Behavioral Health IT:

Moving Toward “Whole Person Care”

Kevin ScaliaExecutive Vice President

Netsmart

Al GuidaPresident

Guide Consulting

Agenda

• Value based care is driving risk bearing by providers

• What do the VBC models look like?

• Why is technology required to do VBC?

• Talking points & lessons learned for Hill visits?

• Legislative asks

VALUE-BASED CARE

Outcomes – Improve Population Health

Common Elements of Value-Based Care

Quality – better care, safety, individual & family

experience

Reduce Cost

CO

MP

LE

XIT

Y

Capitation

•Full risk

•Population target

•Disease specific/All

in

Fee-for-service

•One service

•One payment

Case Rate

•Group of services

•Unified payment

•Periodic payment

Bundled Payment

•Bundle of services

•Unified payment

•Quality targets

•Episode-based payment

Total Health

Outcomes

•Shared risk on

total member

experience

Pay for

Performance

• “Upside only”

•Process

measures

Risk Continuum

RISK

Post-Acute Care Integration will be Critical in most Value-Based Care Reimbursement Models

Source: The Advisory Board Company and William Blair

LEVEL OF RISK BEARING

Pay-for-performance Bundled payments Shared-savings models Shared-risk models Full risk models

Hospital value-based payments BCPI initiativeMedicare shared-savings program (MSSP) Track 1 (savings only, no

downside risk)

MSSP Track 2 (60% sharing)

Next Generation ACO (full risk model)

Hospital readmission penaltiesComprehensive joint replacement

(CJR)Medicare Track 3

(up to 75% sharing)Medicare advantage (MA)

Hospital-acquired infection program Cardiac bundlesNext Generation ACO

(80-85% sharing option)Managed Medicaid

Merit-based incentive paymentsMovement toward 50% bundled

paymentsExchange-based plans

Post-acute readmission penaltiesNote: Risk models highlighted by these boxes indicate post-acute care will be a key focus

Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html

CMS Initiatives Will Impact Your Top Line Revenue

Managed Care

Incentive

Payments

CCBHC

Capitation

DSRIP

Value-based

contracting

HEALTH

HOMES

Pay-for-

Performance

MedicaidExpansion

CCOAccountable

CareACOBundled

Payments

RCO

Care

Coordination

THE EXPLOSION OF NOW - Value The Landscape of Today’s Healthcare Industry

PMPM

HHVBP

Trauma-

Treatment

Models

HIE

MEDICATION

MANAGEMENT

Precision

Medicine

Stratification

Clinical Decision Support

Clinical

integration

Predictive

Analytics BIGDATA

KnowledgeFlow

ConsumerApps

Meaningful

Use

THE EXPLOSION OF NOW - TechnologyThe Landscape of Today’s Healthcare Industry

Integrated

Care

Integration with

Physical Health

Care

Mobility

EBP

Jail

Diversion

& Treatment

ICD-10

Population Health Tools

Community Care Integrating with Primary Care

WHAT OUR COMMUNITIES HAVE IN COMMON

•Need to CONNECT to the rest of healthcare

• Play a CARE COORDINATION role for the community

• Highly MOBILE workforce

• HIGH COMPLEXITY reimbursement level/models

• Shift towards VALUE-BASED CARE

• DIFFERENT MARGIN PROFILE than acute care

• Care models tend to be LESS EPISODIC

Key Elements of “Whole-Person” Care

• Value-Based

• Care Coordination/Integration

• Care Management

• Population Health Management

Hosting & SaaS

CLINICAL INNOVATION CARE COORDINATION

BUSINESS EFFICIENCIES

BENCHMARKING

DATA ANALYTICS DE

LIV

ER

ING

VA

LU

E-B

AS

ED

CA

RE

Value

OUTCOMES

COST

=

EMR & Medication

Management

Clinical Decision

Support

Information

Exchange

Primary Care

Integration

Regulation/

Legislation/MU

Population & Community

Health Management

IMP

RO

VE

OU

TC

OM

ES

RE

DU

CE

CO

ST

Revenue Cycle

Management Managed

Services Technology

Partners

Provider Path to Deliver Value-Based Care

Value-Based Care Considerations

• Early models of VBC often stratified and attributed populations for participants

– Health Homes (SPMI and Asthma, COPD, Diabetes)

• Emerging models do not attribute within an assigned population…

– Providers own the population and need to determine the best care mix for clients

– Providers must also stratify and identify priority cohorts on their own

VBC Requires Building an Expanding Set of Workforce and Technology Capabilities

• Cost accounting knowledge

• Highly functional EHR capabilities

• Data exchange capabilities

• Management of episodic rates of service

• On demand consumer access

• Automated measurement of systemic quality indicators

CCBHCs• Requires reduction in cost and improved care for the ENTIRE population served

with an emphasis on vulnerable cohorts

• Requires data exchange and coordination of care across a broader network

• Jails, VA, social service providers and schools

• States are focused on how they gather and report respective quality metrics

• CCBHCs required to alter process and technology to support reporting & service delivery requirements

CCBHCs Address Evolving Care Coordination Requirements

CCBHC Acute Care Hospital(s)Social Services,

School, Justice,

Child Welfare

Inpatient MH

Facilities, Detox,

Residential

FQHC

PCP(s)VA, IHS

Low HighAcuity

Claims

Process,

Case

Management

& Analytics

Care

Management

& EHR

QA UM

Risk Stratification Algorithms

PayersProviders

LowHigh

$$ PMPM + Incentive

Gaps in Care

Clinical Measures

Outcomes Measures

Social Determinants

Integrated IT Systems

Case

ManagersCare

Managers

Emerging VBC Models Driven by Payers

Leveraging Technology for Success

Technology Components For Whole Person Care

Connectivity and Collaboration

Analytics

Referral Management

Population Health Management

EHR +

Complex Billing

Care Coordination

11

12

3

0%

5%

10%

15%

20%

25%

30%

Interoperability Reporting/Analytics

OutdatedSoftware

Equipment

RobustBilling

Software

Care Team Telehealth/Telemonitoring

PopulationHealth Tools

EMR Adoption/Usability

PatientOutreach/Education

Biggest Identified Technology GapsAs providers prepare for value-based care

#1Interoperability #2

Reporting/

Analytics

Analytic Capabilities Continuum

• Standard Report

• Ad Hoc Report

• Query/Drill Down

• Alerts

• Statistical Analytics

• Predictive Modeling/

Forecasting

• Optimization

Predictive and

Prescriptive Analytics

Descriptive Reporting

and Access

Degree of Intelligence

Co

mpe

titive A

dvan

tag

e

Increasing your competitiveness

Missing Data Can Increase Risk

May see up to

16 physicians per year

Medicare beneficiarywith multiple chronic conditions

Important care information is missing

78% of the time

3 out of 10 tests are re-ordered because results cannot be found

Paper patient charts cannot be found on 30% of visits

86% of mistakes made in healthcare industry are administrative

Care Coordination

Patient Medications

• 30% are on 8 or more medications

• 40% of patients do not understand the side effects

Advancing your data exchange capability supports improved care coordination and minimizes risk

Medication Reconciliation Between OrganizationsSafety

• Approximately 50 percent of hospital-related medication errors

and 20 percent of adverse drug events result from poor

communication at transition

• Approximately 60 percent of post-discharge adverse drug

events could be prevented or improved by better intervention

Efficiencies

• Estimated cost of reconciling medications without history:

10 hours/$290

• Estimated cost with increased coordination between hospital

and SNF: 1 hour/$35

Interoperability: The Journey to Integrated Care

Documentation ExchangeStandardizing data transfer with CCDs,

labs, public health registries and health

information exchanges

Secure, Direct ExchangeDirect Message internally as well as externally

to the larger provider community, enabling

coordinated care across the care continuum

Using a Certified EHRDigitized but unconnected to the

larger provider community

Transitions of CarePoint-to-point referrals within

a single workflow

Query-based ExchangeFind/request information from other

providers, such as discharge summaries

CONNECTING TO THE LARGER ECOSYSTEM CONNECTING OUTSIDE YOUR FOUR WALLS

Integrated, Whole-person CareSingle patient record across

the entire continuum

Query for Key patient information

6 Minutes vs. 29 hours

Outcomes Analysis

Cohorts• Diagnosis

• Acuity Level

• Age

• Gender Outcomes

Co

st

Service Analysis• Service Type

• Licensure

• Modality

• Frequency

Outcomes• Reduced Hospitalizations

• Reduced Acuity Levels

• Engagement

• Consumer Satisfaction

• Reduced Risk of Harm

CARE COORDINATION/INTEGRATION

myAvatar

myAvatarCrisis

Call Center

Example: Tampa Bay Area

myAvatar

myAvatar

Example: CMHC to Acute Care

myAvatar

myAvatar

Example: CMHC to FQHC

myAvatar

myAvatar

myAvatar

Example: County to Justice System

myAvatar

Common rules of the roadLegal obligation and agreement to

abide by the same rules

Well-defined technical

specificationsShared rules are not enough; detailed

guide for implementers required

A participant directoryTo connect using the common

standards, systems must know

the addresses and roles of

each participant

The Carequality NetworkA Common Interoperability Framework to Share Health Data

Aggregate

documents across the care

continuum

Connect to all

community

providers on the

Carequality network

Information is

integratedwithin EHR

workflows

Robust consent

service ensures the

right access is

granted

One connection to the

Carequality network means a

connection to every provider

who participates in Carequality

CARE MANAGEMENT

Creating a Safety Net

Creating a network for providersto communicate helps ensure the

consumer’s needs are being met

FOR IMPROVED OUTCOMES

Legend

Provider

Behavioral Health Need

Physical Health Need

Social Health Need

P P

P

P

P

P

P

P

P

N

N

N

NN

N

N

N CONSUMER

N

N

N

Referral CoordinationTHE IMPORTANCE OF CONNECTING REFERRING PROVIDERS

Needs are categorized by Domain

Needs are linked to

Providers who will support

and provide care

There may be overlapbetween providerdomains and type of Need

CATEGORIZING NEEDS BY DOMAIN

CARE NEEDS OF AN INDIVIDUAL MAKING THE RIGHT REFERRAL

Primary Care

Outpatient Clinic

Community ServiceAgency

**

N

N

N

NN

N

N

N CONSUMER

N

N

N

N

N

N

N

Example: Health Homes of Upstate NY

Onondaga CMS

Lake Shore

Behavioral

Health

CENTRAL

WESTERN

Greater Lakes Mental

Health Southern Tier

Huther Doyle

CHAUTAUQUA

FINGER

LAKES

• Social Service Departments

• Local Health Departments

• Inpatient Mental Health

• Substance Use Centers

• CMHC

• Hospitals

• Primary Care Practices

3,300+

NetworkProviders

16,000

CareManagement

60Consumers

Example: Missouri CCHBC

ER Visit

Hospitalization

Patient Specific Data

• CMHC Assignment• Programs• Claims• ED Visits• Providers• Health Plan Eligibility

Missouri

Medicaid

Patient Care Data

Metabolic Screening:

• Vitals• Labs• Health Risk Factors

Population Health Data View

Quality Analytics Org Compliance

Missouri Coalition & View of:

Missouri

DMH

Claims

CMHC EHRs• myAvatar (Ozark)• Anasazi (Pathways)• Credible (New Horizons)• PsychConsult (Truman)

CCBHCC level Care Manager/Coordinator View of:

• Aggregated Patient Data View• Claims

• Alerts and Reminders• Compliance at a patient & coordinator level

Quality Measures & Reporting

Care Management Dashboard

POPULATION HEALTH MANAGEMENT

Meeting clients where they are:Home | School | Work | Community | Clinic

Connecting with clients in the way

that works best for them:

Email | Text | Phone | Face-to-face | Telehealth

En

rollm

en

t / E

ng

ag

em

en

t S

trate

gie

s Differential Management

Risk

Stratification

Population

Identification

Health

Assessment

DEFINE ASSESS STRATIFY ENGAGE MANAGE

Tailored Interventions

Care Coordination

Clinical Case Management

Population Health

Risk Management

Clinical Recovery

Behavioral Health As Community-Based Care Coordination Leader

Attributed to

your ACO

Attributed to

your Bundle

Attributed to

another ACO

Attributed to another

hospital's Bundle

Health System

CCD Data | ED Alerts | ACO Patients | Bundle Payments | Care Plans | Referral Data

Primary Care

Office

Skilled Nursing

Facility

Outpatient

Clinic

Consumer’s

Home

Other Acute

Care Facility

Population

HealthCare

Coordination

HealtheIntent

Healthy Planet

Clinical &

Outcomes

Data

CareInMotionBehavioral Health

LEGISLATION

Netsmart Legislative Advocacy

• Advocacy for health IT-related Congressional legislation and regulatory issues on behalf of our clients

• Founding member of BHIT Coalition– Consortium of 12 key organizations advancing public policy for technology to improve the lives

of people with mental health and addiction disorders

• Engage with key human services and post-acute associations to support their advocacy efforts

• More information at www.ntst.com/legislation

Behavioral Health IT Coalition

NetsmartNational Council for Behavioral Health

American Psychological Association (APA)Association for Behavioral Health and Wellness (ABHW)CenterstoneThe Jewish Federations of North America (JFNA)Mental Health America (MHA)National Association of Counties (NACo)National Association of County Behavioral Health and Disabilities Directors (NACBHDD)National Alliance on Mental Illness (NAMI)National Association of Psychiatric Health Systems (NAPHS)National Association of State Alcohol and Drug Abuse Directors (NASADAD)National Association of Social Workers (NASW)

Improving Access to Behavioral Health

Information Technology Act (H.R. 3331/S.1732)

• HIT incentive payments to improve coordination of behavioral health and addiction treatment services– Via the Center for Medicare & Medicaid Innovation (CMMI)

• Community mental health centers, residential and outpatient MH treatment facilities, substance use treatment facilities, clinical psychologists, clinical social workers

• For adopting certified EHR technology and using it to improve the quality and coordination of care through the electronic exchange of health information.

– Builds on the 21st Century Cures Act HIT requirements for transparency, usability and interoperability

– Sponsors: Sen. Rob Portman (R-OH), Sen. Sheldon Whitehouse (D-RI), Cong. Lynn Jenkins (R-KS) and Cong. Doris Matsui (D-CA)

NEW MANTRA SLIDEBundy