1 Behavioral Health Organizations in Health Information Networks: Some National Perspectives

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Behavioral Health Organizations in Health Information Networks:

Some National Perspectives

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Overview

What is a Behavioral Health Organization (BHO)?

Which BHOs were selected for the interviews and why (selection criteria).

Key barriers.

Lessons learned.

Final thoughts…

What is a Behavioral Health Organization? A Community Mental Health Center

serving seriously mentally ill, severely emotionally disturbed, substance abuse, and/or developmentally disabled clients.

A behavioral health department or delegated entity that manages that benefit for an insurance carrier/managed care organization.

A multi-specialty provider that offers behavioral health (and potentially other services) for multiple payors.

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Which BHOs were selected

Blue Cross Blue Shield of Massachusetts-Behavioral Health Department

Center for Behavioral Health/Centerstone (IN and TN)

Frontier Health (TN and VA)

Kaiser Permanente of Colorado

Marillac Clinic (Grand Junction, CO)

Colorado Western Regional Mental Health Center

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Why were these BHOs/RHIOs selected?

The BHO is participating in one or more RHIOs, e.g. governance, committees, etc.

The RHIO is operational (or imminently operational)

The BHO has at least anecdotal experience to report with respect to experience with various e-health strategies

The RHIO/HIN recommended the BHO because the organization is seen as an involved stakeholder in the network

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Key Barriers to Participation in a HIN (BHO Perspective):

Perception of high cost to join or participate in the RHIO,

Resource limitations (e.g. not enough personnel, priorities are in other areas, etc.),

Perception that the RHIO is not going to be able to meet their needs, and/or,

They are "not wanted" in the planning process and/or governance of a community e-network.

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And the most significantbarrier reported…

Concerns about violating clients’ privacy/security if the (protected health information) were to be

accessed/used inappropriately.

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So why did/do these BHOsparticipate in RHIOs?

If health care (and the RHIO) are going to be “comprehensive” we need to participate.

This represents such a value to our clients (e.g. efficiencies, reduced errors, the “right treatment the first time,” etc.)

We can truly start to prove the value of behavioral health to the overall health of the individual.

Our clients are higher risk/need and more transient than the “average” client so we need a RHIO.

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Another Perspective:Stages of Integration

1. Minimalcollaboration

2. Collaboration at a distance

3. Basic on-siteCollaboration

4. Close Collaboration in a partly integrated system

5. Close Collaboration in a fully integrated system

1. Minimalcollaboration

2. Collaboration at a distance

3. Basic on-siteCollaboration

4. Close Collaboration in a partly integrated system

5. Close Collaboration in a fully integrated system

McDaniel, Hepworth, and Doherty (1992)

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A Comprehensive Health Delivery Network

Quality Health NetworkGrand Junction, CO

PrimaryCare

BehavioralHealth

Organizations

Public HealthAnd Safety

Net

Specialists And

Diagnostics

LocalHospitals

RHIO

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Lessons Learned

Get in the door at the onset. Even if the BHO doesn’t transmit data right away there are still values to participation, e.g. see the other health care data for your clients, reduce redundancy/gaps in service, develop more realistic and effective treatment plans, etc.

Ensure that behavioral health regulations are factored in asap. The best way to ensure that restrictions, authorizations, and so forth are developed is to put them out on the table during development (of the RHIO).

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Lessons Learned (continued)

“Shared organizational language.” RHIOs develop a culture that reflects multiple stakeholders—BHOs should be a part of that, e.g. participation on committees, governing board, etc.

Quality of Care will improve due to participation in a RHIO. This may seem like a “leap of faith” but the research is emerging that shows e-health strategies like EHRs and RHIOs represent a significant value proposition for BHOs (and their clients) also.

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…and one final word from “the field” regarding BHOs in

RHIOs…

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Lessons Learned (continued)

Head any problems off at “the pass.” Some issues perceived by BHOs (and other health care stakeholders) as barriers are…and some issues are more perception than reality. How will you know unless you are there? Some of these issues can be mitigated or resolved with early intervention…

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Conclusion: Battle Scars and Hindsight

Collaboration is foreign and difficult, but worth it.

A champion and leadership are essential;

Common values and shared vision and mission statements are essential;

Competent data are essential;

Good planning contributes to significant change;

Change is fragile;

Structured decision-making (logical and rational decisions) increases system effectiveness.

Managing Change In Chaotic Times: If you draw a line in the sand, make sure the tide is coming in…

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Resources

Sarah Bannon:– Bannon_S@msn.com– W: 517-669-5532

Michigan Health Information Network: www.Mi-HIN.org

Office of the National Coordinator of Health Information Technology: www.govhealthit.com

Health Information and Management Systems Society: www.himss.org

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Respondents

– Jeffrey Simmons, MD, CMO, Beh Health Dept., Blue Cross MA: Jeffrey.Simmons@bcbsma.com

– Dennis Morrison, PhD, CEO, Center for Behavioral Health (Centerstone): DennyM@kiva.net

– Kelli Kane, Executive Director, Beh. Health Department, Kaiser of CO: Kelli.Kane@kp.org

– Linda Kaul, Medical Services Admin., CO CMH Center: lkaul@cwrmhc.org

– Steve Hurd, Ex. Director, Marillac Clinic (Grand Junction, CO): Steve.Hurd@stmarygj.org

– Doug Varney, CEO, Frontier Health (TN and VA): DVarney@frontierhealth.org

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The End….The End….

Thank You!Thank You!

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Part 1CEI Community Mental Health

(CEI)

Part 2Capital Area Health

Alliance (CAHA)

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CEI=Community Mental Health Authority of Clinton-Eaton-

Ingham Counties

Both a Prepaid Inpatient Health Plan (PIHP) serving 8 counties across

Michigan, and a Community Mental Health (CMH) Authority serving 3

counties in Mid-Michigan. Main offices in Lansing.

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CAHACapital Area Health Alliance

Founded in 1994, a coalition of organizations, businesses, health care professionals and volunteers working to empower our community to achieve better health

Participants from Clinton, Eaton and Ingham Counties

In 2005 began work on Regional Health Exchange strategies

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CAHA RHIO Committees

Steering Committee

Business Planning

Community Info Tech Assets and Assessment

Products & Services for Physicians/Providers

Public Health Information Development

Request for Proposal Committee

Work Group/Governance Committee

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CEI CMH Participation

CAHA has welcomed and encouraged CMH and Public Health since Inception– CMH a Member of Governing Board– CMH a Member of RFP Committee

CAHA now working on sustainability model– Stakeholder Investors (for voting seat on board)– Providers to pay ongoing fee for information

exchange– Public Safety Net Role? (when considering size of

investment)

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RHIO Value Proposition / ROI

Major issue is the value proposition for each Participant

CAHA contracted with "Strategies for Tomorrow" consultants to analyze ROI for large participants

Participants agreed to spend a portion of their ROI on funding the RHE

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"Strategies for Tomorrow" CMH Findings

Significant gains in the quality of care for CMH patients related to the HIE

Improvements in Quality Care may not translate into ROI for CMH because

– Limited CMH funds currently spent on Coordination of Care (Behavioral Health Primary)

– Limited CMH funds currently spent on orders, lab results, etc.

– Improvements in coordination of care will be reflected in reduced hospital stays for physical health care, in that inpatient psychiatric stays are not, in the main, the result of lack of coordination of care between physical health care and behavioral health care

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"Strategies for Tomorrow" CMH Findings

Quality of Care will improve due to greater coordination

Safety Net Providers, although often invisible, should be included in Exchanges

Most ROI will go to non-CMH Providers

Potential for collaboration state-wide across CMH's for exchange with RHE's

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Part 2

Issues Affecting Michigan's Public Behavioral Health System

(PIHP's and CMH's)

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Things to Know about Behavioral Health Data Systems

Behavioral Health Practice Management Systems typically separate from Physical Health Systems

A set of National, Multi-State, Regional Behavioral Health Software Vendors

– Netsmart has largest market share

– Echo is a distant second

– At least 20 other national vendors

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Things to Know about Behavioral Health Data Systems (cont)

Typically Started as Practice Mgt Systems

Focused on Administrative Functions– Billing!!!– Enrollments, Scheduling– State Reporting

In the late 1990's, PIHP's Added Care Management Functions– Authorization Tracking– Integration with other Eligibility Systems– Encounter Warehouses

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Things to Know about Behavioral Health Data Systems (cont)

Systems do not tend to use HL7 coding to integrate internally or externally

– Most systems are integrated, with admit/discharge, clinical forms, encounter data all integrated into one system

– Until now, has not been a need to use HL7

– EDI has been primarily limited to specialized MDCH protocols (QI, encounter, Indicators) and ANSI X12 (837, 835, 270, etc.)

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"Strategies for Tomorrow" CMH Findings

Significant gains in the quality of care for CMH patients related to the HIE

Improvements in Quality Care may not translate into ROI for CMH because

– Limited CMH funds currently spent on Coordination of Care (Behavioral Health Primary)

– Limited CMH funds currently spent on orders, lab results, etc.

– Improvements in coordination of care will be reflected in reduced hospital stays for physical health care, in that inpatient psychiatric stays are not, in the main, the result of lack of coordination of care between physical health care and behavioral health care

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Things to Know about Behavioral Health Data Systems (cont)

Practice Management Systems do not tend to utilize Orders and Results

Instead, Systems focus on

– Administrative functions

– Activities/Encounters

– Person-Centered Plans (treatment plans)

– Progress Notes

– Initial and Annual Assessments

– Discharge Summaries

– and a variety of other clinical forms

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Current Multi-CMH Efforts

"The Standards Group" / Health Information Technology (TSG/HIT)

CIO Forum – CIO's of the 18 Michigan PIHP's

Data Exchange Workgroup – A sub-group of the CIO Forum, exploring coordination between PIHP's/CMH's and their RHIO's

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Data Exchange Workgroup

Purpose

In support of Michigan's RHIO System:

Become knowledgeable about data exchange standards (e.g., HL7, CCD, etc.)

Work to ensure National Standards include Behavioral Health

Develop minimum clinical data sets (data elements), and common understandings of that data across CMH's

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Data Exchange Workgroup (cont)

Planned Deliverables:

Behavioral Health Use Cases

Minimum Set Data Elements

Common Translations

Common PIHP understanding of Mental Health Code Privacy Requirements and their impact on data Exchange

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Data Exchange Workgroup (cont)

Some of our Guiding Principles:

Support exchange through RHIO's

Support Interoperability – Vendor Neutral

Based on National Standards

Defining Standards, not an Exchange System

Not an attempt to change local CMH operations or affect local data

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Community Mental Health Authority of

Clinton-Eaton-Ingham Counties

Chuck Dougherty, IS Director

dougherty@ceicmh.org

MiHIA – Michigan Health Information Alliance - www.mihia.org

My Role on MiHIA Technical Advisory Group

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Key Finding: “The Central Medical Trading Area clinical groups HIE priorities appear to match the national trends and experience in the rest of the country.”

Recommendation:“Since our local priorities align with the national experience MiHIA should attempt to utilize the published literature and recommended best practices to guide HIE implementation activities.”

Where does Behavioral Health Fit?

Technical Advisory Group’s Key Finding (November 2007)

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Stage Technology

Solution

Functional

Model

Phase One Clinical Messaging “Push” model to known providers

Phase Two Medication

History & ePrescribing

“Pull” for medication history

ePrescribing for orders/refills

Phase Three Master Patient Identifier & Record Locator Service

“Pull model”: Traditional HIE service offering

Phase Four Consumer Centric Electronic Health Records

Next Generation PHR

(Bi-Directional access to Health Vault, Google, etc)

MiHIA Technical Advisory Group’s Proposal (May 2008)

Again…Where Can Behavioral Health Get in on the Action?

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Potential BH Use Case Example (High Level Concept only)

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Longer Term Visioning - Potential Behavioral Health Opportunities Through MiHIA

•Smoking cessation

•Weight management

•Group therapy

•Technical assistance to physician medical practices for how to expand to include BH

•Telepsychiatry

• Integrated Behavioral Healthcare