Creating the Strategy Structure Process for CCBHC Quality

Creating the Strategy, Structure & Process for CCBHC Quality Reporting Co-Presented by: David Lloyd, MTM Services David Swann, MTM Services Speaker Name Jeff Capobianco, National Council Title Organization

Presentation Overview • Overview of CCBHC Quality Reporting Requirements • Steps Providers can take to Create Value: – Create a Strategy – Make Structural Changes for Quality Reporting – Make Process Changes for Quality Reporting • Creating CCBHC Value! The Top Ten List Presented By: David Lloyd, MTM Services

CCBHC is Driving Organizational Strategy, Structure & Process Change Responding to CCBHC is best achieved through: • Designing a CCBHC Strategy for Quality Reporting • Changing Structures within the organization (e. g. , changes to MIS infrastructure, staffing, contracts, training programs, staffing, data dashboards, etc. ) • Changing Processes within the organization (e. g. , changes to administrative & clinical work/process flows, quality improvement processes, etc. ) Source: Miles, R. E. , Snow C. C. , Meyer A. D. , et al. (1978). Organizational, strategy, structure & process. The Academy of Management Review, vol. 3, issue 3, 546 -562. Presented By: David Lloyd, MTM Services

Seventeen CCBHC Data and Quality Measures Required Reporting 1. 2. 3. 4. 5. 6. 7. 8. 9. Number/Percent of clients requesting services who were determined to need routine care Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients Mean number of days before the comprehensive person-centered and family centered diagnostic and treatment planning evaluation is performed for new clients Number of Suicide Deaths by Patients Engaged in Behavioral Health (CCBHC) Treatment Documentation of Current Medications in the Medical Records Patient experience of care survey Family experience of care survey Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow. Up Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) (see Medicaid Child Core Set) Presented By: David Lloyd, MTM Services 3

Seventeen CCBHC Data and Quality Measures Required Reporting 10. Controlling High Blood Pressure (see Medicaid Adult Core Set) 11. Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention 12. Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling 13. Initiation and engagement of alcohol and other drug dependence treatment (see Medicaid Adult Core Set) 14. Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment (see Medicaid Child Core Set) 15. Adult major depressive disorder (MDD): Suicide risk assessment (use EHR Incentive Program version of measure) 16. Screening for Clinical Depression and Follow-Up Plan (see Medicaid Adult Core Set) 17. Depression Remission at 12 months Presented By: David Lloyd, MTM Services 4

Fifteen State CCBHC Data and Quality Measures Required Reporting 1. 2. 3. 4. 5. 6. 7. 8. Housing Status (Residential Status at Admission or Start of the Reporting Period Compared to Residential Status at Discharge or End of the Reporting Period) Number of Suicide Attempts Requiring Medical Services by Patients Engaged in Behavioral Health (CCBHC) Treatment Follow-Up After Discharge from the Emergency Department for Mental Health or Alcohol or Other Dependence Plan All-Cause Readmission Rate (PCR-AD) (see Medicaid Adult Core Set) Diabetes Screening for People with Schizophrenia or Bipolar Disorder who Are Using Antipsychotic Medications Diabetes Care for People with Serious Mental Illness: Hemoglobin A 1 c (Hb. A 1 c) Poor Control (>9. 0%) Metabolic Monitoring for Children and Adolescents on Antipsychotics Cardiovascular health screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications Presented By: David Lloyd, MTM Services 5

Fifteen State CCBHC Data and Quality Measures Required Reporting 9. 10. 11. 12. 13. 14. 15. Cardiovascular health monitoring for people with cardiovascular disease and schizophrenia Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder Adherence to Antipsychotic Medications for Individuals with Schizophrenia (see Medicaid Adult Core Set) Follow-Up After Hospitalization for Mental Illness, ages 21+ (adult) (see Medicaid Adult Core Set) Follow-Up After Hospitalization for Mental Illness, ages 6 to 21 (child/adolescent) (see Medicaid Child Core Set) Follow-up care for children prescribed ADHD medication (see Medicaid Child Core Set) Antidepressant Medication Management (see Medicaid Adult Core Set) Presented By: David Lloyd, MTM Services 6

Table 3. Quality Bonus Payment Medicaid Adult and Core Set Measures Presented By: David Lloyd, MTM Services 7 7

Designing your CCBHC Report Strategy Presented By: David Swann, MTM Services

CCBHCs Provide Care That Is…… • Community-based • Integrated • Evidence-based • Person- and family-centered • Recovery-oriented • Trauma-focused • Culturally and linguistically competent Presented By: David Swann, MTM Services 9

Developing your Organizational Strategy Complete: • MTM Services’ CCBHC Readiness Tool • SAMHSA Community Needs Assessment Incorporate findings into Current Organizational Strategic Plan: • Senior Management Create Charge for Improvement Teams to implement structural and process changes Presented By: David Swann, MTM Services

Changing Structures to Make CCBHC Quality Reporting Possible! Presented By: David Swann, MTM Services

CCBHC’s Require A Robust Reporting & Quality Improvement Program • The CCBHC Vehicle to: – Collect – Analyze – Report On • To Drive: – Improved Consumer Outcomes – System Outcomes – Training & Support Reporting Must Contain: • Demographic Data • Utilization Data • Staffing Data • Financial Data • Clinical Data Presented By: David Swann, MTM Services

A High-Performing Quality Program: The Four Pillars from the National Quality Forum • Quality of Care – the degree to which health services increase the likelihood of desired health and patient experience outcomes. • Cost of Care – healthcare spending for a patient population, time period and clinical accountability. • Efficiency of Care – measure of the relationship of the cost of care associated with a level of performance measured to dimensions of quality. • Value of Care – measures a stakeholders preference regarding a combination of quality and cost of care performance. Presented By: David Swann, MTM Services

Creating the Structure: Six Steps Reporting Process 3. Determine the Reporting Vehicle 4. Develop an Internal Reporting System 5. Identify a Standing Group to Analyze the Data 2. Select Measures to Report 1. Study the Final Regulations Participate in CCBHC Measurement Presented By: David Swann, MTM Services 6. Design and Implement Rapid Cycle Improvements

The FQHC and Rural Health Center Uniform Data System • Uniform Data System – National Reporting System for FQHCs and RHCs – Annual Reporting Model (February 15 th Deadline) – 12 Tables • CCBHC Reporting System modeled after UDS Presented By: David Swann, MTM Services

Additional Uniform Data System Examples Presented By: David Swann, MTM Services

Changing Processes to Make CCBHC Quality Reporting Possible! Presented By: Jeff Capobianco, National Council

Creating the Process! • Once the Strategy is in place and the structural changes are being made the processes within your organization can begin to be changed. • Requires: – Clear communication from leadership on the what, why, & how – Key Performance Indicator (KPI) targets Presented By: Jeff Capobianco, National Council

Process-flow Redesign • Process-flows (aka workflows) include administrative & clinical components • Require formal process that includes key team members to assess current processes and define the steps to creating new/future processes • CCBHC quality reporting requirements are the KPI’s from which processes can be designed to deliver Presented By: Jeff Capobianco, National Council

Communicating for Effect! • Helping staff transition to new ways of doing their work takes time and a lot of communication • All new processes need monitoring (i. e. , communication/CQI) and measurement (i. e. , KPI’s) • CCBHC quality reporting requires short-term (i. e. , at least quarterly) targets be reported and met—which is not what we/BH is used to doing! Presented By: Jeff Capobianco, National Council

The Top 10 Strategy, Structure & Process Changes Behavioral Health Providers Can Do to Prepare for CCBHC Quality Reporting

1. Complete the MTM/NC CCBHC Readiness & SAMHSA Community Needs Assessments (Strategy) As soon as possible, complete the CCHBC Readiness Assessment which includes Quality Reporting sections and the SAMHSA required Community Needs Assessment that will support the identification of the specific services that need to be provided based on the population that will be served in each market area. Presented By: David Lloyd, MTM Services

2. Develop a CCBHC Strategic Plan (Strategy) • Using the assessment findings develop a Strategic plan, work group charges that requires a communication plan for how the changes will be conveyed and staff “absorption” of the change will be monitored/measured. Presented By: David Swann, MTM Services

3. Identify Costs (Structure) • Behavioral health providers will need to know your costs by staff type and service encounter to define the value of the services provided. Presented By: David Swann, MTM Services

4. Identify your Designated Collaborating Organizations (DCO) (Structure) • Behavioral health providers need to determine what organizations they will need to establish a formal relationship with as a Designated Collaborating Organization to provide the required scope of services and accountability. Presented By: David Swann, MTM Services

5. Develop Program Descriptions (Structure) • Create a Program Description for the distinct service delivery model – Trauma-Informed Recovery Outside the Traditional Four Walls of a historical Community Mental Health Center. Presented By: David Swann, MTM Services

6. Get your Health Information System in Order (Structure) • Determine if the current Health Information System can gather, produce, analyze, effectively and efficiently share clinical information and create reports on the metadata by provider type and make all necessary changes quickly. Presented By: David Swann, MTM Services

7. Create & Implement a Staffing Plan (Structure) • Use the Community Needs Assessment to support the creation of a staffing plan that will identify the types (i. e. , licensed, non-licensed, peer support specialists, etc. ) and numbers of staff needed to deliver the services Presented By: David Lloyd, MTM Services

8. Develop Dashboards that Convey Value (Structure) • Develop the data measurement capability to link the costs incurred to the quality outcomes achieved which will support the measurement of “value” of care. Develop administrative and clinical data dashboards that clearly convey the base rates and target parameters. Presented By: David Lloyd, MTM Services

9. Engage Staff in Consumer-Centered Delivery Process-flows (Process) • Using the costs by staff type identified, develop service delivery process flows that will support the PPS rate through ensuring the appropriate staff type(s) are used to meet the requirement for counting specific service encounters in the PPS rate. Engage teams in consumer-centered work flow assessments to identify efficiencies and inefficiencies in administrative and clinical pathways. Presented By: David Lloyd, MTM Services

10. Shift Thinking to Short-Term Treat-to. Target Outcomes (Process) • Shift the clinical focus from the historical long term outcomes to be achieved model of care to a more focused “treat to target” short term quality outcome measurement approach. Presented By: David Lloyd, MTM Services

Questions and Feedback • Questions? • Feedback? 32

Contact Information: David Lloyd, Founder David Swann, Healthcare Integration Consultant M. T. M. Services Phone: 919 -434 -3709 E-mail: david. lloyd@mtmservices. org Web Site: mtmservices. org M. T. M. Services Phone: 336 -710 -3585 E-mail: david. swann@mtmservices. org Web Site: mtmservices. org Jeff Capobianco, Director of Practice Improvement National Council for Behavioral Health Phone: 202 -684 -7457 E-mail: jeffc@thenationalcouncil. org Web Site: thenationalcouncil. org 33