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Innovation Communities: Celebrating Success
Showcase Webinar
Kate Davidson, LCSW
Kate Davidson, LCSWAssistant Vice President, Practice ImprovementNational Council for Behavioral [email protected]
Presenter
Innovation Community Showcase Webinar
During this webinar we will…
• Reflect on the Innovation Communities▪ Long-Acting Injectable (LAI) Antipsychotics
▪ Risk Stratification
• Celebrate Innovation Communities – challenges, successes, & lessons learned
▪ LAIs • Northwell Health
▪ Risk Stratification • Sullivan County Department of Community Services, Behavioral Health Clinic
• Montefiore Medical Center, Wakefield Hospital
• Park Slope Center for Mental Health
• Harlem East Life Plan
• Preview upcoming Care Transitions Network events
Innovation Communities
Care Transitions Network Clinical Goal:
Reduce all-cause re-hospitalization rates by
50% for people with serious mental illness
• Three (3) month deep dive into subject matter
▪ Webinars – TCPI expert faculty
▪ Affinity Groups – peer-to-peer learning & application
▪ Showcase webinar – celebrate successes
Innovation Communities Support this Goal…
Innovation Community Topics
LAI Antipsychotics
LAIs and the Challenges of Medication Adherence
Helping Patients Make Decisions about LAI Treatment
Current Reimbursement for LAI Antipsychotics
Setting up an LAI Antipsychotic Program
Switching, Dosing, and Other Prescribing Issues
Sustaining a LAI Antipsychotic Program
Risk Stratification
Defining Your Risk Stratification Algorithm
Building a Risk Stratification Algorithm
Mapping the Algorithm to Your EMR
Linking Population Health with Risk Stratification
Using Data to Drive Clinical Supervision
Embedding Risk Stratification into Policies and Procedures
The LAI Innovation Community
Northwell Health
Thank you for your participation in the LAI Innovation Community!
We appreciate the many challenges agencies confront.You are to be applauded for your improvement efforts in a sometimes difficult health care environment.
Thank you for your participation in the LAI Innovation Community!
• Your participation in series of webinars and affinity group meetings
• Goals accomplished:• Better understanding of LAIs as an important intervention for medication non-
adherence and
• Better understanding and utilization of resources to increase prescription of LAIs
Your Accomplishments
• Celebrate your agencies accomplishments
• Sharing of information
• Peer-to-peer learning
• Readiness to learn new and adapt existing practices
• Commitment to organizational success
Organizational Successes
Bleuler Psychotherapy Center: A Holistic Approach
• Utilizing the LAI Innovation Community to promote their vision• Decrease hospitalizations
• Increase number of patients on LAIs
• Increase clients’ life expectancy
• Prepare for Value-based Purchasing agreements
Making Data Driven Decisions
• Utilizing PSYCKES data to inform treatment
• High utilizers of inpatient hospitalizations
• High utilizers of ER visits
• Adherence measure in PSYCKES to see who is picking up their medication (based on pharmacy fill data)
• Translating this information to staff• Behavioral Healthcare Coordination Consultation Form
Administration: Positive & Focused
• Advancement of LAI Program is being driven by administration
• Translating data for staff has been well received
• Continuous reinforcement of ongoing initiatives with staff
• Encouraging open and transparent communication with staff
• Providing on-going training opportunities for staff• In-person Northwell trainings offered through CTN Technical Assistance
▪ Helping Patients Make Decisions about LAI treatment
▪ Diagnosing Comorbidity
Catholic Charities Brooklyn and Queens: Organizational Culture Change
• Utilizing the LAI Innovation Community as a Vehicle for Change
• Increase evidence-based practices
• Decrease hospitalizations
• Negotiate with MCOs
• Prepare for Value-based Purchasing agreements
• Dispelling myths around LAIs• Only for complex cases
• Only for client who are deemed “non-compliant”
Support from Administration
• Communicated with leadership and staff about developing an LAI program
• Encouraging staff to attend the webinars and affinity groups
• Clerical support for authorization and patient specific benefit verification process
• Allows 30-minute medication management appointments
• Identified a Champion: Dr. Felix Sterling• Doubled his use of prescribing LAI in past 2 years
• More than 35 patients on LAIs
• Enthusiastic, knowledgeable, and willing to share his personal experiences with staff
Data Collection
• Looking at the adherence measure in PSYCKES to see who is picking up their medication (based on pharmacy fill data)
• Tracking monthly hospitalization rate through clinical reporting
• Tracking how many clients on LAIs have been hospitalized in the past 6 months
• Disseminating this information to staff
Educating and Training Staff
• Utilized the CTN Technical Assistance Opportunities• LAIs for Prescribers – The Use of Long Acting Injectable Antipsychotics
• LAIs for Non-Prescribers: Are Long Acting Injectable Antipsychotics a Good Choice for Your Patients?
• Ongoing communication with Northwell consultants to assist with • Best Clinical Practice
• Evidence-based practices
Catholic Charities’ LAI program:Future Plans
• Integrate increased LAI use as part of a larger initiative to increase treatment adherence and enhance recovery
• Changing workflow processes:
• Hiring registered nurses to administer the injections and the required observation period
• On-site pharmacy
• Increase staff education
• Working with Northwell to provide more on-site trainings to assist in increasing accurate client education of appropriate LAI treatment
• Market LAIs directly to clients
• Place LAI literature in client waiting areas to increase knowledge and destigmatize LAIs
• Increase communication with administration and clinical staff
• Implement monthly case management meetings to review new clients who may be appropriate for LAI
Next Steps: LAI Resources
• Schedule your FREE LAI training• Customizable to your agencies needs
• Northwell Consultation• Best Clinical Practice Support Services
• Education about other clinical measures including quality of life, functional improvements, and psychopathology
• LAI Prescriber Toolkit • Online learning module that is available through the Center for Practice Innovations
website
Contact InformationMadeline Maldonado, [email protected] Psychotherapy CenterClinical Director
Claudia M. Salazar, [email protected] CharitiesVice President of Clinics, Recovery, and Rehabilitative Services
John Kane, [email protected] Zucker Hillside HospitalNorthwell Health
Delbert Robinson, [email protected] Zucker Hillside HospitalNorthwell Health
Lauren Hanna, [email protected] Zucker Hillside HospitalNorthwell Health
Megan Walsh, MA, LMHC, [email protected] Zucker Hillside HospitalNorthwell Health
The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.
Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
The Risk Stratification Innovation Community
Sullivan County Department of Community Services
Behavioral Health Clinic
Low-Income Patient Populations• The Behavioral Health Clinic sees approximately 1600 patients per
month, ranging in age from 5-years-old through adulthood.
• 6% of our client population are classified as high risk.
• The majority of the clients are people who are impoverished and
the working poor.
• Principle payer is Medicaid Managed Care.
Lack of Transportation• Transportation and access to services is poor.
• We are a large, rural county, roughly the size of Rhode Island,
without viable mass transportation opportunities.
• Transportation has been a factor in client engagement and
retention.
Barriers to Implementing New Processes
Open Access Clinic • The clinic intake and scheduling processes were revised in April 2013
• Instituted an Open Access Clinic▪ Walk-in clinic in which clients are served on a first come - first serve
basis four days a week.
Just-In-Time’ Scheduling• The clinic initiated ‘Just-In-Time’ Scheduling in February 2015.
• Clients are not given a follow-up appointment –▪ Provided with a reminder card to call to schedule their next appointment.
▪ When they call, the appointment is scheduled in 3-5 business days.
Integrated Care• In February 2017, we became an integrated behavioral health clinic
• Combined our OASAS licensed substance abuse clinic and OMH
licensed mental health clinic into one behavioral health clinic under
the licensure of OMH.
Solutions
• Plan to link all clients identified as high risk, not previously assigned a
health home care management program, to a health home care
management program.
• Clinicians are reviewing clinical summaries on Psyckes site for all
clients rostered as high risk.
• Indicators:▪ Engagement and ensuring that high risk clients are seen a minimum of
every 2 weeks
▪ Monitoring medication compliance/adherence
▪ Monitoring usage of ER/inpatient Settings
• Began Wellness/Health Management group in September to promote
healthy lifestyle, diet, and smoking cessation.
Progress
1600 + clients in any given month• Small percentage, approximately 6% are the highest users of emergency
department and inpatient services, both for medical and behavioral
health needs.
• Of those clients, many of them had issues with engagement, medication
adherence, and following treatment recommendations.
Correlations• Strong correlation with secondary issues of substance abuse and mental
illness.
• Strong correlation with mental illness and cardiometabolic issues of
obesity, diabetes, and chronic physical health issues.
• Significant correlation with trauma exposure and behavioral health issues
in our overall patient population.
Discoveries: Patient Populations
• Change is not unique to our organization, as we have instituted several
changes over the past few years.
• Change was embraced by some staff more quickly than others.
• Some staff need extra coaching and prompts to utilize the Psyckes
software on a routine basis.
• Staff initially were enthusiastic about informing clients designated as
high risk, who were not assigned to a health home care management
organization, about the availability of the service.
• Within a month, 41% of high risk clients were linked, however, efforts to
continue to link clients with the service has fallen off.
New Processes & Organizational Engagement
EHR System Upgrade • Currently awaiting a software upgrade to our EHR system to fully
operationalize our algorithm. ▪ Our EHR has been in existence since 2007 and is in need of an upgrade.
▪ We are a county government unit - coordination between our county IT
department and our software vendor needs to take place prior to the update
taking place, which has stalled our efforts to fully operationalize our algorithm.
▪ In the interim, we are manually extracting data from our EHR, which hinders our
ability to fully assess the accuracy and effectiveness of data in our risk
stratification tool.
Trainings Scheduled• November - Training on collaborative documentation practices.
▪ After the training, this practice will be mandatory for clinicians to comply with.
• January & February - Trauma Informed trainings for the entire agency to
enhance our trauma lens
Next Steps
Risk Stratification Modification in a Large Medical Center:
Working within a Framework of Systemic Barriers
Michael Schmidt, LCSW, Clinical Supervisor, Montefiore Medical Center,
Wakefield Hospital
Adult Outpatient Psychiatry
• EMR is a hospital-wide system covering multiple departments and sites
• Therefore, we cannot have reports run for our clinic’s site
• There is a separate finance department, so finance cannot be involved in the clinic’s stratification process
• Montefiore Medical Center’s current Department of Psychiatry risk stratification algorithm is fully operational across multiple sites, so a different algorithm cannot be formally implemented
• The current algorithm informs clinicians’ practices and our Department Policy and Procedure
Barriers
• Psychiatric hospitalizations
• Psychiatric ED visits
• Medical hospitalizations
• Medical ED visits
Revised Indicators of Riskfor Risk Stratification Process
• Report by clinicians (psychiatrists, social workers, psychologists) of the previous occurrences with their patients
• Data entered manually
• Use of PSYCKES if consent given
• Process has been in place
How to Capture Data
Identification of ways to reduce inpatient psychiatric hospitalizations - (in process)
New Departmental Initiative
• Standard of high risk patients seen weekly, moderate risk patients biweekly
• All at risk patients are conferenced with weekly by their treatment team at weekly team meetings and outside of them
• Aggressive outreach for at-risk patients(use of emergency contact/collateral if patient does not respond to outreach for missed appts.
• Use of NYC-WELL referral if emergency contact/collateral does not work and if clinical situation warrants such a referral
• Safety plan developed for all at-risk patients and always incorporated into the treatment plan
Current Clinical Pathways
• The medical element needs to be factored in
• Frequency of psychiatric hospitalizations and ED visits is already an element of risk stratification, but will carry additional weight
• However, barrier exists that the current system is across several psychiatry sites and departments
Modification for New Risk Identification
• Development of a specific weighted algorithm
• Synthesizing what our current data tells us about our population
• Possible modification of clinical pathways
• Continuing to discuss/address systemic barriers
Future Steps
Park Slope Center for Mental Health
• Outpatient Mental Health
• Founded in 1987
• # Clinicians – 25
• # Psychiatrics – 4
• 620 clients and growing• 70% Medicaid
• All ages
• Depression/Anxiety/Bipolar and other psychotic disorders
• Located in the Park Slope Neighborhood of Brooklyn
Challenges
• Small organization with staff wearing multiple hats
• EHR – does not capture and pull all the data we need
• Relying on PSYCKES data – attribution and claim lags
Barriers
• Solution – Four indicators/weighted• PSYCKES Quality Flag – hospitalizations, readmissions
• If on Practice High Risk Flag
• More medium risk than high risk
• Want to prevent movement from Medium to High Risk
Indicators
Engagement Checklist• Operationalize it
Interventions
Harlem East Life Plan
Barriers
• Obtaining Data
• Looking at all the QI / accreditation projects and consolidating where can, leveraging
• Communication with community resources (hospitals – for admissions/readmissions/discharge planning)
• Understanding the different payers and what they allow for interventions –sometimes intervention doesn’t fit the consumer’s need; these can be in conflict with practices programs, interventions and systems
Solutions
• Use PSYCKES – using more frequently now and earlier in the course of treatment
• Put in baseline
• Incorporate indicators used in defining risk into intake process, where needed
• Incorporate therapist input
• Using community resources
• Define treatment protocols and safety planning
• Implementation of health monitoring protocols – Now RNs are part of MH and addiction programs
Progress
• Defined criteria for High, Moderate, Low risk
• Review weekly in team meetings
• Documented treatment protocols and safety planning
• Developed process to move consumers between levels of risk
• Having visual data has increased the buy in from the prescribing providers – improved team work
• Scheduled versus walk in consumers
Discoveries
• Number of pregnancies occurring for females in 20-30 year old in high risk group
• Looking at what agency can do to address this issue
• Number of consumers not reporting hospitalizations – can see the data now so can proactively pursue with the consumer
Next Steps
• Continue to collect data
• Include more indicators like medication adherence
• Process will impact the annual report – will help with how to think about 2018
• Redefining program model for VBP
New Care Transitions Network Series:
Value Propositions + Business Partnerships
Nina Marshall, Senior Director of Practice Improvement
Care Transitions Network
Helene Kopal, Senior Director of Practice Improvement
Care Transitions Network
New Care Transitions Network Series: Value Propositions + Business Partnerships
Clients
Payers
Value Proposition
Community Partners
Value Propositions Should Answer: • Who do you serve?
• What is the benefit of your services?
• What makes your services unique?
• How does this solve a problem?
We’ll Help You Answer: • Who might you partner with?
• What might that partnership look like?
• What are health plans’ pain points?
• How do you articulate your value?
• What is your next best step?
Getting Ready for Value Based Payments
• Develop community partnerships with other providers in the recognition as part of assuming shared accountability for patient outcomes and health communities
• Take steps to create and/or join IPAs and other collaborative organizations;
• Identify the goals and approaches taken by managed care organizations to foster quality care and reduce costs;
• Articulate the defining and differentiating characteristics of their organizations, and formulating value propositions; and
• Create a strategy to secure contracts and agreements aligned principally on quality and cost of services
Value Proposition + Business Partnerships Series
Mastering PSYCKES: Maximizing Data Sources to Operationalize Population Health
• Thursday, November 2nd, 2017 – 12:00-1:00pm E.T. This Thursday!
Role of Community Partnerships in Value-Based Payments
• Thursday, November 30th, 2017 – 12:30-1:30pm E.T.
Payers and Pain Points: Scanning the Health Plan Environment
• Wednesday, December 13th, 2017 – 1:00-2:00pm E.T.
Knowing Your Value: Positioning as Business Partners
• Wednesday, January 17th, 2018 – 2:00-3:00pm E.T.
Regional Workshops: Communicating Your Value Walk away with a value proposition statement
• February and March 2018
Other Upcoming Events
Upcoming Events
Event Date/Time Audience
Opioid Affinity Group #1:
Evaluating Organizational
Readiness to Increase Access
to MAT
Tuesday, 11/28/17,
12:00 pm – 1:00 pm E.T.
Administrators
Opioid Affinity Group #2:
Using Risk Stratification to
Identify High-Risk Populations
and Increase Access
Tuesday, 12/19/17,
12:00 pm – 1:00 pm E.T.
Administrators
Opioid Affinity Group #3:
Developing an Action Plan to
Increase Access to MAT
Tuesday, 1/16/18,
12:00 pm – 1:00 pm E.T.
Administrators
Opioid Affinity Group #4:
Monitoring and Evaluation for
Continuous Quality
Improvement
Tuesday, 1/30/18,
12:00 pm – 1:00 pm E.T
Administrators
The Opioid Affinity Group will help practices
with MAT programs increase access to care for
people with OUD by providing the guidance,
strategies, and resources needed for
organizational transformation
• Enrollment for this affinity group will be limited
to 15 participants to facilitate effective peer-
to-peer sharing and learning
• Target audience:
▪ Administrators of medium-sized practices with
existing MAT programs
Opioid Affinity Group
Sign-up Period: November 14th – November 24th
Your Practice Coaches
Maura Gaswirth
Practice Transformation Specialist
Donna Stevenson
Practice Transformation Specialist
Thank you!
www.CareTransitionsNetwork.org
The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.
Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
