The Future Role Of Mental Health Counselors: Leadership Issues and New Skills Needed For The Decade Ahead

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Neal Hawkins
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1 The Future Role Of Mental Health Counselors: Leadership Issues and New Skills Needed For The Decade Ahead Monica E. Oss, CEO, OPEN MINDS July 11, :10 2:20 PM EDT York Street, Gettysburg, Pennsylvania Phone: info@openminds.com Let s Start At The End Health plans want to pay us for the value we deliver to consumers not how many services we provided 2. As our reimbursement moves away from fee-forservice to pay-for-value, we will need to use more technology better to be competitive How did this happen? How did we arrive at a techenabled, value-based health and human service system? 2 1

com Let s Start At The End.... 1. Health plans want to pay us for the value we deliver to consumers not how many services we provided 2.

2 The Regulatory & Policy Effects of PPACA... 3 Drop in the uninsured population From an estimated 37 million people, or 20 percent of the population, in 2010 To 29 million, or 16 percent, by the second half of Parity legislation provides financial equity in mental health and addiction treatment benefits for almost all Americans with health insurance The Affordable Care Act has over 80 provisions that went into effect between 2010 and 2014 Expanded consumer access -- expanded Medicaid coverage, health insurance exchange, and essential health benefits Insurance coverage reform -- minimum medical loss ratios (MLR) for insurers; preexisting condition exclusions and lifetime limits prohibited Integrated care coordination models -- Medicaid health homes and accountable care organizations in Medicare Pay-for-performance -- Medicare valuebased purchasing initiatives and penalties for high rates of hospital readmissions Environmental Drivers Payer preference for coordinated care medical, behavioral, and social Technology changing nature of service and of competition More managed care across all payers Blurring of role of payer and provider More value-based purchasing riskbased and P4P Environmental drivers with a potential impact on market positioning and sustainability of health and human service organizations More competition with rise of consolidator companies 4 2

Parity legislation provides financial equity in mental health and addiction treatment benefits for almost all Americans with health insurance The Affordable Care Act has over 80 provisions that went

3 The Effect Of Changes In Financing & Technology? The Decentralization Of Expertise The Result? The Transformation Of The Leadership Of the Field 5 Three Mental Health Practice Scenarios Have Different Fit In New Landscape 6 3

The Transformation Of The Leadership Of the Field 5

4 Key Changes: Mental health counselors in private practices funded by third-party payers More focused referral patterns due to narrow networks Changing reimbursement structure Technological substitution from new web-based care delivery tools Participation in integrated models 7 Effects on Practices Referral Patterns The growth of accountable care organizations (now at 17% of the population) is effectively causing the referral networks for behavioral health services to shrink. Most ACOs are owned by some type of health care system and many of those systems are making the decision to hire their own behavioral health professionals rather than refer out. Reimbursement Structure From a reimbursement perspective, health plans are moving to more pay-for-value contracting in the form of both pay-for-performance (P4P) contracting and risk-sharing arrangements. Almost 40% of commercial health plan reimbursement arrangements have some form of P4P and that is spreading to Medicaid and Medicare health plan reimbursement. Technological Substitution Private practices need to invest in practice management and electronic health recordkeeping software with more robust functionality. Most the P4P arrangements shift to more financial risk sharing, the more likely the health plan is to consolidate its provider networks into fewer, and larger, provider organizations. 8 4

population) is effectively causing the referral networks for behavioral health services to shrink.

5 Effects on Practices Less choice for consumers: Means understanding of payer market in your geography and how to develop referral relationships with ACOs and health plans is key Reframe marketing efforts to market within existing networks Ability to work within primary care practices essential in many markets Restructuring practice model to participate in pay-for-performance contracts Almost 40% of commercial health plan reimbursement arrangements have some form of P4P and that is spreading to Medicaid and Medicare health plan reimbursement. 9 Tools And Competencies Needed For Future Success 1 2 Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. Ability to use new tools and techniques for consumer engagement and whole person health management 3 Ability to use EHR data and clinical decision support tools 4 Telehealth platform for consumer service delivery 5 EHR with interoperable data sharing capability 6 Optimized web site for referrals and Positioned & Branded social media presence 7 Referral generation plan 8 Formal (contractual and procedural) relationships with health plans and their ACOS and medical homes 9 Administrative infrastructure for efficient eligibility determination, care preauthorization, and billing processes 10 5

40% of commercial health plan reimbursement arrangements have some form of P4P and that is spreading to Medicaid and Medicare health plan reimbursement.

6 Tools & Competencies Needed For Future Success In Third-Party Payer Practices 1. Formal (contractual and procedural) relationships with health plans and their ACOS and medical homes 2. Administrative infrastructure for efficient eligibility determination, care preauthorization, and billing processes 3. EHR with interoperable data sharing capability 4. Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. 5. Ability to use new tools and techniques for consumer engagement and whole person health management 6. Telehealth platform for consumer service deliver 7. Optimized web site for referrals and Positioned & Branded social media presence 8. Referral generation plan 11 Key Changes: Mental health counselors in cash practices Cash Only Demographic Shifting Americans are paying an increasing amount of their total health care costs including behavioral health services. Due to: Higher premium sharing High-deductible health plans Rising copayment amounts 12 6

Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. 5.

7 Effects on Practices Competition for these consumers is growing just as quickly. Mental health professionals displaced from shrinking networks are creating new cash practices using telehealth to widen their geographic reach to consumers. At the same time, the organized telehealth companies and retail clinic locations are offering mental health counselling services on a cash basis. 13 Tools & Competencies Needed For Future Success In Cash-Paid Practices 1. Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. 2. Telehealth platform for consumer service delivery 3. Optimized web site for referrals and Positioned & Branded social media presence 4. Referral generation plan 14 7

At the same time, the organized telehealth companies and retail clinic locations are offering mental health counselling services on a cash basis.

8 Key Changes: Mental health counselors employed by service provider organizations Use of EHRs for practice documentation (more scrutiny by payers) Practice using decision support tools that fit with the organizations pay-for-value arrangements Productivity-based compensation Practice in community-based settings (including primary care) Use of tech-enabled models of service dleivery 15 Effects on Practices Shifting Roles The role of health care provider organizations that offer mental health counseling services is shifting with the health care landscape. And the role of mental health counselors is shifting with it. The driver of change is the shift to value-based reimbursement models. Pay-For-Performance >> Pay-For-Success >> Risk-Based Reimbursement Arrangements This Financing Shift Is Pushing The Entire Health System To: Coordinated care management models (the whole person approach) Integrated service delivery models Implementation of interoperable EHRS Standardized clinical treatment protocols based on clinical outcomes Use of clinical decision support tools 16 8

Practices Shifting Roles The role of health care provider organizations that offer mental health counseling services is shifting with the health care landscape.

9 Tools & Competencies Needed For Success In Provider Systems 1. Ability to participate in eligibility determination, care preauthorization, and billing processes 2. Use of EHR with interoperable data sharing capability 3. Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. 4. Ability to use new tools and techniques for consumer engagement and whole person health management 5. Telehealth platform for consumer service deliver 17 OPEN MINDS Ten Key Tools For Success of Mental Health Counselors Mental health counselors in private practice with thirdparty reimbursement Mental health counselors in private practice with private pay Mental health counselors employed by service provider organizations 1. Knowledge of and ability to use new treatment tools genetic, diagnostic, disease statement management, neurotech, pharmaceutical, etc. X X X 2. Ability to use new tools and techniques for consumer engagement and whole person health management X X X 3. Ability to use EHR data and clinical decision support tools X X 4. Telehealth platform for consumer service delivery X X X 5. EHR with interoperable data sharing capability X X 6. Optimized web site for referrals and Positioned & Branded X X social media presence 7. Referral generation plan X X 8. Formal (contractual and procedural) relationships with health plans and their ACOS and medical homes X 9. Administrative infrastructure for efficient eligibility determination, care preauthorization, and billing processes X 10. Ability to work as part of a medically-oriented clinical team X 18 9

Ability to use new tools and techniques for consumer engagement and whole person health management 5.

10 Managing Strategy During Market Turbulence Sustainability in current environment Surviving the turbulence of change Planning for sustainable future 19 Questions Discussion 20 10

11 Chronic Care Management Disability Supports & Long-Term Care Mental Health Services Addiction Treatment Social Services Intellectual & Developmental Disability Supports Child & Family Services Juvenile Justice Adult Corrections Health Care York Street, Gettysburg, Pennsylvania Phone: info@openminds.com 11

Child & Family Services Juvenile Justice Adult Corrections Health Care www.openminds.

Next Generation EHRs: How To Meet The Demands Of Your Market With Transformational Technology

Next Generation EHRs: How To Meet The Demands Of Your Market With Transformational Technology A White Paper By OPEN MINDS & Core Solutions Published July 2015 Executive Summary With the shifting financing