Transcript Slides A3 - Collaborative Family Healthcare Association

Financial Stability and Cost Control - Session #A3
Proving Your Value: Optimizing
the Business Case for
Integrated Behavioral Health
Kent A. Corso, PsyD, BCBA-D and Lesley Manson, PsyD
Co-Authors of Integrating Behavioral Health into the Medical Home: A Rapid Implementation Guide,
2016, by Greenbranch Publishing
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships
during the past 12 months.
Learning Objectives
At the conclusion of this session, the participant will be able to:
 Identify process and outcome improvement metrics which promote sustainable models
of integrated care delivery for families and patients.
 Describe and discuss data mining options for collecting metrics to demonstrate fidelity,
quality improvement, and fiscal sustainability related to integrated care programs.
 Identify, evaluate and select tools for effective financial strategic planning and
management in integrated care.
Bibliography / References
1. Corso, Hunter, Dahl, Kallenberg, and Manson (2016). Integrating behavioral health into the medical home:
A rapid implementation guide. Greenbranch: Phoenix, Maryland.
2. Robinson, P. & Reiter, J. (2015). Behavioral Consultation and Primary Care: A Guide to Integrating
Services (2nd Edition). Springer International Publishing: Geneva, Switzerland.
3. Savage, A., Lauby, T., & Burkard, J. F. (2014) Examining selected patient outcomes and staff satisfaction in
a primary care clinic at a military treatment facility after implementation of the patient-centered medical
home. Military Medicine, 178(2):128 – 134.
4. Bendix, J. (2014) RVUs: A valuable tool for aiding practice management. Understanding the basics of the
RVU can assist physicians and practice managers in a wide variety of finance and management-related
tasks. Med Econ 91(4): 48-51.
5. Kilbourne, A. M., Keyser, D., & Pincus, H. A. (2010). Challenges and opportunities in measuring the quality
of mental health care. Canadian Journal of Psychiatry, 55(9), 549-557.
6. Goldman, Spaeth-Rublee, Pincus (2015). Quality indicators for physical and behavioral health care
indicators. Journal of the American Medical Association, 314(8):769-770. doi:10.1001/jama.2015.6447
Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of
this presentation.
Overview
Why Bother Proving Your Value?
The Role of Process and Outcome Metrics
Optimizing Your Value: Concepts, Calculations and Demonstrations
Data Mining Options for Demonstrating Fidelity and Quality Improvement
Tools for Financial Strategic Planning and Management for Sustainability
Conclusion
Why Bother?
Remaining Current with American Healthcare
◦ Meeting the Triple or Quadruple Aim
◦ Taking advantage of special programs, incentives or
healthcare initiatives
Survival
◦
◦
◦
◦
Many funding streams eventually dry up
If you ARE the business side of the house, it’s your job
If you are NOT the business side of the house, they will come knocking eventually
Integrated healthcare IS the standard of care
The Role of Outcome and Process Metrics
Outcome Metrics help us answer:
“How we are doing?”
◦ Clinical
◦ Financial
◦ Operational
Process Metrics help us answer:
“Why are we doing this well or poorly?”
Outcome Metrics
(within the Triple Aim)
Clinical Outcome Metrics Appropriate for
Primary Care
Instrument
Clinical Focus
PHQ-9
Depression
GAD-7
Anxiety
SF-12
Medical symptoms and functioning
PAM
Motivation for health behavior change
BHM-20
Global mental health; overall functioning
WHOQOL
Quality of life measure
PEG
Measure of pain intensity and interference
Functional Outcomes of Sleep Questionnaire
Quality of life questionnaire to determine functional status
due to sleep problems
Dallas Pain Questionnaire
Chronic pain and its impact on behavior
Columbia Suicide Severity Rating Scale (CSSRS)
Suicide
Duke Health Profile
Mental health symptoms
Process/Operational Metrics (within the Triple
Aim)
Process/Operational Metrics (within the Triple
Aim)
Process/Operational Metrics (within the Triple
Aim)
Optimizing Your Value: Key Concepts
Business Case Analysis (BCA) - A decision support and planning tool that projects the likely
financial results and other business consequences of an action. The analysis essentially
considers “What happens if we take this or that action?" and answers in business terms—
business costs, business benefits, and business risks.
BCA
Optimizing Your Value: Key Concepts
Pro Forma - a method of calculating current or projective fiscal results; describes a presentation
of data, in financial terms, where the data reflect the world on an “as-if” basis.
Pro
Forma
Optimizing Your Value: Key Concepts
Return on Investment (ROI) - A performance measure used to evaluate the efficiency of an
investment or to compare the efficiency of a number of different investments. ROI measures the
amount of return on an investment relative to the investment’s cost. To calculate ROI, the benefit
(or return) of an investment is divided by the cost of the investment, and the result is expressed
as a percentage or a ratio.
gain from program—cost of program
x 100 = percent of ROI
cost of program
Data Mining Options for Demonstrating
Fidelity and Quality Improvement
o Claims data (ROI for insurance companies)
o Joint ventures with
insurance companies
o Registries
o Survey Data
o Electronic Health Records
o HIE (Health Information Exchanges)
o HEDIS, UDS, NQF,
Physician Quality Reporting
o Self-reporting
o Other ways?
Understand Your Data and Sources
Forms of Data: How to choose?
◦ Claims
◦ Chunking
◦ Small amounts
◦ Analytical vs. Clinical
Volume of Data
◦ How to understand it?
◦ How is it relevant?
Data Points
Clinical Indicators
◦ Mortality
◦ Health status
◦ Biometrics
◦ Disease prevalence
◦ Disability status
◦ Health Maintenance
◦ Health assessments
(screening tools)
◦ ED visits
◦ Re-admission
◦ PHM
Standardization
◦ HEDIS
◦ UDS / NQF / CMS
◦
◦
◦
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Annual QI Goals
RVUs/Productivity
Fiscal ROI
NCQA PCMH
Organizational
◦ Employee wellness
◦ Job satisfaction
◦ employment sustainment
◦ Satisfaction
Model
◦ Length of session
◦ CPT coding
◦ Diagnosis coding
◦
◦
◦
◦
◦
Visit type
Productivity
Huddles
Communication
Documentation
Think We Can Make Fidelity and
Quality Great Again?
PQRS
o PQRS - the quality reporting program that encourages individual eligible professionals (EPs) and
group practices to report information on the quality of care to Medicare.
o As of 2015, the program applies a negative payment adjustment to individual EPs and PQRS
group practices who did not satisfactorily report data on quality measures for Medicare Part B
Physician Fee Schedule (MPFS) covered professional services in 2013.
o Those who report satisfactorily for the 2015 program year avoid the 2017 PQRS negative
payment adjustment.
PQRS There are several PQRS criteria that could be evaluated or considered as
measures of your clinical outcomes. If you have Medicare providers and do not currently
monitor these quality data for reporting, you may already be losing money. A few
examples relevant to IBH are listed below.
PQRS #9 – Anti-depressant Medication Management
PQRS#1 - Diabetes Hemoglobin A1c Poor Control
PQRS #106 – Adult Major Depression Disorder
PQRS #370 – Depression Remission at Twelve Months
PQRS #173 – Unhealthy Alcohol Use
PQRS #131 – Pain Assessment and Follow Up
PQRS #247 – Substance Abuse Disorders
PQRS #128 – Preventative Care and Screening: Body Mass Index Screening and Follow – Up Plan
PQRS #317 – Preventative Care and Screening: High Blood Pressure and Follow-Up with Lifestyle Modifications
PQRS #134 (NQF 0418) – Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
(National Quality Strategy Domain: Community/Population Health)
◦ www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
PQRS Integrated Care Targets by
Domain
Effective Clinical Care Measures:
Safety Measures:
Adult Major Depressive Disorder
Medication Reconciliation / Monitoring
Suicide Risk
Elder Maltreatment
Substance Use
Population Health Measures:
Body Mass
Pain
Depression
Tobacco
Under PQRS, an eligible professional (EP) is defined as one of
the following types of professionals:
1. Medicare physicians
Doctor of Medicine
Doctor of Osteopathy
Doctor of Podiatric Medicine
Doctor of Optometry
Doctor of Oral Surgery
Doctor of Dental Medicine
Doctor of Chiropractic
2. Practitioners (continued)
Clinical Social Worker
Clinical Psychologist
Registered Dietician
Nutrition Professional
Audiologists
*Includes Advanced Practice Registered
Nurse (APRN)
2. Practitioners
Physician Assistant
Nurse Practitioner*
Clinical Nurse Specialist*
Certified Registered Nurse Anesthetist* (and
Anesthesiologist Assistant)
Certified Nurse Midwife*
3. Therapists
Physical Therapist
Occupational Therapist
Qualified Speech-Language Therapist
HEDIS
◦ Psychiatric hospitalization (e.g., 7 and 30-day follow-up)
◦ Antidepressant medication adherence (e.g., 6 month treatment duration)
◦ Others include: treatment adherence for ADHD in children and schizophrenia in
adults, treatment engagement for chemical dependency
◦ Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
◦ Depression Remission, Response or Treatment Adjustment for Adolescents and
Adults
◦ Depression Screening and Follow-up for Adolescents and Adults
◦ Emergency Department Utilization
Fidelity Measures
o Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)
 Bheeler et al., Translational Behavioral Medicine 2013 Dec;3(4):379-91.
o Care Management / Collaborative Care Model (3CM Model)
 Oxman et al., Med Care 2006;44: 1030–1037.
Calculating and Demonstrating
Your Value
o Direct Revenue: dollars
o Indirect Revenue (e.g., productivity, operational efficiency, etc.)
o Cost Savings: cost management without sacrificing the quality of care; doing more with what you have and doing
more without spending more money on resources or time.
o Cost Offset: occurs when general healthcare savings are identified as exceeding the cost of the integrated care
intervention.
Financial Strategic Planning and Management
for Sustainability
Conclusions
If you don’t feel compelled to prove your value, someone will ask you to do it, eventually.
Regarding metrics…just ensure you ask “good” questions and the data will give you “good”
answers.
Outcomes tell us “what” and process/operational metrics help us understand “why.”
There are many ways to demonstrate ROI and they may not be in direct revenue.
There are many options when it comes to measuring quality; while there are fewer options
for fidelity measurement, that doesn’t make it any less important.
If your “success story” is not sustainable, consider developing a new story.
Plan, implement, evaluate, iterate, repeat
Session Evaluation
Please complete and return the evaluation form before leaving
this session.
Thank you!