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?