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Arizona Behavioral Health Payment Reform Toolkit

Provider Readiness Assessment Results

April 13-14, 2015

Dale Jarvis, CPAJohn Freeman, BAKaren Linkins, PhDJennifer Brya, MA, MPP

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Overview• Things are moving quickly in your

environment• New Governor• Merger of DBHS and AHCCCS• Provider Rate Cut• Rapid Ramp Up of the RBHAs

• This is a Time of Great Opportunity and Threat for the BH Delivery System• This webinar has been organized as a two way

communication process• Sharing what we’ve learned from you• Asking you Poll Questions to help us identify any needed

course corrections to adapt this rapidly changing environmentPoll Question 1

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Wrapping Our Brains Around the Data

• 47 Agencies• 8,900 FTEs• 309,000 Clients (duplicated)• Quartiles based on the number of clients served.

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How We Extracted MeaningStep 1: Categorize Agencies for several question into:• We’re good at this (Yes/Almost Always/Completed)• We might need to work on this

Step 2: Identify Areas that represent: • Comparatively Strong (Green Flag)• Comparatively In Between (Yellow Flag)• Potential Achilles Heals (Red Flag)

Step 3: Present the Data in a meaningful way

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Does your organization have a defined Level of Care (LOC) system in place?• Under 1/2 of the Agencies use a Level of

Care System as a standard tool• About 1/3 of the Agencies use LOC used to determine

duration and intensity of care

Poll Questions 2 & 3

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Open Access and No Show Tracking

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EBP Use

• EBP Use: Yes = 98% Agencies• Ongoing Training & Supervision in Use: Yes = 85%

Agencies• Routinely Screen/Assess for Trauma: Yes = 81%

Agencies

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Some of the EBPs In Use• ACT• CBT• DBT• EMDR• EFT• Play Therapy• Structured Family Therapy• Child Parent Psychotherapy• TF-CBT• Triple P Parenting Program• Brief Solution Focused• Acceptance & Commitment

Therapy• A-CRA• WRAP• WHODAS

• Trauma Informed Care• Forensic ACT• Supportive Housing• Medication Assisted Treatment• Hazelden Living in Balance• Relapse Prevention Therapy• Motivational Interviewing• Peer Support• Mindfulness• Seeking Safety• Matrix Model• Stages of Change• Art Therapy• Nurturing Parent• Child & Family Team Process• CDSMA

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Outcome-Based Care• Does your organization use clinical tools to

routinely measure effectiveness of care and client improvement?

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Some of the Clinical Improvement Tools In Use• ASAM• SASSI• ORS/SRA• ASQS• CASII• BERS• Beck• SEARS-P• EDI-3• CBCL• Triple P• SBIRT

• PHQ-9• GAD-7• GAF• PAWS• CASIJ• MHSIP• Duke Profile• WI-QOL• BMI• BP• M3• ASQ

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Outcome-Based Care• From the Boot Camp we think that the provider

network can benefit from taking this work to the next level.

Treat to Target to Fidelity1. A multidisciplinary care team works

with an individual with behavioral health disorders to complete a multi-dimensional assessment;

2. The assessment is used to identify specific and measurable goals for the individual including at least one clinical goal and one personal goal;

3. The client and their team develop a professional care plan and self-care plan that includes setting targets related to the goals, utilizing validated tools to measure improvement;

4. The team supports client engagement throughout the process, engaging the client in all aspects of the care planning and treatment, understanding how the client is progressing through the stages of change, and providing high-touch care management;

5. The client and team monitor progress in a persistent and individualized way to determine whether the care is working, using the clinical measurement tools to determine whether the targets are being reached;

6. There are regular case reviews with the team and with the client to determine whether the care plan is working or needs adjusting; if targets are not being met, care plans are changed;

7. Electronically shared information is available to all members of the care team, ideally through the use of a patient registry, including the care plans, medication list, and results from the outcomes tracking tools;

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Primary Care/Behavioral Health Integration• No Integration/Separate Treatment = 21%• Unstructured Partnership = 9%• Structured Partnership = 23%• Co-located/Integrated =15%• Integrated = 17%• Other = 15%

• Partnership/Co-located/Integrated Total: 64%

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Health Indicators • Strongest in: Health Education (72%), Blood Pressure

(72%), BMI (68%)• Need work in: Weight Loss Management (43%),

Tobacco Cessation (49%), and Chronic Disease Self-Management (49%)• Care Management:• Need work in: Service Utilization and Outcome

Data (38%), Transitions between Levels of Care (55%), Rx Reconciliation (53%), Lab and Test Tracking (47%)

Poll Question 5

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Coordinate with Other Organizations

• Strongest in: • Tracking Referrals (68%)• Sending Information to the Referral Source (68%)

• Need work in: • Client Follow Up that Appointments are Completed (40%)• Tracking Results and Following Up on Additional Care

Needs (30%)• Confirming Transportation (49%)• Conduct Appointment Scheduling (36%)

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Billing – Completed %• Contracts With Major Payers (57%)• Following Up On Unpaid Claims (57%)• Obtaining Pre/Re-authorizations (55%)• Billing w/in 7 Days of Cut-off Date (51%)• Clarity of Employee Roles Supporting Billing (43%)• Using Sliding Scale (32%)

Poll Question 6

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Cost Accounting – Completed %• Use Utilization and Cost Data to Develop Case Rates

for Payers (26%)• Using Cost Data to Calculate Costs of All Services

Provided By Organization (21%)• Using Data to Summarize Costs Per Client (17%)

Poll Question 7

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Electronic Health Record Software in Use1. Claimtrak2. Credible3. Custom Software4. HMS5. Netsmart6. NextGen7. SalesForce8. Unicare9. Valant10. Welligent

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Software In Use• Most agencies are using EMR/software products

for: progress notes, client assessments, treatment plans, medication management (these are most likely acting as an ‘electronic’ file cabinet)• Fewer agencies use EMR software for: appointment

scheduling, crisis plans, wellness and recovery plans• Very low use: labs, clinical outcome measures,

clinical and quality reporting

Poll Question 8

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Thinking Ahead to Next Steps• Things are moving quickly in your environment• New Governor• Merger of DBHS and AHCCCS• Provider Rate Cut• Rapid Ramp Up of the RBHAs

• In order to ensure that we are providing the most value to the Arizona BH System, let us know what you think about the pace of the Toolkit project.

Poll Question 9