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Improving Clinical Outcomes through Integrated Care: A Payer-Provider Partnership Model

1 CE Hour

Presented By

  • Chris Barton, LCSW, Michael D’Amico, LCSW, and Vera Sansone, LCSW
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The presenters will discuss their experience developing and implementing an integrated system of care that partners community-based, nonprofit behavioral health treatment providers with primary care practices (PCPs) and social service agencies to identify community members in need of treatment for serious mental illness or substance use, and then collaborate in the delivery of care to support the consumers. They will elaborate on the Integrated System of Care model that relies on the behavioral health providers, not PCPs, to quarterback care and uses a flexible case rate and performance incentives to compensate provider partners. They will also discuss the use of standardized instruments to determine care needs and evaluate outcomes. Finally, the presenters will discuss the unique payer-provider partnership model that has supported this program’s development and expansion.

Learning Objectives

At the end of this session, attendees will be able to:

  1. Define integrated care and describe the clinical and other outcomes from the Integrated System of Care model.
  2. Define measurement-based care and convey an understanding of its importance in evaluating programs and leveraging these in value-based arrangements.
  3. Articulate the merits of payer-provider partnerships to develop and evaluate innovative treatment programs.
CE Policy and this educator have no conflicts of interest and have not received any commercial support for this program or its contents.
Chris Barton, LCSW, Michael D’Amico, LCSW, and Vera Sansone, LCSW
Chris Barton
Chris Barton LCSW
Director, Integrated Systems of Care & Network Innovation
Chris Barton currently serves as the Director, Integrated Systems of Care & Network at Horizon Blue Cross Blue Shield of New Jersey (Horizon), where she is responsible for the development and statewide expansion of an innovative program that integrates physical health, behavioral health and social determinants of health care through a network of non-profit community based treatment providers and health system partners. This program is achieving significant reductions in substance use and mental health symptoms and improvement in quality of life for members served, and is also reducing ER visits and overall cost of care. Chris is also responsible provider performance monitoring and value based contracting for behavioral health. Chris was hired at Horizon specifically because of her background and experience in both state government and as a New Jersey treatment provider. Chris joined Horizon with more than three decades of clinical and administrative experience in substance use disorder treatment in New Jersey. In her early career, Chris’s work in New Jersey state government focused on research and quality improvement initiatives designed to improve access, engagement and outcomes from treatment. Following her state service, Chris moved to Turning Point, where she served as Chief Operating Officer and was responsible for program development, quality improvement, accreditation, grant funding and oversight of a full continuum of residential and outpatient treatment programs. Immediately before joining Horizon BCBSNJ, Chris served as the Executive Director for Catholic Family & Community Services, a multi-social service, Catholic Charities agency meeting the needs of people struggling with poverty, homelessness and food insecurity, as well as substance use and mental illness, in Northern New Jersey. Chris brings an appreciation of state government, licensure, contracting, quality improvement and treatment outcomes, as well as the new knowledge she has gained from a payer perspective working at Horizon. Chris is a Licensed Clinical Social Worker. She earned a Master of Social Work from Rutgers, The State University of New Jersey and a Bachelor of Social Work from Slippery Rock University of Pennsylvania.
Michael D’Amico
Michael D’Amico LCSW
Vice President, Oaks Integrated Care
Mike is a Licensed Clinical Social Worker, based out of New Jersey, who earned his Bachelor’s degree in Sociology and Master’s Degree in Social Work from Rutgers University. Mike has been extending his clinical skills to individuals served by Oaks since 2012. Currently, Mike serves as Vice President at Oaks Integrated Care overseeing Ambulatory Mental Health Programs, Acute Care Services, as well as Addictions Treatment Services. As a champion of evidence-based practices, data driven decision-making and person-centered care, Mike has been a driving force behind implementing new cutting-edge models of behavioral health care such as the Certified Community Behavioral Health Clinics. Mike has experience working with the National Council for Mental Well-Being advocating for legislative change to improve behavioral health services throughout the country in addition to serving on steering and advisory committees on the county and state level including work with NJ’s Department of Health Office Based Opioid Treatment (OBOT) project. Mike also works as adjunct faculty for Rutgers University’s School of Social Work. His blend of strong leadership and clinical expertise helps to ensure sound business decisions without compromise to clinical quality. Mike lives in Burlington County, NJ with his wife, who is a practicing LPC and professor, along with their 2 children.
Vera Sansone
Vera Sansone LCSW
President & CEO, CPC Behavioral Healthcare
Vera Sansone, LCSW serves as President and CEO of CPC Behavioral Healthcare in Monmouth County, New Jersey since 2014. Prior to that she was the Chief Operating Officer for 15 years. Vera worked in public and non-profit managerial roles in New York for many years prior to relocating to New Jersey in 1991. CPC Behavioral Healthcare is currently one of the seven original New Jersey agencies designated as a Certified Community Behavioral Health Clinic (CCBHC) and is also involved in a SAMSHA grant for Medication Assisted Treatment (MAT) and Integrated Care. CPC is currently one of the largest CCBHC’s in New Jersey. CPC was also the first agency in the country to partner with Horizon Blue Cross Blue Shield to pilot the Integrated System of Care (ISC) program which offers clients a whole-person approach by integrating physical health, mental health and substance use treatment through care management, health promotion, and support services by coordinating client’s health needs and specializing in the integration of behavioral health and primary care. Vera serves on the State Professional Advisory Committee (PAC) for Addictions and Co-Occurring Disorders and was recently named as a member of the Governor’s Fee-For-Service (FFS) Transition Oversight Board.
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