1© 2017. All Rights Reserved.
www.openminds.com15 Lincoln Square, Gettysburg, Pennsylvania 17325
Phone: 717-334-1329 - Email: [email protected]
#OMTechnology
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
2© 2017. All Rights Reserved.
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
4© 2017. All Rights Reserved.
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
5© 2017. All Rights Reserved.
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
6© 2017. All Rights Reserved.
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
11 | MAXIMUS: PRESENTATION TITLE
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
12 | MAXIMUS: PRESENTATION TITLE
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.
13 | MAXIMUS: PRESENTATION TITLE
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
15 | MAXIMUS: PRESENTATION TITLE
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
16 | MAXIMUS: PRESENTATION TITLE
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
17 | MAXIMUS: PRESENTATION TITLE
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
MAXIMUS Mozzaz Case Management 22
• 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
MAXIMUS Mozzaz Case Management 23
• 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
MAXIMUS Mozzaz Case Management 24
• 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
MAXIMUS Mozzaz Case Management 25
• 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
MAXIMUS Mozzaz Case Management 26
• 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
MAXIMUS Mozzaz Case Management 27
• Participants can easily access facilitator contact information
• Participants can make calls from directly within the application
Support Group Information
MAXIMUS Mozzaz Case Management 28
• 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
MAXIMUS Mozzaz Case Management 29
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
MAXIMUS Mozzaz Case Management 30
Program Staff Care Portal
Review real-time reports of participant activity on the app
MAXIMUS Mozzaz Case Management 31
Program Staff Care Portal
Produce graphic view of participant activity on the appEnhance case
management by allowing analysis of participant activity specific to their needs
MAXIMUS Mozzaz Case Management 32
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
MAXIMUS Mozzaz Case Management 34
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
Project Transition Proprietary & Confidential
39
Project Transition Products and Options for Today’s Discussion
Project Transition Proprietary & Confidential
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
Project Transition Proprietary & Confidential
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
Project Transition Proprietary & Confidential
42
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
Each of these steps is significant process of itself (this is woefully inadequate
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
Each of these steps is significant process of itself (this is woefully inadequate
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Methodology, System of Support (SOS)
Project Transition Proprietary & Confidential
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
Project Transition Proprietary & Confidential
51
Project Transition and Mozzaz
Project Transition Proprietary & Confidential
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
Project Transition and Mozzaz
• 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)
Project Transition Proprietary & Confidential
Key Service Metrics (these are Metrics, not Outcomes!)
53
Project Transition and Mozzaz
Project Transition Proprietary & Confidential
54
Project Transition: Outcomes Home Page
54
Project Transition Proprietary & Confidential
55
55
Project Transition Proprietary & Confidential
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57
Questions & Discussion
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