The Care Transitions Network

Size: px

Start display at page:

Download "The Care Transitions Network"

Alannah Gaines
5 years ago
Views:

1 Making the move to Value Based Reimbursement/Payment/Purchasing (VBR/P 2 ): Using Data to Improve Care Delivery and Your Organizations Performance The Care Transitions Network Presented by: Scott C. Lloyd, President M.T.M. Services P. O. Box 1027, Holly Springs, NC Phone: Fax: scott.lloyd@mtmservices.org Web Site: Presented By: Scott Lloyd, President 1

2 Experience Improving Quality in the Face of Healthcare Reform MTM Services has delivered consultation to over 800 providers (MH/SA/DD/Residential) in 46 states, Washington, DC, and 2 foreign countries since MTM Services Access Redesign Experience (Excluding individual clients): 5 National Council Funded Access Redesign grants with 200 organizations across 25 states 7 Statewide efforts with 176 organizations Over 5,000 individualized flow charts created Leading CCBHC Set up and/or TA efforts in 5 states Presented By: Scott C. Lloyd, President 2

4 Shift in Payment Model 1. As parity and national integrated healthcare provided under the Affordable Care Act (ACA) are implemented, new models of shared risk funding are being introduced. 2. A shift by payers such as Medicaid, Medicare and Third Party Insurance from paying for volume to paying for value provides a significant challenge for CBHOs. 3. Ability of all staff to develop a dynamic tension between quality and cost as if they are on a pendulum 4. A large majority of CBHOs do not have an ongoing awareness of their cost of services or cost of processes involved in the delivery of services (i.e., What is your cost and time to treatment? ) Presented By: Scott Lloyd, President 4

5 The Values that Community BH Clinics Now Need 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 measurement information about the clinical outcomes achieved). 5. Be Resilient (Have ability or willingness to use alternative payment arrangements). Presented By: Scott Lloyd, President 5

6 Value of Care Equation 1. Services provided Timely access to clinical and medical services, service array, duration and density of services through Level of Care/Benefit Design Criteria and/or EBPs that focuses on population based service needs 2. Cost of services provided based on current service delivery processes by CPT/HCPCS code and staff type 3. Outcomes achieved (i.e., how do we demonstrate that people are getting better such as with the DLA-20 Activities of Daily Living) 4. Value is determined based on can you achieve the same or better outcomes with a change of services delivered or change in service process costs which makes the outcomes under the new clinical model a better value for the payer. Presented By: Scott Lloyd, President 6

7 Value of Care Equation Presented By: Scott Lloyd, President 7

8 JIT To a Prescriber in 3 Days

9 The Values that Community BH Clinics Now Need Certified Community Behavioral Health Clinics (CCBHCs) 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

10 JIT To a Prescriber in 3 Days The False Reality of Full!

11 JIT To a Prescriber in 3 Days The False Reality of Full! 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?

12 JIT To a Prescriber in 3 Days The False Reality of Full! Team members with differing opinions, but neither side has data to back their points is a key roadblock to successful changes!

13 Process Redesign Review Presented By: Scott C. Lloyd, President 13

14 JIT To a Prescriber in 3 Days The False Reality of Full! The Client s Definition of Access Client Calls for Help Wait Time # 1 Assessment Appointment Wait Time # 2 Treatment Planning Appointment Wait Time # 3 Client Arrives for an Open Session

15 JIT To a Prescriber in 3 Days The False Reality of Full! How did We Get to Here? System Noise Anything that keeps staff from being able to do the job they want to do: Helping consumers in need!

16 JIT To a Prescriber in 3 Days The False Reality of Full! Areas of System Noise 1. Dealing with consumers angry about the wait 2. Dealing with poorly laid out documentation. 3. Poorly functioning EMR/EHR 4. Dealing with No Shows/Late Cancellations 1. Medication Call Ins 2. Rescheduling/Crisis Events 3. Direct Service Production Hits 5. Naturally Occurring vs. Structured Downtime

17 Rosecrance Berry Campus Rockford, IL Open Access Case Study Richard Jaconette M.D. Child/Adolescent Psychiatrist 17

18 JIT To a Prescriber in 3 Days The False Reality of Full!

19 JIT To a Prescriber in 3 Days The False Reality of Full!

20 JIT To a Prescriber in 3 Days The False Reality of Full!

21 JIT To a Prescriber in 3 Days The Crux of the Problem We make Consumers Guess! 10 7 Days???? Days??? Hours?? Where will you be in Days at 2:15!?

22 JIT To a Prescriber in 3 Days Biggest Obstacle To Implementation Anxiety--Within the: Doctor Families Front Office Staff Other Clinicians Administration

23 JIT To a Prescriber in 3 Days Key Factors for Success! 1. No Prescriber Appointments are Scheduled more than 3 to 5 days out. 2. No More Calling in Med Requests, the consumer must be seen face to face for a script. 3. No more rescheduling no show events, they have to go to the no show clinic (NSNAP).

24 JIT To a Prescriber in 3 Days Key Factors for Success! Details This slideshow has gone over the broad strokes of JIT Access, BUT there are a lot of details that are needed to make sure that this is implemented appropriately for the team who is implementing it. Without appropriate consultation, the failure rate is high for teams trying to put this system into place.

25 JIT To a Prescriber in 3 Days Results

26 JIT To a Prescriber in 3 Days Results Show Rates

27 JIT To a Prescriber in 3 Days Results - Production

28 JIT To a Prescriber in 3 Days Results - Growth

29 JIT To a Prescriber in 3 Days Results - Financial JIT first 90 days Review Billable Hours: Providers totaled 925 billable hours for the period July to September Providers totaled 1,062 billable hours for the period November 2014 to January An overall 15% in hours /A 4 hour a day increase Billable Dollars Providers totaled $146,421 for the period July to September Providers totaled $199, for the period November 2014 to January An overall 36% increase in dollars. / A $1, per day increase. *** Percentage of billable hours verses total hours increased for an average of 48.6 % to 61% from the July to September 2014 period to the November 2014 period to January 2015 period. *** These daily averages are based on actual hours during these periods. We had 64 billable days in the July to Sept 2014 period and 58 during the November 2014 to January 2015 period.

30 JIT To a Prescriber in 3 Days Results - Clinical Where would you have gone without our services?

31 JIT To a Prescriber in 3 Days Results Customer Satisfaction Question Percentage that agree I received services in a reasonable amount of time from the time I walked in today 89.5% I was treated with courtesy and respect today 96.5% I was educated about any medication ordered for me 97.2% I was educated about any follow up treatment ordered for me 98.4% I am in charge of my plan and it clearly reflects what I want and need to achieve 96.6% I would recommend Monarch to a friend or family member 97.5%

32 Value of Care Equation Outcomes achieved (i.e., how do we demonstrate that people are getting better Presented By: Scott Lloyd, President 32

33 How to Support Statewide Measurement of Outcomes Achieved The ability of all CBHC members of a state association to use an state-wide standardized outcome tool for all ages and diagnostic groups that can objectively measure, record and report in a user friendly format how clients are getting better based on the services that they have received. One of the blessings that CBHCs have is an abundance of different outcome tools that seem to proliferate on a regular basis. A key challenge that CBHCs have is the abundance of different outcome tools that are being used within each center, each state across all CBHCs and nationally. Presented By: David Lloyd, Founder, MTM Services 33 Presented By: Scott Lloyd, President 33

34 Statewide Adoption of the DLA-20 Missouri Utah North Dakota Western New York Kansas South Carolina Mississippi Maryland (statewide use of the DLA20 that will be made available to CBHCs through its contract with ValueOptions/Beacon) Rhode Island Alaska (proposed by Alaska BH Providers Association) Georgia (Pilot Program with 10 CSBs) Over 10 Electronic Clinic Record Vendors have licensed the DLA- 20 to integrate into their software Presented By: David Lloyd, Founder, MTM Services 34 Presented By: Scott Lloyd, President 34

35 DLA-20 Crosswalk to Severity Levels in the DSM-5 and ICD 10 >= 6.0 (>60) = Adequate Independence; No significant to slight impairment in functioning mgaf tallies # symptoms few and mild (51 60) = Mild impairments, minimal interruptions in recovery ICD 10 4 th digit modifier = (41 50) = Moderate impairment in functioning ICD 10 4 th digit modifier = 1 mgaf tallies number of symptoms = (31 40) = Serious impairments in functioning ICD 10 4 th digit modifier = 2 mgaf tallies number of symptoms = (21 30) = Severe impairments in functioning ICD 10 4 th digit modifier =3 mgaf tallies number of symptoms = (20 or less) = Extremely severe impairments in functioning ICD10 4 th digit modifier = 3 mgaf identifies intensely high-risk symptoms Presented By: Presented Scott By: Lloyd, David Lloyd, President Founder, MTM Services 35 35

36 Treat to Target Clinical Approach Needed for Medicaid Reform Model and Authorization Levels Identified 1. Most of our clinicians use a treat to target approach to planning, service delivery, and adjusting the care plan if it s not working. 2. The majority of clinicians and supervisors have studied the treat to target literature and develop care plans that include measureable targets (e.g. 25% improvement in DLA-20 aggregate score, 50% reduction in PHQ-9 scores within 12 weeks), measure progress at least monthly, and work with consumers to adjust the care plan if targets are not being met. 3. Part of this process includes the use of clinical tools that measure improvement in symptomology, functional status, and recovery and resilience-building for the children, families and adults we serve. Presented By: Scott Lloyd, President 36

37 Value of Care Determination After implementation of the essential performance indicators for the above three components of Value of Care have been completed the individual results need to be integrated so that the resulting data from each of the components supports an objective determination of the level of value that your CBHC is providing. This level of objectivity can be very helpful to support individual CBHC and state association s business case to differentiate member CBHCs from other providers Presented By: Scott Lloyd, President 37

38 DLA-20 Statewide Use Supports Delta Score Based Outcome Measurement Presented By: Scott Lloyd, President 38

39 Sample Data Presented By: Scott Lloyd, President 39

40 Sample Data Presented By: Scott Lloyd, President 40

41 Measuring Value of Care (Services Provided, Cost of Services and Outcomes Achieved= VALUE Presented By: Scott Lloyd, President 41

42 Sample Data Presented By: Scott Lloyd, President 42

43 Sample Data Presented By: Scott Lloyd, President 43

44 Presented By: Scott Lloyd, President 44

The Care Transitions Network

Making the move to Value Based Reimbursement/Payment/Purchasing (VBR/P 2 ): Using Data to Improve Care Delivery and Your Organizations Performance The Care Transitions Network Presented by: Scott C. Lloyd,