Thought Leader Spotlight, Sponsored by Netsmart
In 2002, the estimate of children diagnosed with Autism Spectrum Disorder was 1 in 150. The rates were surveyed every two years and saw steady increases with the rate estimated at 1 in 88 children in 2008 when states began passing laws mandating insurance coverage for treatment of Autism Spectrum Disorder (see Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014). As a result of the 2012 California Autism Insurance Law, Kaiser Permanente (KP) approached Easterseals Southern California (ESSC) to be a single access point for behavioral assessments and ongoing autism therapy services.
Easterseals Southern California (ESSC) is one of the largest of 72-affiliates associated with the national Easterseals. ESSC serves communities from central through southern California and is an established industry leader for providing services to children and adults with intellectual/developmental disabilities, including residential services, independent living, supported employment, early education, and day services. Dr. Paula Pompa-Craven, Vice President and Chief Clinical Officer at ESSC, accepted the opportunity to create an Autism Services Program at a time when no one knew the level of demand and scale of services that would be required of providers.
In April 2018, the CDC increased the estimate of autism spectrum disorder diagnosis from two years prior by 15%, to 1 in 59 children (see Autism Rates & Autism Costs – A Future View). The laws mandating insurance coverage, studies demonstrating the effectiveness of treatment, and an increase in diagnosis have resulted in an increased demand for autism services (see State Insurance Mandates for Autism Treatment Helped 12% More Children Obtain Treatment). While the cause of Autism Spectrum Disorder is debated, the continued increase in incidence suggests that these new national numbers may still reflect persistent underreporting.
ESSC created a new scaleable Autism Services program, encompassing behavioral services, speech, occupational and physical therapy, to meet the rapidly growing demand. This included hiring and training staff to provide client services. As the demand continued to grow, it became increasingly difficult to hire and train staff to meet the demand while reimbursement rates provided an additional challenge for providers (see South Carolina Sued Over Low Medicaid ABA Rates, Louisiana Department Of Health And Hospitals Cut ABA Medicaid Rates By 20%, Tricare To Cut Autism ABA Therapy Reimbursement Rates To Align With Commercial Insurers).
ESSC developed a strategy to be more efficient with consistent, high quality staff training and client services through the use of technology. A key part of the ESSC strategy was the selection of Netsmart for their enterprise electronic health record (EHR). Netsmart includes functionality beyond a basic EHR, with solutions and services like hosting, revenue-cycle management, and analytics and was able to replace several other information systems at ESSC. Pompa-Craven explained, “We chose Netsmart after a rigorous selection process because of our shared vision to have our client’s complete physical and behavioral health record available for our organization and our health provider partners to provide a high quality, consistent continuum of care.”
An electronic health record creates value for ESSC through:
- Consolidation of systems
- Consistent data collection and quality improvement
- Improved staff engagement and satisfaction
- Enhanced HIPAA compliance
Consolidation of systems – ESSC had five different systems to manage processes such as scheduling, intake, and billing. The Netsmart platform puts all of this information into one system, making it easier for staff to find the information they need and spot gaps in data. Additionally, the system automates the referral process.
“We get up to 300 referrals a month and that number is continuing to increase,” Pompa-Craven said. “As these referrals increase, we need a system that is automated with one touchpoint and fewer people handling information to reduce the potential for error.”
Consistent data collection and quality improvement – Structured data collection allows ESSC to better monitor individual client performance and performance at the population health level. In the outdated model, if management wanted to look at the data collected, they had to manually collect the papers, combine, and create graphs. With a structured EHR, supervisors no longer have to call a staff member and ask for guidance or clarification on their notes. Instead, they will be able to provide real-time feedback and training. Additionally, ESSC is more easily able to track organization-wide performance on key metrics and performance indicators.
Improved staff engagement and satisfaction – Some of the major challenges ESSC faces are staff engagement, satisfaction, and turnover. The workforce that provides autism services is highly mobile, and therefore doesn’t have the same sense of camaraderie as in a typical office environment. The nature of the job can easily lead to fatigue and frustration. ESSC is addressing these issues with the assistance of technology, including the EHR, which allows for more engagement with the organization and increased assistance from supervisors, including real-time feedback.
“If the plan was to teach a client to request something they like, but the situation isn’t conducive that day, supervisors can change the course of treatment for the day, as needed,” Pompa-Craven explained, “If the therapist isn’t sure what to do in a situation they can log into the system and use secure video to conference a supervisor for immediate assistance.”
Enhanced HIPAA Compliance – Many of the services Easterseals provides to individuals with autism are conducted in their homes. Staff visit the home and do all documentation in a binder that stays in that home. Pompa-Craven noted this creates risks to data as they don’t have total control over how the data is stored and who sees the data in the client home. With the new Netsmart mobile application, staff will enter data directly into the EHR, mitigating risks with data collection, storage, transfer, and reporting.
The current challenges facing organizations that provide autism services are unlikely to abate in the next couple of years. Better outcomes tracking, continuous quality improvement, fewer errors, and greater efficiency give organizations that automate services and processes a competitive edge.