njamhaa value based care presentation conf/f morrison.pdfnetsmart technologies managed care...
TRANSCRIPT
2/16/2018
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Leveraging Technology to Capture Outcomes and Demonstrate Value:
Practical Approaches to Move to Value Based Care
Dennis Morrison, PhD
Chief Clinical Advisor
Netsmart Technologies
Managed Care
Incentive Payments
CCBHC
Capitation
DSRIPValue-basedcontracting
HEALTHHOMES
Pay-for-Performance
MedicaidExpansion
CCOAccountable
CareACOBundled
Payments
RCO
CareCoordination
PMPM
HHVBP
Standardized Processes and Workflows:
It all Starts With Measurement
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MEASUREMENT
Knowledge
Without Data
is
Opinion
Measurement isn’t new…
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Improvement in TherapyClient Self Report
y = 10.825ln(x) + 26.459R² = 0.8934
0
10
20
30
40
50
60
70
80
90
0 10 20 30 40 50 60 70 80 90 100
Perc
en
t Im
pro
ved
NUMBER OF SESSIONS
N=2400
15 SITES
30 YEARS
Howard, KI, Kopta, MS, Krause, MS, Orlinsky, DE, The dose-effect relationship in psychotherapy. American Psychologist Feb 1986 V41, No2 pp 159-164
DESCRIPTIVE ANALYTICS
BENCHMARKING
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Why Benchmark?
Performance is measured in all organizations
Clinical, operational and financial
How helpful is performance data?
Manage by data rather than by opinion
The Limitations of Your Performance Data
Your internal data system tells you:
“Our no-show rate is 17%”
Your next question should be?
Compared to what?
ContextIs
Critical
Practice Based Evidence Clinical ImprovementHigh-Low-Average
0
2
4
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12
14
Pre Time 1 Time 2 Time 3 Time 4 Time 5
Outc
om
es (
Hig
her
is b
etter)
You Are
Here
Best
Worst
AverageWorst
Performers Get Better
Variance Shrinks
Top Performers Get Better
Average Change
Worst Outlier Change
Based on work done by Brent James at Intermountain Health Care
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Consider these data
1 4.26 1 3.1 1 5.39 16 12.5
2 5.68 2 4.74 2 5.73 5 6.89
3 7.24 3 6.13 3 6.08 5 5.25
4 4.82 4 7.26 4 6.42 5 7.91
5 6.95 5 8.14 5 6.77 5 5.76
6 8.81 6 8.77 6 7.11 5 8.84
7 8.04 7 9.14 7 7.46 5 6.58
8 8.33 8 9.26 8 7.81 5 8.47
9 10.84 9 9.13 9 8.15 5 5.56
10 7.58 10 8.74 10 12.74 5 7.71
11 9.96 11 8.1 11 8.84 5 7.04
Average 6.00 7.50 6.00 7.50 6.00 7.50 6.00 7.50
Std. Dev. 3.32 2.03 3.32 2.03 3.32 2.03 3.32 2.03
Sample 1 Sample 2 Sample 3 Sample 4
Adapted from E.Tufte The Visual Display of Quantitative Information. Graphics Press, Cheshire, CT 1983
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0 5 10 15
Sample 1
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0 2 4 6 8 10 12
Sample 2
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Sample 3
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Sample 4
Consider
how your
end user
absorbs
information
Trendto Md
Compared to Md
Percentile Rank
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All clients with Behavioral Health Dx
All clients with Endocrine Dx
All clients with Both
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PREDICTIVE ANALYTICS
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Foundations ofValue-based Care
Healthcare CostsIf other prices had followed the same trend as healthcare…
One dozen eggs would cost $55
A gallon of milk would cost $48
A dozen oranges would cost $134
Source: The Healthcare Imperative. Institute of Medicine
Disproportionate Cost
50.0%
0.5%
25.0%
1.5%
20.0%
19.5%
5.0%
78.9%
Percent of Members Percent of Cost
5% of people account
for ~80% of the cost
25% of people account
for ~98% of the cost
5%/50% is more
typical
Aetna Primary Care Medicaid Plan
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Annual Per Capita Costs of Behavioral Health Comorbidities
Medicaid Beneficiaries
$8,000$9,488 $8,788 $9,498
$15,691$14,081
$15,257 $15,430 $16,267
$24,693
$15,862 $16,058 $15,643$18,156
$24,281
$24,598 $24,927 $24,443
$36,730 $35,840
Asthma/COPD Congestive HeartFailure
Coronary HeartDisease
Diabetes Hypertension
No BH/SUD BH/No SUD SUD/No BH BH and SUD
Source: Center for Health Care Strategies
Life Expectancy
77.97
66.2
51.8
No Mental Disorder Any Mental DisorderGeneral Population
Any Mental DisorderPublic Sector
• Bar 1 & 2: Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011 June;49(6):599-604
• Bar 3; Daumit GL, Anthony CB, Ford DE, Fahey M, Skinner EA, Lehman AF, Hwang W, Steinwachs DM. Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res. 2010 Apr 30;176(2-3):242-5
From Silos to Whole Person CareThe Evolution
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PRIMARY CARE INTEGRATION
Primary Care Integration StatsNearly 60 percent of people being treated for depression in the United States receive treatment in the primary care sector. (1)
Patients with depression constitute 5 percent to 10 percent of patients seen in primary care clinics. (2)
50% - 75% of patients with depressive disorders were inaccurately diagnosed by primary care physicians (3)
Of the 10 most common complaints in primary care, less than 16% had a diagnosable physical etiology (4)
Of individuals who die by suicide, 40% had visited their primary care physician within the month before their suicide (5)
85% of physician visits are for problems that have a significant psychological and/or behavioral component, such as chronic illnesses (6)
51% of behavioral health care services are delivered by non-psychiatric physicians (7)
Primary care practitioners prescribe about 70% of all psychotropic medications and 80% of antidepressants while psychiatrists wrote less than 18%. (8)
70% of all primary care physicians visits are for psychosocial problems (9)
Psychological treatments for depression and anxiety are on par or better than most medications, often with better and longer lasting outcomes. (10,11)
Psychologically distressed patients use 2 to 3 times more health care services than non-distressed patients.(12)
Non-Psychiatric Physician Visits in Panic Disorder
Salvador-Carulla, et al (1995). Costs and Offset Effect in Panic Disorders. British Journal of Psychiatry 166, (23-28).
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How to Coordinate Care
Minimal Coordination
Primary Care Provider
SUD Provider
MH Provider
Virtual Integration
Primary Care Provider
SUD Provider
MH Provider
Hospital
Small GrpPractice
Solo Doc
Solo Practitioner
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Incentive Evolution
Reimbursement Model Strategy
Fee for Service Do More, Make More
Managed Care Do Less, Make More
Value Based Purchasing Do Better, Make More
Value = Quality/Cost
Integrated or Value Based Care = Reform of some flavor
• Reduce institutional/inpatient care
• Lower Emergency Room usage
• Ensure appropriate Level of Care
• Drive consumer satisfaction
• Deliver health services within an integrated and connected delivery
system
• Identify and manage “high risk/cost” individuals
• Improve “value”
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CO
MP
LE
XIT
Y
Capitation
•Full risk
•Population target
•Disease
specific/All in
Fee-for-service
•One service•One payment
Case Rate
•Group of services•Unified payment•Periodic payment
Bundled Payment
•Bundle of services•Unified payment•Quality targets•Episode-based
payment
Total Health
Outcomes
•Shared risk on
total member
experience
Pay for
Performance
• “Upside only”•Process measures Move sequentially through
different forms of payments,
each built upon the last
Risk Continuum
RISK
Value Based Care
Considerations
• Early models stratify and attribute the population for you
• Emerging VBC models require you to create and analyze at a deeper level those cohorts
• Cohorts can be developed by utilization patterns, disease states, medications, etc.
• Attributed populations are just the start….you own the population on daily rate PPS model
Value Based Purchasing and Care Coordination
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Excellence in Mental Health Act –A Transformational Shift
Expansion of Services
New Payment Model
Quality Measures & Reporting
Care Coordination
Health Care Payment Learning and Action Network (LAN) Alternative Payment Model (APM) Framework
Category 1: FFS payments not linked to quality.
Category 2: FFS payments linked to quality and value.
Category 3: Alternative payment models based on FFS.
• Shared savings/shared risk.
• Bundled or episode-based payments.
Category 4: Population-based payments.
Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group. Health Care Payment Learning and Action Network. “Alternative Payment Model (APM) Framework: Final White Paper.” January 2016. Available at: https://hcp-lan.org/workproducts/apm-whitepaper.pdf.
Goal
Goal
Strategies
Carve-in. • MCOs receive a payment to manage both behavioral and physical health
services, among other services as relevant. • 16 states e.g. TN
Carve-out. • Some or all behavioral health benefits are separately managed by a
specialized behavioral health organization or by the Medicaid state agency on a FFS basis. Meeting these requirements often entails greater coordination of providers on the ground
• e.g. PA.
Specialty managed care model. • Specialty behavioral health organizations manage all benefits, including
physical health benefits, which are carved into the program • e.g. AZ.
Source: Center for Health Care Strategies
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Provider-based Delivery System Reforms
Health Homes. • Created by Affordable Care Act
• Comprehensive care management services
• Fourteen of 22 for individuals with serious mental illness.
• Usually based in a behavioral health provider’s office
• Must offer comprehensive care management, transitional care and follow-up, and referrals to community and social support services.
Accountable Care Organizations (ACOs). • Hold providers financially accountable for health outcomes and costs of their patient population.
• Usually shared savings or shared savings/shared risk payment models.
Certified Community Behavioral Health Centers (CCBHCs). • Created through Protecting Access to Medicare Act
• Demonstration program to expand access to behavioral health services in community-based settings.
• Eight states selected
• Must provide a comprehensive range of behavioral health services
• Staffing, access, care coordination, data collection and quality requirements
• PPS - quality bonus payments or payment linked to quality outcomes.
• D. Hasselman and D. Bachrach, Implementing Health Homes in a Risk-Based Medicaid Managed Care Delivery System. Center for Health Care Strategies, June 2011. Available at:
http://www.chcs.org/media/Final_Brief_HH_and_Managed_Care_FINAL.pdf.
• Center for Health Care Strategies. “Medicaid Health Homes: Implementation Update.” January 2017. Available at: http://www.chcs.org/media/Health_Homes_FactSheet-01-18-17.pdf.
SUD Improvement Strategy: IAP
Medicaid Innovation Accelerator Program (IAP) CMS 2015
Six states to improve states’ substance use disorder delivery systems via incentivizing better outcomes.
CMS to share “starting point” resources
• Episodes of care and payment bundles for (MAT) services
Pennsylvania:
• 45 Centers of Excellence to integrate behavioral health and primary care for Medicaid enrollees with an opioid use disorder.
https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/reducing-substance-use-disorders/reducing-substance-use-disorders.html.
https://www.medicaid.gov/stateresource-center/innovation-accelerator-program/iap-commentary/index.html#/entry/41018
http://www.dhs.pa.gov/citizens/substanceabuseservices/centersofexcellence/
Provision (in a manner reflecting person-centered care) of the following services which, if not available directly through the certified community behavioral health clinic, are provided or referred through formal relationships with other providers:
1. Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization
2. Screening, assessment, and diagnosis, including risk management
3. Patient-centered treatment planning
4. Outpatient mental health and substance use services
Expansion of Services
CCBHC Program/Service Requirements
5. Outpatient clinic primary care screening and monitoring
6. Targeted case management
7. Psychiatric rehabilitation services
8. Peer support, counseling services, and family support services
9. Connections with other providers and systems (criminal justice, foster care, child welfare, education, primary care, hospitals, etc.)
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i. Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization
ii. Screening, assessment, and diagnosis, including risk management
iii. Patient-centered treatment planning
iv. Outpatient mental health and substance use services
v. Primary care screening and monitoring
Care Coordination
vi. Targeted case management
vii. Psychiatric rehabilitation services
viii. Peer support, counseling services, and family support services
ix. Services for members of the armed services and veterans
x. Connections with other providers and systems (criminal justice, foster care, child welfare, education, primary care, hospitals, etc.)
CCBHC Acute Care Hospital(s)Social Services, School,
Justice, Child Welfare
Inpatient MH Facilities, Detox, ResidentialFQHC
PCP(s)VA, IHS
Care coordination, including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services, including acute, chronic, and behavioral health needs.
New Payment Model
PPS-1: Daily Rate PPS-2: Monthly Rate
Prospective Payment SystemOne Selected by State
Total annual allowable CCBHC costs
Total number of CCBHC
Medicare daily visits per year
Total annual allowable CCBHC costs excludingcosts for services to clinic users with certain
conditions and outlier payments
Total number of CCBHC Medicare unduplicated monthly visits per year excluding clinic users
with certain conditions
Quality Measures and Reporting
• Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients
• Patient experience of care survey and family experience of care survey
• Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) (see Medicaid Child Core Set)
• Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention
• Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
• Initiation and engagement of alcohol and other drug dependence treatment (see Medicaid Adult Core Set)
• Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment (see Medicaid Child Core Set)
• Adult major depressive disorder (MDD): Suicide risk assessment (use EHR Incentive Program version of measure)
• Screening for Clinical Depression and Follow-Up Plan (see Medicaid Adult Core Set)
• Depression Remission at 12 months
CCBHC Quality Measures (11)
CCBHCs and demonstration states are required to submit quality measures. Clinical, service and cost data will have to be captured and accessible from all providers to meet reporting requirements including quality measures reporting.
Note the heavy reliance on process measures
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Collaborative Care Model (CCM) Primary Care:University of Washington
Team-based approach include a primary care physician, care manager, and a consulting psychiatrist.
The five core principles of the model:
• Patient-centered team care
• Population-based care
• Measurement-based treatment
• Evidence-based care
• Accountable care
• Principles of Collaborative Care. University of Washington, Psychiatry & Behavioral Sciences Division of Population Health, AIMS Center. https://aims.uw.edu/collaborative-care/principles-collaborative-care.
• Bao et al. Value-Based Payment in Implementing Evidence-Based Care: The Mental Health Integration Program in Washington State. American Journal of Managed Care, 2017;23(1):48-53. http://www.ajmc.com/journals/issue/2017/2017-vol23-n1/value-based-payment-in-implementing-evidencebased-care-the-mental-health-integration-program-in-washington-state?elq_cid=1268989&x_id .
25 percent of total provider payments in
CCM models:
Improved provider fidelity to key elements of CCM
Improved patient depression outcomes.
Certified Community Behavioral Health (CCBHC) Programs
Remember This?
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Population Health Strategy
Total Population
Population to Engage
Care Coordination
&
Care Management
Start with Population Risk Stratification
Target a small number of population health management use cases that will produce
immediate results
Use data from a variety of sources
Stratification can be as simple as:
Top 1% based upon chronic conditions
Top 1% based upon client cost
Meeting clients where they are:Home | School | Work | Community | Clinic
Connecting with clients in the way
that works best for them:
Email | Text | Phone | Face-to-face | Telehealth
En
roll
me
nt /
En
ga
ge
me
nt
Str
ate
gie
s Differential Management
Risk Stratification
Population Identification
Health Assessment
DEFINE ASSESS STRATIFY ENGAGE MANAGE
Tailored Interventions
Care Coordination
Clinical Case Management
Population Health Risk Management
Clinical Recovery
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Focusing on Interventions
71%215
30171%
Goal: 60%
Managed Identified Intervene ID Name Gender Age Case Manager Action
234234 Arenciba, Victor
M 57 Gibson, Janet
101 Brown, Todd M 64 Gibson, Janet
456 Walken, Tonya
F 19 Green, Sue
6576 Jones, Betty F 65 Gibson, Janet
Hemoglobin A1c Control for Diabetes
Quality Measures & Reporting – Population Health
21%268
129221%
Goal: 70%
Adult Body Mass Index (BMI)
Screening and Follow-Up
54%697
129754%
Goal: 65%
Suicide Risk Assessment
46%594
129546%
Goal: 37%
Screening for Clinical Depression and Follow-Up Plan
71%215301
71%
Goal: 60%
Unhealthy Alcohol Use: Screening and Brief Counseling
CCBHCs Require Us to Think in NEW AND INNOVATIVE WAYS
• Reduction in cost and improved care for the ENTIRE population
• Data exchange and coordination of care across a broader network
• Alter process and technology to support reporting & service delivery requirements
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State Strategic Initiative Examples
North Carolina CCBHC Overview
The populations of focus are children and youth with serious emotional disturbances, adults with serious mental illness, individuals with long-term and serious substance use disorders and those with mental illness and substance use disorders.
Name North Carolina Count
Motivational Interviewing/Motivational Enhancement Therapy MI/MET 8
Cognitive Behavioral Treatment CBT 6Assertive Community Treatment ACT 5
Early/1st Interventions for PsychosisSpecialty Care for First
Episode Psychosis 5
Medication OptimizationEvidence Based Medications Evaluation and Management 5
Trauma Focused-Cognitive Behavioral Treatment TF-CBT 5Dialectical Behavior Therapy DBT 4
Wellness Recovery Action Plan 4
Wrap Around (any kind) Community Wrap Around 4
Family Psychoeducation 3Medication Assisted Treatment 3
Multi-systems Treatment MST 3
Recovery Supports Peer Recovery Supports 3Forensic ACT 2
Functional Family Therapy 2
Other Trauma Informed Care 2
Supported Employment 2
North CarolinaCCBHC Outcomes Measures• Motivational Interviewing,
Motivational Enhancement Therapy
• Cognitive Behavioral Therapy
• Trauma-Focused/Trauma Informed CBT
• Dialectical Behavior Therapy
• Community Wrap-around
• Evidence-based Medication Evaluation and Management
• Assertive Community Treatment
• Multi-systemic Therapy
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Florida Care Coordination Framework
“The organization of care activities between two or more participants including the person served and family (with consent) involved in an individuals care to facilitate the effective delivery of health care services.”
Florida High Level Recommendations
Add Care Coordination as a billable, covered service
Contract with network service providers that are qualified based on core competencies outlined in framework
Standardize Level of Care assessments and fund implementation
Implement data sharing agreements across providers and funders to ensure effective flow of information
Managing Entities to link with stakeholders that provide services and supports (primary care, housing, employment, criminal justice) that ensures holistic
approach and addresses social determinants of health.
Monitor implementation and outcomes.
Implement consistent discharge protocols for individuals returning to community from state mental health treatment facilities.
Priority Named Populations Persons with a Serious Mental Illness awaiting placement in a civil state
mental health treatment facility (SMHTF) or awaiting discharge from a SMHTF back to the community
Individuals with a SMI and/or Substance Use Disorder who account for a disproportionate amount of BH expenditures
Over time the ME’s will have flexibility to add priority populations based on needs identified in their respective regions. The above first two groups were chosen to “pilot” this approach.
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California Whole Person Care
The overarching goal of the Whole Person Care (WPC) Pilots is the coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and wellbeing through more efficient and effective use of resources.
Program Design
• Targeting homeless individuals with avoidable ED visits
• Created due to rise of ED utilization by homeless recipients
• Funded by local hospitals and HHS
• Managed by county coalition
Program Tenets
• Assertive community outreach and ongoing service engagement
• Comprehensive behavioral and medical evaluations and comprehensive multi-modal assessments
• Personalized holistic care plan
• Assignment and referral to the principal agencies
County Example
Target Population
• Medi-Cal insured adults with…
• Highest medical utilization, repeated avoidable ED visits
• 2 serious chronic conditions (one is MH or SUD)
• High risk for homelessness
Key Elements of County VBC Program
Missouri Health Home
…develop Missouri’s CMHC Healthcare Home and Primary Care Health Home models
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Why CMHC Healthcare Homes?
Because addressing behavioral health needs requires addressing other healthcare issues
• Individuals with SMI, on average, die 25 years earlier than the general population.
• 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.
• Second generation anti-psychotic medications are highly associated with weight gain, diabetes, dyslipidemia (abnormal cholesterol) and metabolic syndrome.
CMHC as Health Care Home
Case management coordination and facilitation of healthcare
Primary Care Nurse Care Managers
Medical disease management for persons with SMI
Preventive healthcare screening and monitoring by MH providers
Integrated/consolidated CMHC/CHC Services
ED Visit Data
Hospitalization
Patient Specific Data• CMHC assignment• Programs• Providers• Health plan eligibility• Claims• ED visits
MissouriMedicaid
Patient Care Data
Metabolic Screening Data• Vitals• Labs• Health risk factors
Quality Analytics Org Compliance
Missouri Coalitionview of:
Missouri Department of Mental Health
Claims Data
CMHC EHRs
CCBHC LevelCare Manager orCoordinator view of:• Aggregated patient data• Claims• Alerts and reminders• Compliance at patient and
coordinator level
Quality Measures and ReportingPopulation Health Data View
Interoperability
Analytics
Care Coordination
Missouri CCBHC Example
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The Power of Whole Person Care
18 Month Cost Savings
• Health Homes: $23.1M
• Disease Management: 3,560 lives $22.3M
Community Hospital Acceleration, Revitalization, andTransformation (CHART) Investment Program
…$120 million reinvestment program funded by an assessment on large health systems and commercial insurers that will make phased investments for certain Massachusetts community hospitals to enhance their delivery of efficient, effective care.
http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/investment-programs/chart/chart-report-final.pdf
CHART Hospitals
http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/investment-programs/chart/chart-report-final.pdf
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The CHART Investment Program Theory of Change
Foster executive commitment to change and prioritize investments where such commitment is present;
Provide meaningful infrastructure investments to build a foundation for change;
Incentivize innovative delivery models
Build a model for sustainability.
http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/investment-programs/chart/chart-report-final.pdf
Strategic Areas of Investment for CHART Hospitals
http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/investment-programs/chart/chart-report-final.pdf
Priority Domains
Reducing readmissions and improving transfers to post-acute care
Reducing unnecessary ED utilization
Enhancing behavioral health care
Building the technological foundation necessary for patient safety, quality and efficiency
http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/investment-programs/chart/chart-report-final.pdf
One significant driver of visits to the ED is lack of
sufficient and easily accessible behavioral health care for patients with mental illness and substance use
disorder.
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Delivery System Reform Incentive Payment Program (DSRIP)
DSRIP waivers are not grant programs – they are performance-based incentive programs.
DSRIP Project Example
Implementing Patient Activation Activities to Engage, Educate and Integrate the Uninsured and low/non-utilizing Medicaid Populations into Community based care
• Core Components and Deliverables:Patient Engagement: Develop activities that promote community activation and engagement
Linkages to financially accessible health care resources: Provide community bridges that allow access to health coverage resources
Linkages to Health Systems and PPS: Build linkages to community based primary and preventative services and community based health education to grow community and patient activation across the region
Leveraging HH Care Managers to perform the Patient Activation Measure tool
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Patient Activation: Four Stages
Believing the patient role is important
Having the confidence and knowledge necessary to take action
Actually taking action to maintain and improve one's health,
Staying the course even under stress (1).
1. Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research, 39(4 Pt 1), 1005–1026. http://doi.org/10.1111/j.1475-6773.2004.00269.x
2. http://www.insigniahealth.com/products/pam-survey
Disengaged and
Overwhelmed
Becoming Aware but Still
StrugglingTaking Action
Maintaining Behaviors (2)
The Journey to Integrated CareInteroperability
Documentation ExchangeStandardizing data transfer with CCDs, labs, public health registries and health
information exchanges
Secure, Direct ExchangeDirect Message internally as well as
externally to the larger provider community, enabling coordinated care across the care
continuum
Using a Certified EHRDigitized but unconnected to the
larger provider community
Transitions of CarePoint-to-point referrals within
a single workflow
Query-based ExchangeFind/request information from other
providers, such as discharge summaries
Integrated, Whole-person CareSingle patient record across
the entire continuum
Query for Key patient information
6 Minutes vs. 29 hours
Direct Secure Messaging Solution
Quickly and securely exchange referrals with external provider organizations
Send and receive clinical data, lab results and treatment plans as required for integrated care models
Incorporate external data directly into the consumer’s chart utilizing the existing user workflow
A Look at Some Key Capabilities
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TECHNOLOGY, LEADERSHIP AND CULTURE
Every system is perfectly designed to get the results it gets.
Leslie Proctor Editor’s Notebook: A Quotation with a Life of Its Own. Patient Safety and Quality Healthcare July / August 2008 https://www.psqh.com/analysis/editor-s-notebook-a-quotation-with-a-life-of-its-own/
Source: Earl Conwayor Paul Batalden or W. Edwards Deming or Don Berwick or…
Conway’s Law
Companies create products and services that are a reflection of themselves, the way they’re organized,
communicate and work.
Sam Newman 30 JUN 2014 Demystifying Conway’s Law. ThoughtWorkshttps://www.thoughtworks.com/insights/blog/demystifying-conways-law
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Culture“Culture is not the most important thing,
it’s the only thing”.
Jim Sinegal, Costco co-founder
Leaders need to recognize that all experiences create culture, and their culture is either working for them or against them.
Roger Connors, CEO Partners in Leadership in Organizational Culture In The Digital Age. https://www.forbes.com/sites/shamakabani/2014/06/10/organizational-culture-in-the-digital-age/#17ca85d971df
…if you asked most people to list the things that create and maintain a strong company culture…
Ashley Goldsmith & Leighanne Levensaler Build a Great Company Culture with Help from Technology. Harvard Business Review FEBRUARY 24, 2016 https://hbr.org/2016/02/build-a-great-company-culture-with-help-from-technology
…chances are they wouldn’t list technology.
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Leadership and Technology Lines Blurring
…CEO, CFOs and COOs are becoming more immersed in technology decisions, while CIOs and CTOs -- and their IT staff
members as well -- are being asked to join in on high-level decision-making teams.
Joe McKendrick JUL 5, 2015 Business Leaders Step Into Technology While Technologists Step Into Leadership Roles. Forbes. https://www.forbes.com/sites/joemckendrick/2015/07/05/business-leaders-step-into-technology-while-technologists-step-into-leadership-roles/#3d7506a26b81
Keys to Successful HIT Implementation
Workflow
Data Flow
Leadership
Leadership and The “Why”
Technology = “what”
Project management = “how” and “when”.
But only Leadership can address the “why”
Why are we doing this and why aren’t we doing that?
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The Unique Role of Senior Leadership (especially the CEO):
What Can Only You Do?
Send a clear and unequivocal message:
This change is going to happen
The organization will be better off because of it
All are invited to be part of the adventure, but it will happen
These are the things we will no longer be doing.
We will carry the wounded but we will shoot the stragglers
The Unique Role of Senior Leadership: Develop Guiding Principles. Example: EHR Implementation
Single Source of Truth
Data will be entered once and once only
“Go Live” is the beginning, not the end
We aren’t as different as we think we are
80% is good enough to start
Common Themes for Value Based Care Initiatives
If you’ve seen one, you’ve seen one
Targeted Population
Care Coordination
Measurement and Analytics
Leadership
Electronic Data Capture and Exchange
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Key Challenges in Implementing Value Based Purchasing
Quality Measurement
Provider Capacity
Oversight
Privacy And Data-sharing Constraints.
Soper, MH, Matulis, R, and Menschner, C. Moving Toward Value-Based Payment for Medicaid Behavioral Health Services Center for Health Care Strategies June 2017
Too often we hold fast to the clichés of our forbearers.
We subject all facts to a prefabricated set of
interpretations.
We enjoy the comfort of opinion without the discomfort of
thought.
-John F. Kennedy
Thank YouDennis Morrison, PhD
Chief Clinical Advisor
Netsmart
Twitter: @DrDennyM
YouTube TEDxBloomingtonhttp://www.youtube.com/watch?v=zQbtDaJCi0M