Costing Out Services that Generate Outcomes
|
|
- Theodora Hampton
- 5 years ago
- Views:
Transcription
1 Practice Transformation Academy Webinar #4: Costing Out Services that Generate Outcomes Nina Marshall, MSW Senior Director, Policy and Practice Improvement
2 Webinar Logistics We recommend calling in on your telephone Remember to enter your Audio PIN so we can unmute your line if you have a question Audio PIN: Will be displayed after you login This button should be clicked if you re calling in by telephone. Here s your audio PIN
3 How to ask a question Use the questions dialogue box to submit questions. OR To speak, please raise your hand. You are currently muted. We will call on you in the order in which hands are raised and unmute your line.
4 Costing
5 Value in Value-Based Payments = Quality Cost
6 Poll Question Who do we have with us today? Administrators/Program Staff Finance Direct care staff Other
7 Poll Question What statement best describes you? I am a costing newbie I understand what costing means in concept, but not in practice We ve costed out our services in FFS but not yet for bundled or other VBP arrangements We re comfortable with our costs for both FFS and bundled payment arrangements
8 Costs Depends on Who is Paying the Bills For example: State Medicaid Authority Medicaid Managed Care Organization Participating Providers Total Cost of Care Unit Costs
9 Cost Revenue Margin Payers Provider payments, admin costs, facilities, QI functions, etc. PMPM from those issuing the contract Revenue less costs; subject to Medical Loss Ratio (MLR) Providers Staff salaries, hourly staff fees, overhead, training, facilities, etc. Payer payments, grants, etc. Revenue less costs
10 Value in Value-Based Payments = Cost Payer cares about contracted rates Provider decisionmaking informed by own costs Quality
11 Provider Costs for Services Not your Medicaid fee schedule Not an individual clinician s salary divided by number of available billable hours Is based on: Salaries, hourly staff payments, IT, administrative costs, facility costs and other overhead costs Impacted by reimbursable and non-reimbursable activities Everything necessary to make your service happen
12 Costing for Fee-for-Service What are all of the costs that it takes to make a service happen Example: 90792/psychiatric assessment: Appointment scheduling time Direct clinician time AND Intake time (e.g., by social worker, front desk or care management staff) Documentation time Overhead costs like facilities, staff meetings, other nondirectly reimbursable activities necessary to do the work Examples of other factors influencing cost: Travel time No show rates
13 Gathering Data Time studies Workflow diagrams Working with finance team Historical data re: volume, length, type of services
14 Time Study: All Staff Time Monday Tuesday Wednesday Thursday Friday 8:00-8L15 8:15-8:30 Activity note 8: :45-9:00 9:00-9:15 Etc.
15 Analysis Options: Time, Wait, Cost, Revenue
16 Example Activity Staff Type Hourly Cost Hour Increment Appointment Scheduling Appointment reminder Direct care time Admin Assistant Admin Assistant $ $4.50 $ $4.50 Cost (Hourly cost x Hour increment) Psychiatrist $ $40.00 Documentation Psychiatrist $ $16.00 Other Costs $50.00 TOTAL PER $115.00
17 Forecasting Value Added Activities
18 Cost Flexibility in VBP Arrangements FFS limitations: Only receive payment if service delivered within (1) authorization limits, (2) personnel/clinician type requirements, (3) prescribed duration Inhibits creativity and use of alternative care strategies Incentivizes volume, not outcomes VBP opportunities: Manage towards the outcome, not the specific service requirements More client-centered What if you had $500 to spend? exercise
19 8 Steps to Bundled/Case Rate 1. Define the Population 2. Estimate the Penetration Rate 3. Define the Levels of Care 4. Estimate the Case Mix 5. Estimate the Utilization at Each Level of Care 6. Estimate the Cost per Unit of Service 7. Run the Calculations & Set the Case Rates 8. Identify the Performance Metrics Download: CASE RATE TOOLKIT: Preparing for Bundled Payments, Case Rates, & the Triple Aim (National Council for Behavioral Health)
20 Steps to Develop a Case Rate 1. Define the Population Who could receive the service(s)? 2. Estimate the Penetration Rate Who is likely to receive the services? 3. Define the Levels of Care What types of services are needed? 4. Estimate the Case Mix For those receiving the services, how many will need services by LOC? 5. Estimate the Utilization at Each Level of Care What s the anticipated volume + type of service for each level of care? 6. Estimate the Cost per Unit of Service Apply costs to separate activities to attain an estimated cost/unit 7. Run the Calculations & Set the Case Rates Apply the costs/unit to the volume and population estimates 8. Identify the Performance Metrics How will you know if (a) your services are aligned with client needs, (2) if your utilization and LOC assumptions are right?
21 Step 1. Defining the SBIRT Population Calculate the number of clients who are attributed to your organization meaning the number of people who receive these services from your agency. For example, total population of people served is 10,000 which includes children, adolescents and adults.
22 Step 2. Estimating the Penetration Rate The penetration rate is the number of clients who are likely to receive the case rate service. For this example adult clients who are going to receive SBIRT services will be included All adults clients will receive at least a brief intervention screening for alcohol misuse or addiction. This means the total population of clients served (i.e., 10,000) 6,000 adult clients will receive an SBIRT service.
23 Step 3. Define the Categories of Care/Levels of Care The SBIRT service can be broken in three levels or categories of care: 1. (Level One) Brief intervention: Screening using a research validated tool. 2. (Level Two) Brief treatment: For clients who screen positive. 3. (Level Three) Referral to Treatment: For clients for whom a brief treatment is not effective.
24 PAUSE in the 8 Steps Importance of Levels of Care and Defining Population Eligibility for Services
25 PMPM Breakdown to Payers
26 Back to It: Step 4. Estimate the Case Mix Using historical claims data, determine on average, using at least a year s worth of data to calculate the average, how many clients receive each level of care. Step 4 ABC Healthcare SBIRT Case Mix Intensity SBIRT Service Adults Level One Brief Intervention 50% Level Two Brief Treatment 40% Level Three Referral to Treatment 10%
27 Step 5. Estimate the Utilization at Each Level of Care Using claims data determine minimum, average and maximum amount of time spent at each level of care. Step 5 ABC Healthcare Level of Care Utilization SBIRT Service Intensity Minimum Average Maximum Level One 5 mins 15 mins 25 mins Level Two 10 mins 25 mins 40 mins Level Three 15 mins 35 mins 70 mins
28 Step 6. Estimate the Cost per Unit of Service Code Payer Description MD/DO Commercial & Medicaid Commercial & Medicaid G039 6 G039 7 G044 2 G044 3 H004 9 H005 0 Medicare Medicare Medicare Medicare Medicaid Medicaid Alcohol &/or substance abuse structured screening & brief intervention services; 15 to 30min Alcohol &/or substance abuse structured screening & brief intervention services; greater than 30min Alcohol &/or substance abuse structured screening & brief intervention services; 15 to 30min Alcohol &/or substance abuse structured screening & brief intervention services; greater than 30min Prevention: Screening for alcohol misuse in adults including pregnant women once per year. No coinsurance; no deductible for patient Prevention: Up to four, 15 minute, brief face-to-face behavioral counseling interventions per year for individuals, including pregnant women, who screen positive for alcohol misuse; No coinsurance; no deductible for patient Alcohol &/or drug screening (code not widely used) Alcohol &/or drug service, brief intervention, per 15 min (code not widely used) Step 6 ABC Healthcare Cost Per Unit of Service Registered Registered Nurse Nurse Masters Behaviorist Doctorate Behaviorist Masters Below Masters 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% 75% 75% 0% 85% 85% 0% TOTAL: Unit Cost $ $ $ $ $ $ $ $ $ Hourly Cost $66.82 $ $58.84 $ $17.33 $ $96.00 $ $ 97.27
29 Step 7. Run the Calculations & Set the Case Rates Step 7 ABC Healthcare SBIRT Case Rate SBIRT Level Description Average Hours Rate Case Rate Level One Brief Intervention 15 mins $97.27 $24.32 Level Two Brief Treatment 25 mins $97.27 $40.85 Level Three Referral to Treatment 35 mins $97.27 $56.42 Step 7 ABC Healthcare SBIRT Total Cost of SBIRT Services Description Case Mix Cases Case Rate Level One 50% 3000 $24.32 Level Two 40% 2400 $40.85 Level Three 10% 600 $56.42 Totals 100% 6000
30 Step 8. Identify Performance Metrics Are the services provided leading to good outcomes? How do you know this? How will you know if people are in the right level of care? How much service is being provided to people? How do clinicians know how much service to provide? Is the delivery mechanism the best (e.g., group vs. individual; telephonic or home-based vs. office-based)
31 Recap 1. Define the Population Who could receive the service(s)? 2. Estimate the Penetration Rate Who is likely to receive the services? 3. Define the Levels of Care What types of services are needed? 4. Estimate the Case Mix For those receiving the services, how many will need services by LOC? 5. Estimate the Utilization at Each Level of Care What s the anticipated volume + type of service for each level of care? 6. Estimate the Cost per Unit of Service Apply costs to separate activities to attain an estimated cost/unit 7. Run the Calculations & Set the Case Rates Apply the costs/unit to the volume and population estimates 8. Identify the Performance Metrics How will you know if (a) your services are aligned with client needs, (2) if your utilization and LOC assumptions are right?
32 Possible Places to Start Top performance measures for pay for performance arrangements Follow Up After Hospitalization for Mental Illness (31.5%) Readmission Rates (15%) Access (15%) Chronic Conditions Cost Calculator Analyze your charges to payers by diagnostic group and start to breakdown your costs
33 Resources Free Bhbusiness Online Courses Case Rate Toolkit MTM Services Kathy Dettling Chronic Conditions Cost Calculator New York: Medicaid Cost & Utilization Reports
34 BHbusiness Courses Free and self-paced Costing Out Your Services Complete worksheets for activity-based costing Determine whether you are costing out your services correctly. Explore process map costing to assist in budget projections. Select one or two services to cost out, identify key uses for cost data, and learn how this ties into revenue forecasting. Bundled Payments Demonstrate basic knowledge of bundled payment financing Understand impact on your clinical and business processes Assess organizational readiness for bundled payment financing Develop plan to address opportunities/barriers arrangements
35 Thank you! Presenter Contact Information Nina Marshall
CCBHCs Part 1: Managing Service Mix and Clinical Workflows Under a PPS. Tim Swinfard. Virna Little, PsyD, LCSW-R, SAP. Rebecca Farley, MPH
CCBHCs Part 1: Managing Service Mix and Clinical Workflows Under a PPS Tim Swinfard President, Compass Health CEO, Pathways Community Health Virna Little, PsyD, LCSW-R, SAP Senior Vice President, Psychosocial
More informationValue-Based Payments 101: Moving from Volume to Value in Behavioral Health Care
Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Nina Marshall, MSW Senior Director, Policy and Practice Improvement NinaM@TheNationalCouncil.org Bill Hudock Senior Public
More informationBehavioral Health Billing and Coding Guide for Montana FQHCs & Primary Care Providers. Virna Little, PsyD, LCSW-R, SAP, CCM Laura Leone, MSSW, LMSW
Behavioral Health Billing and Coding Guide for Montana FQHCs & Primary Care Providers Virna Little, PsyD, LCSW-R, SAP, CCM Laura Leone, MSSW, LMSW Objectives Answer questions specific to FQHC and Primary
More informationRPC VALUE BASED PAYMENT AD HOC WORK GROUP EDUCATIONAL SERIES: Care Transitions Network. July 12, PM
RPC VALUE BASED PAYMENT AD HOC WORK GROUP EDUCATIONAL SERIES: Care Transitions Network July 12, 2017 1-2PM AGENDA Welcome Regional Planning Consortiums VBP Ad Hoc Work Groups Care Transitions Network Q&A
More informationWelcome and Orientation Webinar
Welcome and Orientation Webinar Care Transitions Network for People with Serious Mental Illness National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of
More informationEnhanced Access: Lessons Learned & Advice for CCBHCs. August 9, 2017
Enhanced Access: Lessons Learned & Advice for CCBHCs August 9, 2017 Today s Faculty Moderator: Rebecca Farley David VP, Policy and Advocacy at National Council CCBHC Policy Pro 10+ years in health system
More informationFinancing and Sustainability Strategies for Behavioral Health Integration Anna Ratzliff, MD, PhD Associate Director for Education AIMS Center
Financing and Sustainability Strategies for Behavioral Health Integration Anna Ratzliff, MD, PhD Associate Director for Education AIMS Center Advancing Integrated Mental Health Solutions The Healthier
More informationAlternative Managed Care Reimbursement Models
Alternative Managed Care Reimbursement Models David R. Swann, MA, LCSA, CCS, LPC, NCC Senior Healthcare Integration Consultant MTM Services Healthcare Reform Trends in 2015 Moving from carve out Medicaid
More informationThe Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way
The Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way Mental Health Association in New York State, Inc. Annual Meeting Gregory Allen, MSW Director Division of Program
More informationHealth Center Strong:
Health Center Strong: Developing and Expressing Health Center Value Jonathan Chapman Director, CHC Advisory Services, Capital Link NHCHC National Conference and Policy Symposium May 18, 2018 1 Capital
More informationData Driven Decision Making for CCBHCs. September 14, :30pm 1:30pm ET
Data Driven Decision Making for CCBHCs September 14, 2017 12:30pm 1:30pm ET Webinar Login Directions Recommend calling in on your telephone. Enter your unique Audio PIN so we can mute/unmute your line
More informationGreat Lakes Healthcare Financial Management Association (HFMA)
Great Lakes Healthcare Financial Management Association (HFMA) Vickie R. Kunz Senior Director, Health Finance April 28, 2017 Click to enter date About MHA Established in 1919; Nonprofit (501c 6) Approximately
More informationThe New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018
The New York State Value-Based Payment (VBP) Roadmap Primary Care Providers March 27, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx We will
More informationCollaborative Care Model. Post-Acute Care / Long-Term care / Sub-Acute Care. Proposal
Definitions: Collaborative Care Model Post-Acute Care / Long-Term care / Sub-Acute Care Proposal For the purposes of this proposal, we use definitions consistent with AMDA The Society for Post-Acute and
More informationBehavioral Health and Alternative Payment: A (Non-Scientific) Progress Report. Stephanie Jordan Brown April 26, 2016
Behavioral Health and Alternative Payment: A (Non-Scientific) Progress Report Stephanie Jordan Brown April 26, 2016 The prevalence and under-treatment of behavioral health disorders is well documented...
More informationRN Behavioral Health Care Manager in Primary Care Settings
RN Behavioral Health Care Manager in Primary Care Settings Integrated Care and the Expanding Role of Nurses Seattle Airport Marriott, SeaTac, WA Tuesday, January 9, 2018 The Healthier Washington Practice
More informationValue Based Payment. June 1, 2017
Value Based Payment June 1, 2017 MCTAC Overview What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers
More informationFostering Effective Integration of Behavioral Health and Primary Care in Massachusetts Guidelines. Program Overview and Goal.
Blue Cross Blue Shield of Massachusetts Foundation Fostering Effective Integration of Behavioral Health and Primary Care 2015-2018 Funding Request Overview Summary Access to behavioral health care services
More informationBegin Implementation. Train Your Team and Take Action
Begin Implementation Train Your Team and Take Action These materials were developed by the Malnutrition Quality Improvement Initiative (MQii), a project of the Academy of Nutrition and Dietetics, Avalere
More informationCare Transitions in Behavioral Health
Janssen Pharmaceuticals, Inc. Presents: Care Transitions in Behavioral Health Chuck Ingoglia, MSW Senior Vice President, Policy and Practice Improvement, National Council for Behavioral Health Nina Marshall,
More informationSpecialty Behavioral Health and Integrated Services
Introduction Behavioral health services that are provided within primary care clinics are important to meeting our members needs. Health Share of Oregon supports the integration of behavioral health and
More information2015 Annual Convention
2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities
More informationHome Health & HP Provider Relations
Home Health & Hospice HP Provider Relations October 2010 Agenda Session Objectives Home Health Benefit Coverage Billing Overhead Multiple Visits Most Common Denials Hospice Benefit Coverage Election/Revocation/Discharge
More informationDisclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationWhat is a Pathways HUB?
What is a Pathways HUB? Q: What is a Community Pathways HUB? A: The Pathways HUB model is an evidence-based community care coordination approach that uses 20 standardized care plans (Pathways) as tools
More informationDriving Incremental Change to Achieve Organizational Change. Practice Transformation Academy Webinar #3
Driving Incremental Change to Achieve Organizational Change Practice Transformation Academy Webinar #3 Presenters National Council for Behavioral Health Mental Heath Association of Greater Lowell Kate
More informationNYS Value Based Payments (VBP):
NYS Value Based Payments (VBP): Provider Associations, Community Based Organizations, and Consumer Advocates Town Hall Meeting Jason Helgerson NYS Medicaid Director December 16, 2016 2 Today s Agenda Agenda
More informationState Resources, Policy, and Reimbursement Information
State Resources, Policy, and Reimbursement Information Policies, billing procedures, and referral procedures related to suicide prevention in primary care vary significantly across states. Understanding
More informationPractice Transformation Academy Orientation Webinar. Monday, October 9, 2017
Practice Transformation Academy Orientation Webinar Monday, October 9, 2017 GoToWebinar Logistics Introductions We will unmute you when it is your turn to speak If you do not have audio set up, please
More informationPhysician Engagement
Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.
More informationHOMECARE AND HOSPICE REIMBURSEMENT
Hospice Modeling Hospice Changes to Prepare for Medicare Reimbursement and Care Delivery Reform Robert J. Simione Managing Principal Simione Healthcare Consultants, LLC HOMECARE AND HOSPICE REIMBURSEMENT
More informationCHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE
CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE TABLE OF CONTENTS What is Chronic Care Management (CCM)?... 2 Why CCM?... 2 Clinician/Practice Benefits... 3 Patient Benefits... 4 What is Included in CCM?...
More informationTIME STUDY TRAINING. Prepared For: INDIANA MENTAL HEALTH PROVIDERS
TIME STUDY TRAINING Prepared For: INDIANA MENTAL HEALTH PROVIDERS Introduction This training is to give you the instructions necessary to complete the time study during the week of July 9 15, 2018. There
More informationPutting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018
Putting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018 WEBINAR FACILITATOR Hannah Stanfield NCQA PCMH CCE Practice Transformation Coordinator WACMHC
More informationMEDICAID TRANSFORMATION PROJECT TOOLKIT
MEDICAID TRANSFORMATION PROJECT TOOLKIT Medicaid Transformation Demonstration Contents Domain 1: Health and Community Systems Capacity Building... 2 Financial Sustainability through Value based Payment...
More informationWIMCR and CCS FAQ Categories
WIMCR and CCS FAQ Categories WIMCR and CCS General Information and Resources... 1 WIMCR and CCS County Agency Overview... 1 WIMCR Direct Service Checklist... 2 WIMCR and CCS Direct Service and Support...
More informationMonica E. Oss, Chief Executive Officer, OPEN MINDS CBHC Annual Conference September 29, 2012 / 10:00 am
Monica E. Oss, Chief Executive Officer, OPEN MINDS CBHC Annual Conference September 29, 2012 / 10:00 am Why the demand for coordinated care? What factors are shaping emerging models? What are the emerging
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationAnnual Wellness Visit (AWV) Delivery Business Case
Annual Wellness Visit (AWV) Delivery Business Case The implications of the adopting and/or actively promoting AWV services for the practice s bottom line are dependent on a number of factors, including:
More informationRPC and OMH Collaborative Care Webinar. February 1, pm
RPC and OMH Collaborative Care Webinar February 1, 2018 1 2pm AGENDA Welcome & Introductions OMH Care Collaborative Overview Q&A Cathy Hoehn, LMHC RPC Initiative Director CH@clmhd.org 518 396 0788 www.clmhd.org/rpc
More informationMinnesota s Plan for the Prevention, Treatment and Recovery of Addiction
Minnesota s Plan for the Prevention, Treatment and Recovery of Addiction Background Beginning in June 2016, the Alcohol and Drug Abuse Division (ADAD) of the Minnesota Department of Human Services convened
More informationLeading By Example. Begin with a vision. Disclosures. Learning Objectives 3/25/2017. Tripp Logan, PharmD
Leading By Example Melissa Somma McGivney, PharmD, FAPhA, FCCP Associate Dean for Community Partnerships; Associate Professor University of Pittsburgh Tripp Logan, PharmD Senior Quality Consultant - MedHere
More informationRural and Independent Primary Care.
Rural and Independent Primary Care www.caravanhealth.com Agenda 2015 Results from Rural ACO Participants Fundamental population health programs. Overview of additional rural value-based payments Opportunities
More informationAppendix B: Formulae Used for Calculation of Hospital Performance Measures
Appendix B: Formulae Used for Calculation of Hospital Performance Measures ADJUSTMENTS Adjustment Factor Case Mix Adjustment Wage Index Adjustment Gross Patient Revenue / Gross Inpatient Acute Care Revenue
More informationACOs, CCOs: Challenges & Opportunities. Speakers. Case Study of Oregon 3/7/2014. Chris Apgar. Dick Sabath. Dawn Bonder
s, CCOs: Challenges & Opportunities 2014 Compliance Institute Wednesday, April 2 San Diego, CA Speakers Chris Apgar CEO and President, Apgar and Associates, LLC Dick Sabath Compliance Officer, Trillium
More informationAligning Executive, Physician and Staff Compensation with Population Health Goals
Aligning Executive, Physician and Staff Compensation with Population Health Goals WILLIAM F. JESSEE, MD, FACMPE Becker s Hospital Review 8th Annual Meeting Chicago, IL April 17, 2017 0 Welcome Today s
More informationVALUE-BASED PAYMENT: THE BASICS. A Better Way to Pay for and Promote Quality and Value in Health Care Settings
VALUE-BASED PAYMENT: THE BASICS A Better Way to Pay for and Promote Quality and Value in Health Care Settings Goals of this Presentation Introduce key concepts about Value-Based Payment (VBP) Demonstrate
More informationHealth Care Evolution
Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO
More informationState Policy Report #47. October Health Center Payment Reform: State Initiatives to Meet the Triple Aim. Introduction
Health Center Payment Reform: State Initiatives to Meet the Triple Aim State Policy Report #47 October 2013 Introduction Policymakers at both the federal and state levels are focusing on how best to structure
More informationVBR - Methodologies of Implementing Costing Measurements
VBR - Methodologies of Implementing Costing Measurements Presented by: MTM Services P. O. Box 1027, Holly Springs, NC 27540 Phone: 919-387-9892 Fax: 919-773-8141 E-mail: Scott.Lloyd@mtmservices.org Web
More informationMinnesota Accountable Health Model Practice Transformation Grant Program
Amendment to the Request for Proposals Minnesota Accountable Health Model Practice Transformation Grant Program Posted October 20, 2014 Amended November 5, 2014 As of October 23, 2014, the following changes
More informationBENCHMARKING FOR ORGANIZATIONAL EXCELLENCE IN ADDICTION TREATMENT
BENCHMARKING FOR ORGANIZATIONAL EXCELLENCE IN ADDICTION TREATMENT Operational Benchmarks 1. Initial Access Initial Access Average number of calendar days between date of first contact and date of initial
More informationCoding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care
P R A C T I C E R E S O U R C E A P R I L 2015 NO.2 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care By Margaret McManus, MHS The National Alliance to Advance Adolescent
More informationDSRIP 2017: Lessons Learned and Paving the Way for Success
DSRIP 2017: Lessons Learned and Paving the Way for Success Greg Allen, MSW (Moderator) Director, Division of Program Development and Management Office of Health Insurance Programs, New York State Department
More informationCentral Oregon Integrated Care Collaborative: Operational Strategies for Success
Central Oregon Integrated Care Collaborative: Operational Strategies for Success 1 May 8, 2018 2 Welcome! Mike Franz, MD, DFAACAP, FAPA Medical Director, Behavioral Health, PacificSource Thanks to the
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More informationBeacon Health Strategies Primary Care Provider Training
Beacon Health Strategies Primary Care Provider Training REFERRAL AND RESOURCE GUIDE Updated June 2015 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 15, 2015 1 Agenda 1. Review Medi-Cal Managed
More informationAVATAR Billing Providers Bulletin
DPH Fiscal - CBHS Billing Page 1 of 6 HIPAA 5010 The Health Insurance Portability and Accountability Act (HIPAA) of 1996 carries provisions for administrative simplification. This requires the Secretary
More informationNew Jersey Medicaid Medical Home Demonstration Project Report to the Legislature
New Jersey Medicaid Medical Home Demonstration Project Report to the Legislature November 2012 Division of Medical Assistance and Health Services NJ Department of Human Services Introduction In September,
More informationMedicaid Update Special Edition Budget Highlights New York State Budget: Health Reform Highlights
Page 1 of 6 New York State April 2009 Volume 25, Number 4 Medicaid Update Special Edition 2009-10 Budget Highlights David A. Paterson, Governor State of New York Richard F. Daines, M.D. Commissioner New
More informationThe Readmissions Quality Collaborative. Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013
The Readmissions Quality Collaborative Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013 Overview Background and Scope of the Problem The Readmissions Quality Collaborative
More informationThought Leadership Series White Paper The Journey to Population Health and Risk
AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the
More information1/15/13. Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals. Webinar Organizer.
Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals Presented by: Jim Clarkson CEO of Via Positiva, LLC Webinar Organizer Misti Storie, MS, NCC NAADAC, Director of
More informationCPC+ CHANGE PACKAGE January 2017
CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION
More informationChildren s Medicaid System Transformation: HCBS Rates & SPA Rate Code Review. December 21, 2017
Children s Medicaid System Transformation: HCBS Rates & SPA Rate Code Review December 21, 2017 Introduction & Housekeeping Housekeeping: Slides are posted at MCTAC.org Questions not addressed today will
More informationOneCity Health Partner Webinar
1 OneCity Health Partner Webinar Past, Present, and Looking Ahead December 13, 2016 Today s Presenter 2 Richard Bernstock, Bronx Hub Executive Director Topics for Today s Webinar 3 OneCity Health Partner
More informationA Study on Promoting Integrated Behavioral Health and Primary Care in New Hampshire
A Study on Promoting Integrated Behavioral Health and Primary Care in New Hampshire December 9, 2014 Concord, New Hampshire Thank you for your flexibility! Thank you for joining us via webinar; we are
More informationThe Business Model Transition To Value-Based Reimbursement
The Business Model Transition To Value-Based Reimbursement The 2017 OPEN MINDS Technology & Informatics Institute Wednesday, November 8, 2017 2:00pm 5:00pm Ken Carr, Senior Associate, OPEN MINDS #OMTechnology
More informationPresentation Objectives
Quality Improvement and Value-Based Purchasing (VBP) How your QI program can prepare you for transformation Paul Mulhausen, MD, AGSF, FACP Medical Director Telligen Quality Improvement Network Quality
More informationState of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS)
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS) Outpatient Facility Behavioral Health Integration Billing Frequently Asked Questions (FAQs) 1.
More informationIntegration Workgroup: Bi-Directional Integration Behavioral Health Settings
The Accountable Community for Health of King County Integration Workgroup: Bi-Directional Integration Behavioral Health Settings May 7, 2018 1 Integrated Whole Person Care in Community Behavioral Health
More informationMarch Data Jam: Using Data to Prepare for the MACRA Quality Payment Program
March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health CMS Change Package: Primary and Secondary
More informationResident Rotation: Collaborative Care Consultation Psychiatry
Resident Rotation: Collaborative Care Consultation Psychiatry Anna Ratzliff, MD, PhD James Basinski, MD With contributions from: Jurgen Unutzer, MD, MPH, MA Jennifer Sexton, MD, Catherine Howe, MD, PhD
More informationThe Integration of Behavioral Health and Primary Care: A Leadership Perspective
The Integration of Behavioral Health and Primary Care: A Leadership Perspective Eboni Winford, Ph.D. Behavioral Health Consultant Cherokee Health Systems Our Mission To improve the quality of life for
More informationIntegrating Behavioral and Physical Health
Integrating Behavioral and Physical Health Kim Salamone, Ph.D. Vice President, Health Information Technology Wednesday, April 12, 2017 Agenda Introduce Health Services Advisory Group (HSAG) Centers for
More informationThree World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective
Three World Concept of Behavioral Health and Primary Care Integration Part 3 The Clinician Perspective Colorado Behavioral Health Association October 3, 2010 Three World Model C. J. Peek suggests that
More informationFQHC Behavioral Health Billing Codes
FQHC s Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though process clearly reflected in assessment
More information2
2 3 4 5 Keep moving SUCCESS REQUIRES CONTINUOUS DISRUPTION 6 7 10 11 12 13 15 Define or be defined What is integrated behavioral health and primary care? The care that results from a practice team
More informationCompleting the Specialty Practice Assessment Tool: Guide for Behavioral Health Organizations and Divisions
Completing the Specialty Practice Assessment Tool: Guide for Behavioral Health Organizations and Divisions Instructions: Please find below guiding questions for behavioral health organizations or divisions
More informationRevised for SIM Cohort 2, 2017
Colorado State Innovation Model (SIM) Implementation and Milestone Reporting Summary Guide for Primary Care and Bi-directional Health Home Milestone Activities Revised for SIM Cohort 2, 2017 1 Table of
More informationBlending Behavioral Health and Primary Care. Cherokee Health Systems Clinical Model
Blending Behavioral Health and Primary Care Cherokee Health Systems Clinical Model Brittany Tenbarge, Ph.D. Behavioral Health Consultant Licensed Clinical Psychologist Our Mission To improve the quality
More informationPrimary Care Setting Behavioral Health Billing Codes
Primary Care Setting s Medicaid Medicare Third Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though
More informationCAQH CORE and ehealth Initiative Joint Webinar
CAQH CORE and ehealth Initiative Joint Webinar Data Needs for Successful Valuebased Care Outcomes Monday, November 20, 2017 2:00 3:00 pm ET 2017 CAQH, All Rights Reserved. Logistics Presentation Slides
More informationMIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD
MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities
More informationThe Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center
The Influence of Health Policy on Clinical Practice Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center Disclaimer Director: Multiple Chronic Conditions Resource Center www.multiplechronicconditions.org
More informationMedicare Cost Reporting and PPS FFY 2015 Proposed Rule Why it Still Matters. Glenn Grigsby, CPA OACHC 2014 Annual Spring Conference March 11, 2014
Medicare Cost Reporting and PPS FFY 2015 Proposed Rule Why it Still Matters Glenn Grigsby, CPA OACHC 2014 Annual Spring Conference March 11, 2014 Agenda Medicare cost report myths Common cost reporting
More informationCost Containment Strategies For Home Health
Cost Containment Strategies For Home Health David Berman, CPA, CVA, Principal Simione Healthcare Consultants Rob Simione, BS, CPA, Vice President of Simione Financial Monitor Objectives Identify direct
More informationInnovation Communities: Celebrating Success Showcase Webinar
Innovation Communities: Celebrating Success Showcase Webinar Kate Davidson, LCSW Presenter Kate Davidson, LCSW Assistant Vice President, Practice Improvement National Council for Behavioral Health KateD@TheNationalCouncil.org
More informationOverview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016
Overview of Medicaid and the 1115 Medicaid Transformation Waiver Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Speaker Carol Wilkins, MPP Consultant carol.wilkins.ca@gmail.com
More informationIME Provider Questions Friday July 8, 2016
IME Provider Questions Friday July 8, 2016 We received several questions that had been covered repeatedly in the trainings and the training materials. Please visit the NJSAMS Home Page and our website,
More informationAlternative Payment Models for Behavioral Health Kim Cox VP, Provider Network
Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network Kim Cox Vice President, Provider Network, Optum Kim Cox is Vice President of Provider Network. She joined Optum in February
More informationPPS Performance and Outcome Measures: Additional Resources
PPS Performance and Outcome Measures: PPS Performance and Outcome Measures: This document includes supplemental resources to the content on PPS Performance and Outcome Measures presented at the December
More informationConnected Care Partners
Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?
More informationOregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority
Oregon s Health System Transformation: The Coordinated Care Model March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority The Challenges Oregon Faced Rising healthcare costs outpacing
More information907 KAR 10:025. Reimbursement provisions and requirements regarding outpatient psychiatric hospital services.
907 KAR 10:025. Reimbursement provisions and requirements regarding outpatient psychiatric hospital services. RELATES TO: KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23) STATUTORY AUTHORITY:
More informationBoosting Your Bottom Line
Boosting Your Bottom Line Making More Money for Clinics Lisa Clark, MBA NYS Office of Mental Health 7/26/16 Partners in CTAC and MCTAC include: Agenda Introduction Review of Revenue Maximization Basics
More informationCalculating the Value of a Physician Assistant
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/calculating-the-value-of-a-physicianassistant/3649/
More informationTransforming Healthcare Delivery, the Challenges for Behavioral Health
Transforming Healthcare Delivery, the Challenges for Behavioral Health Presented by: M.T.M. Services, LLC P. O. Box 1027, Holly Springs, NC 27540 Phone: 919-434-3709 Fax: 919-773-8141 E-mail: mtmserve@aol.com
More informationFinancing Integrated Healthcare in Texas : Presented by: Kathleen Reynolds, LMSW, ACSW
Financing Integrated Healthcare in Texas : Presented by: Kathleen Reynolds, LMSW, ACSW kathyr@thenationalcouncil.org The Concept of Community Health Money Organizations are stewards of public funding the
More informationNewsBrief. Network. MyQuest Offers Online Lab Results. Best Practices for Doctor-Patient Experience. Role of PCPs in AOD Dependence
Network NewsBrief A publication for AvMed Providers and Staff Spring 2018 MyQuest Offers Online Lab Results Best Practices for Doctor-Patient Experience Role of PCPs in AOD Dependence TABLE OF CONTENTS
More information