BEHAVIORAL HEALTH/ HUMAN SERVICES INFORMATION SYSTEMS SURVEY

Transcription

1 BEHAVIORAL HEALTH/ HUMAN SERVICES INFORMATION SYSTEMS SURVEY JUNE, 2009 SPONSORED BY: CONDUCTED BY: Paul M. Lefkovitz, Ph.D. Lead Consultant

2 BEHAVIORAL HEALTH/HUMAN SERVICES INFORMATION SYSTEMS SURVEY June, 2009 Copyright Notice The Behavioral Health/Human Services Information Systems Survey (the "Survey") and the results thereof are for sole and exclusive use of the Software and Technology Vendors Association ("SATVA") and its current members and entities who were members in FY08-09 ("Licensed Members") only. Licensed Members may use the Survey solely for their internal business purposes only and not for further distribution or resale. All other use is strictly prohibited, without prior written permission from SATVA. (Permission may be requested by sending an to the following address: Each citation to, excerpt from or other reference to the Survey must include the following legend: *The Behavioral Health/Human Services Information Systems Survey is used with permission from the Software and Technology Vendors Association. Copyright 2009 Software and Technology Vendors Association. Further reproduction and distribution is prohibited. All Rights Reserved. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 1

3 BEHAVIORAL HEALTH/HUMAN SERVICES INFORMATION SYSTEMS SURVEY June, 2009 Table of Contents Copyright Notice... Table of Contents.. Executive Summary. Background.... Methodology... Findings Which of the following best describes your organization? Which of the following client populations does your organization serve? Please provide break-outs of revenue as a PERCENT of total revenue... 4a. Current total operating budget... 4b. Uncompensated care c. Number of consumers served per year. 4d. Number of FTEs in your organization... 4e. Number of FTEs in your organization dedicated to Information Technology. 4f. IT FTEs as a percentage of total FTEs.. 5. What are the PRIMARY barriers to the implementation of information technology in behavioral healthcare?... 6a. Rate how beneficial each of the following would be to the quality of behavioral healthcare: Telepsychiatry.. 6b. Rate how beneficial each of the following would be to the quality of behavioral healthcare: Electronic medical records. 6c. Rate how beneficial each of the following would be to the quality of behavioral healthcare: Inter-operability with general medical/primary care systems d. Rate how beneficial each of the following would be to the quality of behavioral healthcare: Personal medical records.. 7. What reimbursement change(s) would be most effective in helping you afford or implement health information technology in the future? How helpful is your clinical information system/electronic health record in contributing to the quality of care in the services you provide? Are you currently providing mobile care, for example, home-based services, community-based care outside of the facility? If yes, do you have electronic access to your primary electronic health record when you are outside the office? If you are a community behavioral health agency, are you responsible for providing inpatient care either directly or contractually? How satisfied are you with your current behavioral health application IT vendor(s)? Do you use an Application Services Provider (ASP) for hosted software? Who is the primary decision maker for IT purchases?... 15a. How much will you spend this fiscal year in each of these IT-related categories? (Means)... 15b. How much will you spend this fiscal year in each of these IT-related categories? (Medians) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 2

4 Table of Contents (Continued) 15c. Break-Out of Free-Standing Psychiatric Hospital and Psychiatric Units in General Hospital Current Year Spending Data. 16. Compared to this year, how much do you plan to spend next year in each of these IT-related categories? If sufficient resources were available, how much would you spend next year, compared to this year in each of these IT-related categories?... 18a What is your estimated total annual IT-related spending this year, next year, and next year if sufficient resources were available?... 18b. Current IT spending as a percentage of total budget.. 18c. Next year IT spending as a percentage of total budget... 18d. Desired IT spending as a percentage of total budget Where did you get the following components of your organization s business/administrative information system that are electronically available?... 20a. Rate the level of implementation of each the components of your clinical information system that is electronically available 20b. Ratings of the helpfulness of clinical information systems or electronic health records in contributing to quality of care in services (Item 8) by levels of implementation of clinical information system components (Item 20a.). 20c. Cross tabulation. Ratings of satisfaction with current behavioral health IT vendors (Item 12) by levels of implementation of clinical information system components (Item 20a.) Which of these methods is/will be your regular PRIMARY means of communication with your referral sources and other providers Which of these methods is/will be your PRIMARY means of communication regularly used with your health plan members or consumers 23. To what extent do you consider participating in a RHIO (Regional Health Information Exchange) or HIE (Health Information Exchange) to be important? To what extent do you consider CCHIT (Certification Commission for Healthcare Information Technology) certification to be important? Do you have information systems that are currently integrated/ interoperable with primary health care?. 26. Do you have information systems that are currently integrated/ interoperable with public health?... Market Estimates.. Benchmarking Section... IT FTEs as a Percentage of Total FTEs. Current IT Spending as a Percentage of Total Budget Next Year IT Spending as a Percentage of Total Budget Desired IT Spending as a Percentage of Total Budget Hardware Expense as a Percentage of Total IT Expense... IT Personnel Expense as a Percentage of Total IT Expense. Summary and Implications Appendix A: Behavioral Health/Human Services Information Systems Survey. Appendix B: Invitation to Participate in Survey Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 3

5 BEHAVIORAL HEALTH/HUMAN SERVICES INFORMATION SYSTEMS SURVEY June, 2009 Executive Summary A comprehensive national survey was launched in January of 2009 to provide a contemporary picture of behavioral health and human services information systems practices and trends. The project was co-sponsored by the Software and Technology Vendors Association (SATVA), the National Council for Community Behavioral Healthcare, the Mental Health Corporations of America (MHCA), and the National Association of Psychiatric Health Systems (NAPHS). This report contains a summary of the findings of that study. Method An on-line survey was conducted containing 26 questions related to the demographic characteristics of providers, utilization of information technology (IT), IT expenditures, service delivery practices, and attitudinal factors. Survey responses were received from 440 organizations representing varied segments within the behavioral health and human services industry. Aggregated survey responses for each question were reported by overall sample as well as eight organization types, including community behavioral health providers; hospitals or psychiatric units in general hospitals; residential facilities; state or county providers; private clinical group practices; substance abuse or addictions providers; managed care organizations; and others. The information was summarized using descriptive statistics only. No inferential statistics were applied to the data. Findings It was found that information technology is widely perceived to offer positive contributions to the effectiveness of behavioral health and human services. However, its ultimate potential still awaits fulfillment. While substantial financial resources are already devoted to information technology in behavioral health and human services, additional support is needed to galvanize development efforts and fill significant key implementation gaps. The perceived value of information technology was found to be related to its level of implementation. High levels of perceived benefit were found with respect to the value of electronic medical records and inter-operability with medical/primary care systems. The perceived benefit of other technology platforms such as telepsychiatry and personal medical records was not as robust. The primary barrier to the adoption of information technology is most often perceived to be financial in nature. Other factors, such as lack of compatibility and concerns about loss of privacy were decidedly more modest. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 4

6 A high level of satisfaction among providers was found to exist with information technology vendors. Degree of satisfaction was found to be related to level of implementation. Those with fully implemented IT components are more likely to be satisfied. In general, the primary decision-maker for IT-related purchases was found to be the CEO. However among hospital/psychiatric units, the CIO was most frequently identified as the primary decision-maker. The preponderance of software is purchased as opposed to developed in-house. Only a small minority of providers use an application services provider for hosted software. On average, total information technology spending (including staffing, software, hardware, etc.) in behavioral healthcare/human services represents approximately 1.8% of the total operating budget. This figure lags far behind the corresponding IT spending figure of 3.5% in general healthcare. In terms of personnel, IT staffing generally represents about 1.3% of total FTEs. Again, this figure is only 31% of the comparable figure of 4.3% in general health care. In the current healthcare environment, expectations for future IT spending are conservative, with most respondents projecting static or slightly declining expenditures next year. However, the need for IT resources far outstrips current levels of support. If sufficient resources were available, overall IT spending would increase by about 15%. It was found that most providers have acquired software in key business/administrative areas such as general ledger, payroll, accounts receivable, accounts payable and state or regulatory reporting. However, in terms of the clinical electronic medical record, significant gaps were found to exist, particularly in terms of level of implementation. Fewer than half of behavioral health and human services providers possess fully implemented clinical electronic record systems. Level of implementation was found to be related to satisfaction with IT vendor and perceived value of the electronic record. Technology is anticipated to contribute to changes in day-to-day communications with referral sources, other providers, and consumers. Communications with referral sources and other providers is expected to shift primarily from telephone, fax, and (in that order) to the internet, , and the telephone, respectively. Communications with consumers is also expected to embrace broader technology platforms but the telephone is still anticipated to represent the primary medium. Level of inter-operability with both primary health care and public health was found to be in its formative stages. However, as noted above, a significant belief in the value of inter-operability was found to exist among respondents. There was limited awareness and belief in the importance of participating in a Regional Health Information Organization (RHIO) or a Health Information Exchange (HIE). Awareness is likely to increase greatly in the coming years, however, given the provisions of the American Recovery and Reinvestment Act that call for the development of such arrangements. Similarly, awareness and support for the importance of software certification such as CCHIT (Certification Commission for Healthcare Information Technology) was not found to be robust at this point in time. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 5

7 In summary, information technology is a dynamic and evolving force in behavioral healthcare and human services. As funding barriers are addressed and as more providers realize the benefits of full system acquisition and implementation, the impact of information technology on the efficiency and the effectiveness of service delivery can be expected to increase significantly. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 6

8 BEHAVIORAL HEALTH/HUMAN SERVICES INFORMATION SYSTEMS SURVEY June, 2009 Background In 2001, a consortium of six behavioral health software vendors commissioned an in-depth survey of behavioral health software practices and trends. The project was conducted by William M. Mercer, Incorporated. The study provided a vehicle for vendors to identify market opportunities, guide strategic business decisions, and respond to information requests from prospective investors. The consortium, along with additional vendors, eventually coalesced into the Software and Technology Vendors Association (SATVA). In 2008, SATVA leaders determined that it was time to update the information provided by the 2001 survey. It was also decided to expand upon the mission of the project to include a broader consideration of the information technology needs among behavioral health and human services providers, the impact upon the quality and efficiency of service delivery, barriers to implementation, and advocacy opportunities. With that expanded vision in mind, a collaboration was established between SATVA, the National Council for Community Behavioral Healthcare, the Mental Health Corporations of America (MHCA), and the National Association of Psychiatric Health Systems (NAPHS). Study Contract Selection Centerstone Research Institute (CRI) was one of the organizations invited to bid for the opportunity to update and expand upon the 2001 study. CRI, a 2008 Excellence in Innovation award winner (National Council of Community Behavioral Healthcare) is active in groundbreaking research studies with a number of leading universities and is intimately familiar with the behavioral health industry. CRI was selected to conduct this study. Methodology The 2001 survey provided a point of departure in planning the 2009 project. A work group with representation from each of the sponsoring associations reviewed 2001 survey items for continued relevance, clarity, and desired detail. Modifications and deletions were made as deemed necessary. The expanded scope of the project provided the impetus for a number of new items related to the impact of information technology upon service delivery, unmet needs, directions for the future, and emerging trends. Efforts were made to be comprehensive while simultaneously avoiding the imposition of an unacceptable burden upon the respondents. The resultant survey is presented in Appendix A. A review of the market segments employed in the 2001 survey was conducted and certain modifications were made. The following organizational categories were selected for the current survey: Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 7

9 1. State/County Provider 2. Community Behavioral Health Provider 3. Other Behavioral Health Provider 4. Substance Abuse/Addictions Provider 5. Managed Care Organization 6. Free-Standing Psychiatric Hospital 7. Psychiatric Unit in General Hospital 8. Residential Treatment Center 9. Private Clinical Group Practice 10. Other The 2001 survey was distributed via regular US mail. It was felt fitting and appropriate to take full advantage of the technological advances that have occurred since then. Therefore, an invitation to participate in the current survey was distributed via and other electronic media. Each sponsoring association ed to their contact lists an electronic link to the survey. In addition, notices appeared in the on-line versions of Behavioral Healthcare and Addiction Professional Magazines. The invitation introduced and described the objectives of the project. Respondents were promised a copy of the executive summary of the findings. Assurances were provided that all information would be held in the strictest of confidence and that an organization s individual responses would not be shared with any entity, including the sponsoring associations. It was pointed out that data was being submitted to and managed by Centerstone Research Institute, an independent research organization. A copy of the invitation to participate is presented in Appendix B. The survey itself was also administered via a web-based electronic platform. SurveyMonkey was selected as the vehicle to be employed. Widely regarded as user-friendly, this popular webbased software offers powerful features for the design and analysis of survey data. The respondent accessed the survey by clicking on a link in the electronic notice they received. The survey consisted of four screen pages containing a total of 28 items. The survey was organized into four sections: (1) Organizational Demographic Information, (2) Opinions/Service Delivery Information, (3) Information Technology-Specific Information and (4) Contact Information. The respondent could exit the on-line survey at any point and access his or her partially completed survey at a later time. A copy of the on-line survey appears in Appendix B. The survey was launched in January of It was closed on March 6, The use of web-based technology obviated the 2001 survey task of entering the responses into a database. Completion of the on-line survey automatically entered the respondent s information into the database. This process eliminated the potential for data entry errors and the need for extra reviews of the data. Contact information was solicited solely to allow CRI to assist users in the event they needed help with the survey. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 8

10 Survey responses for each question were analyzed by overall sample as well as eight organization types, including community behavioral health providers; hospitals or psychiatric units in general hospitals; residential facilities; state or county providers; private clinical group practices; substance abuse or addictions providers; managed care organizations; and others. The information was summarized using descriptive statistics only. No inferential statistics were applied to the data. Acknowledgement is extended to Kevin Scalia, representing SATVA and Dennis P. Morrison, Ph.D., representing Centerstone Research Institute for their key roles in planning and implementing this study. Deep appreciation is also tendered to Jason Luellen, Ph.D. Senior Statistical Analyst, Centerstone Research Institute for his generous, skillful, and critical assistance in the preparation of tables and figures. Findings A total of 440 survey responses were received. Organizational types were combined for the analysis due to small sample sizes in some of the categories. The original ten categories were combined into the following eight categories for the analysis: 1. Community behavioral health provider 2. Hospital or psychiatric unit (Includes Free-Standing Psychiatric Hospital, Psychiatric Unit in General Hospital) 3. Residential facility 4. State or county provider 5. Private clinical group practice 6. Substance abuse or addictions provider 7. Managed care organization 8. Other (Includes Other Behavioral Health Provider and Other Provider) On the following pages, survey findings are presented for each item or question in chronological order. Item numbers in the report correspond to the survey numbers. For each survey question or item, one or more tables are presented that report the results for the overall sample and broken out by organization type. In addition, one or more charts for each question or item is presented to graphically illustrate the findings, also for the overall sample and broken out by organizational type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 9

11 Question 1. Which of the following best describes your organization? The total number of survey respondents was 440, of which 429 (97.5%) classified their organization into one of the organization types presented in Table 1. Those 429 respondents comprise the full sample on which the remainder of this report is based. Table 1 also presents the estimated total of providers within the United States for each organization type. Finally, the table includes survey responses as a percent of total entities for each type within the United States. As Table 1 illustrates, the majority of respondents identified themselves as community behavioral health providers (54.5%). In the 2001 survey, a total of 330 responses were received. Of those, 58.2% identified themselves as community behavioral health providers. Estimates of number of providers in the United States, broken out by organization type, were obtained. It was determined that community behavioral health survey respondents represent over 12% of the nation s providers, a very robust sample. Each of the other organizational types represents less than 10% of national counterparts. Therefore data presenting organization type break-outs, other than community behavioral health, should be regarded with appropriate caution. Table 1 Percentage of Respondents by Organization Type (N = 429) % N Estimated Number of Entities in U.S. Survey Respondents As a Percent of Total Entities in U.S. Organization type Community behavioral health provider 54.5% (234) 1893 a 12.4% Hospital or psychiatric unit 5.6% (24) 1560 a 1.5% Residential facility 6.5% (28) 508 a 5.5% State or county provider 2.3% (35) 1,555 b 8.8% Private clinical group practice 7.2% (31) 200,000 c <1% Substance abuse or addictions provider 4.9% (21) 2,000 d <1% Managed care organization 1.4% (6) 62 e 9.7% Other 11.7% (50) 5,000 f <1% Source References a Mental Health, United States, 2004, SAMHSA b Based on assumption that half of total US counties have a Mental Health Department, plus the 55 states/territories c Estimated from Occupational Outlook Handbook, , US Department of Labor d Based on industry expert estimates. Reliable data is unavailable. e NCQA Managed Behavioral Health Organization Listing f This category includes diverse behavioral health-oriented specialty, human services and social service organizations and this is a very rough estimate based upon US Dept of Health and Human Services internet resources. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 10

12 Organization Type Community behavioral health provider Hospital or psychiatric unit Residential facility State or county provider Private clinical group practice Substance abuse or addictions provider Managed care organization Other 5.6% 6.5% 8.2% 7.2% 4.9% 1.4% 11.7% 54.5% Figure 1. Question 1. Percentage of respondents by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 11

13 Question 2. Which of the following client populations does your organization serve? A total of 420 of 429 (97.9%) respondents answered Item 2. Of those, 232 (55.2%) were community behavioral health providers, 23 (5.5%) were hospital or psychiatric units, 28 (6.7%) were residential facilities, 33 (7.9%) were state or county providers, 30 (7.1%) were private clinical group practices, 21 (5.0%) were substance abuse or addictions providers, 6 (1.4%) were managed care organizations, and 47 (11.2%) were other types of organizations. Table 2 shows the percentage and number of respondents by client population served, overall and by organization type. Further, the results are presented graphically in Figures A high percentage of providers among all organization types serve the mental health population, with the exception of those that self identified as addiction providers. Most providers across each of the organizational types were also found to serve the addiction population. Therefore, the market overlap between mental health and addiction was found to be very high, which is consistent with the findings of the 2001 study. Therefore, software vendors are still advised to cross-market to these two populations. Other populations served were found to vary considerably by organization type. Those details can be reviewed in the table and figures below. Table 2 Percentage of Respondents by Client Population Served, Overall and by Organization Type Client population served Mental retardation Mental health Substance abuse or addictions or developmental disabilities Child welfare Criminal justice Other (N = 420) % N % N % N % N % N % N Overall 91.4% (384) 70.5% (296) 37.6% (158) 31.2% (131) 36.0% (151) 15.2% (64) Organization type Community behavioral health provider 98.3% (228) 73.7% (171) 40.5% (94) 42.7% (99) 45.3% (105) 19.4% (45) Hospital or psychiatric unit 10 (23) 73.9% (17) 21.7% (5) 21.7% (5) 13.0% (3) 4.3% (1) Residential facility 75.0% (21) 5 (14) 14.3% (4) 25.0% (7) 28.6% (8) 3.6% (1) State or county provider 90.9% (30) 78.8% (26) 69.7% (23) 12.1% (4) 33.3% (11) 6.1% (2) Private clinical group practice 10 (30) 6 (18) 2 (6) 6.7% (2) 13.3% (4) 1 (3) Substance abuse or addictions provider 42.9% (9) 10 (21) (0) 4.8% (1) 28.6% (6) 9.5% (2) Managed care organization 83.3% (5) 10 (6) 10 (6) (0) 16.7% (1) (0) Other 80.9% (38) 48.9% (23) 42.6% (20) 27.7% (13) 27.7% (13) 21.3% (10) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 12

14 Overall Mental health 91.4% Substance abuse or addictions Mental retardation or developmental disabilities Child welfare Criminal justice Other 37.6% 31.2% 36.0% 15.2% 70.5% 25.0% % 10 Community Behavioral Health Providers Hospitals or Psychiatric Units Mental health 98.3% Mental health 10 Substance abuse or addictions 73.7% Substance abuse or addictions 73.9% Mental retardation or developmental disabilities 40.5% Mental retardation or developmental disabilities 21.7% Child welfare 42.7% Child welfare 21.7% Criminal justice 45.3% Criminal justice 13.0% Other 19.4% Other 4.3% 25.0% % % % 10 Residential Facilities State or County Providers Mental health 75.0% Mental health 90.9% Substance abuse or addictions 5 Substance abuse or addictions 78.8% Mental retardation or developmental disabilities 14.3% Mental retardation or developmental disabilities 69.7% Child welfare 25.0% Child welfare 12.1% Criminal justice 28.6% Criminal justice 33.3% Other 3.6% Other 6.1% 25.0% % % % 10 Private Clinical Group Practices Substance Abuse or Addictions Providers Mental health 10 Mental health 42.9% Substance abuse or addictions 6 Substance abuse or addictions 10 Mental retardation or developmental disabilities 2 Mental retardation or developmental disabilities Child welfare 6.7% Child welfare 4.8% Criminal justice 13.3% Criminal justice 28.6% Other 1 Other 9.5% 25.0% % % % 10 Figures 2-8. Question 2. Percentage of respondents by client population served, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 13

15 Managed Care Organizations Other Mental health 83.3% Mental health 80.9% Substance abuse or addictions 10 Substance abuse or addictions 48.9% Mental retardation or developmental disabilities 10 Mental retardation or developmental disabilities 42.6% Child welfare Child welfare 27.7% Criminal justice 16.7% Criminal justice 27.7% Other Other 21.3% 25.0% % % % 10 Figures Question 2. Percentage of respondents by client population served, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 14

16 Question 3. Please provide break-outs of revenue as a PERCENT of total revenue. Three hundred and twenty-six (76.0%) of the respondents provided break-outs of revenue as a percentage of total revenue. This included 176 (54.0%) community behavioral health providers, 17 (5.2%) hospital or psychiatric units, 25 (7.7%) residential facilities, 24 (7.4%) state or county providers, 29 (8.9%) private clinical group practices, 18 (5.5%) substance abuse or addictions providers, 5 (1.5%) managed care organizations, and 32 (9.8%) other types of organizations. The mean percentages by revenue source, overall and by organization type, appear in Table 3 and Figures Overall, Medicaid was found to be the primary funding source (38.9%). However, as anticipated, payer mix was found to differ considerably among organization types, as illustrated in the table and figures below (N = 326) Medicare Medicaid Table 3 Mean Percentage of Total Revenue by Revenue Source, Overall and by Organization Type Other public sector funding Revenue source Commercial insurance Managed care Self-pay Grants Other Overall 6.2% 38.9% 19.0% 7.7% 8.2% 7.9% 8.3% 3.8% Organization type Community behavioral health provider 5.2% 44.7% 23.0% 4.6% 2.7% 3.6% 12.0% 4.4% Hospital or psychiatric unit 21.6% 29.8% 4.1% 15.1% 22.9% 6.1% 0.5% Residential facility 0.1% 54.1% 15.5% 7.8% 4.7% 14.4% 1.7% 1.7% State or county provider 4.2% 61.0% 17.8% 3.6% 3.6% 2.4% 4.4% 3.0% Private clinical group practice 11.7% 7.4% 2.9% 28.5% 30.2% 18.9% 0.2% 0.3% Substance abuse or addictions provider 0.1% 15.6% 20.4% 13.7% 15.1% 29.9% 4.5% 0.7% Managed care organization 0.2% 70.4% 26.0% 0.2% 1.6% 0.8% 0.8% Other 9.8% 20.8% 21.2% 3.4% 14.0% % 10.2% Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 15

17 Overall Medicare Medicaid Other public sector funding Commercial insurance Managed care Self pay Grants Other 6.2% 19.0% 7.7% 8.2% 7.9% 8.3% 3.8% 38.9% Community Behavioral Health Providers Hospitals or Psychiatric Units Medicare Medicaid Other public sector funding Commercial insurance Managed care Self pay 5.2% 4.6% 2.7% 3.6% 23.0% 44.7% Medicare Medicaid Other public sector funding Commercial insurance Managed care Self pay 21.6% 29.8% 4.1% 15.1% 22.9% 6.1% Grants 12.0% Grants 0.5% Other 4.4% Other Residential Facilities State or County Providers Medicare 0.1% Medicare 4.2% Medicaid 54.1% Medicaid 61.0% Other public sector funding 15.5% Other public sector funding 17.8% Commercial insurance 7.8% Commercial insurance 3.6% Managed care 4.7% Managed care 3.6% Self pay 14.4% Self pay 2.4% Grants 1.7% Grants 4.4% Other 1.7% Other 3.0% Private Clinical Group Practices Substance Abuse or Addictions Providers Medicare 11.7% Medicare 0.1% Medicaid 7.4% Medicaid 15.6% Other public sector funding 2.9% Other public sector funding 20.4% Commercial insurance 28.5% Commercial insurance 13.7% Managed care 30.2% Managed care 15.1% Self pay 18.9% Self pay 29.9% Grants 0.2% Grants 4.5% Other 0.3% Other 0.7% Figures Question 3. Mean percentage of total revenue by revenue source, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 16

18 Managed Care Organizations Other Medicare 0.2% Medicare 9.8% Medicaid 70.4% Medicaid 20.8% Other public sector funding 26.0% Other public sector funding 21.2% Commercial insurance 0.2% Commercial insurance 3.4% Managed care 1.6% Managed care 14.0% Self pay Self pay 1 Grants 0.8% Grants 10.6% Other 0.8% Other 10.2% Figures Question 3. Mean percentage of total revenue by revenue source, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 17

19 Question 4a. Current total operating budget. A total of 271 (63.2%) organizations provided data on total operating budget. Among those organizations were 166 (61.3%) community behavioral health providers, 10 (3.7%) hospitals or psychiatric units, 19 (7.0%) residential facilities, 23 (8.5%) state or county providers, 12 (4.4%) private clinical group practices, 12 (4.4%) substance abuse or addictions providers, 5 (1.8%) managed care organizations, and 24 (8.9%) other organization types. The results are given in Table 4 and Figures The overall mean total operating budget was found to be $20,841,940. Just under one-third reported a current total operating budget of over $20,000,000 while 5.9% reported a budget of under $1 million. As would be expected, significant differences were found to exist among organization types. Hospitals/psychiatric units and managed care companies were much more likely to report a budget exceeding $20 million than other organization types. Seventy-five percent of private clinical group practices reported a budget of less than $1 million. The current findings reflect growth in total operating budget when compared with the 2001 survey. In the current sample, 57.9% of the respondents reported an operating budget exceeding $10 million in contrast to only 43.6% in the 2001 survey. Table 4 Percentage of Respondents by Operating Budget Category, Overall and by Organization Type Operating budget $0- $1,000,000 $1,000,001- $5,000,000 $5,000,001- $10,000,000 $10,000,001- $20,000,000 Over $20,000,000 (N = 271) % N % N % N % N % N Overall 5.9% (16) 19.6% (53) 16.6% (45) 26.2% (71) 31.7% (86) Organization type Community behavioral health provider 1.8% (3) 16.9% (28) 18.7% (31) 33.1% (55) 29.5% (49) Hospital or psychiatric unit (0) (0) 2 (2) 1 (1) 7 (7) Residential facility (0) 42.1% (8) 15.8% (3) 26.3% (5) 15.8% (3) State or county provider (0) 26.1% (6) 8.7% (2) 21.7% (5) 43.5% (10) Private clinical group practice 75.0% (9) 25.0% (3) (0) (0) (0) Substance abuse or addictions provider 8.3% (1) 25.0% (3) 25.0% (3) 16.7% (2) 25.0% (3) Managed care organization (0) (0) (0) (0) 10 (5) Other 12.5% (3) 20.8% (5) 16.7% (4) 12.5% (3) 37.5% (9) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 18

20 Overall $0 $1,000, % $1,000,001 $5,000,000 $5,000,001 $10,000,000 $10,000,001 $20,000,000 Over $20,000, % 16.6% 26.2% 31.7% Community Behavioral Health Providers Hospitals or Psychiatric Units $0 $1,000, % $0 $1,000,000 $1,000,001 $5,000, % $1,000,001 $5,000,000 $5,000,001 $10,000, % $5,000,001 $10,000,000 2 $10,000,001 $20,000, % $10,000,001 $20,000,000 1 Over $20,000, % Over $20,000, % % Residential Facilities State or County Providers $0 $1,000,000 $0 $1,000,000 $1,000,001 $5,000, % $1,000,001 $5,000, % $5,000,001 $10,000, % $5,000,001 $10,000, % $10,000,001 $20,000, % $10,000,001 $20,000, % Over $20,000, % Over $20,000, %.0% % Private Clinical Group Practices Substance Abuse or Addictions Providers $0 $1,000, % $0 $1,000, % $1,000,001 $5,000, % $1,000,001 $5,000, % $5,000,001 $10,000,000 $5,000,001 $10,000, % $10,000,001 $20,000,000 $10,000,001 $20,000, % Over $20,000,000 Over $20,000, %.0% % Figures Question 4a. Percentage of respondents by operating budget category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 19

21 Managed Care Organizations Other $0 $1,000,000 $0 $1,000, % $1,000,001 $5,000,000 $1,000,001 $5,000, % $5,000,001 $10,000,000 $5,000,001 $10,000, % $10,000,001 $20,000,000 $10,000,001 $20,000, % Over $20,000, Over $20,000, %.0% % Figures Percentage of respondents by operating budget category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 20

22 Question 4b. Uncompensated care. A total of 213 (49.7%) organizations provided data on uncompensated care. Among those organizations were 134 (62.9%) community behavioral health providers, 10 (4.7%) hospital or psychiatric units, 15 (7.0%) residential facilities, 11 (5.2%) state or county providers, 11 (5.2%) private clinical group practices, 9 (4.2%) substance abuse or addictions providers, 4 (1.9%) managed care organizations, and 19 (8.9%) other organization types. The results are given in Table 5 and Figures The mean total uncompensated care across all responding organizations was found to be $1,174,864. Overall, it was found that just over one-third of the respondents reported less than $100,000 in uncompensated care per annum in contrast to approximately one-quarter that reported in excess of $1 million. Large differences were observed among organization types, as one would expect. These differences can be examined in the table and figures below. Table 5 Percentage of Respondents by Uncompensated Care Category, Overall and by Organization Type Uncompensated care $0-$100,000 $100,001- $500,000 $500,001- $1,000,000 Over $1,000,000 (N = 213) % N % N % N % N Overall 35.7% (76) 26.3% (56) 14.6% (31) 23.5% (50) Organization type Community behavioral health provider 27.6% (37) 30.6% (41) 14.2% (19) 27.6% (37) Hospital or psychiatric unit (0) 3 (3) 1 (1) 6 (6) Residential facility 6 (9) 2 (3) 6.7% (1) 13.3% (2) State or county provider 81.8% (9) 9.1% (1) 9.1% (1) (0) Private clinical group practice 72.7% (8) 18.2% (2) 9.1% (1) (0) Substance abuse or addictions provider 33.3% (3) 11.1% (1) 44.4% (4) 11.1% (1) Managed care organization 5 (2) (0) 25.0% (1) 25.0% (1) Other 42.1% (8) 26.3% (5) 15.8% (3) 15.8% (3) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 21

23 Overall $0 $100, % $100,001 $500, % $500,001 $1,000, % Over $1,000, % Community Behavioral Health Providers Hospitals or Psychiatric Units $0 $100, % $0 $100,000 $100,001 $500, % $100,001 $500,000 3 $500,001 $1,000, % $500,001 $1,000,000 1 Over $1,000, % Over $1,000, % % Residential Facilities State or County Providers $0 $100,000 6 $0 $100, % $100,001 $500,000 2 $100,001 $500, % $500,001 $1,000, % $500,001 $1,000, % Over $1,000, % Over $1,000,000.0% % Private Clinical Group Practices Substance Abuse or Addictions Providers $0 $100, % $0 $100, % $100,001 $500, % $100,001 $500, % $500,001 $1,000, % $500,001 $1,000, % Over $1,000,000 Over $1,000, %.0% % Figures Question 4b. Percentage of respondents by uncompensated care category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 22

24 Managed Care Organizations Other $0 $100,000 5 $0 $100, % $100,001 $500,000 $100,001 $500, % $500,001 $1,000, % $500,001 $1,000, % Over $1,000, % Over $1,000, %.0% % Figures Question 4b. Percentage of respondents by uncompensated care category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 23

25 Question 4c. Number of consumers served per year. A total of 279 (65.0%) organizations provided data on the number of consumers served per year. Among those organizations were 169 (60.6%) community behavioral health providers, 11 (3.9%) hospital or psychiatric units, 20 (7.2%) residential facilities, 23 (8.2%) state or county providers, 15 (5.4%) private clinical group practices, 12 (4.3%) substance abuse or addictions providers, 5 (1.8%) managed care organizations, and 24 (8.6%) other organization types. The results are given in Table 6 and Figures The mean total number of persons served per year across all responding organizations was found to be 8,417. It was found that the mean number of clients served was 8,417 across all organization types. Almost one-third of the respondents serve fewer than 2,000 while only 5% serve in excess of 25,000. Marked differences among organization types were noted. These findings can be reviewed in the tables and figures that follow. Table 6 Percentage of Respondents by Number of Consumers Served Category, Overall and by Organization Type Number of consumers served 0-2,000 2,001-10,000 10,001-25,000 Over 25,000 (N = 279) % N % N % N % N Overall 31.9% (89) 52.7% (147) 10.8% (30) 4.7% (13) Organization type Community behavioral health provider 18.9% (32) 63.9% (108) 12.4% (21) 4.7% (8) Hospital or psychiatric unit 9.1% (1) 54.5% (6) 27.3% (3) 9.1% (1) Residential facility 85.0% (17) 5.0% (1) 5.0% (1) 5.0% (1) State or county provider 26.1% (6) 60.9% (14) 13.0% (3) (0) Private clinical group practice 66.7% (10) 33.3% (5) (0) (0) Substance abuse or addictions provider 75.0% (9) 16.7% (2) 8.3% (1) (0) Managed care organization (0) 6 (3) 2 (1) 2 (1) Other 58.3% (14) 33.3% (8) (0) 8.3% (2) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 24

26 Overall 0 2, % 2,001 10, % 10,001 25, % Over 25, % Community Behavioral Health Providers Hospitals or Psychiatric Units 0 2, % 0 2, % 2,001 10, % 2,001 10, % 10,001 25, % 10,001 25, % Over 25, % Over 25, %.0% % Residential Facilities State or County Providers 0 2, % 0 2, % 2,001 10, % 2,001 10, % 10,001 25, % 10,001 25, % Over 25, % Over 25,000.0% % Private Clinical Group Practices Substance Abuse or Addictions Providers 0 2, % 0 2, % 2,001 10, % 2,001 10, % 10,001 25,000 10,001 25, % Over 25,000 Over 25,000.0% % Figures Question 4c. Percentage of respondents by number of consumers served category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 25

27 Managed Care Organizations Other 0 2, , % 2,001 10, ,001 10, % 10,001 25, ,001 25,000 Over 25,000 2 Over 25, %.0% % Figures Question 4c. Percentage of respondents by number of consumers served category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 26

28 Question 4d. Number of FTEs in your organization. A total of 286 (66.7%) organizations provided data on their number of FTEs. Among those organizations were 170 (59.4%) community behavioral health providers, 12 (4.2%) hospital or psychiatric units, 20 (7.0%) residential facilities, 23 (8.0%) state or county providers, 15 (5.2%) private clinical group practices, 12 (4.2%) substance abuse or addictions providers, 5 (1.7%) managed care organizations, and 29 (10.1%) other organization types. The results are given in Table 7 and Figures The mean total number of FTEs across all responding organizations was found to be 318. Overall, it was found that just under one-third of the respondents employ under 100 persons while thirty-six percent employ over 250 individuals. Considerable differences among organization types were found to exist, as one might expect. These differences can be examined further in the table and figures that follow. In the 2001 survey, 43.6% of the respondents employed 100 or fewer persons and only 28% employed over 250 persons. These figures suggest growth in FTEs since the 2001 study. Table 7 Percentage of Respondents by Number of FTEs Category, Overall and by Organization Type Number of FTEs ,000 Over 1,000 (N = 286) % N % N % N % N % N Overall 31.1% (89) 32.5% (93) 24.8% (71) 8.4% (24) 3.1% (9) Organization type Community behavioral health provider 22.4% (38) 36.5% (62) 28.8% (49) 8.2% (14) 4.1% (7) Hospital or psychiatric unit (0) 58.3% (7) 16.7% (2) 25.0% (3) (0) Residential facility 35.0% (7) 35.0% (7) 15.0% (3) 15.0% (3) (0) State or county provider 34.8% (8) 30.4% (7) 26.1% (6) 4.3% (1) 4.3% (1) Private clinical group practice 10 (15) (0) (0) (0) (0) Substance abuse or addictions provider 5 (6) 41.7% (5) (0) 8.3% (1) (0) Managed care organization 6 (3) (0) 4 (2) (0) (0) Other 41.4% (12) 17.2% (5) 31.0% (9) 6.9% (2) 3.4% (1) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 27

29 Overall % 31.1% 32.5% 501 1,000 Over 1, % 8.4% Community Behavioral Helath Providers Hospitals or Psychiatric Units % % % % % 501 1, % 501 1, % Over 1, % Over 1,000.0% % Residential Facilities State or County Providers % % % % % % 501 1, % 501 1, % Over 1,000 Over 1, %.0% % Private Clinical Group Practices Substance Abuse or Addictions Providers % , , % Over 1,000 Over 1,000.0% % Figures Question 4d. Percentage of respondents by number of FTEs category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 28

30 Managed care Organizations Other % % % 501 1, , % Over 1,000 Over 1, %.0% % Figures Question 4d. Percentage of respondents by number of FTEs category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 29

31 Question 4e. Number of FTEs in your organization dedicated to Information Technology. A total of 283 (66.0%) organizations provided data on their number of FTEs dedicated to IT. Among those organizations were 171 (60.4%) community behavioral health providers, 11 (3.9%) hospital or psychiatric units, 20 (7.1%) residential facilities, 22 (7.8%) state or county providers, 15 (5.3%) private clinical group practices, 11 (3.9%) substance abuse or addictions providers, 5 (1.8%) managed care organizations, and 28 (9.9%) other organization types. The results are given in Table 8 and Figures Overall, the mean total number of FTEs dedicated to information technology across all responding organizations was found to be 4.5. Forty-five percent of organizations employ from two to five FTEs. In the 2001 survey, 49.4% of the respondents employed from 2 to 5 FTEs. Differences noted among organizational types can be reviewed in the table and figures below. Table 8 Percentage of Respondents by Number of FTEs Dedicated to IT Category, Overall and by Organization Type Number of FTEs dedicated to IT Over 8 (N = 283) % N % N % N % N Overall 35.0% (99) 45.2% (128) 11.7% (33) 8.1% (23) Organization type Community behavioral health provider 26.3% (45) 52.6% (90) 12.9% (22) 8.2% (14) Hospital or psychiatric unit 54.5% (6) 36.4% (4) 9.1% (1) (0) Residential facility 5 (10) 35.0% (7) 5.0% (1) 1 (2) State or county provider 31.8% (7) 31.8% (7) 22.7% (5) 13.6% (3) Private clinical group practice 8 (12) 13.3% (2) 6.7% (1) (0) Substance abuse or addictions provider 54.5% (6) 45.5% (5) (0) (0) Managed care organization 2 (1) 2 (1) 4 (2) 2 (1) Other 42.9% (12) 42.9% (12) 3.6% (1) 10.7% (3) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 30

32 Overall % % % Over 8 8.1% Community Behavioral Health Providers Hospitals or Psychiatric Units % % % % % % Over 8 8.2% Over 8.0% % Residential Facilities State or County Providers % % % % % Over 8 1 Over %.0% % Private Clinical Group Practices Substance Abuse or Addictions Providers % % % % 6 8 Over 8 Over 8.0% % Figures Question 4e. Percentage of respondents by number of FTEs dedicated to it category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 31

33 Managed Care Organizations Other % % % Over 8 2 Over %.0% % Figures Question 4e. Percentage of respondents by number of FTEs dedicated to it category, overall and by organization type. Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 32

34 Question 4f. IT FTEs as a percentage of total FTEs. A total of 278 (64.8%) organizations provided data for computing IT FTEs as a percentage of total FTEs. Among those organizations were 169 (60.8%) community behavioral health providers, 11 (4.0%) hospital or psychiatric units, 20 (7.2%) residential facilities, 22 (7.9%) state or county providers, 14 (5.0%) private clinical group practices, 11 (4.0%) substance abuse or addictions providers, 5 (1.8%) managed care organizations, and 26 (9.4%) other organization types. The results are given in Table 9 and Figures The mean number of Information Technology FTEs as a percentage of total FTEs across all responding organizations was found to be 2.45%. The median was observed to be 1.33%. Direct comparisons with the 2001 survey data cannot be drawn due to the reporting methods employed in the earlier study. For example, public sector agencies were found in 2001 to have 1-2% of their staff in IT. That range is roughly comparable to the current median value of 1.4% among community behavioral health organizations. Organization types differed, from a low of.6% for hospitals/psychiatric units to highs of 2.9% in private clinical group practices and 3.5% in managed care organizations. These differences among organizational types can be examined further in the table and figures presented below. Behavioral health care/human services appears to lag well behind general health care in this regard. In Managing Health Care Information Systems, Wager et al cite the work of Cruz, 2003 in reporting that IT employees constitute 4.3% of all employees in general health care settings. The median figure of 1.33% in behavioral health care/human services represents only 31% of the general health care setting figure. Table 9 Percentage of Respondents by IT FTEs as a Percentage of Total FTEs Category, Overall and by Organization Type IT FTEs as a percentage of total FTEs 0%-0.75% 0.76%-1.50% 1.51%-3.00% Over 3.00% (N = 278) % N % N % N % N Overall 25.5% (71) 31.3% (87) 29.9% (83) 13.3% (37) Organization type Community behavioral health provider 19.5% (33) 36.1% (61) 36.1% (61) 8.3% (14) Hospital or psychiatric unit 63.6% (7) 27.3% (3) 9.1% (1) (0) Residential facility 35.0% (7) 3 (6) 25.0% (5) 1 (2) State or county provider 22.7% (5) 27.3% (6) 22.7% (5) 27.3% (6) Private clinical group practice 5 (7) (0) (0) 5 (7) Substance abuse or addictions provider 27.3% (3) 18.2% (2) 45.5% (5) 9.1% (1) Managed care organization 2 (1) (0) 2 (1) 6 (3) Other 30.8% (8) 34.6% (9) 19.2% (5) 15.4% (4) Centerstone Research Institute 2009 Software and Technology Vendor's Association. All Rights Reserved. 33