Becoming a Model Behavioral Health and Social Service Provider of the Future
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Transcript of Becoming a Model Behavioral Health and Social Service Provider of the Future
Becoming a Model Behavioral Health and Social Service Provider of the Future
Debra Rex, President and CEO, Beech BrookJean Solomon, VP Health Integration, Beech Brook
2014 OACCA Advocacy Conference
Susan DentzerSr. Policy Analyst
Robert Woods Johnson foundation
“We’re all using a cloudy crystal ball where we can’t see much more than 3-4 months out”
“Waste” accounted for 34% to 50% of the $2.2 trillion spent nationally on
health care in 2007
Health Care Reform – The Drivers
Individual behaviorse.g., preventable risk factors like smoking, obesity or non-adherence to Rx regimen
Clinical diversitye.g., defensive medicine, uneven adoption of evidence-based medicine
Operational inefficiencye.g., underuse of HIT, lack of process coordination across system, wasteful administrative overhead
Financial/Resource Allocatione.g., dollars spent on inpatient/institutional care and FFS
Appropriate Spending
~58%
~10%
~18%
~14%
Ohio Seven of the 10 leading causes of
death in Ohio are lifestyle oriented – most of which are avoidable –
and approximately 75 percent of all health care spending goes to
address chronic diseases. Payment systems are based on volume with no expectation of outcomes and the current system of care does
not reward doctors for being comprehensive, thorough, or
providing good continuity of care to patients.
“Our nation is at a crossroad. The healthcare system we have simply cannot be sustained. If it does, our schools will fail, our roads will fail, our competitiveness will fail. Wages will continue to lag and, paradoxically, so will our health”
Quote from Don Berwick former Administrator CMS.
Health Care Reform – The Drivers
It is better to be prepared for an opportunity and not have one, than to have an opportunity and not be prepared. Whitney Young, Jr.
So what does it all mean?
More managed
care
Payment Reform
and Value-Based
Purchasing
Business Infrastructu
re and Information Technology
Focus on Provider
Outcomes
Community Based,
Coordinated Care
The focus will be on providing high quality care for more people with the same (or smaller) total budget
Increasing use of managed care financing and service delivery models
Phasing out of fee for service with carve-in expected in 2016 (?): ACO’s and integrated health systems
More efficient treatment techniques focused on recovery and prevention/early intervention
More community-based diversion and alternative programming
More administrative requirementsMore reporting requirements
Expansion of Managed Care
Building relationships Establishing contracting
and marketing functions
Enhancing authorization functions
Expanding utilization management capacity
Developing payer preferred services
Learning about MCP outcome requirements
Expansion of Managed Care FinancingBeech Brook Activities
Introduction of global payment models: heightened risk and accountability
Increased transparency of performance Linking reimbursement to desired outcomes Introduction of incentives and penalties Increased competitiveness in the
marketplace Increased focus on customer satisfaction
Payment Reform and Value-Based Purchasing
Educating the agency about payment reform e.g., case rate, bundled and capitation models, and risk
Educating about the definition and importance of “value”
Tracking and analyzing the cost of each service at the activity level
Ensuring a strong compliance plan to combat fraud and abuse
Focusing on customer service
Payment Reform and Value-Based Purchasing Beech Brook Activities
Data driven decision support Cross-organizational health information
exchange Care coordination and team communication Efficient processes and rapid access Cost-effectiveness Accountability Technology assisted therapies and tele-
health services
Business Infrastructure and Information Technology
Configuring workflows and the EHR to support centralized scheduling, access, prescribing, treatment planning, care coordination, etc.
Researching data warehouse capabilities to support clinical decision making, QI and effective financial management
Working to streamline and standardize operations
Driving a culture of measurement and accountability
Infrastructure and Information Technology Beech Brook Activities
Client satisfactionConsumer engagementPerson-centered careCulturally competent
Rapid access Valued models of care Transparent demonstration of high quality
care Accountability
High Performing Provider
Embedding the concept of whole health, recovery and resiliency deeply into the fabric or the organization
Using culturally competent staff and practices
Consistently measuring client satisfaction
Working to identify and demonstrate treatment effectiveness through measurement of client centered performance indicators
High Performing ProviderBeech Brook Activities
Single provider Integration of BH and PC
One Stop Shopping
Community Based Coordinated CareThe case for one-stop shopping
Consider the Mom with three kids, depression and diabetes, who just lost her job. She is on the verge of homelessness, her kid has asthma and the other is due to appear in juvenile court
Declining stability in the
current environment
Surviving the Change
Sustainability in the new
environment
Managing a Disruptive Transition
Paradigm Shifts
Before the Storm
Multiple unconnected separate providers
Provider centered care Unconnected to PCP Reimbursed for volume Limited use of technology and
data Process outcomes Limited experience in financial
risk Clinical “judgment” Single client focus Rapid cost growth
After the Storm
Formal or virtual system of care: connected to a multi-disciplinary team
Patient-centered care Reimbursed for value Data supported decisions and
health information exchange More efficient, evidence-based
treatment techniques Payment tied to quantitative
demonstration of clinical and financial efficiency and effectiveness
Sustainability?????
How Will You Survive the Change?
Endurance……..
What are your thoughts?
Will you have sufficient capital to weather the transformation?
How do you lead? Will you remain niche? Work
to build a larger system? Affiliate? Create or join an ASO?
What about the RT beds? How will child welfare change
as the dollars are managed? What about the workforce?