LSF HEALTH SYSTEMS Information Technology Plan

Transcription

1 LSF HEALTH SYSTEMS Information Technology Plan I. INTRODUCTION The LSF Health Systems software is a web-enabled, secure website providing access to LSF, the Provider Network and DCF. At this time, the primary function of the software is to allow capture of related data supplied by Providers for the purpose of determining the historical and ongoing cost and nature of the system of care. In addition to data capture provided, the software provides for the following current and planned functions: Secure Management of User System Access Contract Management Provider Deliverables Management Bed Count Management Wait List Management Capture and Reporting of Consumer Satisfaction Surveys Utilization Management Financial tracking and cost Management Provider Payment tracking and access to payment history Performance Measures Reporting Immediate funding stream category and identification Comprehensive assessment tools Reporting per funding stream Accounting per funding / service/ agency Additional Financial Reporting Data Extracts The software is designed to accept data electronically via Web-based portals, which, over time, can offer a complete, integrated behavioral healthcare suite to enable users to access information 24 hours a day, seven days per week. Access to the system is role based with different roles assigned by job type to LSF staff, DCF, the Provider network, and other stakeholders, as necessary. The following descriptions of LSF Health Systems software and technologies provide specific information regarding the processes and tools used to gather the required data (as defined in PAM 155-2) to perform the functions for the Managing Entity.

2 II. SYSTEM ENHANCEMENTS The Department must recognize that a software system that contains this functionality does not currently exist and LSF Health Systems is working thorough the design, development, testing and implementation process with our Management Team and our provider network. Therefore, LSF Health Systems is prioritizing implementation of critical functionality as well as design new upcoming functionality pertained in this plan for a secondary release. In subsequent years, LSF will continue to expand on system functionality to meet and exceed the requirements of the DCF contract in order to administer superior behavioral healthcare on behalf of its clients. It will continue to be the responsibility of LSF Health Systems to manage the System of Care and oversee the collection of data in order to assure accurate financial management, utilization management and performance measures throughout this process. 1. The exchange of screening and assessment results among Network Service Providers to better coordinate care as outlined in the current Information Technology Plan; Through the software planning phase LSF is reviewing the option to build an information exchange (IEX) that allows data to flow between LSF and Network Service Providers already established information systems. The LSF proposed IEX will not recreate Providers client management systems but will transmit data on a transactional basis and then allow LSF to report and pull analytics from the IEX; these transmissions will occur in XML format so the data transmission in platform agnostic. The IEX will collect and transmit a different data set from the uploads; the IEX will be used to coordinate the exchange of screening and assessment result among network service provides. 2. Automated referral and electronic consent for release of confidential information within and between Network Service Providers; LSF is reviewing the plan to design and develop the IEX that has the capacity to perform both referral tracking and to track consent for release of confidential information electronically. If this plan is chosen, the software will be designed to reduce the administrative burden imposed on providers and LSF staff by providing a platform to gather objective clinical data. The software will be designed to emphasize paperless transactions to ensure access to real-time comprehensive program information. In addition, the software will enable and support improved communications and increased collaboration among providers, LSF staff, and our consumers/members. Our software provides greater flexibility through the use of leading software development technologies such as ASP.net, MVC and SSRS with leading technology vendor Microsoft.

3 3. Integrated processes for tracking and coordinating intake, admission, discharge and follow-up throughout the SOC; In the software planning phase LSF is reviewing the option of the IEX to enhance the current data upload portal for providers to include additional enhancements for screens and workflows to integrate the processes of assessment, intake, admission, discharge and follow-up which eases the administrative burden to providers and informs utilization management decision making. The data in the proposed screens would be entered by subcontracted providers. This enhancement would the tools in the hands of the providers enabling them to view, submit, and execute care management transactions online, via our secure, scalable and trusted web portal information exchange. Although still in the initial design phases, the proposed IEX will serve as the single, transactional database to incorporate all referrals, service network, availability, referral acceptance, assessment data; the IEX will act as the LSF Health Systems hub for coordination of services. 4. Electronic reconciliation of invoices submitted to the Department, including reconciliation of the amount of funding and services specified in this contract; On a monthly basis, LSF submits data received from providers to DCF by means of electronic transmission to the SAMH State system. LSF analyzes monthly data submitted by providers that is rejected by the LSF automated system as well as those records that are rejected by SAMH. Records are analyzed and assessed whether justifiably rejected or not. DCF can use this data, combined with data from Managing Entities around the State to develop analytical reporting for the system of behavioral health care across Florida. Through direct access to SAMH data, LSF would be able to compare financial transactions within the LSF information system to that captured in SAMH during the monthly upload process. 5. Electronic reconciliation of invoices submitted to the Department, including reconciliation of the amount of funding and services specified in this contract as well as the Managing Entity s audit report and information system for Individuals Served; All service events are entered into the system as supplied by the Providers through either DDE (Direct Data Entry) or file upload into LSF Health Systems software as either SERV or EVENT data. The Contract Management module of the system will identify by provider and contract which services are apportioned and consequently which service records match to the contracts between the Provider and LSF. Each contract will identify the cost center with each service category that will allow each service record a full trace of the program grant, or funding source under which the service has been allocated. This software functionality will allow an LSF user to specify a provider, and retrieve the following information about a given contract or Service and Billing transaction: Maintain a distinct data location specifically purposed to support service billing

4 For each service, review defined financial billing rules to determine if service records should be accepted or denied ( System Denied ) automatically by the system Ensure duplicate processing of the same service is not performed; Ensure that updates to previously denied services may be accomplished by Providers for SERV or EVENT records having the same Key Index Fields Calculate billing associated with services rendered, based on contracted unit costs. Provide for a data table which supports the User Interface with the ability to Drill Down into Service detail and Approve or Deny Individual Services, Services aggregated to the Service Category Level, or Services aggregated to the Provider level within a timeframe selected by the ME login Gives the ME Contract Manager and the Provider Contract Manager the ability to tell at a glance exactly how they are performing on the contract Number of units of service provided per month in comparison to annual encumbrance Review PAM data supplied by Providers; already verified to have the correct Service Modifier (SERV.MOD4 and EVENT.MOD4) OCA and Cost Centers Allow for an expanding set of LSF Billing Validation Rules to be defined within the system to deny services and payment Allow for definition of Special Financial Billing rules to be defined within the system that can be used to bill services separately from a Contract Rate per Unit of Service Maintain a historical database of rules which were applied to a given service so as to enable subsequent review of denied payments This functionality will provide both an aggregate broad cost center level overview and/or an aggregate total of specific contracted dollars by cost center across the system of care. It will allow the LSF Network Manager to group, and sort the data as needed to evaluate how funds are allocated across the region by provider, by county, or by circuit. Additionally the System flags will be placed on each record to indicate at the Cost Center Level which under or overproducing records at any given point in time. 6. Automated processes for state and federal data analysis and reporting; LSF Health Systems is currently performing an in depth review of all Performance Measures contributing factors including DCF Dashboard results, data supplied by Providers, Performance Measure SQL provided by DCF, and SQL Modification by Five Points to enable DCF SQL, as well as interpretation of PAM Specifications as required for correct execution of the Measure. The staff have completed a side by side comparison of DCF SQL as compared to LSH Health Systems Production SQL with additional text reasons for any derived variances between the two and this has been supplied to DCF, other MEs and presented on the weekly conference calls with DCF. This activity will ensure LSF is calculating the performance measure and outcome data in the same format and calculations as DCF and Statewide with all MEs. The LSF Health System Software currently allows access to the Performance Measure Reports via Reports / Performance Measures on the System menu. The System presents a dashboard view of all measures with a simple view by Provider and by Measure. Additional enhancements to this screen include an output to excel and PDF for stakeholder review. Currently, only appropriate user roles have

5 been set up and are being maintained to ensure only specific roles have access to these reports and that each Provider only sees their specific outcome measures. Other State and Federal Data Analysis and reporting is being built into the LSF health systems software via ad hoc reports and export of data for LSF staff to mine manually. Such reports include individuals served, quality assurance, financial reporting, UM reporting, etc. 7. Compliance with federal and state laws, and regulations pertaining to security and privacy of protected health information. LSF Health Systems software maintains compliance with all applicable Federal and state legislative mandates regarding Protected Health Information (PHI). We maintain a robust library of policies and procedures to align company operations with compliance mandates and best practices. This library is reviewed and modified at least annually as circumstances require. All employees and contractors receive mandatory training in addition to those required by the Department of Children and Families. Attendance records and certificates confirming successful completion become part of their permanent employment files. Further, we perform comprehensive internal audits quarterly to ensure compliance with our subcontract, Five Points, policies and procedures and to identify potential gaps and appropriate control measures to address any areas of non-compliance. The policies, procedures and internal audit reports are available for review upon request.