Presented by: President M.T.M. Services, LLC P. O. Box 1027, Holly Springs, NC 27540

Transcription

1 Presented by Scott C C. Lloyd, oyd, President M.T.M. Services, LLC P. O. Box 1027, Holly Springs, NC Phone: Fax: Scott.lloyd@mtmservices.org Web Site: wwww.mtmservices.org

2 David Lloyd, Founder of and Senior Consultant for the National Council Scott Lloyd, President of and Senior Consultant for the National Council Randy Love, Chief Information Officer for SPQM Data Reporting Services Willa Presmanes, M.Ed., M. A., Medical Necessity/Utilization Management Expert and Co-Author of the DLA-20 (Daily Living Activities) functionality scale Bill Schmelter, Ph.D., Lead Clinical & Collaborative Documentation Consultant for and Consultant for the National Council Michael Flora, M.B.A., M.A.Ed., L.P.C.C., L.S.W., Lead Operations Consultant for, CEO of the Ben Gordon Center in DeKalb, IL, and Consultant for the National Council David Swann, MA, LCAS, CCS, LPC, NCC M.T.M. Services Senior Integrated Healthcare Consultant, CEO of a public Local Management Entity in North Carolina, and Consultant for the National Council Joy Fruth, M.S.W., Lead Process Change Consultant for M.T.M. Services and Consultant for the National Council Katherine Hirsch, MSW, LCSW, Collaborative Documentation Consultant Specializing in Collaborative Documentation with Children and Consultant for the National Council John Kern, MD - Collaborative Documentation Consultant for M.T.M. Services and Consultant for the National Council Annie Jensen, MSW, LCSW - Process Change Consultant for, Vice President of Operations/ Burrell Behavioral Health, and Consultant for the National Council Jennifer Hibbard - Operations Consultant for, CEO View Point Health in Georgia, and Consultant for the National Council Jennifer Senechal Financial Controller and Cost & Revenue Analyst for M.T.M. Services 2

3 Experience Improving Quality in the Face of Healthcare Reform has delivered consultation to over 700 providers (MH/SA/DD/Residential) in 45 states and 2 foreign countries since Access Redesign Experience (Excluding individual clients): 5 National Council Funded Access Redesign grants with 200 organizations across 25 states 6 Statewide efforts with 140 organizations Over 1,500 individualized flow charts created Over $16,000,000 in Annual Savings generated thus far A lot of happy staff and consumers 3

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6 Federal O.I.G. IG The Office of Inspector General -Do you know about the Exclusion s Database? -Do you know about RAC teams? -A lot of states are passing compliance responsibilities to providers. -Do you know why money is being taken back? -Increased audits with an emphasis on Medical Necessity Linkage and The Rehabilitation Model. 6

7 The Compliance Officer is accountable for the organization s compliance program, not the organization s compliance. Everyone is accountable for the latter by either their own conduct or staff or activity overseen. Source: Adam J. Falcone ( com) 7

8 Community Behavioral Health Clinics (CBHCs) have an excellent opportunity to be helpful partners in the new integrated healthcare system if they can display the following specific values: 1. Be Accessible (Provide fast access to all needed services). 2. Be Efficient (Provide high quality services at lowest possible cost). 3. Be Connected (Have the ability to share core clinical information electronically). 4. Be Accountable (Produce information about the clinical outcomes achieved). 5. Be Resilient (Have ability or willingness to use alternative payment arrangements).

9 In a system based on value-based purchasing, employers and other purchasers gather and analyze information on the costs and quality of various competing providers and health plans. They contract selectively with plans or provider organizations based on demonstrated performance, or at least proposed approaches for improving performance. Ideally, quality information becomes a factor in the setting of plan prices, and employee contributions vary with each plan's "score," which reflects a combination of quality and cost indicators. In this manner, the best performing plans and providers are rewarded with greater volume of enrollees or patients. Source: Theory and Reality of Value-Based Purchasing: Lessons from the Pioneer - Publication #

10 What data is needed for the decision, and how to attain it! 10

11 Question #1: Why are you in this meeting? Team members often feel that the topic of the meeting does not impact them directly. Teams get bored in the standard team meeting format that repeats the same/similar information. Teams who are not focused on a common goal often do not achieve their changes! How can the meeting s topic be tied to your organization s mission/vision? 11

12 Team members with differing opinions, but neither side has data to back their points is a key roadblock to successful changes! 12

13 Process Redesign Review Data is the key! Without data, teams set up to their exceptions. What is the best way to present it to staff? What data do you need and how do you get it? 13

14 No Show/ Cancellation Holiday Sick Leave Vacation Leave Travel Training Typical Center Staff Resource Utilization Billable Service Meetings Paperwork Non-Billable Service 14 14

15 Collaborative at Documentation o Same Day Access JIT Prescriber Scheduling No Show Management Utilization Review/Utilization Management Episode of Care (EOC) / Level of Care (LOC) 15

16 Costing based upon the different types of integrated health care models, benefit and concerns. 16

17 1. Accountable Care Organizations (ACOs) Model of Service Delivery. 2. Primary Care Practice Medical Homes Integration of primary care, and behavioral health needs available through and coordinated by the PCP. 3. CBHO Health Homes/ Person-Centered Medical Homes Integration of primary care, and behavioral health needs available through and coordinated by the CBHO. 4. Federally Qualified Health Centers (FQHCs) Integration of primary care, oral health, and behavioral health needs. 5. Multi Agency Health Homes Integrates medical, behavioral, social services, etc. 6. FQBHC? To be seen, currently being proposed in D.C., with the hope to be a reality in the future. 1717

18 Clinical Integration - what is experienced by the consumer in relation to the providers - this is the goal. To achieve that goal, it s important to be clear about which integration mechanisms are being selected and why... mechanisms promoting the goal of clinical integration include: Clinical integration: dually trained clinicians or interdisciplinary teams. Clinical practice integration: formal collaboration and consultation mechanisms, required screening practices, collaboration practices built into service protocols. Programmatic integration: incorporating health education into psychiatric rehabilitation or incorporating behavioral health intervention into diabetes management. Physical integration: co-location of services in either direction. Structural integration: behavioral health and primary care services under a common administrative authority, which can create standards for collaboration and clinical integration. Fiscal integration: mental health and primary care services under a common funding stream which can potentially be utilized to promote any of the other activities... This is an excerpt from the paper, "Behavioral Health/Primary Care Integration Models, Competencies, and Infrastructure" by the National Council for Behavioral Health. 18

19 Process Redesign Review RESULTS 19

20 Process Redesign Review 20

21 Process Redesign Review Although the group average was a 50% reduction in wait time, that means different things for different teams based upon their starting point. In the results above from the National Council s most recent Access Redesign grant, you can see that two teams actually reduced their wait time by 90% or more during our 8 months work time! 21

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23 The False Reality of Full!

24 The False Reality of Full!

25 The False Reality of Full!

26 The importance of knowing your organization s real costs situation. 26

27 Successful Costing Models Knowing Your Real Costs 27

28 Successful Costing Models Your Costs Versus Statewide Averages $300 $ $200 $150 $100 $50 $ Bachelors Level Below Bachelors Level Masters Level & Ab bove Psychiatrist & AR RNPs Current Cost Per Hour Statewide Avg. Cost PH Cost PH at 60% Productivity Statewide Avg. Cost PH at 60% Current Actual Reimbursement PH Statewide Avg. Reimbursement PH 28

29 Successful Costing Models CCPA Case Study 29

30 Advanced Data Driven Reporting Tools/Dashboards Why create an integrated data base reporting model using service encounter data rather than claims data? > Behavioral Health providers and state agencies have collected a large amount of data historically. > The historically collected data has not proven to be useful information to measure key qualitative and operational service delivery areas within the service delivery system > A significant amount of the data was manually collected/ self-reported data which presented concerns about accuracy and reliability > Multiple data bases at the local and state levels have supported data reports in the past and reliability, accessibility and comparability of output has been an ongoing challenge > Historical results of a no/low level of information data model decision making has had to rely on anecdotal, personal opinion and philosophical information 30

31 Advanced Data Driven Reporting Tools/Dashboards Local Support Needed for SPQM Quality Management System SPQM utilizes the CBHO s existing transaction database SPQM does NOT require special hardware SPQM does NOT alter existing information systems in any way. SPQM does NOT require any additional data entry for staff SPQM does NOT require additional staff to manage data SPQM provides monthly analysis and management consultation 31

32 Advanced Data Driven Reporting Tools/Dashboards Benefits of the SPQM System 1. Provides graphical measurement of service process performance compared to vertical line data reports 2. Has proven to promote a more positive need to change response from staff 3. Ability to pinpoint management and service delivery needs 4. Provides excellent corporate compliance measurement capabilities 5. Enables Information Systems to provide Ad Hoc measurement of service process as needed rather than in a monthly report format 6. Utilizes current service utilization data base without any additional keying of data 7. Moves staff from philosophical ideas and opinions to actual service process performance decision-making 32

33 Advanced Data Driven Reporting Tools/Dashboards 33

34 /MTM i