Information Technology - nasmhpd.org · Health Information Technology ... Technology Guidance for the Horizontal Integration of ... addressing the premature mortality of people with

Information Technology: Opportunities for Care

Coordination

Megan Lape, M.S.W., APHSA

Joel E. Miller, M.S. Ed., NASMHPD July 16, 2013

Welcome and Introduction

• One of SAMHSA's key areas of focus is ensuring that the behavioral health care system fully participates with the general health care delivery system in the adoption of Health Information Technology (HIT) and interoperable Electronic Health Records (EHR).

• The Health Information Technology Strategic Initiative at SAMHSA is led by Dr. H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM, Director of the Center for Substance Abuse Treatment.

2

Motivations and Purpose of the Webinar

Patient Protection and Affordable Care Act, ARRA-HITECH, DRA of 2005

Renewed focus on care coordination between primary care (P.C.) and behavioral health (BH) providers.

• Most behavioral health providers are not eligible for Electronic Health Records (EHRs) incentive program.

• However, State Behavioral Health Agencies (SBHAs) should facilitate adoption across providers.

Facilitating adoption of Health I.T. will:

• Support integration of PC and BH;

• Address BH provider needs; and

• Help eligible providers achieve Meaningful Use.

3

4

Information Technology: Opportunities for Care Coordination

5

American Public Human Services Association

MISSION: APHSA pursues excellence in health and human services by supporting state and local agencies, informing policymakers, and working with our partners to drive innovative, integrated

and efficient solutions in policy and practice.

-American Association of Public Welfare Attorneys -American Association of SNAP Directors -Association of Administrators of the Interstate Compact on Adoption and Medical Assistance -Association of Administrators of the Interstate Compact on the Placement of Children -IT Solutions Management for Human Services

-National Association for Program Information and Performance Measurement -National Association of Public Child Welfare Administrators -National Association of State Child Care Administrators -Center for Workers with Disabilities -National Association of State TANF Administrators -National Staff Development and Training Association www.aphsa.org

AFFILIATES

http://www.aphsa.org/

Gainful employment

and independence

Stronger families,

adults, and communities

Healthier families,


Sustained well-being of children and

youth

Pathways: The Opportunities Ahead for Human

Services


Pause: Vernacular Check

•INTEROPERABILITY does not mean integration

•INTEGRATION/CARE

COORDINATION


Healthier families,


•Foundational steps: -Provide means to access basic medical care for families and children -Link human services programs with health programs-no wrong door -Holistic spectrum of care opportunities -Connect families and individuals to underpinnings of a healthier life style


http://www.aphsa.org/Policy/pathways.asp

http://www.aphsa.org/Policy/pathways.asp


•Bridging the Divide •Guidance on Governance, Technology & a 21st Century Business Model for HHS •Maturity Model & Self-Assessment Tool •2012 & 2013 Webinar Series

http://nwi.aphsa.org

http://nwi.aphsa.org/

A FULLY INTEGRATED HEALTH AND HUMAN SERVICES SYSTEM THAT OPERATES A SEAMLESS, STREAMLINED INFORMATION EXCHANGE,

SHARED SERVICES AND COORDINATED CARE DELIVERY SYSTEM THAT IS A CONSUMER-FOCUSED , MODERN MARKETPLACE EXPERIENCE

DESIGNED TO IMPROVE CONSUMER OUTCOMES, IMPROVE POPULATION HEALTH OVER TIME, AND BEND THE HEALTH AND HUMAN

SERVICES COST CURVE BY 2025.

10


Pathways: The Opportunities Ahead for Human Services


http://nwi.aphsa.org

APHSA’s 21st Century Health & Human Service Business Model

© Cari DeSantis 2012

http://nwi.aphsa.org/

What is the vision of the 21st century behavioral health system?

•Interactive, consumer-centered and controlled data and systems •Standardized, streamlined, interoperable, and automated processes •Real-time, fully automated reporting and exchange mechanisms

•Elimination of administrative and programmatic barriers to care •A seamless and transparent integration of treatment programs and recovery support services across not just health related entities, but across other sectors as well

SOURCE: BH-MITA Concept of Operations Document Version 2.0, August, 2008, http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/BH-MITA-COO.pdf.


http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/BH-MITA-COO.pdf


















Service Oriented Architecture (SOA) -SOA serves as the backbone architecture for diverse operating systems in many public & private industries -SOA is a commonly used approach to share information across systems

Examples in of SOA in HHS: -Medicaid Information Technology Architecture 3.0 -Behavioral Health-Medicaid Information Technology Architecture 2.0 (http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/MITA/Medicaid-Information-Technology-Architecture-MITA-and-Behavioral-Health.html)

-National Human Services Information Architecture 1.0 SOURCE: Technology Guidance for the Horizontal Integration of Health and Human Services, April, 2012, http://nwi.aphsa.org/DOCS/Technology-Guidance.pdf

How can IT enable the vision of the 21st century BH system?

http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/MITA/Medicaid-Information-Technology-Architecture-MITA-and-Behavioral-Health.html



























http://nwi.aphsa.org/DOCS/Technology-Guidance.pdf




OPPORTUNITIES

• CMS’ IT Guidance 2.0 http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-

Systems/downloads/exchangemedicaiditguidance.pdf

• Enhanced FFP at 90% for Medicaid http://www.gpo.gov/fdsys/pkg/FR-2011-04-19/pdf/2011-9340.pdf

• OMB Circular A-87 Cost Allocation Exception 1st Tri-Agency Letter: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-

Topics/Data-and-Systems/Downloads/Cost-Allocation-IT-Systems.pdf

2nd Tri-Agency Letter: http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-01-

23-12.pdf

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/downloads/exchangemedicaiditguidance.pdf













http://www.gpo.gov/fdsys/pkg/FR-2011-04-19/pdf/2011-9340.pdf









http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/Cost-Allocation-IT-Systems.pdf



















http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-01-23-12.pdf












OPPORTUNITIES CONT’D…. •Electronic Use & Exchange of Health Information

-Electronic Health Records (EHRs) *Among community-based BH providers not eligible for MU incentives:

•65% use an EHR at 1 or more sites •21% use and EHR across their sites •35% use a paper/electronic combination across their site

*Barriers for non-eligible BH providers & professionals:

-Purchasing & maintenance cost, loss of productivity, training, resistance to change, privacy laws, lack of awareness and need

SOURCE: Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Health Information, June, 2013, http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf

http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf


OPPORTUNITIES CONT’D…. Electronic Use & Exchange of Health Information

-Health Information Exchanges (HIEs) *56 states and territories have been awarded cooperative agreements supporting HIE

*As of Dec., 2012, 39 states and territories have operational directed exchange mechanisms broadly available and 9 more states have these mechanisms available in regions or as part of pilots





OPPORTUNITIES CONT’D…. Electronic Use & Exchange of Health Information

-Interoperability: •Standards & Interoperability (S&I) Framework

-Multi-stakeholder, iterative approach to development of flexible, modular standards, services and policies to enable information exchange across different systems in different settings -Groundwork for the health domain of the National Health Information Exchange (NIEM)




• Learn and promote the SAMHSA Business Operations Collaborative to BH providers

• Become familiar w/ BH-MITA & ask SAMHSA to fill out the State Self-Assessment

• A-87 cost allocation exception-it’s not too late! Speak with your Medicaid director to get added into the Expedited Eligibility & Enrollment APD for phased development before it expires

• Contact State HIE grantee to identify and develop approaches to enable health information exchange services to BH providers not eligible for EHR incentives

Information Technology:

Opportunities for Care Coordination

Considerations & Next Steps….

NASMHPD's Vision and Mission

Vision

• Mental health is universally perceived as essential to overall health and well-being with services that are available, accessible, and of high quality.

Mission

• NASMHPD serves as the national representative and advocate for state mental health agencies and their directors and supports effective stewardship of state mental health systems.

• NASMHPD informs its members on current and emerging public policy issues, educates on research findings and best practices, provides consultation and technical assistance, collaborates with key stakeholders, and facilitates state to state sharing.


“Health I.T. is, in many respects, the backbone to making dramatic improvements in improving the health of Americans and slowing down the rate of increase in health care costs – the backbone to payment reforms, the backbone to transparency, the backbone to providing new ways of delivering care. Electronic health records and the opportunities of application for Health I.T. is transformational.”

Former Senator Tom Daschle (D-SD)

20

Future of Behavioral Health is in Technology

• If BH organizations cannot adopt H.I.T. at a rate comparable with P.C. facilities, hospitals or physicians, it will likely be difficult to provide comprehensive & coordinated care -- and to compete in the marketplace.

• Health care plans, purchasers and consumers will expect ongoing collaboration and interaction between primary and specialty care. ACOs, health homes, and bundled payment structures will require the capability to exchange data to support effective and efficient care.

• For those who provide and receive services from specialty BH organizations, H.I.T. is critical to coordination of care and instrumental in addressing the premature mortality of people with SMI, literally helping to save lives (Parks, et al, NASMHPD 2006).

21

Setting the Stage

• The burden of BH conditions (including MH/SUDs) in the U.S. remains great. Consider the prevalence and treatment of mental illness. By 2011, almost 20% of adults in the United States had suffered from a mental health condition at some point in their lives.

• Mental illness is a source of significant comorbidity in the chronically ill, particularly for patients with diabetes. Diabetes patients are twice as likely to suffer from depression as the general population.

• Mental illness is also associated with higher rates of S.A. In 2011, 23 million people ages 12-64 reported symptoms of SUDs, while only 11% received treatment at a specialty facility.

• A substantial volume of BH care is delivered in P.C .settings. General and internal medicine physicians cared for 34% of patients with a primary MH diagnosis in 2011 alone.

• Given the burden of illness and the volume of BH care delivered in primary care settings, better integration between BH and primary care is needed.

22

Setting the Stage

• Health information technology (H.I.T.), including electronic health records (EHRs), personal health records (PHRs), health information exchange (HIE), mobile health, and other technologies that support health and wellness are key enablers of care coordination and integration.

• However, BH clinicians currently have limited adoption of interoperable information systems. In a recent study, just over 20% of 505 BH organizations surveyed indicated that they had fully adopted an EHR.

• BH organizations cited as barriers to EHR adoption concerns over initial productivity losses, lack of qualified IT and project management staff, provider resistance, and privacy laws.

23

Setting the Stage

• The collection and exchange of health information has long been seen as a catalyst for improving the health care delivery system.

• BH is an integral component of overall health and is a practice area where H.I.T. holds tremendous opportunities. Integrating H.I.T. into BH care facilities and allowing providers to effectively use it can lead to significant gains in reducing discontinuity of care, enhancing client engagement, supporting medication management, and establishing processes for tracking a range quality measures.

• However, integrating H.I.T. efforts into BH care settings presents unique challenges. Several states have begun to navigate those issues & can provide an early set of best practices & lessons for developing a strategy to implement H.I.T. in the BH setting.

Cross-cutting Issues in Behavioral Health and Primary Care Integration

• Behavioral health stakeholders are largely supportive of information sharing to improve patient care. However, behavioral health providers have low levels of health IT adoption, in part because most lack the financial resources to acquire these systems and most are ineligible for financial incentives through the Medicare and Medicaid EHR Incentive programs.

• Moreover, EHRs do not typically support federal and state requirements for increased privacy protections for behavioral health data in the medical record, and HIEs are still struggling with how to manage patient consent requirements for behavioral health data disclosure.

• To aid in the integration of behavioral health and primary care using health IT, both EHR vendors and HIEs will need to ensure that their systems include the necessary functionality to support information sharing while complying with federal and state regulations.

25


• Compliance with The Federal Confidentiality of Alcohol and Drug Abuse Patient Records law – or “42 CFR Part 2,” which specifies the conditions and requirements for disclosure of patient information regarding substance abuse treatment programs – is a significant concern of the behavioral health community.

• This regulation requires the patient to provide authorization (also referred to as consent in this document) before his or her substance abuse treatment information is disclosed to external entities.

• The regulations prohibit the re-disclosure of this information in the absence of consent. In regards to inpatient BH information, many state laws impose additional requirements for sharing of BH information, prohibiting disclosure and/or re-disclosure of sensitive data by providers in the absence of patient consent.

26


• HIPAA privacy regulations include restrictions on sharing psychotherapy notes. Clients do not have the right to access providers‟ psychotherapy notes if they are kept separately from the patient’s record unless state law supersedes this regulation.”

• Providers are also prohibited from disclosing psychotherapy notes to health plans without patient consent. Due to these regulations, data segmentation within EHRs and HIEs will be needed to protect specific patient information.

• Electronic data systems and workflows – and other components of the new 21st Century I.T. System – will also need to handle the multiple types of patient consents needed to disclose sensitive data in different jurisdictions.

• These regulations protect patients, but they also present significant challenges to the electronic exchange of data between BH and P.C. providers.

27

Care Coordination

Definition:

• Serious BH disorders typically represent chronic conditions that are often associated with chronic physical illnesses.

• A patient may move from one care setting to another, perhaps moving back and forth between outpatient and inpatient care settings, in order to receive treatment for a mix of both medical and behavioral health issues.

• Care coordination helps ensure a client’s needs and preferences for care are understood, and that those needs and preferences are shared between providers, patients, and families as a patient moves from one health care setting to another.

• Care among many different providers must be well-coordinated to avoid waste, over-, under-, or misuse of prescribed medications, and conflicting plans of care.

28

Care Coordination

• I.T. in a BH care setting can serve as a valuable tool for a patient's entire medical team, placing isolated episodes into context, and informing providers, and affecting the patient’s entire health management plan.

• Providers can use EHRs to support continuous care and monitoring, coordinate care between providers, and can be instrumental in identifying clients whose care should be escalated or modified.

• Integrating EHRs and other health I.T. tools has the potential to extend patient care beyond the traditional clinical setting by integrating information streams with tele-health, social services, corrections, and school-based health systems.

29

N.Y. State Initiative: New York Community-Based and Provider-Centric Approach

• New York is using a community-based and provider-centric approach to BH IT. The Health Care Efficiency and Affordability Law (HEAL), passed in New York in 2004, supports projects to accelerate the adoption of HIT & interoperable EHRs.

• HEAL awarded $120 million to community-based HIT projects to build a more streamlined approach to sharing client information, with a focus on BH and LTC.

• One of the HEAL’s initiatives allows the Regional Extension Adoption Center for Health (REACH) to create a new division of the extension center dedicated exclusively to BH providers.

• The proposed project will utilize NYC REACH's existing H.I.T. and interoperability infrastructure to facilitate health information exchange between designated BH providers & existing Patient Centered Health Home-qualified practices.

30

I.T. and Care Coordination

• A psychiatrist at Maimonides Medical Center in Brooklyn, was talking with his colleagues when his cell phone buzzed in his pocket. What he found in his inbox was an automated alert from the Brooklyn Health Information Exchange (BHIX).

• Clicking the link within the email, he navigated to BHIX’s secure Clinical Messaging Center and saw that one of his patients had just been admitted to the ED at Lutheran Medical Center located a few miles away. In a few hours, the physician was able to proactively check in with his patient while she was still in the ED.

• “Beyond the benefits of coordinating care between disparate systems and providers, as an individual physician, I now have a greater sense of where my patients are. Having that information is incredibly powerful.”

• Because of this, coordination of mental health care and general health care through HIE is vital to improving health outcomes.

31

http://www.maimonidesmed.org/Main/Home.aspx

http://www.lutheranmedicalcenter.com/

I.T. and Care Coordination Among Bi-Polar and Schizophrenic Patients

• To get started, BHIX and Maimonides selected a panel of patients using the

diagnosis codes that indicate bi-polar and schizophrenia, as well as zip codes for the region they wanted to monitor. In addition, the partners defined several events that would trigger an alert for their selected panel of clients, including an inpatient admission.

• When BHIX, Maimonides and the six other participating hospital sites (including four teaching hospitals, a SNF and LTC facility, and a level one trauma center) were ready to launch, each site designated care coordinators to receive and monitor these alerts and to follow up with clients and clinicians as appropriate.

• Through the original HEAL project, BHIX and Maimonides have enrolled more than 5000 clients and generated more than 10,000 alerts.

32

I.T. and Care Coordination Among Bi-Polar and Schizophrenic Patients, cont.

• Maimonides & BHIX are using the initial alerting success as a springboard for additional BH care coordination efforts, including patient education about BHIX consent.

• One home health care organization is receiving BHIX alerts when their clients are admitted to the hospital or the ED. H.I.T. is saving time and $ for the agency, which now doesn’t have to send a home care nurse to a patient’s home when they are not there.

• Additionally, the alerts allow the home health care providers to better coordinate BH care by following up with caregivers in the hospital or ED after a patient’s discharge.

• “Now that we have the infrastructure in place, what we are doing with automated alerting is the tip of the iceberg. As long we have the data & rules set up, we can establish triggers for an entire practice’s patients…for things like abnormal labs…and even a trigger for the absence of data. We are constantly working with our clinicians to determine how they want to use this functionality to improve care coordination.”

33

Nebraska Initiative: Provider Outreach and Adoption Incentives

• Reaching community providers is an important step in deploying health IT systems across the delivery system, particularly in BH which relies heavily on local services.

• Innovative outreach strategies may be necessary to encourage adoption and use in community clinics and among other safety net providers, particularly those who treat substance abuse.

• Nebraska has built a business model to support their H.I.T. efforts. Their model relies in part on fees paid by providers. Recognizing the financial burden for providers in adopting EHR systems, their model includes subsidies for the costs associated with implementing the system and participating in statewide HIE.

• The participation fees are initially reduced and will increase incrementally over a period of five years.

34

Missouri Health Home Initiative

• Independent Living increased by 33%

• Vocational Activity increased by 44%

• Legal Involvement decreased by 68%

• Psychiatric Hospitalization decreased by 52%

• Illegal Substance use decreased by 52%

****

• IN ADDITION- Study shows CMHCs services substantially decrease overall medical cost

35

Issues, Initiatives and Trends

Ongoing issues related to care coordination for behavioral health consumers include:

• Concerns who should have access to what information & when, how much control the client should have, ensuring clients understands implications of disclosure;

• Ability of existing technologies to support the sharing of BH information while complying with 42 CFR Part 2 and other State regulations;

• Ability for H.I.T. systems to maintain robust systems of consent management, which allow for recipients of BH services to make an informed decision about the disclosure of their BH info, separate & distinct from their consent of HIPAA data;

• What mechanisms should be used to ensure that all relevant providers are informed about changes to the patient’s status or care plan;

• How can we ensure providers can accurately interpret information they receive; &

• Overcoming societal barriers to information sharing.

36

Client Engagement

Definition:

• Use of the term “patient engagement” or “client engagement” reflects a cultural shift towards patient-centeredness in health care, where patients are seen as equal partners in their care and respected as experts in their own health experience.

• As part of patient-centered care, patient engagement is the active sharing of information & decision-making with clients to help them understand diagnoses & treatment options, select options that meet their goals, and manage their care.

• An important cornerstone of patient engagement is patient-provider communication; the bi-directional sharing of information and dialog between patient and provider facilitates patients playing an active role in their own care.

• Strong patient-provider communication has been associated with improved patient comprehension & retention of information, as well as increased patient satisfaction, increased compliance, reduced anxiety, & improved outcomes.

37


• Embracing patient engagement represents significant cultural, organizational & technical challenges for BH and P.C. providers.

• Cultural challenges include resistance of health care providers to embrace clients as equal partners in their own care. Organizational challenges include working within institutions that have not incorporated patient-centric workflows.

• Technical challenges include working with H.I.T. systems that are not patient-centric, user friendly, or able to collect patient reported data or exchange pertinent patient information with other systems.

38

Medication Management, Adherence,

and Abuse

Definition:

• Medication management refers to the standard of care that ensures patients ‟medications are assessed to determine their appropriateness, effectiveness, & safety for patients medical conditions.” Medication regimens increase in complexity as comorbidities increase, requiring comprehensive review & reconciliation of drugs.

• Medication management includes an individualized care plan in which the patient understands & actively participates to optimize treatment outcomes.

• Researchers have found non-adherence to be approximately 60% among patients with bipolar disorder. Promoting adherence among those with BH disorders may greatly improve outcomes. Addressing the growing problem of Rx abuse is also a priority.

• In 2010, an estimated 2.4 million people aged 12 year or older used Rx drugs non-medically for the first time.

39

Prescription Drug Abuse

• Prescription drug abuse is the nation’s fastest-growing drug problem. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically.

• Overdoses of opioid prescription drugs now kill more people in the U.S. than do overdoses from heroin and cocaine combined. According to the CDC, prescription drug related deaths have now exceeded the number of motor vehicle traffic deaths.

• RX Drug Monitoring Programs (PDMPs) are statewide electronic data-bases designed to be used as a tool by providers to identify & intervene in cases of potential prescription drug abuse. The data-bases collect, monitor, & analyze electronically transmitted prescribing & dispensing data submitted by pharmacies & dispensing practitioners.

40


• The ability to comprehensively review patient medications is imperative for providers when making treatment decisions.

• Medication management promotes patient safety, enabling providers to assess and identify potentially harmful drug interactions or dosing errors.

• Maintaining active medication lists and performing formulary checks are important to providers when prescribing medications. Privacy laws and regulations can present challenges to sharing patient’s BH treatment information, including medications, which creates difficulty when selecting medications or transitioning between care providers & care settings.

• Overcoming barriers to information sharing and coordination of care will be critical for improving safety and efficacy of care for patients with BH disorders.

41

Issues, Initiatives and Trends, cont.

• The proliferation of Health 2.0 tools like social networking sites & smart phone/tablet applications is an important trend related to medication management. Clients capturing & managing their own medication data could make Rx lists more complete & aid in Rx reconciliation.

• Depending upon tool capabilities, patient use of these tools could also improve side effects tracking and treatment adherence.

• When shared, data from these tools could give providers better information about how their patients are doing between visits – Are they taking their medications as prescribed? Experiencing side effects? How are they managing these? – and could help ensure correct medication combinations and dosages.

42

Issues, Initiatives and Trends, cont.

• Previous initiatives like SAMHSA’s Medication Management Algorithm Project (MedMAP) have established the benefit of medication management for BH clients in certain areas.

• Recent publications on medication management within BH settings have suggested that these systems may only be effective if patients understand how to manage the data provided by the system appropriately and that medication management is most effective when it is employed as a tool that engages providers and patients together as a team.

• Accordingly, in addition to the data segmentation and consent management issues already noted, patient and provider education in medication management, workflow, and associated tools should be considered as key part of BH and PC integration using H.I.T.

43

N.Y. PSYCKES as a Tool to Support

Quality Improvement in Poly-pharmacy

New York State Office of Mental Health has used the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) as a tool to support several statewide quality collaborative projects. Projects have focused on:

• Reducing psychotropic poly-pharmacy;

• Reducing the use of higher metabolic impact antipsychotics among individuals with existing cardio-metabolic conditions including obesity, hypertension, hyperlipidemia, diabetes and ischemic vascular disease;

• Reducing higher than recommended dosing; and

• Youth psychotropic poly-pharmacy set (“too many, too much, too young”).

New projects in development include:

• Reducing hospital re-admissions; and

• Health promotion.

44

N.Y. PSYCKES as a Tool to Support Quality Improvement in Poly-pharmacy, cont.

• Significant reductions in the prevalence of quality concerns have been observed. The first statewide PSCYKES QI Medicaid Project had 343 participating clinics. Participating clinics reached the target reduction of 30% reduction.

• As of December 2011, clinics reported changing the medication regimens of 7400 consumers such that they no longer met criteria for the selected indicator set, representing 32% of positive cases identified in PSYCKES at baseline across participating clinics statewide.

• Monthly QI data reported by participating clinics was mirrored in Medicaid data analysis, which indicated significant reductions in prevalence of quality concerns, with an associated $2.9 million in attributable savings in Rx costs in the first year.

• Similarly, in a joint quality collaborative between OMH and Greater New York Hospital Association, 25 participating hospital affiliated clinics reported impact for 581 consumers such that they no longer met criteria for the cardio-metabolic quality concern, representing 25% of positive cases identified at baseline for that collaborative.

45

Next Steps to Prepare

• Develop a culture of excitement about the use of technology to improve quality of care in your agency.

• Educate your providers and other staff about what is coming in the near future.

• Review your specific operational environment including your current and future financial status, technological maturity of your state delivery care systems as well as client characteristics, and develop a plan prioritizing your most needed services.

46


• States can charge convened groups to identify use cases that would benefit from additional automation or standardization, & develop priorities for key initiatives that support system efficiencies, clinical decision support & EBP guidelines.

• States can use their purchasing power to specify that BH H.I.T. be a requirement in provider networks & contracts for Medicaid managed care & state employee benefit programs.

• States can work with stakeholders to develop educational opportunities for providers & consumers to clarify the value of including BH information in health information exchange & to improve understanding of the laws affecting BH information.

47

Identified Solutions and Points of Influence for States

Purchasing and Contractual Leverage

• States may consider leveraging their role as major purchasers of health care services – through Medicaid and state employee benefit programs – to specify that BH H.I.T. be a requirement in provider networks and contracts.

• A payer-driven model may be found in integrated health care systems such as Kaiser Permanente, which has invested heavily in web-based functionalities so that physicians, hospitals, and health plan administration can easily connect and coordinate care delivery.

• Functions comprised within systems like Kaiser Permanente’s emphasize a continuum of care and can include electronic health records, electronic prescribing, and case management software, and clinical guidelines.

48


• Remember, it is all about the data – analyzing the data, and using the data to improve clinical and operational practices, not just having the data to play with.

• It is not until your agency captures, analyzes, and uses the data that you can implement care coordination processes and evaluate best practices to improve the quality of are you provide.

• The future is bright for I.T. in BH care. The challenge remains in deciding what to do first within limited financial resources that will have the greatest impact on the quality of care provided to BH consumers.

49

Identified Solutions and Points of

Influence for States

Seeking Out Alternative Funding

• States may consider exploring a mix of funding sources that offer chances

for states to develop a range of technology tools in behavioral health.

• For instance, states that receive grants from CMS to implement an Advanced Primary Care (APC) model, also known as the patient-centered health home.

• Emphasize H.I.T.’s role in helping patients to develop an individual care plan for BH issues and coordinating with a patient’s other providers.

50

Keep This Value Proposition In Mind

The value of behavioral health information technology is to improve health outcomes, improve client satisfaction and lower costs by reducing gaps in behavioral and general health coordination and care utilization patterns, through emerging information technologies particularly through the use of electronic health records, health information exchanges and patient engagement.

51

Value Proposition Objectives

1. For Consumers and Families

• Improve outcomes & satisfaction with the health care system by lowering barriers to seeking & persistently using health care services. It is hoped that improved satisfaction will contribute not only to improved outcomes with respect to BH, but lead to appropriate utilization of health care services for the patient & the extended family for all health conditions.

2. For Health Care Providers

• Improve the quality of health care services provided to patients with behavioral health conditions. Support new payment models, such as those required for ACOs, health homes, and new insurance-based physician group incentive payments.

3. For Payers

• Reduce costs associated with substance abuse and mental health—particularly for the Medicaid population that is disproportionately represented in most communities.

4. For Communities

• Promote integration between behavioral health and physical health care to improve population health and lower costs.

QUESTIONS ???

53

For More Information… Please Contact:

–Megan Lape: [email protected]

– Joel Miller: [email protected]

*****

– For more information, please visit the SAMHSA website at: http://www.samhsa.gov/healthIT/

Thank you!

54

mailto:[email protected]

mailto:[email protected]

http://www.samhsa.gov/healthIT/

http://www.samhsa.gov/healthIT/

Information Technology - nasmhpd.org · Health Information Technology ... Technology Guidance for the Horizontal Integration of ... addressing the premature mortality of people with

Documents