CFCHS Status Report FINAL

Status Report: December 2014
About Central Florida Cares Health System
About Central Florida Cares
Central Florida Cares Health System, Inc. (CFCHS) is a not-for-profit organization contracted by the
Department of Children and Families to oversee state-funded mental health and substance abuse
treatment services in Brevard, Orange, Osceola, and Seminole counties.
Our Mission:
Central Florida Cares Health System is a resource center that utilizes state, federal and innovative
funding sources, promising practices, and/or pilot programs to support our providers as they address
identified behavioral health needs of the community.
Our Vision:
Achieve a comprehensive and seamless behavioral health system
promoting recovery and resiliency.
Our Guiding Principles:
 To promote evidence-based practices in service delivery across
the system of care
 To increase ease of access to all needed services
 To improve continuity of service provision and coordination of
services across the system of care
 To reduce utilization of restrictive levels of care and use the
resulting savings to enhance community-based recovery services
 To meet or exceed all outcome and performance requirements
 To work with the Department of Children and Families to
integrate the CFCHS outcomes and its planning processes with
the Department of Children and Families’ annual and long-range
planning
 To adopt integrated approaches which afford access to primary
and specialty medical care in concert with behavioral healthcare
 To always put the person served first in all aspects of its
operations
Our Values:
 The worth of every person
served
 The principles of recovery —
hope, trust, choice, personal
satisfaction,
interdependence, and
community involvement
 The ability of every person to
attain recovery and develop
resiliency
 The need to focus on each
person’s strengths and
competencies
 The need for family-centered
children’s services which
build resiliency
 The need for each person for
respect and dignity
About this Report
This Progress Report provides a snapshot of the progress made by Central Florida Cares Health System
since its work began July 2, 2012. The organization remains highly committed to being efficient,
innovative and nimble as it responds to an ever-changing state and federal landscape while remaining
focused on the needs of the Judicial Circuits 9 and 18 (Brevard, Orange, Osceola and Seminole Counties).
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Message from the CEO
Dear Community Members,
Central Florida Cares Health System is embarking on its third year of service in Brevard, Orange, Osceola
and Seminole Counties and we are proud to share some of our accomplishments with the community.
CFCHS staff members have worked together with our Board of Directors, providers and community
stakeholders to make significant progress toward our vision of a comprehensive and seamless
behavioral health system promoting recovery and resiliency for our community.
Beginning in July of 2012, CFCHS successfully implemented numerous strategies to strengthen the ability
to analyze our system of care, measure and improve our service outcomes and ensure strong financial
stewardship.



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We launched a robust information system that provides CFCHS with the data necessary to
manage and improve our network services, finances and contract management functions.
We developed a needs assessment and strategic plan to improve the utilization of current and
future resources.
Through new policies, systems and automation, we formalized and improved client data
reporting and integrity, service utilization, incident reporting, contract compliance and provider
payment systems.
We created strong partnerships with stakeholders to strengthen collaborative efforts and
improve programs and services.
We are excited about the challenges and opportunities the future holds and have built a strong
foundation to guide our efforts. Central Florida Cares Health System will continue to commit significant
energy towards strategies that will increase the quality, efficiency and effectiveness of our system of
care.
Thank you for your continued commitment and support.
Sincerely,
Maria Bledsoe
Chief Executive Officer
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Financial Progress
Central Florida Cares Health System serves as the managing entity for Circuits 9 and 18 under a contract
with Florida’s Department of Children and Families. Funds allocated to CFCHS include state, federal
block grant and Temporary Assistance to Needy Families (TANF) funding. The approximate allocations
for FY 12-13 were $56.6 million and $58 million in FY 13-14.
CFCHS funding expenditures are divided into four primary program areas: Adult Mental Health (AMH),
Adult Substance Abuse (ASA), Children's Mental Health (CMH), and Children's Substance Abuse (CSA).
Table A. below shows expenditures, by program area, for FY 12-13 and FY 13-14.
Table A. Expenditures by Program Area
FY 12-13 and FY 13-14
$54,732,574
FY Total
$55,642,373
$26,682,648
AMH
$26,101,889
$12,919,395
ASA
$14,708,504
$7,038,359
CMH
$6,952,712
$8,092,172
CSA
$7,879,269
$0
$10,000,000
$20,000,000
$30,000,000
FY 12-13
Table B. illustrates the percentage of total expenditures in
each of the four primary program areas. The only major
change in expenditures between FY 12-13 and FY 13-14
was the addition of a pregnant and post-partum expansion
grant in Adult Substance Abuse for FY 13-14.
$40,000,000
$50,000,000
$60,000,000
FY 13-14
Table B. Percentage of Expenditures by
Program Area
FY 12-13 and FY 13-14
Program
AMH
ASA
CMH
CSA
FY Total
FY 13-14
46.9%
26.4%
12.5%
14.2%
100.0%
FY 12-13
48.8%
23.6%
12.9%
14.8%
100.0%
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Within each of the four primary program areas there are major service types. Tables C.-F. below
illustrate these expenditures for FY 12-13 and FY 13-14.
Table C.
Adult Mental Health Expenditures,
Percentage of Total by Service Type*
Table D.
Adult Substance Abuse Expenditures,
Percentage of Total by Service Type*
FY 12-13 and FY 13-14
FY 12-13 and FY 13-14
FY 12-13
FY 13-14
FY 12-13
Amount
($000)
AMH Service Type
%
Acute
Outpatient
FACT Teams
Residential
44.9%
18.9%
12.5%
13.2%
45.3%
17.5%
13.6%
12.9%
11,811
4,580
3,559
3,355
PATH
TANF
Forensic Diversion
Proviso Projects
Prevention
IDP
2.7%
2.5%
2.3%
2.8%
0.0%
0.3%
2.5%
2.4%
2.3%
2.2%
1.0%
0.3%
663
624
597
580
264
69
Total
100%
100%
26,102
%
FY 13-14
Amount
($000)
ASA Service Type
%
Detox
Residential
Outpatient
20.5%
39.2%
24.1%
28.2%
25.2%
16.7%
4,141
3,699
2,453
0.0%
11.5%
1,689
12.6%
2.1%
11.0%
4.3%
1,625
635
Prevention
1.6%
3.2%
466
Total
100%
100%
14,709
Pregnant Women
(PPW)
Proviso Projects
TANF
%
Table E.
Children’s Mental Health Expenditures,
Percentage of Total by Service Type*
Table F.
Children’s Substance Abuse Expenditures,
Percentage of Total by Service Type*
FY 12-13 and FY 13-14
FY 12-13 and FY 13-14
FY 12-13
FY 12-13
FY 13-14
Amount
($000)
CMH Service Type
%
Outpatient
Crisis
BNET
PRTS
42.9%
35.0%
19.1%
2.7%
41.5%
36.6%
18.2%
2.6%
2,889
2,545
1,263
184
Prevention
Residential
0.0%
0.2%
0.9%
0.1%
63
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Total
100%
100%
6,953
%
FY 13-14
Amount
($000)
CSA Service Type
%
Residential
Outpatient
Detox
Prevention
23.8%
37.4%
12.1%
18.1%
27.1%
29.3%
12.3%
21.0%
2,135
2,309
967
1,652
PPG
TANF
Approp'n 374
7.9%
0.6%
0.0%
7.8%
0.3%
2.2%
613
27
175
Total
100%
100%
7,879
%
*Service Type Abbreviations:
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PATH: Projects for Assistance in Transition from Homelessness
BNET: Behavioral Health Network Title XXI
IDP: Indigent Drug Program
PRTS: Purchase of Residential Treatment Services
Appropriation 374: Informed Families Project
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Service Progress
Central Florida Cares Health System’s funding and contracted services are divided into four main
program areas: Adult Mental Health (AMH), Adult Substance Abuse (ASA), Children's Mental Health
(CMH), and Children’s Substance Abuse (CSA). Within each program area there are 3 main divisions or
categories of services. These categories are displayed below in Table G. with a comparison of the
number of individuals served in each category in FY 12-13 and FY 13-14 (duplicated figures, individuals may
have been served in more than one category).
Table G. Number Served in
Major Program Catergories
FY 13-14 and FY 12-13
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
AMH Residential
AMH Ambulatory
AMH Crisis
ASA Residential
ASA Ambulatory
ASA Detox
CMH Residential
CMH Ambulatory
CMH Crisis
CSA Residential
CSA Ambulatory
CSA Detox
FY 12-13
The overall numbers of individuals served in the four main
program areas shown above illustrate an overall. This
decrease is further highlighted by the table to the right.
FY 13-14
Table C. Change in Number Served
FY 12-13 to FY 13-14
Program
Adult Mental Health (AMH)
% Difference
There was a 10.1% decline in the number served in the
Adult Substance Abuse (ASA)
AMH Ambulatory category which was due primarily to a
Children's Mental Health (CMH)
change in how a provider reported data. There was an
Children's Substance Abuse (CSA)
increase in the number of individuals served in three
categories: ASA Residential (23.2%), ASA Detox (1.8%) and
CSA Residential (14.8%). A FY 13-14 pregnant and post-partum expansion grant plays a role in the
increase in the number served in ASA Residential Services.
-9.0%
-5.7%
-19.4%
-22.6%
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Major Initiatives & Progress
Behavioral Health Need Assessment and Strategic Plan
CFCHS completed a comprehensive Behavioral Health Community Needs Assessment in spring of 2014
that examined community demographics, client demographics, service data, chronic disease and risk
factor data and provider and consumer survey data. CFCHS used this report to develop a Strategic Plan
for FY 14-15 that includes the following goals:
 Goal A: Research Service gaps and needs
 Goal B: Identify promising practices to implement to address needs
 Goal C: Inform all stakeholders how to use CFCHS resources
Community Leadership
CFCHS’s CEO was appointed by Orange County Mayor Teresa Jacobs to the Orange County Youth Mental
Health Commission to serve on Implementation Team tasked with the development of a plan to
prioritize and implement the Commission’s recommendations. Ms. Bledsoe was also appointed to serve
on the Central Receiving Center (CRC) Governing Board by Orange County Commissioner Pete Clarke.
Community Outreach and Education
CFCHS staff participate in a wide variety of events in the community as part of the organization’s
community outreach and education efforts. Recent events include a gathering of NAMI of Greater
Orlando (Nation Alliance on Mental Illness) in May, the 2nd Annual Orange Fiesta sponsored by the
Hispanic Heritage Committee of Greater Orlando in September and a Women’s Health event sponsored
by Florida Hospital held in Sanford in November.
Active Program Committee
CFCHS facilitates an active, multi-agency Program Committee tasked with oversight of the system of
care development and implementation, ensuring that the network has the capacity to effectively
manage service delivery. This committee is responsible for the development of a Service Description
Handbook created to define the different substance abuse and mental health services contracted by
CFCHS and includes a list of network providers. A Consumer Handbook was also developed to assist
consumers and family members in locating state funded services.
Child Welfare Integration and Collaboration
CFCHS works closely with the Department and Children and Families and Community Based Care
agencies to ensure an integration of the two systems when serving the same families. CFCHS serves on
the Local Review Team. As an active member of this team, CFCHS collaborates with local and statewide
organizations to resolve case specific issues for children receiving services from multiple agencies.
CFCHS staff also participates monthly in System of Care meetings to collaborate with other agencies to
reduce barriers in coordinated services.
CFCHS Staff Capacity and Expertise
CFCHS’s Risk Manager received a certification in Health Care Risk Management from the University of
South Florida and the Chief Operating Officer and both Contract Managers received their certification in
Healthcare Compliance from the Compliance Certification Board. Six CFCHS staff are Six Sigma Yellow
Belts and five are currently attending Six Sigma Green Belt training. CFCHS employs two licensed staff:
one Licensed Clinical Social Worker and one Licensed Marriage and Family Therapist.
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Client Information System
CFCHS partnered with a software vendor to develop a robust data, financial, and contract management
automated system that provides CFCHS leadership with up-to-date monthly client data that is used for
strategic planning, financial forecasting and outcome evaluation. This new data system, Five Points, also
allows providers to access their own client data monthly through a collection of customized reports.
CFCHS’s Five Points system was intentionally designed to allow providers to submit their client data in a
way that accommodates each provider’s specific technological capacity as they transitioned from the
Department of Children and Families to the new system.
Data Integrity
CFCHS worked diligently to identify and address data integrity through the examination of data entry
and submission practices and client coding issues. Through provider staff training and improved data
validation processes within the Five Points system, CFCHS had increased the reliability of client and
service delivery data.
Provider Contract Compliance and Network Quality of Care
Since July of 2012, CFCHS has concentrated effort on conducting a rigorous examination of its provider
network to ensuring that providers were meeting contractual requirements, to improve the quality of
care, and by conducting fraud, waste, and abuse prevention and detection activities. Significant
improvements have been made to the system of care, including:
 Systematic invoicing errors identified and corrected
 Corrections made to data reporting practices, including previously incorrect conversion of service
minutes to service units
 Identified and corrected SRT operations to align with standards
 Improved pre-authorization procedures for PRTS clients to ensure financial and clinical eligibility
 Implemented a new outreach policy to focus more funding into direct services
 Did not renew three contracts due to various reasons including under-utilization, financial instability,
and poor performance. A related instance of possible Fraud, Waste and Abuse was reported.
Risk Management, Quality Improvement and Utilization Management
A variety of projects have been successfully implemented to improve the level of contract compliance,
enhance provider engagement and increase the accountability of CFCHS’s provider network.
An automated, confidential, HIPAA compliant incident reporting system (IRMS) was launched to make
reporting more accurate, faster and easier to complete. This new system also provides summary reports
back to each provider—a resource that was never previously available with the old reporting system.
Two special Utilization Modules were launched as part of CFCHS’s Five Points data system. The Bed
Count Module provides a daily “snapshot” of bed occupancy at inpatient/residential programs funded
by CFCHS. The Waiting List Module, designed to comply with federal block grant requirements, keeps
track of individuals placed on provider waiting lists. CFCHS also implemented a Fraud, Waste and Abuse
(FWA) protocol that provides an avenue for reporting these types of concerns through a hotline,
designated email account and web form on the CFCHS website. This protocol has equipped CFCHS with
an additional tool to monitor its provider network.
CFCHS has automated the DCF required Client Satisfaction Survey process with the addition of an Optical
Imaging Recognition system that allows completed surveys to be scanned into the data system rather
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than being mailed and data-entered. CFCHS is also providing feedback reports to network providers
regarding their customer satisfaction data—information that was never before available to providers.
Payment Automation for Validated Service Units
CFCHS improved and automated the provider payment process to ensure that client service units are
correctly reported by providers before they are paid for rendered services. Five Points’ data validation
processes have been improved to reject client data uploaded or entered in the system that does not
meet a variety of criteria. Providers are not paid for units until client data is correctly entered into the
data system.
Family Intervention Specialist (FIS) Program Redesign
CFCHS led a multi-agency effort to redesign the FIS program model to improve the program’s efficiency
and outcomes. FIS is an intervention model for families involved with the child welfare system and
where substance abuse is suspected as a contributing factor to the abuse/neglect situation. The
recommended changes to the program included:
 FIS caseloads reduced to 20 for a period of 60 days (longer depending on the needs of the family) to
ensure engagement in treatment
 Development of a new FIS Tracking System
 FIS staff training on Motivational Interviewing
 Expanded access to FSFN (child welfare data system)
 Co-location of FIS staff with Community Based Care case managers
Since the implementation of the program changes have taken place, the program waiting list has been
eliminated, communication between the FIS staff and child welfare staff has been improved and
quarterly meetings between key agencies are being held to further discuss the program model,
successes and barriers.
Statewide Inpatient Psychiatric Program (SIPP)
CFCHS worked with other agency partners to modify the application process for SIPP, a service available
to all Medicaid-eligible children with a psychiatric disorder who need intensive mental health services in
a residential setting. Since those changes have been implemented, there has been a reduction in
inappropriate or incomplete SIPP applications, families are receiving assistance in accessing community
resources (so their children may be diverted from entering residential care) and the new electronic SIPP
application has proven itself to be a much more efficient process.
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Looking Forward
Strategic Plan Activities
CFCHS will be focused on the implementation of several activities in its FY 14-15 Strategic Plan in the
coming year, including:
 Utilizing the Behavioral Health Assessment and stakeholder input, to identify one gap in service and
seek funding to implement a promising practice to address the service need.
 Develop partnerships with at least one other stakeholder group capable of enhancing behavioral
health in Circuits 9 and 18.
Monthly Report Card/Dashboard
CFCHS is currently developing a monthly “report card” report that will be sent to providers monthly by
their contract managers. The report will provide agencies with continuous feedback on key areas of
contract compliance including:
 Bed Count module
 Wait List module
 Incident reporting
 Client satisfaction surveys
 Spending
 Data submissions
 Required reports
In addition to the reports sent to providers, summary information will be posted on the Dashboard
section of the CFCHS website for the public. A new policy will also be enacted to place providers on
Corrective Action if their contract compliance is repeatedly deficient. If non-compliance continues, the
new policy will allow for financial penalties.
Data Validation Processes
An effort is already underway to identify the most common data errors identified in client data
submitted by providers into the Five Points data system to improve the automated error reporting and
data validation processes. Through data system enhancements and provider training, CFCHS expects to
reduce the number of errors that providers must correct after their initial data submissions (saving
provider staff time and effort) and improve the reliability of data in the system.
Electronic Information Exchange
CFCHS will be investing in software designed to facilitate the secure electronic exchange of consumer
health information within the provider network. The Electronic Information Exchange (EIX) will enable
better coordination of care for consumers, more timely access to care (through electronic referrals), and
a reduction in duplicative services (such as assessments), leading to better care and cost savings which
will allow the system of care to be more efficient.
Quality Improvement and Utilization Management Projects
Beginning this fiscal year, CFCHS is implementing a “secret shopper” program to ensure all network
providers ae offering services that are accessible, courteous, timely and adhere to contract standards.
The findings from these encounters will be shared with providers as part of their regular contract
monitoring.
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A Utilization Module in Five Points is currently under construction to help identify clients who
repeatedly utilize a significant quantity of expensive provider services to allow CFCHS to work with
providers to develop new strategies to serve this target population.
Several CFCHS departments are collaborating on a Six Sigma Green Belt project to implement efforts to
increase the integrity and quality of provider data in the Five Points system.
Practice Improvement
CFCHS is developing a new policy to standardize the financial eligibility practices of providers in their
network to ensure that each provider’s documentation procedures for sliding scale, co-pay, and other
elements of financial eligibility are uniform.
Comprehensive Review of Providers’ Financial Systems
CFCHS’s financial department will be enhancing their process of conducting in-depth reviews of the
financial and accounting systems of their network of providers, including interim reviews of financial
reports for CFCHS contracts. Special attention will be paid to cost allocation plans and the methods
providers utilize to establish the cost-basis for various services.
New Collaborative Service Model
CFCHS staff, in partnership with Aspire Health Partners, DCF, and Community Based Care of Central
Florida, meet bi-weekly to implement the Family Intensive Treatment (FIT) team model in Orange
County. The program is designed to provide intensive team-based, family-focused, comprehensive
services to families in the child welfare system with parental substance abuse.
Mental Health First Aid Training Offered
CFCHS plans to offer Mental Health First Aid trainings to the community through System of Care staff
who are both certified instructors. Participants in the 8-hour course will learn how to offer initial help in
a mental health crisis and connect persons to the appropriate professional and self-help care. The
training also helps individuals identify, understand and respond to signs of mental illnesses and
substance use disorders.
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Acknowledgments
The successes of Central Florida Cares Health System are only possible through a vibrant partnership of
CFCHS staff, Board members, providers and community stakeholders working together to create a
comprehensive and seamless behavioral health care system.
Board of Directors
Executive Committee
Ken Peach, President and Chair, Health Council of East Central Florida
Dick Jacobs, Board Immediate Past President, Aspire Health Partners
Kristen Hughes, Vice President, Lassiter-Ware Insurance
Charles Rogers, Treasurer & Finance Committee Chair, Centennial
Bank
Carol Wick, Secretary, Harbor House of Central Florida
Members At-Large
Richard Barlow, Park Place Behavioral Healthcare
Chief Jeffrey Chudnow, Oviedo Police Department
Ian Golden, Brevard County Housing & Human Services
Robert Wayne Holmes, Community Advocate
Tara Hormell, Children’s Home Society
Belinda Johnson-Cornett, Osceola County Health Department
Muriel Jones, Federation of Families of Central Florida, Inc.
Elaine Kvitek, Orlando Health Behavioral Group
Don Lusk, Brevard Workforce
Joe Mendoza, Consumer Advocate
Dr. Patricia Nellius, Brevard Family Partnership
Debbie Owens, Seminole Prevention Coalition
David Solomon, Innovation Committee Chair, Walt Disney World
Myles Thoroughgood, Orange County Library System Children's Programs
Lori Tomlin, Human Services Associates, Inc.
Jim Whitaker, Circles of Care, Inc.
Network Providers
CFCHS currently contracts with
community providers in the fourcounty area. The collaboration
between CFCHS and this network of
providers is the foundation of each of
the successful and promising efforts
noted in this report.
CFCHS Staff
Maria Bledsoe, Chief Executive Officer
Anna Fedeles, Chief Operating Officer
Claudia Mason, Chief Financial Officer
Mike Lupton, Chief Information Officer
Nikaury Muñoz, Consumer System of Care Manager
Denise M. Williams, Administrative Assistant
Sharon Ramsaran, Senior Accountant
Trinity Schwab, Contract Manager
Stephanie Turner, Contract Manager
Christopher Chung, Data Specialist
Valentina Melnichuk, Human Resources/IRAS
Geovanna Dominguez, Risk Manager
Miralys Camelo, Quality Specialist
Anita Tulloch, Utilization Management Specialist
Stephanie Smith, Consumer System of Care Specialist
Elisa Bustamante, Support Specialist
www.centralfloridacares.org
707 Mendham Blvd., Suite 104
Orlando, FL 32825
(407) 985-3560
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