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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:– [email protected]– 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: [email protected]
– Dennis Morrison, PhD, CEO, Center for Behavioral Health (Centerstone): [email protected]
– Kelli Kane, Executive Director, Beh. Health Department, Kaiser of CO: [email protected]
– Linda Kaul, Medical Services Admin., CO CMH Center: [email protected]
– Steve Hurd, Ex. Director, Marillac Clinic (Grand Junction, CO): [email protected]
– Doug Varney, CEO, Frontier Health (TN and VA): [email protected]
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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
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
