Winning Business and Improving Care

Outcomes

Dr. Carol Clayton and Thomas

Friedman III, MPA

Our Mission

Relias strives to

measurably improve the

lives of the most

vulnerable members of

society and those who

care for them.

The Relias Foundation and Evolution

Behavioral Health, IDD, Corrections,

Law Enforcement

PT, OT, SLP Post-Acute Care

Post-Acute CarePost-Acute Care Post-Acute Care, Therapies

Autism

Acute Care: Hospitals,

Military Hospitals

Acute Care:

Publications, CE, CME

Analytics Assessments,

Data Analytics

Acute Care,

Post-Acute Care

Hospice

Analytics

The new world of healthcare is

creating a critical demand for high-

performing organizations.

Why Relias is Evolving: Meeting the Demands of your

Work Environment

The Evolution of Relias Content

Compliance

• Regulatory

• Annual requirements

Professional Development

• Continuing Education

• Staff Development

Strategic

• Care Delivery

• Changing Reimbursement structures

5

The Evolution of Relias’ Market

Emergency

Departments

Hospitals

HomeWellness

Centers

Physician &

Specialty

Offices

Urgent Care

Centers

Diagnostics,

Lab, Rad

Ambulatory

Procedure

Centers

Inpatient & Outpatient

Rehab/Treatment Centers

Extended Care Facilities

Assisted Living

Home,

Home Health & Hospice

Skilled Nursing

Care Coordination, Managed Care

Behavioral

Health Care

Pre-Acute Acute Post- Acute

Continuum

Ac

uit

y

Intellectual and Developmental Disabilities

Market participant Market leader

The History of CMT, a Relias Learning Company:

“When Chocolate Meets Peanut Butter”

Phase Two – Using Data to Drive Quality of Care

7

# 8

CMT’s Analytic Solution:

Population Health, Clinically Driven, Evidence-Based

Patient

Population

Payers,

and

Behavioral

Care

Providers

# 9

CMT: 15 Years of Clinical and

Technical Innovation

.Net Workflow

Clinical Data Warehouse

Online Analytics

2002 2006 2011 2014

Opioid Risk Reduction Analytics

Population Health Analytics

Risk Stratification; Risk Modeling

Provider and Patient Adherence Solutions

Integrated Care Gap Alerts

Behavioral Pharmacy Best

Practice Solutions

Performance Measurement

Medical Services Claims Processing

Web Based

Intervention and

WorkFlow Support

Non-claims Data

Integration

HIE Integration

EHR Interoperability

2018

CCBHC Measures

IDD Health Alerts

Care Coordination

Tools

Data Driven Care and

Training

Across the HealthCare

Continuum

Relias Is Ready to Address Future Demands

• Population Health Management tools

• Risk Stratification Capabilities

• Data Use and Data Transparency

• Decision Support Tools

• A Data Driven Value Story

• Organizational Change—workforce and

technology enhancements

CMT: Data Tells the Value Story

11

3.5 years

12%

46%

61%

80% 80%88%

97%

0%

20%

40%

60%

80%

100%

120%

Metabolic Syndrome Screening(All HCH Enrollees)

Feb'12BaselineFeb'1312 MonthsJune'1318 MonthsJan'142 YearsJune'142.5 YearsAug'153.5 YearsNCMMCAug'15

76%

10/

CMT supports the two most prominent Medicaid Health Homes

in the nation.

• Saved over $36M year one (10:1

ROI)

• Saved close to $100 million over five

years

• Reduced hospitalizations by 31%

in the first year

• Reduced duplicative prescribers

by 17%

• Awarded “Patient Registry” Data

Analytics contract OK BHH for

Children

Partnership Value Story

Data Tells/Stories Sell –The Missouri Story

2015

The National Association of State Chief Administrators (NASCA) selected Missouri Health Homes as their 2015 Case Study conducted by Harvard University

The American Psychiatric Association (APA) awarded the Missouri CMHC Health Home program the Psychiatric Services Gold Achievement Award

2008

SAMHSA Science and Service Award - For the implementation of one or more evidence-based interventions improving psychiatric prescribing practices.

URAC Best Practices in Consumer Empowerment and Protection Award; -Health Information Technology Category: Silver Award, “Behavioral Pharmacy Management Program”

2006

American Psychiatric Association Bronze Achievement Award - Improving psychiatric prescription practices

13

Relias’ High Performance Model Driving Results Across the Continuum of Care

Pre-Acute Acute Post- Acute Behavioral Health

Assessments: We Don’t All Have the Same

Education Needs.

• As Relias moved beyond compliance, we wanted to

respect the learner’s time.

• “Physicians spend two hours doing administrative tasks

for every hour spent working with patients such as EMR -

- and they likely spend another 2 hours at home doing

charts or working with families.” • We need to analyze what people need to learn.

15

Assessment-Driven Learning Approach

16

PCP PA NP RN

Assess1

Deploy robust clinical knowledge assessment at high-

risk practices

Identify knowledge gaps across your network….

…and at the clinician level

System-wide low

scores on med rec

best practices

Dr. Johnson

Nurse Kim

Dr. Fleming

Teach2

Clinicians receive personalized online education

based on individual needs

Personalized Learning Path for Dr. Fleming

• Antidepressant medication management

• Blood pressure screening

• Cardiac rehab referral

• …

+

Relias recommends additional coaching and

remediation for low performers

Scenarios

17

Dr. Johnson Nurse Kim Dr. Fleming

11 "snacks" = 55 minutes 28 "snacks" = 2.3 hours6 "snacks" = 30 minutes

Dr. Johnson has been

part of the hospital for

20 years

Nurse Kim graduated top

of her class

Dr. Fleming is returning to

practice after a hiatus

As

se

ss

me

nt

pro

file

Focus training on the new

topics and able spend more

time with patients

Focus training on stimulations

that apply knowledge and

concepts

Combination of refreshers

and stimulations that

practice critical thinking

Total Solution –Using Data to Drive Care

Improvements and Workforce

Competency Enhancement.18

“Across the country anyone you talk to

wants to know – ‘How do we drive out

unwanted clinical variation?’ One

aspect is creating processes in the EHR

and clinical decision support tools. But

another aspect is how to change

continuing education to make it

meaningful and drive change…Whether

it’s the business side or clinical

leaders, driving out clinical variation

is a top 3 strategic priority regardless

of whether the organization is still

100% fee for service or shifting to

value. Driving out risk is variation is

critical to safety, patient satisfaction, and

the bottom line.”

What do people need to do? What do they need

to know to accomplish it?

• It is one thing to improve your skills, it is another to

improve performance

• Especially in value-based reimbursements

• Start with Analytics

• Figure out what you need to do better to improve care and

succeed in value based reimbursement, then assess where your

staff is, then train

19

Improving Care for People with ReliasThe Opioid Epidemic

Improving Work Force Performance with ReliasThe Opioid Epidemic

Identify issues before they become victims

Using Machine

Learning and Risk

Prediction Modeling,

all patients in a

population filling an

Opioid Rx the last 90

days are evaluated

using clinically

identified risk factors

to determine potential:

1. % Risk of

Problematic Opioid

Use - next 90 Days

2. % Risk of Overdose

3. Regional breakouts

4. Provider level

breakouts

Option to Export a list of patients for intervention

Available to CMT Clients Q1 2018 and

all Analytics Clients 2H 2018

• History and Evolution of Pain Management and

Opioid Use In America

• Overview/Introduction to Opioid Abuse

• Clinical Practice Guidelines for Prescribing Opioids

• Opioids: Behavioral Health Literacy for the Primary

Care Provider

• Emerging Practices in Opioid Addiction Treatment

Relias Library – Care Team Instruction. Assign in a Data

Driven Work Flow.

# 24

Analytics and Brief Education Impact on Gateway

Opioid Outcomes

Use of Opioids for 60+ Days in the Absence of a

Diagnosis Supporting Chronic Use in Adults decrease of

17%

Use of Opioids for 60+ Days in the Absence of a

Diagnosis Supporting Chronic Use in Elderly Adults

decrease of 14%

Multiple Prescribers of Opioids Without a Malignant

Cancer Diagnosis decreased by 11% (p=0.07)

Jun 2013 Jan 2014

CMT opioid intervention

Jun 2014

Randomized control trial over 6 month period found

statistically significant 21% decrease in triggering post

intervention.

0%

20%

40%

60%

80%

100%

Intervention

Opioid Campaign – Education Plus Analytics

Hospital admissions reduced 17.2%

Average number of opioid prescribers per capita down 19.5%

Average number of opioid pharmacies per capita down 18%

Average monthly dose of opioids (in morphine equivalents)

dispensed reduced 10%

$800,000 in annual savings

Jan 2012 Feb 2013

CMT opioid intervention

Apr 2014

Services for 55,000 enrollees in Missouri State Medicaid

Agency studied over 8 intervention cohorts.

Relias Case Study

Macomb County MI PIHP

26

Macomb County MI PIHP: Targeted Measures

ProAct Measure # HEDIS/Community Health Measure Description

902Adherence to Antipsychotic medications for individuals with Schizophrenia (SAA)

904

Presence of a diabetes screening test during the measurement year for a patient diagnosed with schizophrenia or bipolar disorder who was dispensed an antipsychotic medication

931Presence of a HbA1c and LDL-C tests during the measurement year for a patient diagnosed with schizophrenia and diabetes.

932Presence of a follow-up visit within 30 days after hospitalization for mental illness

933Presence of a follow-up visit during the 30 day initiation phase for 6-12 year old prescribed ADHD medication

936Use of two or more concurrent antipsychotic medications in children 1-17 years of age

940Presence of metabolic testing in children 1-17 years of age that had two or more antipsychotic medications

27

Custom Macomb Training Plan—Payer and Provider

28

Macomb Targeted Measures Course Title Hours

• Presence of a diabetes screening test during the

measurement year for a patient diagnosed with

schizophrenia or bipolar disorder who was dispensed

an antipsychotic medication

• Presence of a HbA1c and LDL-C tests during the

measurement year for a patient diagnosed with

schizophrenia and diabetes.

• A First Look Into Integrated Care for Primary Care Staff

• Managing Medicaid Members with Chronic Behavioral

and Physical Health Conditions

• Building Care Teams and Establishing Check Points:

Diabetes

• Payer Perspective: Diabetes Management

1.25

0.75

0.75

1.00

• Presence of a follow-up visit within 30 days after

hospitalization for mental illness

• Preventing Unnecessary Hospital Admissions and

Readmissions

1.00

• Adherence to Antipsychotic medications for

individuals with Schizophrenia (SAA)

• Psychotropic Medications: Antipsychotics and Beyond

• Medications Related to Schizophrenia and Other Psychotic

Disorders

1.00

1.00

• Presence of a follow-up visit during the 30 day

initiation phase for 6-12 year old prescribed ADHD

medication

• ADHD: Diagnosis and Treatment 2.00

Training Hours: 8.75

Sample Custom Training Plans: NCQA Quality Pathway

Subheading NCQA Code Course Title

Quality Improvement Activities QI6A • Diabetes and CVD: Metabolic Syndrome

• Laboratory Assessment: Cardiovascular Disease, Diabetes and

Metabolic Syndrome

• Behavioral Health Screening Tools

• Risk Screening best practices

• Substance Use Screening in the Emergency Department

QI8J • Quality Improvement: The Basics

• Advanced Quality Improvement for Leadership

Care Coordination QI8A

CC1:ABC&D

CC4A

• Chronic Disease Management: Systems that Effectively Address

Chronic Disease

• Care Coordination: Principles and Best Practices

• Integrating Care Series

EBP Care QI6C

QI8E

QI19A&B

QI10: Element

C

• Evidence Based Practices in Treating SUD

• Nutrition and Diabetes Evidence Based Research

• Nutritional Interventions -Nutrition and Diabetes Evidence Based

Research

29

“Just a shout out to say how

awesome the CMT team is. I

have sincerely never before

had the level of trust, faith,

respect I have for CMT with

any other IT vendor.”

Bradley Casemore, CEO SOUTHWEST MICHIGAN BEHAVIORAL HEALTH

“I have fantasized about the day a

mental health clinician could print

out a histogram of metabolic

screening data in order to activate

good care. Well, voila! I have it at

my fingertips with the CMT ProAct

Tool.”

CEO LARGE MIDWESTERN CMHC AGENCY

“[I] can get performance

specific reporting... I cannot

imagine trying to create an

I/DD health home without

access to CMT.”

Sam Hedrick, CEO RHA HEALTH SERVICES

“The SaaS Solution cut my time

in half for preparing reports.”

Stephanie G. Julian, RN

Assistant Director HCH/Nurse Care Manager BURRELL BEHAVIORAL HEALTH

“[This] is a process that promotes

evidence-based care while helping to

save valuable healthcare dollars.

NCCBH supports these kinds of

initiatives.”

Linda Rosenberg, President & CEONATIONAL COUNCIL FOR BEHAVIORAL HEALTH

Customer Stories

Assessment Tool

31

THANK YOU!

Carol Clayton, PhD111 Corning Road, Suite 250

Cary, North Carolina 27518

Direct: (919) 491-0819

cclayton@reliaslearning.com