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Behavioral Health IT:
Moving Toward “Whole Person Care”
Kevin ScaliaExecutive Vice President
Netsmart
Al GuidaPresident
Guide Consulting
Agenda
• Value based care is driving risk bearing by providers
• What do the VBC models look like?
• Why is technology required to do VBC?
• Talking points & lessons learned for Hill visits?
• Legislative asks
VALUE-BASED CARE
Outcomes – Improve Population Health
Common Elements of Value-Based Care
Quality – better care, safety, individual & family
experience
Reduce Cost
CO
MP
LE
XIT
Y
Capitation
•Full risk
•Population target
•Disease specific/All
in
Fee-for-service
•One service
•One payment
Case Rate
•Group of services
•Unified payment
•Periodic payment
Bundled Payment
•Bundle of services
•Unified payment
•Quality targets
•Episode-based payment
Total Health
Outcomes
•Shared risk on
total member
experience
Pay for
Performance
• “Upside only”
•Process
measures
Risk Continuum
RISK
Post-Acute Care Integration will be Critical in most Value-Based Care Reimbursement Models
Source: The Advisory Board Company and William Blair
LEVEL OF RISK BEARING
Pay-for-performance Bundled payments Shared-savings models Shared-risk models Full risk models
Hospital value-based payments BCPI initiativeMedicare shared-savings program (MSSP) Track 1 (savings only, no
downside risk)
MSSP Track 2 (60% sharing)
Next Generation ACO (full risk model)
Hospital readmission penaltiesComprehensive joint replacement
(CJR)Medicare Track 3
(up to 75% sharing)Medicare advantage (MA)
Hospital-acquired infection program Cardiac bundlesNext Generation ACO
(80-85% sharing option)Managed Medicaid
Merit-based incentive paymentsMovement toward 50% bundled
paymentsExchange-based plans
Post-acute readmission penaltiesNote: Risk models highlighted by these boxes indicate post-acute care will be a key focus
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html
CMS Initiatives Will Impact Your Top Line Revenue
Managed Care
Incentive
Payments
CCBHC
Capitation
DSRIP
Value-based
contracting
HEALTH
HOMES
Pay-for-
Performance
MedicaidExpansion
CCOAccountable
CareACOBundled
Payments
RCO
Care
Coordination
THE EXPLOSION OF NOW - Value The Landscape of Today’s Healthcare Industry
PMPM
HHVBP
Trauma-
Treatment
Models
HIE
MEDICATION
MANAGEMENT
Precision
Medicine
Stratification
Clinical Decision Support
Clinical
integration
Predictive
Analytics BIGDATA
KnowledgeFlow
ConsumerApps
Meaningful
Use
THE EXPLOSION OF NOW - TechnologyThe Landscape of Today’s Healthcare Industry
Integrated
Care
Integration with
Physical Health
Care
Mobility
EBP
Jail
Diversion
& Treatment
ICD-10
Population Health Tools
Community Care Integrating with Primary Care
WHAT OUR COMMUNITIES HAVE IN COMMON
•Need to CONNECT to the rest of healthcare
• Play a CARE COORDINATION role for the community
• Highly MOBILE workforce
• HIGH COMPLEXITY reimbursement level/models
• Shift towards VALUE-BASED CARE
• DIFFERENT MARGIN PROFILE than acute care
• Care models tend to be LESS EPISODIC
Key Elements of “Whole-Person” Care
• Value-Based
• Care Coordination/Integration
• Care Management
• Population Health Management
Hosting & SaaS
CLINICAL INNOVATION CARE COORDINATION
BUSINESS EFFICIENCIES
BENCHMARKING
DATA ANALYTICS DE
LIV
ER
ING
VA
LU
E-B
AS
ED
CA
RE
Value
OUTCOMES
COST
=
EMR & Medication
Management
Clinical Decision
Support
Information
Exchange
Primary Care
Integration
Regulation/
Legislation/MU
Population & Community
Health Management
IMP
RO
VE
OU
TC
OM
ES
RE
DU
CE
CO
ST
Revenue Cycle
Management Managed
Services Technology
Partners
Provider Path to Deliver Value-Based Care
Value-Based Care Considerations
• Early models of VBC often stratified and attributed populations for participants
– Health Homes (SPMI and Asthma, COPD, Diabetes)
• Emerging models do not attribute within an assigned population…
– Providers own the population and need to determine the best care mix for clients
– Providers must also stratify and identify priority cohorts on their own
VBC Requires Building an Expanding Set of Workforce and Technology Capabilities
• Cost accounting knowledge
• Highly functional EHR capabilities
• Data exchange capabilities
• Management of episodic rates of service
• On demand consumer access
• Automated measurement of systemic quality indicators
CCBHCs• Requires reduction in cost and improved care for the ENTIRE population served
with an emphasis on vulnerable cohorts
• Requires data exchange and coordination of care across a broader network
• Jails, VA, social service providers and schools
• States are focused on how they gather and report respective quality metrics
• CCBHCs required to alter process and technology to support reporting & service delivery requirements
CCBHCs Address Evolving Care Coordination Requirements
CCBHC Acute Care Hospital(s)Social Services,
School, Justice,
Child Welfare
Inpatient MH
Facilities, Detox,
Residential
FQHC
PCP(s)VA, IHS
Low HighAcuity
Claims
Process,
Case
Management
& Analytics
Care
Management
& EHR
QA UM
Risk Stratification Algorithms
PayersProviders
LowHigh
$$ PMPM + Incentive
Gaps in Care
Clinical Measures
Outcomes Measures
Social Determinants
Integrated IT Systems
Case
ManagersCare
Managers
Emerging VBC Models Driven by Payers
Leveraging Technology for Success
Technology Components For Whole Person Care
Connectivity and Collaboration
Analytics
Referral Management
Population Health Management
EHR +
Complex Billing
Care Coordination
11
12
3
0%
5%
10%
15%
20%
25%
30%
Interoperability Reporting/Analytics
OutdatedSoftware
Equipment
RobustBilling
Software
Care Team Telehealth/Telemonitoring
PopulationHealth Tools
EMR Adoption/Usability
PatientOutreach/Education
Biggest Identified Technology GapsAs providers prepare for value-based care
#1Interoperability #2
Reporting/
Analytics
Analytic Capabilities Continuum
• Standard Report
• Ad Hoc Report
• Query/Drill Down
• Alerts
• Statistical Analytics
• Predictive Modeling/
Forecasting
• Optimization
Predictive and
Prescriptive Analytics
Descriptive Reporting
and Access
Degree of Intelligence
Co
mpe
titive A
dvan
tag
e
Increasing your competitiveness
Missing Data Can Increase Risk
May see up to
16 physicians per year
Medicare beneficiarywith multiple chronic conditions
Important care information is missing
78% of the time
3 out of 10 tests are re-ordered because results cannot be found
Paper patient charts cannot be found on 30% of visits
86% of mistakes made in healthcare industry are administrative
Care Coordination
Patient Medications
• 30% are on 8 or more medications
• 40% of patients do not understand the side effects
Advancing your data exchange capability supports improved care coordination and minimizes risk
Medication Reconciliation Between OrganizationsSafety
• Approximately 50 percent of hospital-related medication errors
and 20 percent of adverse drug events result from poor
communication at transition
• Approximately 60 percent of post-discharge adverse drug
events could be prevented or improved by better intervention
Efficiencies
• Estimated cost of reconciling medications without history:
10 hours/$290
• Estimated cost with increased coordination between hospital
and SNF: 1 hour/$35
Interoperability: The Journey to Integrated Care
Documentation ExchangeStandardizing data transfer with CCDs,
labs, public health registries and health
information exchanges
Secure, Direct ExchangeDirect Message internally as well as externally
to the larger provider community, enabling
coordinated care across the care continuum
Using a Certified EHRDigitized but unconnected to the
larger provider community
Transitions of CarePoint-to-point referrals within
a single workflow
Query-based ExchangeFind/request information from other
providers, such as discharge summaries
CONNECTING TO THE LARGER ECOSYSTEM CONNECTING OUTSIDE YOUR FOUR WALLS
Integrated, Whole-person CareSingle patient record across
the entire continuum
Query for Key patient information
6 Minutes vs. 29 hours
Outcomes Analysis
Cohorts• Diagnosis
• Acuity Level
• Age
• Gender Outcomes
Co
st
Service Analysis• Service Type
• Licensure
• Modality
• Frequency
Outcomes• Reduced Hospitalizations
• Reduced Acuity Levels
• Engagement
• Consumer Satisfaction
• Reduced Risk of Harm
CARE COORDINATION/INTEGRATION
myAvatar
myAvatarCrisis
Call Center
Example: Tampa Bay Area
myAvatar
myAvatar
Example: CMHC to Acute Care
myAvatar
myAvatar
Example: CMHC to FQHC
myAvatar
myAvatar
myAvatar
Example: County to Justice System
myAvatar
Common rules of the roadLegal obligation and agreement to
abide by the same rules
Well-defined technical
specificationsShared rules are not enough; detailed
guide for implementers required
A participant directoryTo connect using the common
standards, systems must know
the addresses and roles of
each participant
The Carequality NetworkA Common Interoperability Framework to Share Health Data
Aggregate
documents across the care
continuum
Connect to all
community
providers on the
Carequality network
Information is
integratedwithin EHR
workflows
Robust consent
service ensures the
right access is
granted
One connection to the
Carequality network means a
connection to every provider
who participates in Carequality
CARE MANAGEMENT
Creating a Safety Net
Creating a network for providersto communicate helps ensure the
consumer’s needs are being met
FOR IMPROVED OUTCOMES
Legend
Provider
Behavioral Health Need
Physical Health Need
Social Health Need
P P
P
P
P
P
P
P
P
N
N
N
NN
N
N
N CONSUMER
N
N
N
Referral CoordinationTHE IMPORTANCE OF CONNECTING REFERRING PROVIDERS
Needs are categorized by Domain
Needs are linked to
Providers who will support
and provide care
There may be overlapbetween providerdomains and type of Need
CATEGORIZING NEEDS BY DOMAIN
CARE NEEDS OF AN INDIVIDUAL MAKING THE RIGHT REFERRAL
Primary Care
Outpatient Clinic
Community ServiceAgency
**
N
N
N
NN
N
N
N CONSUMER
N
N
N
N
N
N
N
Example: Health Homes of Upstate NY
Onondaga CMS
Lake Shore
Behavioral
Health
CENTRAL
WESTERN
Greater Lakes Mental
Health Southern Tier
Huther Doyle
CHAUTAUQUA
FINGER
LAKES
• Social Service Departments
• Local Health Departments
• Inpatient Mental Health
• Substance Use Centers
• CMHC
• Hospitals
• Primary Care Practices
3,300+
NetworkProviders
16,000
CareManagement
60Consumers
Example: Missouri CCHBC
ER Visit
Hospitalization
Patient Specific Data
• CMHC Assignment• Programs• Claims• ED Visits• Providers• Health Plan Eligibility
Missouri
Medicaid
Patient Care Data
Metabolic Screening:
• Vitals• Labs• Health Risk Factors
Population Health Data View
Quality Analytics Org Compliance
Missouri Coalition & View of:
Missouri
DMH
Claims
CMHC EHRs• myAvatar (Ozark)• Anasazi (Pathways)• Credible (New Horizons)• PsychConsult (Truman)
CCBHCC level Care Manager/Coordinator View of:
• Aggregated Patient Data View• Claims
• Alerts and Reminders• Compliance at a patient & coordinator level
Quality Measures & Reporting
Care Management Dashboard
POPULATION HEALTH MANAGEMENT
Meeting clients where they are:Home | School | Work | Community | Clinic
Connecting with clients in the way
that works best for them:
Email | Text | Phone | Face-to-face | Telehealth
En
rollm
en
t / E
ng
ag
em
en
t S
trate
gie
s Differential Management
Risk
Stratification
Population
Identification
Health
Assessment
DEFINE ASSESS STRATIFY ENGAGE MANAGE
Tailored Interventions
Care Coordination
Clinical Case Management
Population Health
Risk Management
Clinical Recovery
Behavioral Health As Community-Based Care Coordination Leader
Attributed to
your ACO
Attributed to
your Bundle
Attributed to
another ACO
Attributed to another
hospital's Bundle
Health System
CCD Data | ED Alerts | ACO Patients | Bundle Payments | Care Plans | Referral Data
Primary Care
Office
Skilled Nursing
Facility
Outpatient
Clinic
Consumer’s
Home
Other Acute
Care Facility
Population
HealthCare
Coordination
HealtheIntent
Healthy Planet
Clinical &
Outcomes
Data
CareInMotionBehavioral Health
LEGISLATION
Netsmart Legislative Advocacy
• Advocacy for health IT-related Congressional legislation and regulatory issues on behalf of our clients
• Founding member of BHIT Coalition– Consortium of 12 key organizations advancing public policy for technology to improve the lives
of people with mental health and addiction disorders
• Engage with key human services and post-acute associations to support their advocacy efforts
• More information at www.ntst.com/legislation
Behavioral Health IT Coalition
NetsmartNational Council for Behavioral Health
American Psychological Association (APA)Association for Behavioral Health and Wellness (ABHW)CenterstoneThe Jewish Federations of North America (JFNA)Mental Health America (MHA)National Association of Counties (NACo)National Association of County Behavioral Health and Disabilities Directors (NACBHDD)National Alliance on Mental Illness (NAMI)National Association of Psychiatric Health Systems (NAPHS)National Association of State Alcohol and Drug Abuse Directors (NASADAD)National Association of Social Workers (NASW)
Improving Access to Behavioral Health
Information Technology Act (H.R. 3331/S.1732)
• HIT incentive payments to improve coordination of behavioral health and addiction treatment services– Via the Center for Medicare & Medicaid Innovation (CMMI)
• Community mental health centers, residential and outpatient MH treatment facilities, substance use treatment facilities, clinical psychologists, clinical social workers
• For adopting certified EHR technology and using it to improve the quality and coordination of care through the electronic exchange of health information.
– Builds on the 21st Century Cures Act HIT requirements for transparency, usability and interoperability
– Sponsors: Sen. Rob Portman (R-OH), Sen. Sheldon Whitehouse (D-RI), Cong. Lynn Jenkins (R-KS) and Cong. Doris Matsui (D-CA)
NEW MANTRA SLIDEBundy
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