Walking the Whole Health Walk Early lessons, HIN and value-based purchasing ASU Center for Applied Behavioral Health Policy 15 th Annual Summer Institute, Prescott July 16, 2014
Presenters Eddy D. Broadway Chief Executive Officer Angelo Edge Chief Operating Officer Dr. Don Fowls Chief Medical Officer Paul Fawson Director of Health Economics & Value-Based Purchasing Proprietary and Confidential 2 Mercy Care Plan I Mercy Maricopa
Implementation and integration Lessons learned, moving forward Eddy D. Broadway, Chief Executive Officer
Successful Mercy Maricopa launch Among the largest public integrated systems in the U.S. • April 1, 2014, launch brought 17,000 people with serious mental illness into integrated care system • System disruption kept to minimum – Extended contracts through Oct. 1 to all current RBHA providers – Maintained members with PCPs at least through Oct. 1, worked to bring PCPs, specialists into new network Conducted daily pre- and post-transition meetings with regulators, • outgoing RBHA, and daily Command Center staff meetings 4 Mercy Maricopa Integrated Care
Lessons Learned Make no assumptions: Trust, but verify repeatedly DATA • Data is timely • Data is complete • Data is accurate • Data is meaningful 5 Mercy Care Plan I Mercy Maricopa
Lessons Learned Communicate, communicate, communicate • Take every opportunity to include members, providers, advocates and other stakeholders: Program/ SOC, IT, etc. • Over-communicate with providers, state agencies, members, peers, stakeholders and regulators • Over-staff in the call center for the first 30 days to handle unanticipated spike in the inbound call volume • Leverage stakeholders to help communicate key information • Use the Implementation Committee and the Post Go-live Command Center operating models for all Phase II activities 6 Mercy Care Plan I Mercy Maricopa
Moving forward- strategic business priorities Redesign to support integrated system of care • Integrated care ─ Connect providers through health information exchange, increase integrated provider network, continue to coach behavioral and physical health providers on integrated care • Children’s system ─ Reduce number of children in out-of-home and out-of-state care, focus on transitioning youth to adult system, enhance services for children in foster care, launch juvenile justice pilot on peer parent support, create proactive service delivery system • Crisis system ─ Connect crisis, inpatient, corrections and community-based providers; review 360 system evaluation to maximize and align funding, reduce need for facility-based services and meet community needs 7 Mercy Maricopa
Moving forward Redesign to support integrated system of care • Arnold v. ADHS ─ Implement SAMHSA evidence-based practices, increase capacity for services, contract directly with providers, implement pay-for-performance model • General mental health/substance abuse ─ Implement an integrated and coordinated model of care for members with general mental health and substance abuse needs. • Payment reform ─ Recommend payment methods to incentivize service delivery, determine true market cost of services, gauge provider readiness for payment reform, pilot pay-for-performance with certain providers 8 Mercy Maricopa
Health Information Network (HIN) Where the rubber meets the road Angelo Edge, Chief Operating Officer
Mercy Maricopa Promises Summary Create a behavioral health • Connect Provider Network Organization (PNO) clinical focused Health Information location EHRs, crisis network & Mercy Maricopa Exchange (HIE) for Maricopa together for data sharing County • Provide customized Health Home applications that Build a platform for all users to share & receive claims and clinical data exchange member information • Create a robust member-centered referral and in a timely, meaningful manner coordination network Implement a mobile platform to • Allows communication between provider & member communicate with & directly • Health coaching & educational tools for members support members and providers • Predictive modeling tools that allow care teams to Deliver actionable care gaps & easily identify the high risk, high needs, high cost quality metrics reporting member Mercy Maricopa Integrated Care
Mercy Maricopa Health Information Network (HIN) Design goals: • Improve health care quality, coordination and efficiency through the exchange of health information at the point of care, utilizing a secure electronic network accessible by a collaboration of behavioral and primary care providers and service members • Provide seamless data sharing support for multiple levels and versions of integrated care delivery models • Support the drive towards improved care, improved outcomes and lower care delivery costs. Mercy Maricopa Integrated Care
Models of Care for Delivering Integrated Health Services Person- Person Virtual Health Centered Centered Co-location Home Medical Home Health Care (PCMH) Home (PCHCH) Coordinated Care Integrated Care 12 Mercy Maricopa Integrated Care
Mercy Maricopa Integrated Care Models • Co-location • Member is comfortable receiving both their physical and behavioral health services at an SMI clinic • Physical health providers have office space and hours within the SMI clinic • Health Information Exchange links all providers, shares information in near real time and provides alerts when the member accesses crisis services • Community Case Managers and Mercy Maricopa Care Manager / Coordinators work together to facilitate communication • Virtual Health Home • Member has an existing relationship with both a PCP and BH Provider that he or she would like to maintain (not in the same physical location) • Member accesses physical health services through current PCP • Member accesses behavioral health services through an SMI clinic 13 Mercy Maricopa Integrated Care
Mercy Maricopa Integrated Care Models(cont.) • Person-Centered Medical Home (PCMH) • Members prefer to receive services close to their home with community providers • PCMH clinics are often located in Federally Qualified Health Centers (FQHCs). Intended to serve members in the communities in which they reside • PCMH clinics achieve NCQA accreditation status • Mercy Maricopa Care Manager / Coordinators with BH expertise will support the PCMH • Health Information Exchange shares information in near real time with providers involved in the member’s care and provides alerts when the member accesses crisis, ER and inpatient services • Training to key contacts and services providers in the community in order to engage members 14 Mercy Maricopa Integrated Care
Mercy Maricopa Integrated Care Models(cont.) • Person-Centered Health Care Home (PCHCH) • Members prefer to receive services close to their home with community providers • Based on standards established by Utilization Review Accreditation Commission (URAC) • Members receive fully integrated care at provider site • Health Information Exchange shares information in near real time with all providers involved in the member’s care and provides alerts when the member accesses crisis services • On-site Mercy Maricopa Care Manager / Coordinators will: • Connect members to community-based resources and supports • Identify members with high needs using data provided by Mercy Maricopa and follow up with the member’s case manager • Training to key contacts and services providers in the community in order to engage members 15 Mercy Maricopa Integrated Care
HIN is key to integrated care Challenges, opportunities for HIN include: • Better, smarter care in real time ─ Life-saving technology • Member concerns ─ Stigma ─ Security of medical information • Legal issues ─ Attorneys pouring over federal privacy laws and state DOI rules, consent language to ensure compliance 16 Mercy Maricopa
HIN is key to integrated care Mercy Maricopa Health Information Network (HIN) Model 17 Mercy Maricopa
Analytics & Reporting Physical & Behavioral Health Integration: • Integrated Clinical Record ─ Labs, Claims, Pharmacy, Demographics, Clinical and Medical Diagnosis, Advanced Directives, Psychiatric Evaluations, HRA Results, Crisis Plans, Individual Service Plans, etc. • Actionable Items ─ Enriched Health Home Reporting ─ Improved identification of care gaps Mercy Maricopa Integrated Care
Current Status 19 Mercy Maricopa
Future HIN Vision Full integration with: • Health Information Network of Arizona (HINAz) • Behavioral Health Network of Arizona The Network (BHINAz) (HINAz) Mercy Maricopa BHINAz Integrated Care 20 Mercy Maricopa
Improving Patient Outcomes through Value-Based Purchasing Dr. Don Fowls, Chief Medical Officer Paul Fawson, MHSA, MBA, Director of Health Economics & Value-Based Purchasing
Industry Scan Mercy Maricopa
Why Value-Based Purchasing? 23 Mercy Maricopa
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