The Care Transitions Network · 2018. 4. 27. · Dealing with No Shows/Late Cancellations 1. Medication Call Ins 2. Rescheduling/Crisis Events 3. ... Rosecrance Berry Campus Rockford,

Presented By: Scott Lloyd, President 1

Making the move to Value Based Reimbursement/Payment/Purchasing (VBR/P2):

Using Data to Improve Care Delivery and Your Organizations Performance

Presented by:Scott C. Lloyd, President M.T.M. ServicesP. O. Box 1027, Holly Springs, NC 27540Phone: 919-395-5911 Fax: 919-773-8141E-mail: scott.lloyd@mtmservices.orgWeb Site: www.mtmservices.org

The Care Transitions Network

MTM Services’ has delivered consultation to over 800 providers (MH/SA/DD/Residential) in 46 states, Washington, DC, and 2 foreign countries since 1995.

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

Experience –Improving Quality in the Face of Healthcare Reform

2Presented By:

Scott C. Lloyd, President

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?”)

4Presented By:

Scott Lloyd, President

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

“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

Presented By: Scott Lloyd, President 7

“Value” of Care Equation

JIT – To a Prescriber in 3 Days

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).

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JIT – To a Prescriber in 3 DaysThe False Reality of Full!

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?

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!

JIT – To a Prescriber in 3 Days

Process Redesign Review

13Presented By:

Scott C. Lloyd, President

The False Reality of Full!

Client Arrives for an Open Session 

Client Calls for Help 

Assessment Appointment 

Treatment Planning Appointment 

The Client’s Definition of Access

Wait Time # 1

Wait Time # 2

Wait Time # 3

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!

JIT – To a Prescriber in 3 Days

1. Dealing with consumers angry about the wait2. Dealing with poorly laid out documentation.3. Poorly functioning EMR/EHR4. Dealing with No Shows/Late Cancellations

1. Medication Call Ins2. Rescheduling/Crisis Events3. Direct Service Production Hits

5. Naturally Occurring vs. Structured Downtime

Areas of System Noise

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

Rosecrance Berry CampusRockford, ILOpen Access Case Study

Richard Jaconette M.D.Child/Adolescent Psychiatrist

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

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

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

The Crux of the Problem –We make Consumers Guess!

Where will you be in 30-90 Days at 2:15!?

30‐90 Days??

??? ?

??

?

24‐48 Hours

10 – 7 Days

JIT – To a Prescriber in 3 Days

Biggest Obstacle To Implementation

• Anxiety--Within the:– Doctor– Families– Front Office Staff– Other Clinicians– Administration

JIT – To a Prescriber in 3 Days

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).

Key Factors for Success!

JIT – To a Prescriber in 3 Days

Key Factors for Success!

JIT – To a Prescriber in 3 Days

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.

Results

JIT – To a Prescriber in 3 Days

Results – Show RatesJIT – To a Prescriber in 3 Days

Results - ProductionJIT – To a Prescriber in 3 Days

Results - GrowthJIT – To a Prescriber in 3 Days

Results - FinancialJIT – To a Prescriber in 3 Days

JIT first 90 days Review –

Billable Hours:Providers totaled 925 billable hours for the period July to September 2014.Providers totaled 1,062 billable hours for the period November 2014 to January 2015.

An overall 15% in hours /A 4 hour a day increase

Billable DollarsProviders totaled $146,421 for the period July to September 2014.Providers totaled $199,066.80 for the period November 2014 to January 2015.

An overall 36% increase in dollars. / A $1,144.36 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.

Results - ClinicalJIT – To a Prescriber in 3 Days

Where would you have gone without our services?

ResultsJIT – To a Prescriber in 3 Days

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% 

Customer Satisfaction

“Value” of Care Equation

Outcomes achieved (i.e., how do we demonstrate that people are getting “better”

Presented By: Scott Lloyd, President 32

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 33Presented By:

Scott Lloyd, President 33

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 34Presented By:

Scott Lloyd, President 34

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

5.1- 6.0 (51 – 60) = Mild impairments, minimal interruptions in recoveryICD 10 4th digit modifier = 0

4.1- 5.0 (41 – 50) = Moderate impairment in functioning ICD 10 4th digit modifier = 1 mGAF tallies number of symptoms = 1-3

3.1- 4.0 (31 – 40) = Serious impairments in functioningICD 10 4th digit modifier = 2 mGAF tallies number of symptoms = 4-6

2.1- 3.0 (21 – 30) = Severe impairments in functioningICD 10 4th digit modifier =3mGAF tallies number of symptoms = 7-10

2.0 (20 or less) = Extremely severe impairments in functioningICD10 4th digit modifier = 3mGAF identifies intensely high-risk symptoms

35Presented By:  David Lloyd, Founder, MTM ServicesPresented By:

Scott Lloyd, President 35

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

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

3737Presented By:

Scott Lloyd, President

DLA-20 Statewide Use Supports Delta Score Based Outcome Measurement

Presented By: Scott Lloyd, President 38

Presented By: Scott Lloyd, President 39

Sample Data

Presented By: Scott Lloyd, President 40

Sample Data

Measuring “Value of Care” (Services Provided, Cost of Services and Outcomes Achieved= VALUE

Presented By: Scott Lloyd, President 41

Presented By: Scott Lloyd, President 42

Sample Data

Presented By: Scott Lloyd, President 43

Sample Data

Presented By: Scott Lloyd, President 44