A Behavioral Health Collision At The EHR Intersection

Transcription

1 Transforming the HHS Experience Improving the relationship between payers, providers and consumers EHR A Behavioral Health Collision At The EHR Intersection Presenters: Michael R. Lardieri, LCSW AVP Strategic Program Development Behavioral Health Service Line North Shore LIJ Health System Robert Capobianco Vice President Marketing Core Solutions 1

2 Agenda Introductions Behavioral Health Policy Intersection Behavioral Health Organization Survey Signal Results Understanding Technology Transition Preparing For Change Understanding the Roadmap For Change Summary Q & A 2

3 Policy Environment Effecting Behavioral Health Operations: Mental Health Excellence Act Creates Certified Community Behavioral Health Clinics (CCBHCs) Funding: Provides $25M that will be available to states as planning grants to develop applications to participate in the 2- year pilot Stipulates that eight (8) states will be selected to participate Requires participating states to develop a Prospective Payment System for CCBHCs Technology: Data analytics are key to being able to function as a Certified Behavioral Health Clinic Timing: September 1, 2015: Deadline for HHS to publish: Criteria for a clinic to be certified by a State as a CCBHC Guidance for states to establish prospective payment system for participating certified clinics January 1, 2016: Deadline for the Secretary to award planning grants September 1, 2017: Deadline for the Secretary to select the States 3

4 Policy Environment Effecting Behavioral Health Operations: State Home Health Initiatives Enhanced Medicaid reimbursement for services to individuals with approved chronic conditions May include primary care practices, community mental health organizations, addiction treatment providers, Federally Quality Health Centers, health home agencies, etc. Team-based, whole-person orientation with explicit focus the integration of behavioral healthcare and primary care. Funding: Currently a Medicaid-only construct 1115 State Waivers Usually PMPM for 6 required services with more intensive care coordination and patient activation Technology: HIT will be required for documentation, population management, risk monitoring, resource allocation and data analysis Timing: Already in place in a number of states 4

5 Policy Environment Effecting Behavioral Health New Medicare Regulation for Chronic Care Management Services Operations: Two or more chronic conditions Provision of 24 HR X 7 access to address a patient s acute chronic care needs Continuity of care with a designated practitioner or member of the care team to get successive routine appointments Care management for chronic conditions including systematic assessment of medical, functional, and psychosocial needs System-based approaches to ensure timely receipt of all recommended preventive care Medication reconciliation with review of adherence and potential interactions Oversight of patient self-medication mgmt. Management of Care Transitions Coordination with home and community-based clinical service providers Funding: Currently a Medicare-only construct PMPM of approx. $42 in any 30 day period where at least 20 mins. of CCM services were provided Technology: HIT for: documentation, population mgmt., risk monitoring, resource allocation and data analysis Timing: Starts in CY

6 Policy Environment Effecting Behavioral Health Operations: Must have 2014 MU certified EHR technology Funding: Meaningful Use Stage 2 and Beyond Medicare or Medicaid Incentives are available Medicaid providers can still apply into 2016 and receive the full $63,750 over 6 years Technology: HIT will be required for population management, sharing information electronically, clinical quality measure monitoring and reporting, improving patient engagement Timing: Started in 2011 and runs through

7 Policy Environment Effecting Behavioral Health Other State Initiatives (e.g. NYS DSRIP, HARP ) Operations: Revamps the entire Medicaid system Designated providers in specific geographic areas Must coordinate care across all provider systems to improve outcomes and focused on decreasing all hospitalizations by 25% Must understand the system of care and make significant changes Funding: State specific funds $8B reinvestment from Medicaid Transformation Team savings $500M for the Interim Access Assurance Fund temporary, time limited funding to ensure current trusted and viable Medicaid safety net providers can fully participate in the DSRIP transformation without disruption $6.42B for Delivery System Reform Incentive Payments (DSRIP) including DSRIP Planning Grants, DSRIP Provider Incentive Payments, and DSRIP Administrative costs $1.08B for other Medicaid Redesign purposes this funding will support Health Home development, and investments in long term care, workforce and enhanced behavioral health services Providers are at Risk - if state does not meet its targets all providers reimbursements will be effected Technology: HIT for: documentation, population mgmt., risk monitoring, resource allocation and data analysis Timing: Starts in CY

8 Transforming the HHS Experience Improving the relationship between payers, providers and consumers Behavioral Health Organization Survey Results 8

9 Survey Overview Non Management 20% C-level 23% Manager 10% Executive Director 4% Vice President 5% Clinical 13% Director 25% How would you rate your organizations current relationship with your EHR provider? 9

10 Signal 1: BHO EHR Satisfaction No Response 3% Excellent 13% Those receiving federal funds face a 1% penalty in No EHR 30% Poor 14% Average 40% Excellent Average Poor No EHR No Response 10

11 Signal 3: Areas of Dissatisfaction 11

12 Signal 3: Areas of Dissatisfaction Category 1: One- Time Costs 9% No Response 41% Category 2: Big Ticket On-Going Costs 18% Category 3: Additional On- Going Costs 11% All 21% Note: Sub-population analysis of 117 individuals / 100 organizations 12

13 Transforming the HHS Experience Improving the relationship between payers, providers and consumers ICD 10 & DSM V Changing Technology Directions 13

14 Market Requires 2 nd Generation EHRs Generation 2 Industry Evolution 2010 ACA 1980 s DOS First Competitors Mass Production Obsolescence Satisfaction Research & Development Growth Maturity Decline Product Lifecycle 14

15 Design Intent Of Your EHR Billing driven The needs of behavioral health organizations have evolved beyond the original intent of 1 st generation product designs: Custom vs. Configuration Clinical driven 1. When was it created? 2. Who was it built to serve? 3. What problems did it solve? 4. How adaptable is the technology? Flexibility EHR Specialty driven Interoperability 15

16 The Era of Dynamic Healthcare Change Management Requires The Evolution of the Technology Foundation: 2-tier First Generation Architecture Second Generation Client Change the technology to stay Presentation current/status Layer quo Customization Vendor Centered Application Logic Layer Not Native/Bolt-on Disruptive Changes or No Changes at All Resource Management Layer Information Systems Change the technology for transformational flexibility Configuration Customer Centered Native & Interoperable Incremental adaptability 16

17 Signal 4: Areas of Innovation Consumer Engagement Change In Care Models Changes In Reimbursement Decision Support Telepsych Education At-risk Increased Demand Portals PHR Team-based Care Payer Mix Recovery Operational Outcome Mgmt. & Reporting Mobility EHR Innovations Population Mgmt. The sophistication of the needs of behavioral health organizations continue to evolve. Where do these fall on your organizational roadmap? 17

18 Transforming the HHS Experience Improving the relationship between payers, providers and consumers Preparing For Change 18

19 Where Is Your Organization s Satisfaction? Category Excellent Average Poor Description/Action Congratulations! Share your journey & best practices Continue to lead our industry Understand the vendor s technology & product roadmap Assess your relationship Create a timeline for a decision Perform an EHR ROI analysis Re-visit your organizational EHR strategy & roadmap Assess the EHR vendor landscape Time + Technology Maturity No EHR Create a plan avoid analysis paralysis Vendor diligence avoid over-engineering Select & start Be critical: Company vs. Function 19

20 Transforming the HHS Experience Improving the relationship between payers, providers and consumers Creating a Roadmap for Your Organization 20

21 Behavioral Health Maturity Model Automation and Performance Data Centralization Stage 1 Process Automation & Business Rules Integrated Behavioral Health Value-based Behavioral Healthcare Stage 2 Stage 3 Stage 4 Behavioral Health Operational Maturity 21

22 BH Maturity Stage 1: Single System Data Centralization Stage 1 Primary Goals Of Data Centralization: Identify Remove/Reduce Paper Increase Standardization Docs A Docs B Docs C Achieve Data Governance Centralize Tag Functionality: Single source of truth Rules engine Data standardization Value: Reduce Admin Costs Reduce cycle time Increase accuracy Professional Foundational Building Blocks: o Data storage o Process control o Data standardization o Portability 22

23 BH Maturity Stage 2: Process Automation & Business Rules Stage 2 Primary Goals Of Process Automation: Intake Provider Billing Streamline Intake Golden Thread Workflow Integrating Across The Organization Electronic Billing Decrease Process Variation Increase Quality Reduce Admin. Costs Increase Visibility Increase Coordination Functionality: Value: Process Control Standards & Rules Standard Workflow Standard Forms & Reports 1 View Of The Client Increase Clinical Quality Integrated Clinical & Billing Increase Service Revenue Capture Forms Reports Foundational Building Blocks: o Internal Coordination o Clinically-driven Billing o Baseline Performance Measurement o Integration 23

24 BH Maturity Stage 3: Integrated Behavioral Health Intake Provider Billing Reporting Stage 3 Primary Goals Integrated Behavioral Health: Streamline Intake Golden Thread Electronic Billing Workflow Integrating Across The Organization Real-time Analytics Decrease Gaps In Care Client Leakage Increase Care Coordination Increase Interoperability Analytics Process Control Standards & Rules CDS Analytics Forms Reports CCD HL7 Labs erx PCP Payer Functionality: Team-based Care Interoperability Clinical & Operational Analytics Foundational Building Blocks: o External Collaboration & Coordination o Interoperability Value: Coordinated Care Increase Data Enrichment Increase Service Delivery Options & Reimbursements o Clinical-baseline Performance o Alt. Reimbursements 24

25 BH Maturity Stage 4: Value-based Behavioral Health Intake Provider Billing Reporting Stage 4 Primary Goals Value-based Behavioral Healthcare: Streamline Intake Golden Thread Electronic Billing Workflow Integrating Across The Organization Real-time Analytics Decrease Gaps In Care Reduce FFS Increase Care Coordination Client Engagement Population Mgmt. Client Portal Process Control Standards & Rules CDS Analytics Forms Reports CCD HL7 At Risk Analytics Labs erx PCP Payer Functionality: Increase Access Increase Client Centered Manage At-risk Arrangements Foundational Building Blocks: o Population Mgmt. o Client Engagement Value: Population Mgmt. Revenue Protection Ability To Enter New Business Models o Meaningful Use 3 o Hybrid Reimbursements 25

26 Summary Prepare For The Next Wave Of Change These Changes Require Second Generation Technology The Survey Results Are An Indicator Of Acknowledgement & Readiness For Change There Are Methods For Justifying A Change: o Strategic Alignment o EHR Performance Change Is Not An Overnight Process: Create Organizational Roadmap o Big Bang vs. Phases o It s Not a Race o Constant Communication 26

27 Question and Answers THANK YOU! Quick Reference Links Core Solutions, Inc. Website: Core Industry Brochure: Core Cx360 EHR Overview: Core Cx360 2 Min. Video Overview: 27