Innovation Communities: Celebrating Success Showcase Webinar

Transcription

1 Innovation Communities: Celebrating Success Showcase Webinar Kate Davidson, LCSW

2 Presenter Kate Davidson, LCSW Assistant Vice President, Practice Improvement National Council for Behavioral Health

3 Innovation Community Showcase Webinar During this webinar we will Reflect on the Innovation Communities Long-Acting Injectable (LAI) Antipsychotics Risk Stratification Celebrate Innovation Communities challenges, successes, & lessons learned LAIs Northwell Health Risk Stratification Sullivan County Department of Community Services, Behavioral Health Clinic Montefiore Medical Center, Wakefield Hospital Park Slope Center for Mental Health Harlem East Life Plan Preview upcoming Care Transitions Network events

4 Innovation Communities Care Transitions Network Clinical Goal: Reduce all-cause rehospitalization rates by 50% for people with serious mental illness Innovation Communities Support this Goal Three (3) month deep dive into subject matter Webinars TCPI expert faculty Affinity Groups peer-to-peer learning & application Showcase webinar celebrate successes

5 Innovation Community Topics LAI Antipsychotics Risk Stratification LAIs and the Challenges of Medication Adherence Helping Patients Make Decisions about LAI Treatment Current Reimbursement for LAI Antipsychotics Setting up an LAI Antipsychotic Program Switching, Dosing, and Other Prescribing Issues Sustaining a LAI Antipsychotic Program Defining Your Risk Stratification Algorithm Building a Risk Stratification Algorithm Mapping the Algorithm to Your EMR Linking Population Health with Risk Stratification Using Data to Drive Clinical Supervision Embedding Risk Stratification into Policies and Procedures

6 The LAI Innovation Community

7 Northwell Health

8 Thank you for your participation in the LAI Innovation Community! We appreciate the many challenges agencies confront. You are to be applauded for your improvement efforts in a sometimes difficult health care environment.

9 Thank you for your participation in the LAI Innovation Community! Your participation in series of webinars and affinity group meetings Goals accomplished: Better understanding of LAIs as an important intervention for medication nonadherence and Better understanding and utilization of resources to increase prescription of LAIs

10 Your Accomplishments Celebrate your agencies accomplishments Sharing of information Peer-to-peer learning Readiness to learn new and adapt existing practices Commitment to organizational success

11 Organizational Successes

12 Bleuler Psychotherapy Center: A Holistic Approach Utilizing the LAI Innovation Community to promote their vision Decrease hospitalizations Increase number of patients on LAIs Increase clients life expectancy Prepare for Value-based Purchasing agreements

13 Making Data Driven Decisions Utilizing PSYCKES data to inform treatment High utilizers of inpatient hospitalizations High utilizers of ER visits Adherence measure in PSYCKES to see who is picking up their medication (based on pharmacy fill data) Translating this information to staff Behavioral Healthcare Coordination Consultation Form

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17 Administration: Positive & Focused Advancement of LAI Program is being driven by administration Translating data for staff has been well received Continuous reinforcement of ongoing initiatives with staff Encouraging open and transparent communication with staff Providing on-going training opportunities for staff In-person Northwell trainings offered through CTN Technical Assistance Helping Patients Make Decisions about LAI treatment Diagnosing Comorbidity

18 Catholic Charities Brooklyn and Queens: Organizational Culture Change Utilizing the LAI Innovation Community as a Vehicle for Change Increase evidence-based practices Decrease hospitalizations Negotiate with MCOs Prepare for Value-based Purchasing agreements Dispelling myths around LAIs Only for complex cases Only for client who are deemed non-compliant

19 Support from Administration Communicated with leadership and staff about developing an LAI program Encouraging staff to attend the webinars and affinity groups Clerical support for authorization and patient specific benefit verification process Allows 30-minute medication management appointments Identified a Champion: Dr. Felix Sterling Doubled his use of prescribing LAI in past 2 years More than 35 patients on LAIs Enthusiastic, knowledgeable, and willing to share his personal experiences with staff

20 Data Collection Looking at the adherence measure in PSYCKES to see who is picking up their medication (based on pharmacy fill data) Tracking monthly hospitalization rate through clinical reporting Tracking how many clients on LAIs have been hospitalized in the past 6 months Disseminating this information to staff

21 Educating and Training Staff Utilized the CTN Technical Assistance Opportunities LAIs for Prescribers The Use of Long Acting Injectable Antipsychotics LAIs for Non-Prescribers: Are Long Acting Injectable Antipsychotics a Good Choice for Your Patients? Ongoing communication with Northwell consultants to assist with Best Clinical Practice Evidence-based practices

22 Catholic Charities LAI program: Future Plans Integrate increased LAI use as part of a larger initiative to increase treatment adherence and enhance recovery Changing workflow processes: Hiring registered nurses to administer the injections and the required observation period On-site pharmacy Increase staff education Working with Northwell to provide more on-site trainings to assist in increasing accurate client education of appropriate LAI treatment Market LAIs directly to clients Place LAI literature in client waiting areas to increase knowledge and destigmatize LAIs Increase communication with administration and clinical staff Implement monthly case management meetings to review new clients who may be appropriate for LAI

23 Next Steps: LAI Resources Schedule your FREE LAI training Customizable to your agencies needs Northwell Consultation Best Clinical Practice Support Services Education about other clinical measures including quality of life, functional improvements, and psychopathology LAI Prescriber Toolkit Online learning module that is available through the Center for Practice Innovations website

24 Madeline Maldonado, LCSW-R Bleuler Psychotherapy Center Clinical Director Contact Information Delbert Robinson, MD The Zucker Hillside Hospital Northwell Health Claudia M. Salazar, LCSW Catholic Charities Vice President of Clinics, Recovery, and Rehabilitative Services John Kane, MD The Zucker Hillside Hospital Northwell Health Lauren Hanna, M.D. The Zucker Hillside Hospital Northwell Health Megan Walsh, MA, LMHC, MBA The Zucker Hillside Hospital Northwell Health The project described was supported by Funding Opportunity Number CMS-1L from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

25 The Risk Stratification Innovation Community

26 Sullivan County Department of Community Services Behavioral Health Clinic

27 Barriers to Implementing New Processes Low-Income Patient Populations The Behavioral Health Clinic sees approximately 1600 patients per month, ranging in age from 5-years-old through adulthood. 6% of our client population are classified as high risk. The majority of the clients are people who are impoverished and the working poor. Principle payer is Medicaid Managed Care. Lack of Transportation Transportation and access to services is poor. We are a large, rural county, roughly the size of Rhode Island, without viable mass transportation opportunities. Transportation has been a factor in client engagement and retention.

28 Solutions Open Access Clinic The clinic intake and scheduling processes were revised in April 2013 Instituted an Open Access Clinic Walk-in clinic in which clients are served on a first come - first serve basis four days a week. Just-In-Time Scheduling The clinic initiated Just-In-Time Scheduling in February Clients are not given a follow-up appointment Provided with a reminder card to call to schedule their next appointment. When they call, the appointment is scheduled in 3-5 business days. Integrated Care In February 2017, we became an integrated behavioral health clinic Combined our OASAS licensed substance abuse clinic and OMH licensed mental health clinic into one behavioral health clinic under the licensure of OMH.

29 Progress Plan to link all clients identified as high risk, not previously assigned a health home care management program, to a health home care management program. Clinicians are reviewing clinical summaries on Psyckes site for all clients rostered as high risk. Indicators: Engagement and ensuring that high risk clients are seen a minimum of every 2 weeks Monitoring medication compliance/adherence Monitoring usage of ER/inpatient Settings Began Wellness/Health Management group in September to promote healthy lifestyle, diet, and smoking cessation.

30 Discoveries: Patient Populations clients in any given month Small percentage, approximately 6% are the highest users of emergency department and inpatient services, both for medical and behavioral health needs. Of those clients, many of them had issues with engagement, medication adherence, and following treatment recommendations. Correlations Strong correlation with secondary issues of substance abuse and mental illness. Strong correlation with mental illness and cardiometabolic issues of obesity, diabetes, and chronic physical health issues. Significant correlation with trauma exposure and behavioral health issues in our overall patient population.

31 New Processes & Organizational Engagement Change is not unique to our organization, as we have instituted several changes over the past few years. Change was embraced by some staff more quickly than others. Some staff need extra coaching and prompts to utilize the Psyckes software on a routine basis. Staff initially were enthusiastic about informing clients designated as high risk, who were not assigned to a health home care management organization, about the availability of the service. Within a month, 41% of high risk clients were linked, however, efforts to continue to link clients with the service has fallen off.

32 Next Steps EHR System Upgrade Currently awaiting a software upgrade to our EHR system to fully operationalize our algorithm. Our EHR has been in existence since 2007 and is in need of an upgrade. We are a county government unit - coordination between our county IT department and our software vendor needs to take place prior to the update taking place, which has stalled our efforts to fully operationalize our algorithm. In the interim, we are manually extracting data from our EHR, which hinders our ability to fully assess the accuracy and effectiveness of data in our risk stratification tool. Trainings Scheduled November - Training on collaborative documentation practices. After the training, this practice will be mandatory for clinicians to comply with. January & February - Trauma Informed trainings for the entire agency to enhance our trauma lens

33 Risk Stratification Modification in a Large Medical Center: Working within a Framework of Systemic Barriers Michael Schmidt, LCSW, Clinical Supervisor, Montefiore Medical Center, Wakefield Hospital Adult Outpatient Psychiatry

34 Barriers EMR is a hospital-wide system covering multiple departments and sites Therefore, we cannot have reports run for our clinic s site There is a separate finance department, so finance cannot be involved in the clinic s stratification process Montefiore Medical Center s current Department of Psychiatry risk stratification algorithm is fully operational across multiple sites, so a different algorithm cannot be formally implemented The current algorithm informs clinicians practices and our Department Policy and Procedure

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36 Revised Indicators of Risk for Risk Stratification Process Psychiatric hospitalizations Psychiatric ED visits Medical hospitalizations Medical ED visits

37 How to Capture Data Report by clinicians (psychiatrists, social workers, psychologists) of the previous occurrences with their patients Data entered manually Use of PSYCKES if consent given Process has been in place

38 New Departmental Initiative Identification of ways to reduce inpatient psychiatric hospitalizations - (in process)

39 Current Clinical Pathways Standard of high risk patients seen weekly, moderate risk patients biweekly All at risk patients are conferenced with weekly by their treatment team at weekly team meetings and outside of them Aggressive outreach for at-risk patients(use of emergency contact/collateral if patient does not respond to outreach for missed appts. Use of NYC-WELL referral if emergency contact/collateral does not work and if clinical situation warrants such a referral Safety plan developed for all at-risk patients and always incorporated into the treatment plan

40 Modification for New Risk Identification The medical element needs to be factored in Frequency of psychiatric hospitalizations and ED visits is already an element of risk stratification, but will carry additional weight However, barrier exists that the current system is across several psychiatry sites and departments

41 Future Steps Development of a specific weighted algorithm Synthesizing what our current data tells us about our population Possible modification of clinical pathways Continuing to discuss/address systemic barriers

42 Park Slope Center for Mental Health

43 Challenges Outpatient Mental Health Founded in 1987 # Clinicians 25 # Psychiatrics clients and growing 70% Medicaid All ages Depression/Anxiety/Bipolar and other psychotic disorders Located in the Park Slope Neighborhood of Brooklyn

44 Barriers Small organization with staff wearing multiple hats EHR does not capture and pull all the data we need Relying on PSYCKES data attribution and claim lags

45 Indicators Solution Four indicators/weighted PSYCKES Quality Flag hospitalizations, readmissions If on Practice High Risk Flag More medium risk than high risk Want to prevent movement from Medium to High Risk

46 Engagement Checklist Operationalize it Interventions

47 Harlem East Life Plan

48 Barriers Obtaining Data Looking at all the QI / accreditation projects and consolidating where can, leveraging Communication with community resources (hospitals for admissions/readmissions/discharge planning) Understanding the different payers and what they allow for interventions sometimes intervention doesn t fit the consumer s need; these can be in conflict with practices programs, interventions and systems

49 Solutions Use PSYCKES using more frequently now and earlier in the course of treatment Put in baseline Incorporate indicators used in defining risk into intake process, where needed Incorporate therapist input Using community resources Define treatment protocols and safety planning Implementation of health monitoring protocols Now RNs are part of MH and addiction programs

50 Progress Defined criteria for High, Moderate, Low risk Review weekly in team meetings Documented treatment protocols and safety planning Developed process to move consumers between levels of risk Having visual data has increased the buy in from the prescribing providers improved team work Scheduled versus walk in consumers

51 Discoveries Number of pregnancies occurring for females in year old in high risk group Looking at what agency can do to address this issue Number of consumers not reporting hospitalizations can see the data now so can proactively pursue with the consumer

52 Next Steps Continue to collect data Include more indicators like medication adherence Process will impact the annual report will help with how to think about 2018 Redefining program model for VBP

53 New Care Transitions Network Series: Value Propositions + Business Partnerships Nina Marshall, Senior Director of Practice Improvement Care Transitions Network Helene Kopal, Senior Director of Practice Improvement Care Transitions Network

54 New Care Transitions Network Series: Value Propositions + Business Partnerships Clients Value Propositions Should Answer: Who do you serve? What is the benefit of your services? What makes your services unique? How does this solve a problem? Payers Value Proposition Community Partners We ll Help You Answer: Who might you partner with? What might that partnership look like? What are health plans pain points? How do you articulate your value? What is your next best step?

55 Getting Ready for Value Based Payments Develop community partnerships with other providers in the recognition as part of assuming shared accountability for patient outcomes and health communities Take steps to create and/or join IPAs and other collaborative organizations; Identify the goals and approaches taken by managed care organizations to foster quality care and reduce costs; Articulate the defining and differentiating characteristics of their organizations, and formulating value propositions; and Create a strategy to secure contracts and agreements aligned principally on quality and cost of services

56 Value Proposition + Business Partnerships Series Mastering PSYCKES: Maximizing Data Sources to Operationalize Population Health Thursday, November 2 nd, :00-1:00pm E.T. This Thursday! Role of Community Partnerships in Value-Based Payments Thursday, November 30 th, :30-1:30pm E.T. Payers and Pain Points: Scanning the Health Plan Environment Wednesday, December 13 th, :00-2:00pm E.T. Knowing Your Value: Positioning as Business Partners Wednesday, January 17 th, :00-3:00pm E.T. Regional Workshops: Communicating Your Value Walk away with a value proposition statement February and March 2018

57 Other Upcoming Events

58 Upcoming Events Opioid Affinity Group Sign-up Period: November 14 th November 24 th Event Date/Time Audience Opioid Affinity Group #1: Evaluating Organizational Readiness to Increase Access to MAT Opioid Affinity Group #2: Using Risk Stratification to Identify High-Risk Populations and Increase Access Opioid Affinity Group #3: Developing an Action Plan to Increase Access to MAT Opioid Affinity Group #4: Monitoring and Evaluation for Continuous Quality Improvement Tuesday, 11/28/17, 12:00 pm 1:00 pm E.T. Tuesday, 12/19/17, 12:00 pm 1:00 pm E.T. Tuesday, 1/16/18, 12:00 pm 1:00 pm E.T. Tuesday, 1/30/18, 12:00 pm 1:00 pm E.T Administrators Administrators Administrators Administrators The Opioid Affinity Group will help practices with MAT programs increase access to care for people with OUD by providing the guidance, strategies, and resources needed for organizational transformation Enrollment for this affinity group will be limited to 15 participants to facilitate effective peerto-peer sharing and learning Target audience: Administrators of medium-sized practices with existing MAT programs

59 Your Practice Coaches Maura Gaswirth Practice Transformation Specialist Donna Stevenson Practice Transformation Specialist

60 Thank you! The project described was supported by Funding Opportunity Number CMS-1L from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.