Most specialty provider organization executive teams are looking at the twin challenges of retooling their services lines for success in a market moving toward integrated care coordination and value-based reimbursement. The question is what does this mean for the technology infrastructure of these organizations?
That was the focus of the town hall session, Building An Infrastructure For Integrated Care: A Town Hall Discussion On Interoperability, Technology & Innovation at the recent 2018 OPEN MINDS Technology & Informatics Institute. Our panel featured executives from two provider organizations that are the midst of this evolution in technology – Katy Beveridge, Vice President of Operations at LifeWorks NW and Brandon Ward, Psy.D., Director of Enterprise Applications at Mental Health Center of Denver. The panel was rounded out by A.J. Peterson, Vice President, Interoperability at Netsmart and Monica E. Oss, Chief Executive Officer at OPEN MINDS.
Both organizations have extensive experience with the new market model. LifeWorks NW is a Portland, Oregon-based $44 million behavioral health organization. They are a designated certified community behavioral health center (CCBHC) providing integrated care. And, LifeWorks NW is paid a case rate for mental health services (what Ms. Beveridge calls, “fee-for-service on steroids”) and fee-for-service for addiction treatment services. Oregon is currently in the process of gearing up for its next Medicaid managed care procurement cycle and its expected that the state will include value-based reimbursement (VBR) requirements.
Mental Health Center of Denver is a $98.5 million behavioral health organization in the city of Denver, with a long track record in providing behavioral health services under a capitated financial model. It also provides supportive housing and has opened up an innovative community center at its Dahlia Campus that includes an urban farm, dental care, early childhood education, health services, and community spaces.
The panel had a wide-ranging discussion of the issues, but there were a few technology “must haves” that I took away from the discussion.
Real-time platform facilitating care management – In managing consumer care, less than real-time information is costly. Not knowing a consumer’s history and current status makes care coordination less effective—increasing costs while compromising outcomes.
Ability to share data with both other provider organizations and with payers – Crucial to managing performance is the ability to receive and share information about consumers with other health care organizations. To participate in this type of data collaborations, provider organizations need both an EHR capable of sharing data and a health information exchange protocol with other providers or payers.
Care team “alerts” about changes in consumer health status – To improve care management and performance, its important to have a system that alerts your team to when a consumer visits the emergency room or is admitted to the hospital. Alerts make these events top of mind and bring them to your attention, often months before claims or other data becomes available.
Combining financial and clinical data to facilitate metrics-informed contract management – The ability to aggregate disparate data within your organization—from your EHR, HR information system, general ledger, and more—is essential for successfully managing payer contracts. Managing clinical outcomes or financial performance in silos doesn’t work in this new environment. Ms. Beveridge gave a great example. LifeWorks NW developed a data warehouse where they collect data from multiple systems in near real-time and use that data to make management decisions for each payer contract. They are just starting to use the data to move beyond managing the current system to developing predictive indicators.
If your organization is on the front end of this evolution in tech functionality, how do you get started? Both Ms. Beveridge and Dr. Ward shared some key pieces of advice. First, they said that it is important to start with simple metrics like demographic data and diagnostic data and then move on to more complicated performance measures. Second, its important to train your team on the new systems and using the new information – and build their trust.
To build that trust, Dr. Ward and Ms. Beveridge talked about not only listening to team feedback, but also acting on this feedback. By doing this, team members are more likely to use the tech platform and its information, which can result in better organizational performance. Dr. Ward explained that in order to build trust and improve adoption of new technology solutions, his team focuses on providing a two week turn around in order to implement some of the critical feedback provided by technology users. While not every project can be implemented in this manner, for those where this type of methodology is applicable, they have the benefit of improving technology in near real-time.
For more on the technology capabilities your organization needs to be successful in a value-based market, check out these resources from the OPEN MINDS Circle library:
- IT Touches Everything
- The ‘Best Practice’ Challenge
- Within Your Reach: Creating A Virtual Healthcare Network
- Your Digital Tech Integration Checklist
- Using Data Can Make Care Coordination More Efficient (& Effective)
- The Digital Decision Crossroads
- Preparing For The Very Glacial VBR Rollout In Some Markets
- HIE 3.0?
- The Primary Care Reinvention
- What Will Mental Health Treatment Look Like In The Years Ahead?
For more on preparing for VBR, join us at The 2019 OPEN MINDS Performance Management Institute in Clearwater Florida on February 15 for the session, “Rate Setting For Value-Based Reimbursement: A Guide To Developing Capitated Payment Models,” led by David E. Wawrzynek, MBA, Senior Associate, OPEN MINDS and featuring Debbie Cagle Wells, Chief Marketing Officer, Centerstone.