Behavioral Health IT: Moving Toward Whole Person Care. Kevin Scalia Executive Vice President Netsmart. Al Guida President Guide Consulting

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2 Behavioral Health IT: Moving Toward Whole Person Care Kevin Scalia Executive Vice President etsmart Al Guida President Guide Consulting

3 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

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5 VALUE-BASED CARE

6 Common Elements of Value-Based Care Outcomes Improve Population Health Quality better care, safety, individual & family experience Reduce Cost

7 COMPLEXITY Risk Continuum Fee-for-service One service One payment Pay for Performance Upside only Process measures Case Rate Group of services Unified payment Periodic payment Bundled Payment Bundle of services Unified payment Quality targets Episode-based payment Capitation Full risk Population target Disease specific/all in Total Health Outcomes Shared risk on total member experience RISK

8 Post-Acute Care Integration will be Critical in most Value-Based Care Reimbursement Models LEVEL OF RISK BEARIG Pay-for-performance Bundled payments Shared-savings models Shared-risk models Full risk models Hospital value-based payments BCPI initiative Medicare shared-savings program (MSSP) Track 1 (savings only, no downside risk) MSSP Track 2 (60% sharing) ext Generation ACO (full risk model) Hospital readmission penalties Comprehensive joint replacement (CJR) Medicare Track 3 (up to 75% sharing) Medicare advantage (MA) Hospital-acquired infection program Cardiac bundles ext Generation ACO (80-85% sharing option) Managed Medicaid Merit-based incentive payments Movement toward 50% bundled payments Exchange-based plans Post-acute readmission penalties ote: Risk models highlighted by these boxes indicate post-acute care will be a key focus Source: The Advisory Board Company and William Blair

9 CMS Initiatives Will Impact Your Top Line Revenue Source:

10 THE EXPLOSIO OF OW - Value The Landscape of Today s Healthcare Industry CCO Bundled Payments ACO PMPM Capitation Accountable Care HEALTH HOMES Incentive Payments CCBHC RCO Pay-for- Performance HHVBP Medicaid Expansion DSRIP Managed Care Value-based contracting Care Coordination

11 THE EXPLOSIO OF OW - Technology The Landscape of Today s Healthcare Industry HIE Clinical integration Consumer Apps Integrated Care Clinical Decision Support Trauma- Treatment Models Predictive Analytics Precision Medicine MEDICATIO MAAGEMET ICD-10 Meaningful Use EBP Population Health Tools Stratification Knowledge Flow Integration with Physical Health BIG DATA Care Mobility Jail Diversion & Treatment

12 Community Care Integrating with Primary Care WHAT OUR COMMUITIES HAVE I COMMO eed to COECT to the rest of healthcare Play a CARE COORDIATIO role for the community Highly MOBILE workforce HIGH COMPLEXITY reimbursement level/models Shift towards VALUE-BASED CARE DIFFERET MARGI PROFILE than acute care Care models tend to be LESS EPISODIC

13 Key Elements of Whole-Person Care Value-Based Care Coordination/Integration Care Management Population Health Management

14 REDUCE COST IMPROVE OUTCOMES DELIVERIG VALUE-BASED CARE Provider Path to Deliver Value-Based Care EMR & Medication Management Regulation/ Legislation/MU Clinical Decision Support Information Exchange Primary Care Integration Population & Community Health Management OUTCOMES COST = Value Hosting & SaaS CLIICAL IOVATIO Revenue Cycle Management BUSIESS EFFICIECIES Managed Services CARE COORDIATIO Technology Partners BECHMARKIG DATA AALYTICS

15 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

16 VBC Requires Building an Expanding Set of Workforce and Technology Capabilities Cost accounting knowledge Highly functional EHR capabilities Data exchange capabilities On demand consumer access Automated measurement of systemic quality indicators Management of episodic rates of service

17 CCBHCs Requires reduction in cost and improved care for the ETIRE 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

18 CCBHCs Address Evolving Care Coordination Requirements FQHC Inpatient MH Facilities, Detox, Residential Social Services, School, Justice, Child Welfare CCBHC Acute Care Hospital(s) VA, IHS PCP(s)

19 Emerging VBC Models Driven by Payers Case Managers Low Acuity High Care Managers Payers $$ PMPM + Incentive Gaps in Care Providers Low High Clinical Measures Outcomes Measures Social Determinants Claims Process, Case Management & Analytics Risk Stratification Algorithms QA UM Integrated IT Systems Care Management & EHR

20 Leveraging Technology for Success

21 Technology Components For Whole Person Care 1 EHR + Complex Billing 3 12 Care Coordination Referral Management Population Health Management Connectivity and Collaboration Analytics

22 Biggest Identified Technology Gaps As providers prepare for value-based care 30% 25% 20% 15% # 1 Interoperability # 2 Reporting/ Analytics 10% 5% 0% Interoperability Reporting/ Analytics Outdated Software Equipment Robust Billing Software Care Team Telehealth/ Telemonitoring Population Health Tools EMR Adoption/ Usability Patient Outreach/ Education

23 Competitive Advantage Analytic Capabilities Continuum Increasing your competitiveness Optimization Predictive Modeling/ Forecasting Statistical Analytics Predictive and Prescriptive Analytics Alerts Query/Drill Down Ad Hoc Report Descriptive Reporting and Access Standard Report Degree of Intelligence

24 Missing Data Can Increase Risk Important care information is missing 78% of the time 3 out of 10 tests are reordered because results cannot be found May see up to 16 physicians per year Paper patient charts cannot be found on 30% of visits Medicare beneficiary with multiple chronic conditions 86% of mistakes made in healthcare industry are administrative

25 Patient Medications 30% are on 8 or more medications 40% of patients do not understand the side effects Care Coordination Advancing your data exchange capability supports improved care coordination and minimizes risk Medication Reconciliation Between Organizations Safety 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 SF: 1 hour/$35

26 Interoperability: The Journey to Integrated Care Documentation Exchange Standardizing data transfer with CCDs, labs, public health registries and health information exchanges Secure, Direct Exchange Direct Message internally as well as externally to the larger provider community, enabling coordinated care across the care continuum Integrated, Whole-person Care Single patient record across the entire continuum Using a Certified EHR Digitized but unconnected to the larger provider community Transitions of Care Point-to-point referrals within a single workflow Query-based Exchange Find/request information from other providers, such as discharge summaries Query for Key patient information 6 Minutes vs. 29 hours COECTIG TO THE LARGER ECOSYSTEM COECTIG OUTSIDE YOUR FOUR WALLS

27 Cost Outcomes Analysis Outcomes Reduced Hospitalizations Reduced Acuity Levels Engagement Consumer Satisfaction Reduced Risk of Harm Cohorts Diagnosis Acuity Level Age Gender Outcomes Service Analysis Service Type Licensure Modality Frequency

28 CARE COORDIATIO/ITEGRATIO

29 Example: Tampa Bay Area myavatar myavatar Crisis Call Center myavatar myavatar

30 Example: CMHC to Acute Care myavatar myavatar

31 Example: CMHC to FQHC myavatar myavatar myavatar

32 Example: County to Justice System myavatar

33 The Carequality etwork A Common Interoperability Framework to Share Health Data Connect to all community providers on the Carequality network Aggregate documents across the care continuum Robust consent service ensures the right access is granted Information is integrated within EHR workflows One connection to the Carequality network means a connection to every provider who participates in Carequality Common rules of the road Legal obligation and agreement to abide by the same rules Well-defined technical specifications Shared rules are not enough; detailed guide for implementers required A participant directory To connect using the common standards, systems must know the addresses and roles of each participant

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35 CARE MAAGEMET

36 Creating a Safety et FOR IMPROVED OUTCOMES P P Creating a network for providers P to communicate helps ensure the consumer s needs are being met Legend P P Provider Behavioral Health eed P COSUMER Physical Health eed Social Health eed P P P

37 Referral Coordination THE IMPORTACE OF COECTIG REFERRIG PROVIDERS CATEGORIZIG EEDS BY DOMAI CARE EEDS OF A IDIVIDUAL MAKIG THE RIGHT REFERRAL eeds are categorized by Domain COSUMER * Primary Care Outpatient Clinic * eeds are linked to Providers who will support and provide care There may be overlap between provider domains and type of eed Community Service Agency

38 Example: Health Homes of Upstate Y Inpatient Mental Health Substance Use Centers CMHC CHAUTAUQUA WESTER Social Service Departments Local Health Departments Greater Lakes Mental Health Southern Tier Lake Shore Behavioral Health Hospitals Primary Care Practices FIGER LAKES Huther Doyle CETRAL Onondaga CMS Care Management 60 etwork Providers 3,300+ Consumers 16,000

39 Example: Missouri CCHBC CCBHCC level Care Manager/Coordinator View of: Aggregated Patient Data View Claims Alerts and Reminders Compliance at a patient & coordinator level ER Visit Missouri Medicaid Hospitalization Claims Missouri DMH Patient Specific Data CMHC Assignment Programs Claims ED Visits Providers Health Plan Eligibility Patient Care Data Population Health Data View Quality Measures & Reporting Missouri Coalition & View of: Quality Analytics Org Compliance Metabolic Screening: Vitals Labs Health Risk Factors CMHC EHRs myavatar (Ozark) Anasazi (Pathways) Credible (ew Horizons) PsychConsult (Truman)

40 Care Management Dashboard

41 POPULATIO HEALTH MAAGEMET

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43 Enrollment / Engagement Strategies DEFIE ASSESS STRATIFY EGAGE MAAGE Population Identification Health Assessment Risk Stratification Differential Management Tailored Interventions Care Coordination Clinical Case Management Population Health Risk Management Clinical Recovery Connecting with clients in the way that works best for them: Text Phone Face-to-face Telehealth Meeting clients where they are: Home School Work Community Clinic

44 Behavioral Health As Community-Based Care Coordination Leader Behavioral Health CareInMotion Clinical & Outcomes Data HealtheIntent Healthy Planet Attributed to your ACO Attributed to another ACO Attributed to your Bundle Attributed to another hospital's Bundle Health System CCD Data ED Alerts ACO Patients Bundle Payments Care Plans Referral Data Outpatient Clinic Care Coordination Primary Care Office Consumer s Home Population Health Skilled ursing Facility Other Acute Care Facility

45 LEGISLATIO

46 etsmart 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

47 Behavioral Health IT Coalition etsmart ational Council for Behavioral Health American Psychological Association (APA) Association for Behavioral Health and Wellness (ABHW) Centerstone The Jewish Federations of orth America (JFA) Mental Health America (MHA) ational Association of Counties (ACo) ational Association of County Behavioral Health and Disabilities Directors (ACBHDD) ational Alliance on Mental Illness (AMI) ational Association of Psychiatric Health Systems (APHS) ational Association of State Alcohol and Drug Abuse Directors (ASADAD) ational Association of Social Workers (ASW)

48 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)

49 EW MATRA SLIDE Bundy