Kevin Scalia Netsmart EVP, Corporate Development Dr. Michael Mittleman PSCH SVP, Corporate Compliance
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1 Using Technology to Succeed with Health Homes and ACOs Kevin Scalia Netsmart EVP, Corporate Development Dr. Michael Mittleman PSCH SVP, Corporate Compliance
2
3 PLAYING OFFENSE
4 Dispropor onate Cost for Members with Behavioral Health Comorbidity 100% 90% 80% 70% 60% 50% 5% 20% 25% 78.9% 40% 30% 20% 10% 0% 50% Member Rank Percen le % Cost Percen le
5 US Millions
6 Medicaid Costs
7 Innovations Designed to Improve Care and Reduce Costs Health Homes Integrated Care Organizations Dual Eligibles BH Elderly Physically disabled I/DD Care Coordination
8 Federal Health Home Policy Created by Section 2703 of ACA Eligibility: Medicaid eligible Two or more chronic conditions, or One chronic condition and at risk for another, or A serious and persistent mental health condition
9 Eligible Conditions Mental health disorder Substance use disorder Asthma Diabetes Heart disease and overweight (BMI > 25)
10 Health Home Services Defined by Section 1945(h)(4) of ACA: Comprehensive care management Care coordination and health promotion Comprehensive transitional care from inpatient to other settings including follow-up Individual and family support Referral to community and social support services The use of HIT to link services
11
12 Improving VALUE = Outcomes Reducing Cost
13 Change of Focus Required Element of Change Today Future Care focus Sick care "Healthcare" wellness and preven on, disease management Care management Delivery Model Care Se ng Quality measures Payment Manage u liza on and cost within a care se ng Fragmented/silos In office/hospital Process- focused, individual Fee- for- service Manage ongoing health (and op mize care episodes) Care con nuum and coordina on (right care, right place, right me) In home, virtual (e- visits, home monitoring, etc) Outcomes- focused, popula on- based Value- based (outcomes, u liza on, total cost) Financial incen ves Do more, make more Perform be er on measures, make more Financial performance Margin per service, procedure (bed, clinician, etc) Margin per life
14 How to Drive Accountable Care Clinical'Innova+on' Care'Coordina+on' Improve Outcomes Reduce Cost EHR & Medication Management Meaningful Use Hosting & SaaS Clinical Decision Support Information Exchange Business'Efficiencies' Revenue Cycle Management Managed Services Primary Care Integration Technology Partners Population & Community Health Management Delivering'Accountable'Care' "2013"Netsmart"Technologies"
15 Data Analytics Strategy Enterprise EHR Avatar Tier Evolve Insight Enterprise EHR Avatar Tier Evolve Insight Enlighten Analytics Enlighten Analytics Aggregate Data Behavioral Pathway Systems (1000 s of Organiza ons) New Outcomes Measures/Metrics Descrip ve Analy cs Centerstone Research Institute Encounter Level Data Netsmart Research Database (20MM People) Other Research Entities Predic ve Analy cs
16 The same challenge Different Approaches INTEGRATED CARE APPROACHES
17 New York Approach Acute Care 1 Acute Care N RHIO BH Provider Primary Care SU Provider CareConnect Health Homes HH 1 HH 2 HH N Optum Health Magellan Value Options NYCCP CCBH % Clients shared between orgs
18 Kansas Approach Acute Care 1 Acute Care N KHIE Primary Care Benchmarking Health Homes CMHC 1 CMHC 2 CMHC 27 Some Consumers Shared Optum Centpatico Amerigroup KHS or KHSlike Organization
19 Massachusetts Approach Integrated Care Organization Risk Bearing Entity Regional Care Center Primary Care MHC Regional Care Center Primary Care MHC Regional Care Center Primary Care MHC CMHC Hospital Social Services
20 Pennsylvania I/DD Approach Integrated Care Organization MHC Risk Bearing Entity CMHC Hospital Social Services
21 Uncharted Territory 3M Grouper provides Physical Risk data What to use for MH Risk? How to calculate: MH Risk x Physical Risk = Aggregate Risk
22 Behavioral/Physical Acuity Priorities MH Diagnosis Physical Health Diagnosis MH Functional Level from DLA (Score = 80-20) Or (GAF=1-100) Physical Health Risk from 3M Grouper (0-100) Aggregate Risk Depression CHF Depression Diabetes Schizophrenia Diabetes
23 Health Homes Today
24 Public Health Social Services Substance Abuse Popula on Health Analy cs Claim Processing CareConnect Individual HIEs & RHIOs Primary Care Provider Management Care Management / Coordina on Developmental Disabili es / Behavioral Health Primary Care
25 Provider Registry Clinical Registries Inbound Claims Outcomes Authorizations Referrals Outbound Claims Assessments Enrollment Consent Consume Provider Perspectives rportal Portal Coordination Plan Treatment Guidelines Population Based Evidence Analytics Utilization Management Clinical Research Case Management Medicaid Medicare BC/BS MCO Social Services Consumer Inpa ent MH Facility Local Health Dept. CMHC Substance Use PCP Hospital Pharmacies HIEs Insurance
26 Clinical Innovation Care Coordination Improve Outcomes Reduce Cost EHR & Medication Management Meaningful Use Hosting & SaaS Clinical Decision Support Information Exchange Business Efficiencies Revenue Cycle Management Managed Services Primary Care Integration Technology Partners Population & Community Health Management Delivering Accountable Care 2013 Netsmart Technologies
27 Healthix PSCH NS/LIJ Physical Health CareConnect Referrals BHIX/ Maimonedies Bronx Lebanon CBC
28 New York City Health Home CASE STUDY: COORDINATED BEHAVIORAL CARE
29 Coordinated Behavioral Care
30 CBC Implementa on Timeline GO-LIVE Initial Screening Health Risk Assessment SF-12 Provider Connect HIE Integration Events CCD Quality Measures CBC 7/12 12/12 01/13 2/13 Team Training End-User Training Install Requirements Capture Build 30 days Phased Implementation Needed to be live within 30 days. Accomplished this by aggressively managing scope Mutual Agreement Netsmart and CBC agreed on scope and worked together to adapt to changing requirements Project Management Increased frequency of project meetings to support aggressive timeline
31 Dashboard Alerts Missed Medica on Refills Missed Appointments Arrests
32 NYC Health Homes Some Lessons Learned Three rules for HH success: communications, communications, communications Many HH members, many votes, slow consensus building Work committees need wide latitude to develop ideas for board consideration Be agile or perish; extreme regulatory volatility Be BFF s with your legal counsel Define IT needs internally; outsource the solution At startup PMPM alone won t cut it; seed money is necessary Full-time HH and IT staffs are a must
33 IT Capabilities Maintained by One CBO Health Home Member Electronic Health Record Integrated EHR Billing System Care Management Functionality Financial Management System Document Management System Informatics Resources RHIO/HIE Connectivity
34 Health Home Provider Constituencies Hospital CBO FQHC Residences Health Plan/MCO Transporta on
35 The Adaptive CBO HIPAA HH? SNP? IPA? NewCo? ACA MCO EHR Revenue Regula on Back Office Services Open for Business!
36 The Adaptive CBO Essential Services Care Coordination Housing/Residential Services Therapies/Innovative Services (Urgent-Care) Transportation Vocational / Social Ventures Multiple Cohorts: MH, DD, SA, HIV/AIDS
37 Increased Agility - CBO in a Box Customers Program Services CBO Common Back Office ü Corporate Compliance ü Accounting Health Home Care Coordination 1 ü Billing Hospital Housing ü Payroll FQHC Therapy ü HR MCO Transportation 2 ü IT ü Informatics/QA SNP Vocational/Social 3
38 Synergies Technology Platforms EHR; BH HIE Care Management/Claims Processing, Provider Portal, HIE Connectivity Care Management/Claims Processing, Provider Portal, BH HIE Connectivity EHR; Care Management; Provider Portal; BH HIE Connectivity CBC/PSCH CBO Consortium Healthix; BHIX; Interboro; Bronx RHIO; PSCH NS-LIJ; FQHC s; PSCH HHC; PSCH Academic Medical Center; PSCH Health Homes RHIO s/hie s Care Coordination Local Government Hospital (Under Discussion) ACO in a Box ; Informatics
39 Some Useful Websites NYS Medicaid Redesign Team: NYS Health Homes: NY ehealth Collaborative: Accountable Care Organizations Defined: Back Office Outsourcing Considerations for Small and Medium Sized Not-for-Profits: Netsmart Plexus Revenue Cycle Management:
40 Thank You! Contact Information Kevin Scalia Executive Vice President Netsmart Technologies 3500 Sunrise Highway - Suite D122 Great River, NY KScalia@ntst.com Michael R. Mittleman, PhD Senior Vice President PSCH, Inc th Avenue 3 rd Floor Flushing, NY Michael.mittleman@psch.org
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