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ATR WEBINAR: CORE ELEMENTS FOR SUCCESSatr-resources.altaruminstitute.net/sites/default/files... ·...
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ATR WEBINAR: CORE ELEMENTS FOR SUCCESS
Transcript of ATR WEBINAR: CORE ELEMENTS FOR SUCCESSatr-resources.altaruminstitute.net/sites/default/files... ·...
ATR WEBINAR: CORE ELEMENTS FOR SUCCESS
WELCOME
Technical Instructions • You may ask a question at any time during the
Webinar by typing it into the “Questions” field below the slide presentation and then pressing “Enter.” Most questions will be addressed at the end of the presentation.
• Today’s slides, as well as additional resource materials, are available in the “Downloads” area to the left of the slide presentation.
Today’s Speakers
• Will Ferriss - SAMHSA
• Harrison Kinney – Director of Strategic Initiatives, Community Healthcore
• Eva L. Petoskey – Director, Anishnaabek Healing Circle, Access to Recovery, Inter-Tribal Council of Michigan
• Mindy Hale – IT Coordinator, New Mexico ATR
MODULE I: Why Experience with the Traditional Substance Use
Disorder Treatment System Is Not Enough
Elements of Recovery-Oriented Systems of Care
Person–centered
Family and other ally involvement
Individualized and comprehensive services across the lifespan
Systems anchored in the community
Continuity of care
Partnership/consultant relationships
Strengths-based
Culturally responsive
Responsiveness to personal belief systems
Commitment to peer recovery support
Inclusion of the voices and experiences of recovering individuals and their families
Integrated services
System-wide education and training
Ongoing monitoring and outreach
Outcomes-driven
Research-based
Adequately and flexibly financed
ATR Core Services in New Mexico (http://atrnm.org)
New Mexico was awarded ATR 1 and ATR 2, but it was within ATR 3 that it became adept in demonstrating: Promotion of recovery and resiliency. Enhanced cost-effective service outcomes. Tailoring to diverse service populations. Transparency of expenditures and outcomes. Exceptional risk management.
All these factors combine to allow innovative tailoring of services to the strengths and needs of the individuals it serves.
ATR Core Services in New Mexico (http://atrnm.org)
New Mexico ATR uses Central Intake staff to assess strengths and
needs, engage participants, and coordinate the use of vouchers to purchase tailored clinical services and an array of recovery supports.
New Mexico ATR initially adopted the regional model of piloting services.
Now that the model has been refined, the regional approach is the foundation for a limited statewide rollout.
Inter-Tribal Council of Michigan
The Inter-Tribal Council of Michigan (ITC) is a consortium of 12 federally recognized tribes in Michigan.
The ITC has collaborated with the Michigan tribes on a wide range of health and human service initiatives over the past 40 years.
The elected tribal chairpersons from the consortium tribes serve as the ITC Board of Directors.
Michigan Federally Recognized Tribes
Core Process Differences Supported Client Choice
Supported client choice within the CI Care Coordination process allows individuals to select the Treatment and Recovery Support Services which best suit their particular path to recovery:
1. The process of choice inherently strengthens personal recovery and resiliency, and provides the platform for Recovery Management from the onset. 2. Coaching by the CI Service Coordinators on how to determine what services may be helpful and to later determine if the selected services were actually helpful further empowers.
Core Process Differences
Core Process Differences
Supported client choice allows for an informed selection of treatment and recovery support services, which best suit the client’s particular path to recovery. This process:
Strengthens personal recovery and resiliency. Provides the platform for recovery management Fosters client empowerment.
Initial and ongoing coaching by the Central Intake staff allows clients to:
Select/reselect what services may be helpful. Identify service gaps. Determine if selected services were actually helpful.
Core Process Differences Supported Client Choice
The Voucher Management System requires that the provider submit process and outcome data along with the their payment invoice. This allows the State to have the capability to: 1. Effectively manage burn rates, which greatly reduces the risk of over- or under-expenditure. 2. Identify which providers and Central Intake staff are following the required standard operating procedures. 3. Allow the State to trend aggregate, Central Intake-specific, and provider outcome data for evaluation and planning purposes.
Core Process Differences Transparent Cost and Outcome Transparency
New Mexico ATR has been able to craft innovative services for Native Americans and Veterans/National Guard because of its ability to:
1. Offer diverse treatment and recovery support services that are tailored to specific strengths and service need. 2. Mitigate the risks of over- or under-expenditures and the risk of Central Intake or provider staff not following required operational procedures. 3. Closely track service outcomes to determine which service combinations are effective and which are not. These ATR functions could allow it to be an exceptional service platform
under the radically new systems being developing under the Affordable Care Act (ACA).
Safe, Cost-Effective Innovation
Safe, Cost-Effective Innovation
MODULE II: How ATR is a Blueprint/Model for Future Behavioral
Health Systems of Care: ATR and Managed Care
ACA & Public Healthcare Costs
The Affordable Healthcare Act will significantly expand access to publicly
funded care through Medicaid expansion, insurance exchanges and inclusion of block grants into a braided mix.
Publically funded health care costs are already burdening the economy and are projected to increase exponentially.
Conundrum: How to expand care and yet reduce expense!
Managed Care Organizations
Managed care organizations (MCOs) already have a significant role in reducing health care costs, which will only increase over time.
MCOs can cut costs by denying, limiting, and delaying payments. Or, it
can fund wellness systems of care that reduces the need for costly procedures.
ATR provides an excellent platform for MCOs to reduce costs through
health/wellness systems that focus personal responsibility for health and recovery.
Integrated Health Care
ACA will require health systems to fully integrate behavioral and physical health.
MCOs will be contracted to undertake capitated risk for a person’s total behavioral and physical health care costs.
Studies indicate that modest expenditures in substance use disorder treatment can significantly reduce health care costs.
ATR Central Intake staff are in an exceptional position to manage components of the integrated behavioral/physical health care system for MCOs that reduce cost through improved wellness.
ATR and Personal Responsibility
People’s inability to assimilate personal responsibility for wellness into their lifestyle often precipitates the need for expensive medical care.
Helping people to become motivated to develop the skills to promote wellness to effectively manage their healthcare conditions could dramatically improve health and reduce costs.
The ATR service philosophy of resiliency and recovery provides the needed service platform to empower people to assimilate personal responsibility for wellness .
Outcomes
MCOs will not be interested in purchasing units of services unless there is undisputable research that indicates there is a reduction of costs.
Instead MCOs are quickly moving to payment for turnkey health outcomes in which the provider entity undertakes some of the capitated risk.
Moving from the payment by unit of service to outcomes is an opportunity for ATR systems to contract with MCOs.
Risk Management
ATR has an opportunity to partner with MCOs to improve health and manage risk through the use of management information systems, such as the New Mexico Voucher Management System. In a timely fashion, it provides the MCOs the data needed to manage risk:
Process: Are the right combination of services being provided? Outcome: Are expected health outcomes milestones being met? Costs: Are the costs within the expected range by individual, by provider, and by system? Cost/Benefit: Cost/benefit dashboards can be developed so that the MCO has an exceptional risk management tool .
MODULE III: Making ATR Work: Grantee Examples
Need for New Knowledge, Skills, Abilities, and Competencies
ATR is in an exceptional position to bring to the integrated health care system the skills necessary to reduce costs through improved wellness based on personal responsibility. Examples include: Person-centered/strengths-based care coordination assessment and
service plan. Motivational enhancement. Culturally responsiveness. Peer coaching and mentoring.
Getting Commitment
Assets we started with and built on: A strong foundation of collaboration between the key tribal
collaborators in Michigan. Skills in facilitating meetings with the intentional goals of respect,
transparency, and community empowerment/self-determination. A learning community that included our tribal collaborators and other
engaged providers.
Learning Community
As a collective learning community, we: Expanded our view of recovery beyond the acute care model. Expanded care coordination and integrated this service into the tribal
continuum of care. Expanded the array of services to assess and support long-term
recovery. Developed a peer recovery coach training program that is being pilot-
tested at several tribal sites.
Expanded the Array of Services As a collective learning community we:
Expanded the array of services to include cultural-specific and recovery services that would not have been available to our population without ATR.
Built systems to sustain these services. Created new service codes for a wide array of cultural and recovery
support services.
Making ATR Work As a collective learning community we: Created an emerging tribal recovery-oriented system of care (ROSC)
model. Maximized braided funding—working on “payer of last resort” issues. Created an extensive Web-based and in-person training program for
our providers. Developed our capacity to manage data by building an extensive
array of automated real-time reports to help us manage our resources.
Translating this Success We have planted the seeds for a tribal ROSC transformation process.
We have built skills for preventing fraud, waste, and abuse through
electronic auditing.
We have helped build the capacity of our collaborators to successfully do third-party billing. This will be useful under the Affordable Care Act.
Contact
Harrison Kinney [email protected] Eva L. Petoskey, MS Director, Anishnaabek Healing Circle Access to Recovery Inter-Tribal Council of Michigan 2926 Ashmun Sault Sault Marie, MI 49783 [email protected]
MODULE IV: How ATR Success Can Translate Beyond ATR
It’s a new paradigm.
Maximizing the Utility of Your Information System
Presenter
Presentation Notes
Your information system is integral to a client’s treatment not just a means for providers to be reimbursed.
Information systems for managing
grant funding in behavioral health services
should have the flexibility to become an integrated tool in your
delivery of care model.
Information systems …
Where to Start
To integrate your information system, your project intent and process must be clearly defined.
To that end, let’s start:
One funding source cannot serve complete needs. Acknowledge this and maximize what can be done under the grant
requirements. Grant Intent: Client targets, available dollars, target population Define your goals.
Presenter
Presentation Notes
(Acknowledge) - When you receive a grant, many entities will want to be included – all with different areas of interest. (Grant requirements) - The reality is there is not enough money, there is never enough money to serve everybody. (Grant Intent) Be clear and consistent on the intention of this funding. Develop simple talking points for your team. Ambiguity leads to a confusing IS as well as waste and abuse with an increased ability to commit fraud.
Where to Start, continued
Define your Episodes of Care (EOC, i.e., vouchers) Best practice or promising practice Allow flexibility in adjusting what EOCs and services are supported
under the grant. Regularly review intention, outcomes, and cost.
New Mexico Example: Due to grant requirements , the EOC is set to 3 months with the
ability to place holds and extend EOC expiration dates due to incarceration or hospitalization. Clinical EOCs are based on ASAM levels of care.
0.5 Early Intervention and Level I Outpatient
Presenter
Presentation Notes
(Best or promising practices) whenever possible This makes it easier to clearly define the process for providers and for your IS team Likely you will need to make adjustments and sometimes those will need to happen quickly. Make sure your IS can be responsive to needed change. (Example Intention, Outcomes, Cost): ATR I – 12 months to 6 months, ATR II 4 months to 3 months, ATR III 3 months Chances are at least one client will have circumstances that interrupt the voucher. How will you deal with this? Level II.1 Outpatient discontinued MATRIX discontinued Why? Intention – door to recovery not the entire room 3 month voucher and available funds for required targets did not support the more intensive LOC best practice
Defining EOCs (i.e., vouchers)
Presenter
Presentation Notes
Pay attention to the details How much will you reimburse for your EOC? Do you want to enforce a monthly allowance? What services are billable under your EOC? What is your reimbursement rate per unit for each service? Does your best or promising practice set a limit on sessions per day, per week, per month? This allows your providers to know what’s expected to meet best practices and tells your IS what rules need to be set in the system to enforce these practices. Set parameters to prevent waste and abuse.
Defining the Process
Once you have the big picture defined, what is the client’s flow through the system? New Mexico Example: Central
Intake Client
Clinical Provider
RSS Provider
RSS Provider
Presenter
Presentation Notes
This example is a very generalized view.
Integrating the Process and Your Information System Central Intake Process
Client referred to Central Intake, by self or other Eligibility determination Clinical assessment Level of care determination and referral Recovery support services (RSS) assessment RSS determination and referral Coordination and follow-up
Providers Process Receive referrals Provide services Bill for services
Presenter
Presentation Notes
This is the real world steps that are reinforced by your IS.
New Mexico Central Intake Dashboard
Presenter
Presentation Notes
After a client is registered, the CI is taken to the management dashboard. IS - Force following the process flow Ensures consistency across CIs These are the steps and this is their order Contact information is completed and shown in green Next step is eligibility. Once completed, it turns green and Assessment turns yellow. The Intake GPRA and Client Notes can be entered at any time. In reviewing process data, it was determined that CIs were pretty good at entering an intake GPRA on every individual assessed. However, there were enough client’s missed that it was impacting target numbers. The process and IS were modified to not allow invoicing for an assessment until the GPRA intake was submitted.
New Mexico Central Intake Dashboard
Presenter
Presentation Notes
This image shows the dashboard after an individual has gone through the CI process and has received services at a Provider. The CI can see at a glance where the individual is currently referred for clinical and RSS and when the referral occurred. Under Administration, they can monitor the client’s engagement. If the clinical services had not yet been provided, the link would not be green.
Clinical Services
Presenter
Presentation Notes
The CI can see what services a client has received and when. Because it is the joint responsibility of the CI and Provider to get a client into treatment, it is important each know what is happening. The CI is responsible for the coordination of all services so they need to have the tools to do their jobs. The IS helps providers manage available dollars. EOC has a total amount issued and an amount available per month Once a month passes, all $ not used in that month are reverted to the voucher pool The IS is programmed to enforce service delivery limitations. This prevents waste and abuse. A provider can only bill for pre-approved services under the limitations of the referred EOC.
Communication
Presenter
Presentation Notes
We just talked about client engagement being a joint responsibility. The IS incorporates a note sharing function for providers and CIs to communicate securely on individual client issues. This eliminates the phone tag that often occurs.
What About Grants Management?
What you have just seen is an information system that helps providers manage client engagement and services.
The information system must also help your management team do
their jobs.
Meeting Expectations
Presenter
Presentation Notes
14 days to get clients into service? Engagement rates? Anything stand out that should be reviewed?
Management Reports: Invoice History
Presenter
Presentation Notes
There are any number of reports you can use to help manage your grant. Basically if your information system collects it, it can report it. Review how your providers are billing Note changes from month to month which might trigger an audit Notice decrease in provider billing between December and February Decrease is with clinical providers Management implemented an increase in clients who can receive RSS vouchers only
Managing Management Changes
In addition to EOC and service limitations, the management team can set intake allowances for each Central Intake location.
Presenter
Presentation Notes
How did they do that? They educated providers about the direction of the program and then… The information system is used to enforce real world changes.
Reaching Targets
Presenter
Presentation Notes
Another example of a report - Where are you compared to your goals at any given moment? Review regularly and make adjustments as needed. Target numbers not being met? Redistribute intake allowances. Need to serve more people with less money? Implement different strategies like RSS only intakes You should always be able to see where you are and where you need to be.
Waste, Fraud and Abuse
Prevent as much as possible. It’s better for the client. It’s better for the provider. It’s better for the program.
Waste and abuse occurs when providers have clients receive services beyond what is clinically appropriate in order to gain financially. Prevent this by setting specific parameters and enforcing those
parameters through your information system.
Presenter
Presentation Notes
Prevention keeps the money available for the people who need it most.
Electronic Audits
You already collect the data. Display it in a format that quickly shows compliance.
Presenter
Presentation Notes
Even if you are not in a state that is as geographically large as New Mexico, it is still very time consuming to visit every provider and conduct clinical and fiscal audits.
Waste, Fraud and Abuse
Fraud - A false representation of a matter of fact Commonly understood as dishonesty calculated for advantage
How can you use your information system to identify fraud? Transparency Coordinator to Client: “I see you went to your first individual
therapy session with your provider. How was it?” Client to Coordinator: “I haven’t been yet. I missed my first
appointment.” Central Intake Staff to Management on January 25: “The client
was arrested on Jan 15; we request his voucher be put on hold.” Management to Provider X – “You have billed for three services
since this client has been in jail. We are going to come visit you and review your charts.”
Presenter
Presentation Notes
Waste and Abuse can be, in large part prevented by an IS. Fraud is a bit harder. Your IS can serve as a tool for fraud to be identified and therefore help in preventing it with the assistance of dedicated clinicians and coordinators. Transparency – when everyone involved with providing and/or coordinating or managing services for a client, can see –through the IS - what services that client is receiving – fraud is more easily identified and therefore less likely to occur.
Question and Answer Session
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CONCLUSION
THANK YOU
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