Integration of Care Minutes – 5/31/2023

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Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, May 31st, 2023

10:00am-12:00pm

Watch the Zoom Meeting Here

Minutes

Attendance

Committee

Billy Fields

Chris Joseph

Deborah J. Greene

Dorothy Farley

Emma Kaywin

Graham Harriman

Gretchen Ty

Ilana Newman

Janet Goldberg

John Schoepp

Karen McKinnon

Marcelo Maia

Mitchell Caponi

Raffi Babakhanian

Ronnie Fortunato

Steve Hemraj

Staff

Adrianna E. Meiering

Bryan Meisel

Grace Mackson

Ilana Newman

Kimbirly Mack

Scott Spiegler

Agenda Item 1: Welcome, Roll Call & Moment of Silence

The meeting was opened with introductions (name, pronouns) and a quick check in about what committee members did during the holiday weekend (Memorial Day). Mr. Schoepp led the moment of silence.

Agenda Item 2: Behavioral Directive Line-by-Line Editing

Mr. Caponi volunteered to read the directive, starting where the committee left off. Highlights from the editing include:

  • Ms. Newman asked if the Council has the purview to determine how many agencies should deliver services to people with complex mental health needs.
    • Mr. Harriman noted that the Council does have the ability, based on needs data, to determine how many agencies are required to deliver specific types of services.
  • Mr. Hemraj asked if the recipient will allow multiple agencies to work together to apply for funding – where a bilateral arrangement permits two or more agencies to provide the required services.
    • Mr. Harriman noted this is permissible in RWPA and noted that agencies should work together to provide the comprehensive spectrum of services.
  • Ms. Goldberg raised the question of how agencies would work together – would it be by subcontract?
  •  Brief discussion of difference between agency satellite sites versus sub contracted agencies.
  • Question of how to build capacity of agencies without overwhelming or detracting from the competency with which they deliver services.
  • Ms. Farley noted that accessing 2-day appointments is not feasible due to the lack of capacity in the system.
  • State guidelines require in patient mental health patients to have an appointment within 3-5 days of discharge.
  • Article 31’s are supposed to see these patients within a specific time but are managing 3-month waitlists – many agencies are moving to modalities that do not have the same oversight.
    • The crisis in mental health care is unprecedented.
  • Can we ask agencies to perform above the average wait time of securing appointments for the system overall?
  • When clients are discharged, are advised of appointment, but care home is not flagged. Directive seeks to wrap care around clients who are discharged – language made clearer.
  • PSYCKES can be useful but requires consent.
    • Requires a lot of training to be useful.
  • RHIO also requires consent.
  • Both are just reflective of Medicaid claims data.
  • Agencies that don’t know how to use these systems.
  • RHIO provides real time flags – more useful than PSYCKES in identifying clients in real time who need support. PSYCKES great for understanding population data.
    • Inexpensive to access ($500/yr.) – can get thousands of alerts each week.
  • Is it better to have each agency parsing through RHIO data, or one agency conducting this service for the portfolio?
    • Need agency level consent – this is the challenge.
  • Matched RW data to RHIO data to understand correlation – DOHMH could send RW service data to the RHIO – which would be helpful in making the RHIO more robust – would also require consent.
  • Strengthened and clarified language to support PWH with complex behavioral needs or SMI.
  • Peers with SMI are highly effective at supporting others with SMI or complex care needs.
  • Having someone to advocate for you – even a friend, increases likelihood of success in accessing needed services.
  • Clarified services available to PWH with complex behavioral health needs.
  • Harm reduction versus substance use – harm reduction does not include all substance use treatments. Not all substance use services are harm reduction.
    • Included recovery to comprehensively define services.
  • Discussed inclusion of treatment adherence, inclusive of HIV and medical and behavioral health medications
    • Medical is reflective of other medical care needs beyond and inclusive of HIV.
  • Discussed quality of life measures

Public Comment

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 NameConflict
Brenda Starks-RossFood & Nutrition Services, Short-Term Housing, Health Education/Risk Reduction, Family Stabilization and Supportive Counseling, Harm Reduction
Deborah GreeneHarm Reduction
Janet GoldbergMedical Case Management, Harm Reduction, Food & Nutrition Services
Ronnie FortunatoFood & Nutrition Services