An Unprecedented Explosion of Now: In a Rapidly Shifting Healthcare Landscape, Netsmart Model Offers Planning and Measurement System for Strategic Healthcare Information Technology Journey By Michael G. Valentine CEO Netsmart October 2014
The delivery of healthcare services has become increasingly complex in the last decade. The landscape is crowded, with a progressively complex regulatory environment and multiple partners and actors implementing programs and priorities sometimes overlapping, sometimes fragmenting overall care. It is also crowded with health problems new problems and old that are getting bigger or appearing in unexpected places. Globally, more than 350 million people of all ages suffer from depression (Depression, 2012). Approximately 29 percent of adults with medical conditions also have mental health conditions; 68 percent of adults with mental health conditions also have medical conditions (Sarah Goodell, 2011). One in 68 children has been identified with an autism spectrum disorder (CDC Media Relations, 2014). Most adults in nursing homes have some clinically significant psychiatric problem, with estimates of prevalence ranging from 65 percent to 91 percent (D.C. Grabowski, 2010). At Netsmart, we believe that despite the many complex challenges, these are optimistic times for health. The attention and resources being devoted to health are unprecedented. This, too, is part of the healthcare landscape. But attention means close scrutiny, and resources come with an expectation of results. The stakes are high and the responsibility to deliver is great. More than ever, there is a growing understanding of the need to implement a more comprehensive, integrated approach to care. Organizations are being forced to shift from a specialized-care model to one that involves caring for the whole person, focusing on optimal healing and wellness, integrating healing practices and holistic systems of medicine informed by evidence and collaborating and coordinating care between providers. Disruptive technologies and processes will have the biggest impact on healthcare and undoubtedly play a fundamental role in making these aforementioned shifts a reality. If a caregiver from even 20 or 30 years ago walked into a present day care setting, he/she probably wouldn t recognize a lot of what was happening, especially in the realm of healthcare IT. Technology has advanced. As technology continues to advance, tools are becoming smaller and more mobile, allowing for their use in the outpatient or home setting. More sophisticated electronic health records and related solutions are enabling the coordinating of evidence-based client care across care teams. As the choices for the use of healthcare IT evolve and become more robust, it is imperative that healthcare providers plan for and understand the long-term implications of the technologies they employ. They need a map to help them chart the course toward providing the most effective healthcare in the most efficient way, driving better outcomes and ensuring organizational sustainability. At Netsmart, we see ourselves as our client s strategic partner in this journey. We believe it is our obligation to invest today in the solutions required for tomorrow s needs by solving these real-world challenges side-by-side with our clients. We owe it to our clients to deliver healthcare IT innovations, giving them the capabilities to innovate, to redefine who they are and how they deliver their services in this ever-changing healthcare landscape. Page 2
Healthcare 2.0: The HIT Value Model As the CEO of Netsmart, I have the privilege and opportunity to meet with literally thousands of providers each year. The single most commonly asked line of questioning I hear goes something like this: What should I do next? What is the value of progressing down the healthcare IT adoption path? What is the next big thing clinically/financially/operationally, and what value does it bring? These questions are clearly front and center as technology presents itself with all of its enticements. But technological advancement costs money, and organizations want to be confident that they are making the right investments at the right time. To assist in this endeavor, Netsmart has unveiled the Healthcare IT Value Model geared toward the health and human services provider community. This vendor-agnostic common measurement system can give your organization answers to what you should do next and the value associated with that strategic decision. The HIT Value Model tells you where you are compared to others, measures your level of healthcare IT adoption, and gives you feedback on what could be next and where that could take you as your organization progresses. The HIT Value Model is a strategic roadmap embedded in a snapshot of the health and human services care system, with your client (the person) at the center. It offers you a well-defined path for improving financial, clinical and operational performance the key elements for the long-term sustainability of your organization. HIT 1.0 was the excitement of digitization, innovation, optimization, care coordination and clinical advancement. HIT 2.0 is turning these exalted concepts into a concrete reality that ultimately benefits providers and the people who come to them. In its current iteration, the HIT Value Model encompasses five dimensions of the care continuum: Providing Care, Integrating Care, Informing Care, Engaging in Care and Accounting for Care. These are the aspects that Netsmart feels are most vital for the success of a healthcare organization in 2015. But we see this model as ever-evolving and expanding in parallel with the continued evolution of healthcare HIT Value Model Page 3
Person-Centered At Netsmart, we believe that when healthcare IT is designed and implemented with the providers clients in mind, it has the power to connect, inform, empower and protect. The person is at the center of the HIT Value Model because our mission, like your mission, is to maintain or improve the health status of every person. We also recognize that this is the direction in which healthcare is moving. The world is in the me age, the age of the individual, of the consumer. The health and human services community is not immune to this shift, but rather has been at its forefront. There is a growing realization that care needs to be more person-centric and empowering, more able to recognize the strengths of service users and to empower them within the care system. As the traditional, paternalistic and hierarchical model of healthcare comes to an end, Netsmart is ready to work with our clients to develop solutions that achieve this goal. Providing Care We define providing care as planning, delivering and documenting care given. Every healthcare organization provides care. Healthcare information technology is one part of driving a more effective and accountable care process, which can lead to improved outcomes. Effective use of technology by healthcare professionals has the potential to improve healthcare quality and safety in the healthcare office, the community and at home. It can also lead to increased health skills and knowledge. Integrating Care We define integrating care as creating a coordinated, integrated and comprehensive care process across all providers of care, while maintaining responsibility for the health status of a person. There is a subset of the American population with co-morbid mental and medical conditions. Based on epidemiological data from the National Comorbidity Survey Replication, an estimated 34 million American adults, or 17 percent of the adult population, have comorbid mental and medical conditions within a given 12 month period (Benjamin G. Druss MD, 2011). The high prevalence of co-morbidity and system fragmentation leads to problems in quality and costs of care that are complicated and burdensome. The elevated cost of care for this population, coupled with the ACA s push for breaking down silos and providing continuity of care, offers tremendous opportunity for improving care coordination. Healthcare IT will play an integral role in promoting a methodical approach to delivering coordinated services; not just health interventions, but improving health outcomes while ensuring efficient access to the healthcare system, to newly instituted Accountable Care Organizations, health homes and other coordinated care models, and to additional needed support services. While not all providers are embracing and participating in efforts to better coordinate care, at Netsmart we believe this is one of the most important components of the changing healthcare landscape for organizations to understand. This is happening now, and will only accelerate into the future. Informing Care We define informing care as bringing knowledge to the point of action. In the context of healthcare IT, informing care is about bringing information to the professional clinical, financial or operational at the most valuable point in time. We do not believe that healthcare IT or clinical decision support will be successful if viewed as a replacement for the clinicians unique perspective and understanding of a given situation. Rather, we know that clinicians are doing more with less and in a time of rapidly changing best practices and principles. Clinical decision support is a valuable tool for informing care. Page 4
Furthermore, health and human services has struggled for standardization. In order to create improvement, there must be a common way of providing care for like clients and in like organizations. This allows providers to compare the effectiveness of their work to others, and to grow from that experience. One of the real-time challenges for the health and human services community is finding a balance between applying evidence-based and best practices and providing person-centered care. Netsmart is joined with you on this mission. Engaging in Care We define engaging in care as empowering the person to participate directly in the care process. Patient engagement is emerging as a clear competitive edge in the healthcare space. To meet the requirements of the Affordable Care Act s quality of care and patient satisfaction measures, providers will be forced to provide deeper engagement opportunities. A key to this effort will be implementing technology, such as patient apps and portals, which provide patients unprecedented access to their information. Online platforms will ultimately need to connect everyone on a patient s care team, including the patient, with the goal of improving care and the patient experience. Accounting for Care We define accounting for care as managing claims, processing payments and generating revenue from intake to remittance. The U.S. spends more on healthcare per capita than any other country (Organization for Economic Co operation and Development, 2013) with 31 percent of the spend going toward the administration required to support the multitude of complex reimbursement models. Today, the healthcare community must ask itself what actions can reduce the projected growth of health spending, while at the same time enhancing population health. Healthcare information technology has helped improve medical practice management by increasing practice efficiencies and offering cost savings. According to one national survey (HealthIT.gov, 2014): Seventy-nine percent of providers report that with an EHR their practice functions more efficiently. Eight-two percent report that sending prescriptions electronically (e-prescribing) saves time. Based on the size of a health system and the scope of their implementation, the net benefit of implementing a full electronic medical record system would include 15 percent savings from decreased billing errors and a 15 percent savings from improvements in charge capture (Samuel J. Wang, 2003). Page 5
Netsmart s Vision: An Evolving Model While we see the HIT Value Model as a solid first roadmap for measuring and mapping healthcare information technology adoption, we also recognize that this model will need to be flexible and dynamic. As Netsmart works with our clients to determine next steps for their organizations, we will concurrently provide this tool to the greater health and human services community as a means to drive standardization and success. We also appreciate that there are distinct differences between health and human services communities. Over time, we plan to evolve the model to be applicable to each community behavioral health, intellectual and developmental disabilities, addiction treatment, child and family services, for example. We will also continually evaluate the HIT Value Model dimensions. As policies change and the needs of populations evolve, we are working with our clients, and the health and human services community in general, to offer the best measurement tool for their needs. Over time, the model will be expanded to measure achievement with and above adoption. HIT value will then be defined by the combination of an organization s adoption and the measurement of key performance indicators. These performance indicators will be benchmarked against industry standards. This will enable organizations to determine the depth, scope and ultimately effectiveness of the technologies they are adopting. Netsmart is proud to be not only the largest and one of the longest-established healthcare IT solution providers, but also a leader in moving healthcare forward. As the leader, we feel a real obligation to help lead the industry toward a value-based journey in adopting technology. For us, healthcare IT is not a software transaction, but a lasting relationship of continued mutual innovation on behalf of the people our clients serve. I have been involved in many parts of the healthcare landscape and I have no doubt that the providers that serve in this part of healthcare are the most cause connected. We share that same passion to make a difference. To Learn More About the HIT Value Model and the Role It Can Play for Your Organization, visit www.hitvaluemodel.com To Learn More About Our Clients Healthcare IT Achievements, visit www.ntst.com/hear-from-clients/ Page 6
References Benjamin G. Druss M.D., M. A. (2011). Mental disorders and medical comorbidity. Princeton: Robert Wood Johnson Foundation. D.C. Grabowski, K. A. (2010). Quality of mental health care for nursing home residents: A literature review. Medical Care Research and Review, 627-656. CDC Media Relations. (2014, March 27). CDC Newsroom. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/media/releases/2014/p0327-autism-spectrum-disorder.html Depression. (2012, October). Retrieved from Wold Health Organization: http://www.who.int/mediacentre/ factsheets/fs369/en/ HealthIT.gov. (2014, March 20). Benefits of EHRs. Retrieved from HealthIT.gov: http://www.healthit.gov/ providers-professionals/medical-practice-efficiencies-cost-savings (2014). National Diabetes Statistics Report. Atlanta: Center for Disease Control. Organization for Economic Co-operation and Development. (2013). OECD Health Data: Health expenditure and financing: OECD Health Statistics. Retrieved from OECD: http://www.oecd-ilibrary.org/social-issuesmigration-health/total-expenditure-on-health-per-capita_20758480-table2 Samuel J. Wang, M. P. (2003). A Cost-Benefit Analysis of Electronic Medical. New York: Excerpta Medica Inc. Sarah Goodell, M. B. (2011). Mental disorders and medical comorbidity. Princeton: Robert Wood Johnson Foundation. Page 7
ABOUT MICHAEL G. VALENTINE Michael Mike Valentine sets Netsmart s vision and strategy. He focuses on meeting the company s business objectives, securing resources for growth and supporting Netsmart s mission on behalf of its associates and clients. Since joining the company in May 2011, Valentine has more than doubled the size of the company in terms of both clients and revenues, overseen two acquisitions and launched new data and revenue cycle management businesses. Under his leadership, Netsmart has been named one of Kansas City s fastest growing companies and among Kansas City s best places to work by the Kansas City Business Journal. Valentine came from Cerner Corporation, where he served for 13 years in a variety of roles. The last five years he served as executive vice president and chief operating officer. In that capacity, he oversaw delivery and client relationships for Cerner s worldwide operations. Valentine created a centralized implementation model that improved predictable and timely implementation of best practices, created an advanced technology focus that produced key innovations that extended the reach of the existing solution set, launched a leadership development program, and refined client coverage models, among other accomplishments. During his time at Cerner, the company grew revenues to $1.7 billion with 10,000 employees worldwide. Prior to joining Cerner, Valentine co-founded and managed Maryville Technologies, a Midwest-based integrated IT solutions company. Valentine holds a bachelor s degree in industrial engineering from Kansas State University. He is on the board of directors of Streamline Health Solutions, Inc. (NASDAQ: STRM), as well as a volunteer board member with the American Heart Association, American Royal, Kansas State University and Wildscape Foundation. He is married with two children and says he makes everyday matter by ensuring that Netsmart s focus remains centered on our clients success. ABOUT NETSMART Netsmart is committed to helping health and human services providers deliver effective, outcomes-based care with Netsmart s CareFabric solution, a tightly woven framework of innovative clinical and business solutions and services that supports integrated, coordinated delivery of health services across the spectrum of care. More than 23,000 client organizations, including 450,000 care providers and more than 40 state systems, use Netsmart solutions to help improve the quality of life for more than 25 million people each day. Netsmart is pleased to support the EveryDay Matters Foundation, which was established for behavioral and public health organizations to learn from each other and share their causes and stories. For more information, visit www.everydaymatters.com Learn more about how Netsmart and the CareFabric solution are changing the face of healthcare today. Visit www.ntst.com, call 1-800-472-5509, follow us on Twitter, like us on Facebook or visit us on YouTube. For more information about Netsmart, visit www.ntst.com. Page 8