the PHP. These functions are described in both the Affiliation Agreement and the Medicaid Subcontract as is the method by which CEI will monitor the fulfillment of these functions. Additionally, each CMH in the affiliation will retain its state General Fund and local funds, to ensure the autonomy and local relevance of each affiliate.

 

2.  Integrated care manager and provider: Additionally, all of the members of the Affiliation will fulfill both care manager and service provider roles in the fulfillment of the contract with DCH. The care management model being used by this Affiliation is akin to a provider sponsored plans/organizations, in that the four CMH affiliates will:

 

·         Be responsible for managing a population-based rate (the population being the Medicaid eligibles within the community served by each Affiliate)

·         Employ a range of risk management methods in managing the benefit to the Medicaid recipients in their community

·         Make decisions as to whether to directly provide or purchase services, for the Medicaid eligibles within its community, based upon consumer choice, quality, and cost considerations.

·         Be able to capture and reinvest savings created by sound clinical, fiscal and risk management approaches

 

This model is a hybrid of the best of provider-sponsored organizations/plans (PSO, PSP), staff model HMOs/PHPs, and network model HMOs/PHPs and applies a growing body of research, by the Robert Wood Johnson Foundation and others, regarding the use of tight-knit provider and payer/care manager systems to ensure the highest total quality care at the lowest total cost for persons suffering from chronic health conditions, such as serious mental illness and developmental disabilities.  See end note  1 for a representative sample of this RWJ Foundation research.

 

3. The legal structure of the Affiliation, works to ensure local representation and participation, accessibility, accountability, and collaboration in that it is an affiliation of locally-responsive CMHs tied together by functional integration and three legal documents:

·         Affiliation Agreement (among all affiliation members)

·         Medicaid subcontract (between the PHP and each affiliate)

·         Purchase of service agreements between affiliates, for the sale of services to provide shared expertise and efficiencies

These agreements promote functional integration, efficiencies (through the sharing or resources, economies of scale, and expertise), and increased effectiveness and sophistication, without losing local representation and stakeholder participation

 

4.   The multi-party, cross-expertise Affiliation Core Group and multiple Work Groups, which guide the Affiliation, under the authority of the  Board of Directors of the PHP (CEI), consists of representatives from each local CMH and its community.

 

5. The affiliation-wide Consumer and Stakeholder Advisory Council which ensures that the work of the Affiliation is guided by the voice of the consumer. This Council reviews and recommends Affiliation policies and procedures, reviews and analyzes performance indicator data and utilization/service authorization data, promotes and monitors consumer empowerment efforts, and serves as the communication link between the consumers, throughout the region and the Affiliation.

 

6.   Each CMH continually communicates, and seeks guidance, about the work of itself and the Affiliation via a number of locally-based venues: its local Board of Directors (consisting of 1/3 consumers), local consumer advisory councils, and the on-going, day-to-day dialogue with local consumers,  local community collaborative partners, and stakeholders.

7. The strategic use of centralization, standardization, and autonomy in the carrying out of PHP and provider functions and to ensure that all Affiliation members meet industry standards and achieve functional integration. The Affiliation, through the operation of cross-affiliate work groups, draws on the best of what each Affiliate has to offer by:

·         Identifying areas of potential functional integration by examining industry standards and best practices

·         Analyze the current practices of each affiliate against those standards/practices

·         Determine the goal of integration. The goals can be any one or a combination of:

1. reduced total cost/increased efficiency

2. increased effectiveness or sophistication to meet industry or contractual standards

3. improved ability of hub/PIHP to ensure compliance with contractual requirements, improved or retained local responsiveness and/or uniqueness.

·         Determine the best course of action to achieve integration:

o       centralization of function and responsibility;

o       standardization via the application of affiliation-wide best practices and standards to functions carried out locally, by each Affiliate; or

o       autonomous  functions, carried out locally, by each Affiliate.

 

The decision, as to which approach to pursue is made on the basis of effectiveness, efficiencies and total cost (via economies of scale or economies of autonomous parties/small scale), capacity for synergy, nimbleness of action, value of uniform approach, and the existence of unique local characteristics.

 

End Notes

 

1. Below is a representative listing of Robert Wood Johnson Foundation sponsored research underscoring the value of tight-knit multi-disciplinary provider and payer/care manager systems to ensure the highest total quality care at the lowest total cost for persons suffering from chronic health conditions, such as serious mental illness and developmental disabilities.

 

            Chronic Care Initiatives in HMOs: Care Coordination Programs for Working-Age Adults with Multiple Chronic Medical Conditions; Douglas W. Roblin, PhD, Kaiser Foundation Hospitals Research Institute, Portland, OR; ID 026938

 

            Management of Chronic Disease in the Employed Population; Christopher D. Saudek, MD, The Johns Hopkins Hospital, Baltimore, MD; ID 019665