OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES HEATH CARE PROVIDER (HCP) NUMBER: FCC HEALTH CARE CONNECT FUND NETWORK PLAN

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1 OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES HEATH CARE PROVIDER (HCP) NUMBER: FCC HEALTH CARE CONNECT FUND NETWORK PLAN INTRODUCTION The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) was established through the Mental Health Law of ODMHSAS is the state agency for behavioral health services and operates mental health centers across the state. It has been a primary focus of ODMHSAS to provide previously underserved areas of Oklahoma with a significant increase in access to mental health and substance abuse services. As a result of these efforts, Oklahoman s who were once unable to receive services due to geographical barriers are now able to receive the care that they need. Telehealth allows ODMHSAS to deliver critical services to consumers in rural communities who, without this technology, would continue to be at a significant disadvantage due to lack of access to services. BACKGROUND ODMHSAS is filing as a consortium for Health Care Connect Fund support in order to further provide quality mental health and substance abuse services to Oklahomans. As Oklahoma is predominantly a rural state and most professional health care services (including child and adult psychiatrists) are located in urban areas thousands of Oklahomans have been left wanting when it comes to accessing appropriate care for behavioral health services. Those seeking treatment are often required to travel great distances to find services. And, with an average per-capita income below $25,000, many individuals cannot afford to drive the longer distances or are limited as to a means of travel. They cannot afford lost wages, do not have access to child care or have other responsibilities that do not allow them to invest the additional time and cost to seek services in other areas. Oklahomans depend heavily on ODMHSAS s Telehealth network to provide services at a very high level. During fiscal year 2012, ODMHSAS provided services to over 26,000 Oklahomans, and for fiscal year 2013 that number increased by 28% to 33,840 Oklahomans served. The connectivity required for ODMHSAS network will continue to build member capacity to electronically exchange mental health information and engage in Telemedicine/ Tele-psychiatry services. ODMHSAS HCP Network Plan Rev 8/26/2014 Page 1

2 1. GOALS & OBJECTIVES ODMHSAS network is expected to provide a robust and cost effective infrastructure of broadband services to meet behavioral health care related broadband needs. The ODMHSAS Consortium and participating Health Care Provider ( HCP ) locations have a variety of specific goals and objectives including the following: A. To facilitate HCP access to Electronic Health Record systems (EHR) in which broadband connectivity is required to access EHR. B. To facilitate coordination of care between HCP providers and other health care providers by providing access via the broadband network to the regional Oklahoma Health Information Exchange (HIE) SmartNet. C. To provide access to consumers in rural areas to psychiatrists, psychologists, licensed professional counselors and other behavioral specialist via low-latency broadband needed for Telemedicine/Tele-psychiatry services. D. To facilitate access to electronic prescribing and order entry systems via broadband to improve patient care and safety and increase efficiencies. E. To facilitate a robust architecture of broadband services which provide HCPs with access to redundant data centers to mitigate the risks of interruption of the services noted in A through D above to remote HCPs in both rural and urban geographically dispersed areas. F. To maintain and expand the ODMHSAS consortium network management systems and capabilities. G. To provide a cost effective broadband network with the capability to add new HCP(s) to the existing network in a cost effective way. 2. STRATEGY FOR AGGREGATING THE SPECIFIC NEEDS OF HCPS (INCLUDING PROVIDERS THAT SERVE RURAL AREAS) WITHIN A STATE OR REGION A major element of ODMHSAS s strategic vision for the network is to implement and maintain a unified, operational framework for integration of the full continuum of the mental health care system. ODMHSAS will continually evaluate our clinical needs and procure advanced technology to support our mission to develop, manage, and deliver innovative, responsive, and high quality mental health services as requested by the consumers of Oklahoma within a financially realistic environment through the involvement of each staff member. Installed technology must support the activities at each site in communicating with patients and their families, peers, technical experts, licensed contract staff and full-time employees, community stakeholders, reporting agencies, and local, state and federal mental health services as follows: Direct access for patients to mental health provider services Access to patient Electronic Medical Record, Clinical Decision and Charting Applications Access to Treatment Team meetings with staff at remote sites for staff consultation on each client s Treatment Plan and Medical Record Access for training to clinical staff Access for clinical staff to provide mental health services to patients in the community Connectivity to support Systems of Care (SOC) for child centered services as established by the Substance Abuse and Mental Health Services Administration ODMHSAS HCP Network Plan Rev 8/26/2014 Page 2

3 In addition to the above services, the main data site in Oklahoma City provides the primary data center for the agency providing EMR, applications and security for all sites. The ODMHSAS consortium will leverage our network to ensure that are rural sites are able to provide sufficient mental health services to meet the needs of the communities served. The Consortium recognizes that rural sites struggle with providing sufficient care in rural areas due to limited resources, poor retention of skilled personnel, distances between service providers, and poverty of the population served, as well as other factors plaguing other rural systems. While this project cannot reduce the poverty level, the ODMHSAS consortium network can address the accessibility, availability, and acceptability factors faced by rural community members by reducing the need for the population to travel to services, increasing the number of health care resources available to the population, and increasing the tools used to reach out to the community and provide mental health and health care education. By collaborating and utilizing telemedicine, the rural sites are able to share limited resources and have access to other specialties outside their service areas. Additionally, participants are able to take advantage of this collaboration to share counselors, nurses, and other skilled health workers. Connectivity, collaboration and communication serve as a multiplier that greatly improves each of the rural site s ability to serve their clients. The ODMHSAS Consortium network also enhances the health care community s ability to provide a rapid and coordinated response in the event of local or national crisis, expanding the available resources immediately available to respond during these critical times. Regular needs assessment and meetings with ODMHSAS staff and community stakeholders will enable the consortium to address specific needs of both the rural and urban sites. Participating agencies will network with one another and other major health care providers to greatly increase opportunities to collaborate, share information, serve clients, and grow professionally. The high-speed secure network will also enable the participants to aggregate their system applications and data records at a centralized data facility, enabling participating sites to centrally access the applications, electronic medical records, and other data, greatly improving the timeliness of data and record transfers and eliminating the need for separate data centers. Our future is telehealth. It is working to meet the needs of the people of Oklahoma. Additional investment in core behavioral health services is a key to continuing our efforts to address priority health concerns in Oklahoma. 3. STRATEGY FOR LEVERAGING EXISTING TECHNOLOGY TO ADOPT THE MOST EFFICIENT AND COST EFFECTIVE MEANS OF CONNECTING THOSE PROVIDERS The ODMHSAS Consortium has developed a strategy for adopting existing technology to adopt the most efficient and cost-effective means of connecting to our sites for the provision of mental health care. Utilizing asset inventory processes including annual reviews, ODMHSAS technology team regularly evaluates the age and viability of existing equipment with analysis of compatibility and reliability of configuration with new equipment installed. New equipment is added based on the needs analysis of each site and availability of funds. The ODMHSAS Consortium network will be significantly upgraded in fiscal year 2015 with the implementation of a new MPLS Network servicing all clinical sites. New network equipment will be ODMHSAS HCP Network Plan Rev 8/26/2014 Page 3

4 installed at each site to support high bandwidth connectivity provided through MPLS Network. The Consortium will install both wired and wireless connectivity at all sites. The MPLS network will enable ODMHSAS to build an application aware, network based MPLS virtual private network to link locations and efficiently transmit applications such as voice, data, and video over a single connection. The new network uses MPLS standards and brings efficient, secure, and scalable way to support critical IP applications. Central data services are at the two (2) Oklahoma City sites with a new Disaster Recovery site in Norman, Oklahoma. On the new network each site will have 1Gbps connections. The 10 critical sites (24/7/365) will have 20Mbps to 100 Mbps connectivity as defined by qualified services. Secondary/Satellite sites will be serviced with 3-10 Mbps connections. Technologies needed to support an expansion of the network will be installed according to ODMHSAS technology policies and purchasing procedures. Implementation of technology over the next five years will include: Addition of new sites to the network in order to serve communities in need as identified by the ODMHSAS governing board Increase bandwidth to meet the evolving needs of Telehealth and electronic medical records Upgraded network equipment for high speed bandwidth including access to both wired and wireless Internet access Upgraded telemedicine equipment and video for delivery of high quality mental health services Upgraded network security to protect users and meet state, local, and federal requirements Network monitoring and maintenance agreements to ensure reliability of network services 4. HOW THE BROADBAND SERVICES WILL BE USED TO IMPROVE OR PROVIDE HEALTH CARE DELIVERY As an agency, ODMHSAS is committed to delivery of evidence-based practices, and the use of technology to help us reach Oklahomans in need. Our use of telemedicine is part of the commitment, and we have become a national leader in its use to deliver behavioral health services. Despite budget challenges in previous years, and increasing costs for doing business, ODMHSAS has managed to maintain and in some instances increase the number of Oklahomans we serve. This has been due to process changes and restructuring of services, targeted funding for specific at-risk populations and in a big part, due to our use of technology such as telehealth. ODMHSAS has successfully implemented a statewide non-traditional treatment delivery system through the use of video-conferencing technology (TeleHealth). This technology allows ODMHSAS and community providers to deliver mental health and substance abuse services to consumers in rural communities who, without this technology, would continue to be at a significant disadvantage due to a lack of access to services. The telehealth technology has enabled ODMHSAS to provide previously underserved areas of Oklahoma with a significant increase in access to mental health and substance abuse ODMHSAS HCP Network Plan Rev 8/26/2014 Page 4

5 information and services. This method of service delivery has also increased the overall quality of mental health and substance abuse care delivered to the community. Through the Oklahoma Tele-Health Network, Oklahoman s who were once unable to receive services due to geographical, economic and workforce barriers are now able to receive the care that they desire. This network has also facilitated new partnerships, strengthened existing ones and contributed to the goal of merging physical and mental healthcare by providing a mechanism for physician and behavioral health professionals to consult with each other in a more rapid fashion. As a result of this network, the landscape of the service delivery system in Oklahoma has been forever changed. The Goals and objectives of our network plan shall support the Long-Term Goals, Themes and Strategies of the Oklahoma Department of Mental Health and Substance Abuse Services as follows: a. Decrease the incidence and Strategies progression of domestic violence/sexual assault, substance abuse/chemical dependency, and mental illness through increased awareness and understanding of the issues and the provision of prevention and early intervention services. b. People in Oklahoma will receive best-practice interventions and services delivered in a timely, culturally competent manner that promotes recovery and an increased quality of life. c. Program capacity throughout the state will be sufficient to address the size, composition, and distribution of the state's population. d. Services provided through the ODMHSAS will recognize and address the comprehensive and holistic needs of the people served. e. Continuous service and workplace improvements occur through the use of performance indicators and evaluation tools in decision making and implementation of services ANY PREVIOUS EXPERIENCE IN DEVELOPING AND MANAGING HEALTH IT (INCLUDING TELEMEDICINE) PROGRAMS ODMHSAS completed implementation of a fully electronic health record system in ODMHSAS has many years experience in developing and implementing complex networks and systems to support technology in behavioral health, including real time applications like Telemedicine and EMR. ODMHSAS has been recognized by the American Telemedicine Association as having the largest telemedicine network in the nation that specializes in behavioral health. In FY13, 112,100 services were delivered via telepsychiatry more than a 20% increase from FY12. 26,590 Oklahomans were served through the ODMHSAS Telehealth 4790 more than in FY12. $3.4 million was saved by delivering services via telemedicine up from $2.4 million in FY12. More than 15.9 million kgs of CO2 were prevented from being emitted into our atmosphere by conducting services and business processes via telemedicine more than 9x that of FY12. Oklahoma serves as a model for states who are developing telemedicine networks for behavioral health services. ODMHSAS HCP Network Plan Rev 8/26/2014 Page 5

6 More than 550 instances of video-conferencing are in use to improve business processes. ODMHSAS oversees 141 distinct telemedicine sites in Oklahoma as shown in the map below. 6. PROJECT MANAGEMENT PLAN OUTLINING THE PROJECT S LEADERSHIP AND MANAGEMENT STRUCTURE, AND A WORK PLAN, SCHEDULE, AND BUDGET Project Leadership The ODMHSAS Consortium will be led by Director of Telehealth/UC Mark Black and Assistant General Counsel III Robin Wilson with direction from the Oklahoma Department of Mental Health Management Team. Kellogg & Sovereign Consulting, LLC (KSLLC) will provide consulting services for the project. The costs associated with developing, managing and operations of the consortia will be funded by the consortia HCPs (see Budget Section C). Management Structure The ODMHSAS Consortium is an effort of the Oklahoma Department of Mental Health and Substance Abuse Services to provide funding for network connectivity in rural and non-rural areas for behavioral health Telemedicine/ Tele-psychiatry, EMR (electronic medical records), electronic prescribing, order entry, practice management applications, access to regional Health Information Exchanges and access to other Internet based resources used in patient care along with other non-clinical applications and technologies to manage these services. ODMHSAS s management includes a Board of Directors, ODMHSAS Commissioner and Deputy Commissioners. ODMHSAS HCP Network Plan Rev 8/26/2014 Page 6

7 Technical support and administration is provided by the ODMHSAS Information Technology Services Group. Work Plan and Schedule Topic Item Due Date Group/Individuals Responsible RFP Developed and Posted August 2014 ODMHSAS staff works with KSLLC to develop and finalize RFP and supporting material. Mark Black (MB), Robin Wilson (RW) and Debi Sovereign (DS) Bidders Conference Bid Evaluation Contracting between ODMHSAS and Vendors Implementation Projects Initiated per Contracts and Service Agreements Mandatory Bidders Conference on-site at ODMHSAS ODMHSAS staff evaluates vendor bids to determine which are most cost effective. ODMHSAS staff works to finalize contracts and service agreements with successful vendors. ODMHSAS staff work with HCPs and selected Vendors on tasks required implementing contracted services. Second Tuesday after Form 461 posting No later than 14 days after bid closing No later than 21 days after bid closing Within 90 days of bid closing. Mark Black (MB) MB, RW and ODMHSAS Management Team (ODMHMT) MB, RW and ODMHMT MB, RW, ODMHSAS Information Technology Team (ODMHITT) BUDGET A formal budget will be developed as part of the contracting phase when real costs are known. As some revenues for the project are from other funding sources (Oklahoma Universal Service Fund) which may change each year, budgets will be revised to reflect those changes each year. The budget will be modified during the Form 462 filing process. Funding Sources include the following: a) Oklahoma Universal Service Fund ( OUSF ) - Level of funding not covered by HCF up to set bandwidth level determined by OUSF. This varies by HCP depending on services provide for Telemedicine and EMR systems. b) Health Connect Fund 65% of contracted network services. c) Unfunded Costs Any unfunded consortia costs will first be funded by each HCP through revenues (should any be realized) for services provided at the respective HCP site based on the unfunded costs for each specific network connection at that HCP. Since ODMHSAS is the ODMHSAS HCP Network Plan Rev 8/26/2014 Page 7

8 predominant behavioral health service provider for indigent Oklahomans, should there be unfunded consortia costs remaining said costs will be paid from legislative appropriated funds. d) Cost of Consortia Provided Management, Support and Technology Services The Consortium will provide all implementation and support services for the HCPs. These services are provided by the ODMHSAS Information Technology Department which is solely responsible for design, implementation and support of these services. The costs assessed for each HCP will be determined by cost of equipment needed to provide services and number of staff supported by the network for each HCP. CONCLUSION The funding support provided by the FCC s Health Care Connect fund will support ODMHSAS s goals to develop and maintain the technological infrastructure necessary to facilitate high quality, cost-effective services and support for our clients and their families. Achievement of our network goals will further enable our mental health system to improve the wellness, recovery, resiliency, prevention/early intervention, and expansion of opportunities for accessible community-based services for all Oklahomans. ODMHSAS HCP Network Plan Rev 8/26/2014 Page 8

9 OK Dept Mental Health 2401 NW 23 rd St OKC HCP (Sheppard Mall) Carl Albert MH 1101 E Monroe McAlester HCP Jim Talliaferro MH 602 SW 38 th Lawton HCP Jim Talliaferro MH 611 SW B Ave Lawton HCP Jim Talliaferro MH 324 S Hwy 81 Duncan HCP Choctaw St Alva HCP N Grand Enid HCP Mbps 1425 N Main Fairview HCP NE Hwy 54 Guymon HCP Gbps Fiber 20 Mbps Fiber COCMHC-Leland Wolf 1120 E Main Norman HCP COCMHC 909 Alameda Norman HCP OCCIC 2625 General Pershing Blvd Oklahoma City HCP NW Center for BH th St Woodward HCP Gbps Fiber Tulsa Center for BH 2323 S Harvard Tulsa HCP ODMHSAS MPLS CLOUD 1 Gbps Fiber Central Office 1200 NE 13 th St Oklahoma City HCP Cradduck Rd Ada HCP Mbps Fiber 20 Mbps Fiber Griffin Memorial 900 E Main Norman, OK HCP CRC th Ave NE Norman, OK HCP E 2nd Heavener HCP Rogers Dr Holdenville HCP E Jackson Hugo HCP E Lincoln Rd Idabel HCP NE D St Stigler HCP Rose Rock Recovery S 4420 Rd Vinita HCP OK Forensic Center S 4420 Rd Vinita HCP Western State Psych Cntr 1 Mile E Hwy 270 Fort Supply HCP ODMHS Altus 215 Commerce Altus HCP William Ave Woodward HCP HCP Oklahoma Department of Mental Health and Substance Abuse Services Revision 1 Last Updated 8/1/2014 Revised By DJ Sovereign File Name Dept of Mental Health WAN -DS Update vsd