Assessment Overview. David Lloyd, Founder M.T.M. Services

Transcription

1 Integrated Healthcare Readiness Assessment Overview Presented by: M.T.M. Services P. O. Box 1027, Holly Springs, NC Phone: Fax: Web Site: mtmservices.org

2 Overview: Parity Law and ACA Opportunities and Challenges 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

3 Payment Models Highest to Lowest Provider/Payer Risk 1. Full Risk Capitation/Sub-Capitation Rates (Per Member per Month) 2. Partial Risk Outpatient Only Capitation/Sub-Capitation Rates 3. Bundled Rates/Episodes of Care Rates Shared Risk (Case rates that combines the facility cost and care costs) 4. Stratified tifi Case Rates Shared Risk 5. Case Rates Shared Risk 6. Capped Grant Funding Shared Risk 7. Performance Based Fee for Service Shared Risk 8. Fee for Service Payer Risk Presented By: 3

4 Value-Based Purchasing Model

5 Value-Based Purchasing Model Core Elements 1. Know cost per service/staff type 2. Identify clinically recommended service mix, frequency and duration per level of care/intensity of need (i.e., ICD-10 CM) to support tdetermination ti of costs of bundled/episodic care needs 3. Provide outcomes to demonstrate reduction of high/disruptive cost services (i.e., reduction in ER visits) Presented By: 5

6 SAMHSA Ni D i f M d

7 Affordable Care Act Implementation Questions and What Will be the Outcome for CBHOs

8 Two Focus Areas for Participation in the Integrated Healthcare Ecosystem 1. Assess current behavioral health service delivery capacity to address: Loosely held federation of private practices or group practice model Practice management support for the clinical team Objective measurement capacity operations through KPIs and outcomes 2. Then develop integrated healthcare (co-location or bi-directional) capacity 3. System Noise can be so great if area one above is not addressed that transitions into new P4P payment models, integrated care models, outcome based bonus incentive models will overwhelm centers. 8 Presented By: 8

9 Action Items to Consider in an Integrated Healthcare Ecosystem 1. Partnerships with Primary Care Partners to Collaborate, Co-locate, or Integrate Primary Care Professionals 2. Select Model of Integration with Primary Care 3. Which services to Integrate? 4. Organizational Structures needed to support Integration Linkages to Medical Specialists 9 Presented By: 9

10 Healthcare and Parity Law Reform Context: Under an Accountable Care Organization Model the V l f B h i l H lth S i ill d d

11 NCQA Accreditation Standards for Patient- Centered Medical Homes (PCMH)

12 Presented By: Source: Primary Care Corporation PCMH Self- Assessment Tool 12

13 Poll Results based on over 600 Registrants for the NC LIVE Webinar on Enhanced Services Presented by David Lloyd, MTM Services on December 15, 2009 and January 12, From the clinicians i i perspective, are the caseloads in your organization full at this time? Yes = 74% No = 26% 2. Do you know the cost and days of wait for your organization s first call to treatment plan completion process? Yes = 41% No = 59% 3. Indicate the no show/cancellation percentage last quarter in your organization for the intake/assessment appointments: A. 0 to 19% = 20% B. 20 to 39% = 42% C. 40 to 59% = 15% D. Not aware a of percentage = 23% 4. Indicate the no show/cancellation percentage last quarter in your organization for Individual Modality appointments: A. 0 to 19% = 14% B. 20% to 39% = 35% C. Not aware of percentage = 26% Presented By: 13

14 Change Initiatives to Enhance CBHOs Value as a Partner in Healthcare Reform 1. Reduce access to treatment processes and costs through a reduction in redundant collection of information and process variances 2. Develop Centralized Schedule Management with clinic/program wide and individual clinician Back Fill management using the Will Call procedure 3. Develop scheduling templates and standing appointment protocols for all direct care staff linked to billable hour standards and no show/cancellation percentages 4. Design and implement No Show/Cancellation management principles and practices using an Engagement Specialist to provide qualitative support 5. Design and implement internal levels of care/benefit package designs to support appropriate utilization levels for all consumers 6. Design and Implement re-engagement/transition procedures for current cases not actively in treatment. 7. Develop and implement key performance indicators for all staff including cost-based direct service standards 8. Collaborative Concurrent Documentation training and implementation Presented By: 14

15 Change Initiatives to Enhance CBHOs Value as a Partner in Healthcare Reform 9. Design and implement internal utilization management functions including: Pre-Certs, authorizations and re-authorizations Referrals to clinicians credentialed on the appropriate third party/aco panels Co-Pay Collections Timely/accurate claim submission to support payment for services provided

16 Integrated Healthcare Readiness Assessment Focus Areas: 1. Enhance Access to Treatment 2. Centralized Schedule Management including Will Call and Back Fill Support 3. Show/Cancellation Management including Scheduling Templates, and Engagement Specialist 4. Caseload Management including Levels of Care/Benefit Package Designs to support appropriate utilization levels 5. Design and Implement re-engagement/transition procedures for current cases not actively in treatment. 6. Cost Based Key Performance Indicators (KPIs) 7. Measurement KPIs to support coaching/mentoring activities by supervisors/managers 8. Collaborative Concurrent Documentation Models and Processes 9. Internal utilization management functions including Credentialing Support for Clinical Staff; Pre- Certs, authorizations and re-authorizations; and referrals to clinicians credentialed on the appropriate third party/aco panels 10. Payer mix enhancements including Third Party Payers 11. Revenue Cycle Management including co-pay collections and claim submission 12. Outcome Assessment Capacity (i.e., PHQ-9, DLA-20, etc.) 13. Community awareness support including collaboration with medical providers 14. Change Management Capacity including use of Rapid Cycle Change Plan Models Presented By: 16

17 Integrated Healthcare Readiness Assessment Sample Questions:

18 Integrated Healthcare Readiness Assessment Sample Questions: Presented By: 18

19 Healthcare Reform and Parity Readiness Key Performance Value Indicators: 1. Access to treatment processes and costs First call to first face to face Assessment/Treatment Planning Assessment/Treatment Planning to first treatment appointment Assessment/Treatment t t Planning to first medical team appointment t with MD/NPs 2. Use of Centralized Schedule Management with clinic/program wide and measurement of Back Fill management using the Will Call procedures 90% backfill standard 3. Use of scheduling templates and standing appointment protocols for all direct care staff linked to billable hour standards and no show/cancellation percentages Individual Clinician based templates Clinical based templates Presented By: 19

20 Healthcare Reform and Parity Readiness Key Performance Value Indicators: 4. Monitoring No Show/Cancellation management principles and practices using an Engagement Specialist to provide qualitative support Initial No Show/Cancellation to Assessment/Treatment Planning No Show/Cancellation ongoing rates 10% to 15% 5. Use of internal levels of care/benefit package designs to support appropriate utilization levels for all consumers and utilization review of each level Percent of clients that are not completing their identified level of care benefit design 6. Use of person centered re-engagement/transition procedures for current cases not actively in treatment and outcome measurement related to an increase in medication adherence and a reduction in no shows and ER/Psychiatric Hospital visits Level of increased Medication Adherence (client report and clinician report) Level of decrease in no show rates for individual therapy, group therapy and medication management visits Presented By: 20

21 Healthcare Reform and Parity Readiness Key Performance Value Indicators:

22 Healthcare Reform and Parity Readiness Key Performance Value Indicators: 10. Objective and measurable job descriptions including key performance indicators for all staff Do current job descriptions support coaching/mentoring i by supervisors? 11. Use of an objective key performance indicator b d E l ti P f ll t ff

23 Healthcare Reform and Parity Readiness Assessment Typical Findings: 13. Revenue cycle management Level of collection of co-pays and sliding fee scale fees? 14. Outcome Assessment Capacity What current outcome indicators are being used and can the team measure functional improvements in DLAs? 15. Community awareness levels including primary care providers? Is there a community awareness plan, news releases and media list? 16. Ability to use rapid cycle change management model to support the goals and objectives needed to ensure implementation of needed changes Presented By: 23

24 Integrated Healthcare Readiness Assessment Change Management Section: Presented By: 24

25 Integrated Healthcare Readiness Assessment Availability:

26 Sample Readiness Assessment Summary of Findings and Recommendations Report:

27 27

28 Thank you for your attention > Questions and Answer Session > Next Steps? Presented By: 28