Information Exchange & Tech Innovation: How Technology Is ... · Luke Crabtree, JD, MBA, Chief Executive Officer, Project Transition IV. Questions & Discussion Agenda. Technology

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Tuesday, November 7, 2017 ⅼ 2:30pm – 3:45pm

Joseph P. Naughton-Travers, EdM, Senior Associate,

OPEN MINDS

Information Exchange & Tech Innovation: How Technology Is Changing Case Management


I. Technology & Case Management Services

II. Virginia Matthews, RN, BSN, MBA, Project Manager,

MAXIMUS

III. Luke Crabtree, JD, MBA, Chief Executive Officer, Project

Transition

IV. Questions & Discussion

Agenda

Technology & Case Management Services

Opportunities To Leverage New Tools To Improve

Care & Control Costs


Shifting Case Management Models

Payer push

for

integrated

care

management

Emerging

value-based

financing

models

New

technologies

New models

for case

management

Case management is a collaborative process of assessment, planning, facilitation,

care coordination, evaluation, and advocacy for options and services to meet an

individual’s and family’s comprehensive health needs through communication and

available resources to promote quality, cost-effective outcomes.

What case mangement looks like in practice is shifting due to new management and

cost pressures and the emergence of new technologies


The New Models For Case Management

Traditional Case

Management

Managed directly by provider

organization

Behavioral and physical health-

focused

Medicaid FFS

Face-to-face and telephonic

interventions

Targeted case management

New Case

Management Model

Managed by health plans, care

management organizations, and

provider organizations

Whole person care (behavioral,

medical, social)

Part of bundled/full-risk capitation

arrangement

Digital and tech-enabled intervention

Health homes and specialty medical

homes


Technologies Shaping Case Management

• Online services and supports (eCBT, telehealth, mood tracking

apps)

• Remote monitoring of consumers in their home

• Digital/telephone-based appointment setting and reminders

Technologies replacing

face-to-face case

management

• Data analytics for risk stratification and prioritized interventions

• Decision support tools for standardized treatment plans

Technologies prioritizing

which consumers need

high-touch case

management

• GPS monitoring of case managers and visits

• iPads/mobile solutions for immediate input of (and access to)

consumer data

• Connecting consumers to other services and supports

Technologies monitoring

care management

operations & case

managers

MAXIMUS

Virginia Matthews, RN, BSN, MBA, Project Manager,

MAXIMUS

INFORMATION EXCHANGE & TECH INNOVATION: HOW TECHNOLOGY ISCHANGING CASE MANAGEMENT

CALIFORNIA HEALTHCARE PROFESSIONALS DIVERSION PROGRAM

NOVEMBER 9, 2017

MOZZAZ PLATFORM IN USE WITHCASE MANAGEMENT OF PARTICIPANTS WITH SUBSTANCE USE DISORDER

CALIFORNIA HEALTHCARE PROFESSIONALS DIVERSION PROGRAM

NOVEMBER 9, 2017

10 | MAXIMUS: PRESENTATION TITLE

Virginia Matthews, BSN, MBAPROJECT MANAGER

MAXIMUS CALIFORNIA DIVERSION

PROGRAM

PHOTO

PLACEHOLDER


What is the MAXIMUS California Diversion

Program?

A program for Healthcare

Professionals who are suffering

from substance use disorder

and/or mental illness

A voluntary and confidential

monitoring program, which

provides ongoing support and

case management


Role of Case Management:

"a collaborative practice model including patients, nurses, social workers,

physicians, other practitioners, caregivers and the community. The Case

Management process encompasses communication and facilitates care

along a continuum through effective resource coordination.”American Case Management Association. "Definition of Case Management". Retrieved 2017-10-30.

https://en.wikipedia.org/w/index.php?title=American_Case_Management_Association&action=edit&redlink=1

http://www.acmaweb.org/


Goals of Case Management:

"The goals of Case Management

include the achievement of optimal

health, access to care and

appropriate utilization of resources,

balanced with the patient's right to

self determination.”

American Case Management Association

GOAL OF DIVERSION PROGRAM

To protect the public

To return Healthcare Professional to safe practice, through intervention and rehabilitation

To assist the professional to establish long-term recovery practices


HEALTHCARE PROFESSIONALS ARE ESPECIALLY

SUSCEPTIBLE TO SUBSTANCE USE DISORDER.

1ATTITUDEDRUGS ARE NOT

SEEN AS POTENT

CHEMICALS

2ACCESSIBILITYSUBSTANCES READILY

AVAILABLE IN THE

WORKPLACE

3HIGH STRESS

WORKSUBSTANCE ARE OK TO

HELP COPE


California Health Professionals Diversion Process

Voluntary/probation

referralIntake assessment with

Case Manager

Remove

from work

Support Group,

Community 12-Step

mtgs

Return to work with

monitoring3 to 5 years monitoring &

Case Management

Begin Drug Testing


BOARD OF REGISTERED NURSING

DENTAL BOARD

DENTAL HYGIENE COMMITTEE

BOARD OF PHARMACY

PHYSICAL THERAPY BOARD

OSTEOPATHIC MEDICAL BOARD

VETERINARY MEDICAL BOARD

PHYSICIAN ASSISTANT BOARD

MAXIMUS DIVERSION PROGRAM SERVES 8

HEALTHCARE PROFESSIONAL LICENSING BOARDS.

Mozzaz Platform Interface With Multiple Stakeholders

Case

Management

Team

Participant

Mobile AppProgram

Management

• Currently in use with CA Diversion Board of Pharmacy participants

• Mobile phone application that includes scheduling, program forms, key resources, and care team messaging

• All system usage data is tracked and available in real time

Mozzaz Mobile App for Participants

MOBILE APP USES “TILES”TO GUIDE PARTICIPANTS TO RELEVANT CONTENT

• Schedules include standard program components, as well as reminders/forms specific to each Participant

• Participants receive push notifications on their devices that prompt them to complete the required event

Schedules

MAXIMUS Mozzaz Case Management 21

• Participants are able to access forms to provide key data to the MAXIMUS team in real time

• Future use may include participant-specific information to be submitted to program, such as monthly reporting, GPS check-in to required 12-step meetings, worksite monitor report of performance

Forms


• Forms are customized to the needs of the program, and can be used to trigger alerts when necessary

• Allows participant to do a self-check on recovery status

• Encourages the process of introspection and active review of status in recovery

• Responses #1 and #2 trigger notification to program staff

Program-Specific Daily Check-In


• Participants can access key documents and websites on mobile app to support recovery

• Encourages self-sufficient and active involvement in recovery

• MAXIMUS can track engagement to determine what is useful to participants, and to make adjustments where necessary

Program Resources


• Participants can easily access information on Program-specific information, including products they can consume, and those that should be avoided

• MAXIMUS can update and customize this list remotely at any time, and participants will immediately receive the update

Program Resources


• Participants can scroll lists of safe/not safe products, laid out in easy to consume formats

• Previously provided on paper, lists now available on the mobile app

Diversion Approved/Not Approved

Medications


• Participants can access community resources such as local 12-Step meetings, allowing them to adhere to program requirements no matter where they are, even when on approved travel

Community Resources


• Participants can easily access facilitator contact information

• Participants can make calls from directly within the application

Support Group Information


• Participants can easily reach out to their Case Management team members for assistance

• Program staff are notified in real time of request for contact

• Case Management Team can push messages to Participants, visible on login

Interaction with Case Management Team


Program Staff Care Portal

• MAXIMUS staff also complete clinical interventions in the Mozzaz Care Web Portal

• This data is valuable for state level reporting

• Review real-time reports of participant activity on the app

• Review participant communications and requests



Review real-time reports of participant activity on the app



Produce graphic view of participant activity on the appEnhance case

management by allowing analysis of participant activity specific to their needs


Disability Care Teams

Substance Use Disorder Post-Treatment Monitoring, Pre-Treatment Education and Assessment

Disease-specific education, able to offer quizzes to assess understanding of disease process

Enrollee education and support

Workforce services case management

Other Uses for Case Management

• Structure and maintain Care Plans

• Develop Care Maps

• Enrollee Peer support

• Develop and post content

• Push content and alerts to users

• Notifications and updates

• Schedule activities for groups or specific users

• Assign users to specific case managers


Project Transition

Luke Crabtree, JD, MBA, Chief Executive Officer, Project Transition

36

Project Transition Mission: “To enable each Person who has Serious Mental Illness, Co-Occurring

Substance Use Disorder and/or a Dual Diagnosis of I/DD and Behavioral Health conditions to live a

life that is meaningful to her or him, in the community, on terms he/she defines.”

Project Transition

37

Poll The Audience

Project Transition Proprietary & Confidential

38

Project Transition

Project Transition has over 35 years experience working exclusively with some of society’s

most vulnerable Members – Adults, including Emerging Young Adults, who have Serious

Mental Illness, co-occurring Substance Use Disorder and/or a Dual Diagnosis of

Intellectual/Developmental disABILITIES (IDD) and Behavioral Health challenges

We are an outcomes-driven organization, committed to enabling each individual Member,

to live a life that is meaningful to her or him, in the Community, on terms she or he defines

We are in our 2nd generation, founded on the fundamental belief that our Members can and

will thrive in the community if properly and energetically supported

All of our services are delivered by coordinated teams of mental health, substance use

disorder, and IDD professionals


39

Project Transition Products and Options for Today’s Discussion


Comprehensive solutions for customers (States, Counties, Managed Care Organizations,

Department of Intellectual and Developmental disABILITY Services) to delivery outcomes-

driven, person centered solutions in a cost effective way (in response to known gaps,

often from litigation):

• Project Transition “Traditional” Services: Adult Persons with SMI and Co-Occuring

Substance Use Disorder

• Project Transition System of Support (SOS): Adult Persons with a Dual Dx of I/DD and

Severe BH Challenges (Top 3% of typical Medicaid Population)

• Project Transition SOS Preparation for Adulthood: Emerging Young Adults

• Project Transition Specialized I/DD Health Home: Persons with I/DD who require rigorous

integration of Behavioral Health, Primary and Specialty Care

• Project Transition Proprietary Person-Centered Toolkit

• Swing by later and we can discuss

Leverage technology to increase care coordination, efficiency, fidelity to our models, and

innovation in service delivery

• What’s Next: IT-Enabled Dialectical Behavior Therapy and Sills Coaching Line

40

Better Together: Information Technology and Implementation Provider


Lessons Learned – Provider Perspective

• Evolution of Information Technology from the folks that need to adopt the technology

• Hot Servers

• PICNIC

• What were we really doing?

• More Serious Lessons Learned

• REALITY of our work with some of society’s most vulnerable Members

• This is Serious Mental Illness. This is Serious business

• Needs to be set up, needs to be set up right, needs to be run, needs to be run right

• So our great clinicians can do the great work - that is our secret sauce

• Some clinicians and Provider-Organizations are inherently skeptical:

• What’s really at the heart of the pushback (the Black Box)

• If you can imagine a SmartPhone taking some or all of your job… don’t worry…

• It will!

• So let’s define it on the right terms

• Pick the Right Provider Partner (Solution-Focused)

41

Learn from Other Industries who talk about Customer-Centered Service

41


42

Project Transition Methodology, System of Support (SOS)


Each of these steps is significant process of itself (this is woefully inadequate

overview…)

Define Outcomes Together First

• GPS Analogy … My New title: Chairman Of The Obvious

• Focus here PRIOR to picking/defining Product, Service, Technology, Solution

• Rigorously Define the outcomes: Data Dictionary Approach

• Has to be known, fully understood, “POINTED TO” by someone outside of our

clinical/programmatic language … your technology partner is perfect candidate

• You can always back off …

• You can always quit once you now what you’re getting into …

• Assume Research-Grade / 3rd Party Validation of Results

• If we wait for our friends in Academia you’re looking at approx. 17 years cycle time … we don’t

have 17 weeks

• You can always back off

Define Stakeholders Together First – make sure you understand how information flows

in your Customer’s Organization

• Defines your Drilldown Methodology in the Outcomes System

43




overview…)

For Catchment Area - State, County, Market, defined geography, whatever:

• Define known system gaps, silo’s, or other inefficiencies in current state delivery

• Known and agreed upon with your Payor Partner

Define the tools… rigorously... Define the processes and workflows…. Rigorously

• Optimize the workflows

• Map the workflows

• Repeat … with separate team (2nd set of eyes)

• Repeat … with separate team (3rd set of eyes)

• (Nobody does this)

44




overview…)

Work with your technology partner to digitize the toolset

• Simplify. Remember PICNIC

• Build irrevocable and unavoidable workflow infrastructure into EMR (or other electronic tool

that is used, relied upon, and required)

• Simplify. Remember PICNIC. You are most likely NOT the ultimate user – has to be

adopted by her or him

• “I saw the Member” – Now that you now this will happen, assume this will happen. What are you

going to do about it

Now Pilot, not before

You are PROUD of the OUTCOMES

You are accountable for the OUTCOMES

You knew the barriers upfront, you knew the required outcomes upfront, and you

stepped up and made a difference

45



What is the SOS, significant coordination across all key stakeholders

• Exceptional Partnerships across all Stakeholders, driven by TennCare, Department of

Intellectual and Developmental Disabilities, Blue Cross and Blue Shield of Tennessee,

Amerigroup of Tennessee and United Behavioral Health

• IT-Enabled behavioral health services for individuals with I/DD and co-occurring

mental health and/or behavior disorders, delivered through Managed Care

Significant opportunity to lever IT to drive positive outcomes, fidelity to the model, and scale

46



What is the SOS, significant care coordination

• Person-centered assessment

• Crisis intervention, stabilization and prevention to avoid potential triggers and to

provide positive behavior supports

• Comprehensive face-to-face person-centered assessment

• Structured discussions with caregivers (paid or unpaid), family members/conservators, etc., who may help inform the planning process

• Includes comprehensive review of health care issues/needs including physical and mental health diagnoses, skills, skill deficits and other concerns that could trigger need for behavior intervention

• Target medications which could impact behaviors and/or prescribed to address behavioral needs (“chemical restraints”)

Note how each component providers significant opportunity to lever IT to drive positive outcomes, fidelity to the model, and scale

47



What is the SOS, significant care coordination

• IT-Enabled Crisis Prevention and Intervention Plan (CPIP)

• Must be easily understood by those who provide supports, e.g., family members

and direct support staff (person-centered and practical)

• Individualized and speak specifically to known vulnerabilities and potential

triggers and the most effective calming/de-escalation techniques

• Clarify actions the person’s system of support can take when needed—who they

will call, what they will do

• Updated on an ongoing basis, and as needed following any crisis requiring

intervention and/or stabilization services

• TennCare sponsored and driven: For individuals enrolled in an HCBS program

(1915(c) or MLTSS), integrated into the person-centered support plan to ensure

integration/coordination of behavior support needs across services and settings

Perfect candidate to IT-Enable

48



What is the SOS – not just care coordination ….

• 24/7 crisis intervention and stabilization response

– BE WITH THE MEMBER AND CIRCLE OF SUPPORT, including in rural and

substantially under-served areas

– Assist and support the person or agency who is primarily responsible for

supporting an individual with I/DD who is experiencing a behavioral crisis that

presents a threat to the individual’s health and safety or community living

arrangement, or the health and safety of others

– Partner/collaborate with the provider or family caregiver to stabilize in place,

divert from unnecessary/inappropriate inpatient, and support sustained

integrated community living whenever possible/appropriate

– SOS team gains ability to anticipate and prevent behavioral escalations,

reducing the need for crisis intervention by the SOS provider

Scaled across the State, exclusively with the highest utilizers of services, serving

roughly 2.5 times the member population of our company at that time…

Again, perfect candidate to IT-Enable

49



What is the SOS – not just coordinated services, a model of service delivery

• Technology platform tracks outcome measures to drive results

– Decrease crisis events

– Decrease need for out-of-home placement to stabilize crises

– Decrease ER visits and unnecessary/inappropriate inpatient psychiatric

hospitalizations (utilization and cost)

– Decrease inappropriate use of psychotropic medications (i.e., for behavior

management)

– Decrease intensity/cost of HCBS (more cost-effective services/more integrated

settings)

– Increase sustained community living

– Improve quality of life

• Next Phase: use outcomes data to establish a value-based purchasing component

(incentive or shared savings) for reimbursement

• build the capacity of the system to better support individuals with I/DD who experience

challenging behavior—creating more effective Systems of Support

50

Outcomes DemoProject Transition and Mozzaz

50


51

Project Transition and Mozzaz


Wayne

LawrenceHardin

Decatur

Perry

Johnson

Washington Carter

Knox

Loudon

HamblenGrainger

McMinn Monroe

Rhea

Bledsoe

Sequatchie

PolkBradley

Tipton

ShelbyHardeman

Hancock

HawkinsOverton

PickettClay

Cannon

Warren

Bedford

Moore

VanBuren

Grundy

Giles

Marshall

Williamson

Davidson

Houston

RobertsonSumnerMontgomery

Benton

Madison

Scott

Henderson

Stewart MaconSullivanClaiborne

CampbellFentressJacksonObionLake

WeakleyHenry

Trousdale

CheathamUnion

SmithGreene

MorganWilsonDickson Putnam Anderson Unicoi

HumphreysGibsonDyer Jefferson

CockeCumberlandCarroll DeKalb

Rutherford

White

RoaneSevier

Crockett Hickman

Lauderdale Blount

MauryHaywood

MeigsCoffee

Lewis

Chester

HamiltonFayetteMcNairy Lincoln Franklin Marion

0

0

75 Miles

75 KM

*1 Lead State Entity *3 Grand Regions*3 MCO’s

52


• 98% of all Counties in Tennessee are with in the 90 minute response

time

• 98% of all zip codes in Tennessee are with in the 90 minute response

time

• 100% of all counties in Tennessee are within the 2 hour response time

• 100% of all zip codes in Tennessee are with in the 2 hour response

time

• Full Fidelity to the model (8 Core Elements with Defined Service

Levels)


Key Service Metrics (these are Metrics, not Outcomes!)

53



54

Project Transition: Outcomes Home Page

54


55

55


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Questions & Discussion

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Documents

Information Exchange & Tech Innovation: How Technology Is ... · Luke Crabtree, JD, MBA, Chief Executive Officer, Project Transition IV. Questions & Discussion Agenda. Technology