Life on the Corporate Development Front

Discussions of trends seen in Behavioral Heath, Public Health and Healthcare Technology

On November 12^th, Senator max Baucus gave us some insight into where healthcare reform in this country will be headed under the new leadership.  He published a white paper, Call to Action Health Reform 2009. 

In this document he laid out a plan that had three main goals:  1)  Ensuring health coverage for all Americans; 2)  Improving health care quality and value; and 3)  Achieving greater efficiency and sustainable financing.  In the white paper he discusses that we may have reached a tipping point where the main stakeholders in the process – consumers, businesses, labor, providers, plans, manufacturers and state and local governments – cannot afford the cost increases and cost shifting any longer and are willing to engage in serious reform efforts. 

To achieve these goals he wants to set up insurance exchanges that allow all citizens to purchase insurance.  He would allow older citizens to “buy into” Medicare and lower eligibility to those seeking access to Medicaid.  This would increase the consumer volume for many of our clients. 

Key to his whole approach is an increased focus on quality of care delivered versus volume of care delivered.  I see payments in the near future tied to improving outcomes, or as it is known, pay for performance.  To achieve these measures he will increase incentives and investments in healthcare IT (something which President-elect Obama campaigned on).   In his press conference he discussed immediately allowing providers to be incentivized to implement electronic medical records by giving them the same 2% incentive that is now available to Medicare providers for using e-prescribing (see my blog e-prescribing incentives).

Obviously this is in the early stages of development, but I think the train has left the station.

The eHealth Initiative recently released its Fifth Annual Survey of Health Information Exchanges at the State and Local levels.   In this survey we are starting to see the clinical benefit of interoperable clinical systems.    More than 130 HIE initiatives are in progress with 42 of them reporting to be operational. 

The biggest reported reasons for implementing an HIE are improving quality (97%) and patient safety (90%) with the biggest challenge being developing a sustainable business model. 

The big news in this survey is the positive clinical and financial benefits being reported by the users of the system.  69% of the fully operational exchanges reported a reduction in health care costs.  The savings were attributable to reduced staff time, reduced redundant tests and decreased cost of care for chronic patients.  More than half of the exchanges reported positive impact on the delivery of health care.   Major benefits were increased access to lab results, improved compliance with chronic care and prevention guidelines, reduced prescribing errors and more rapid identification of disease outbreaks – something critical to our public health clients. 

The bottom line was that 69% of the operational exchanges reported a positive ROI.  This is the first survey in which a majority of the participants reported a positive ROI.

The economy is capturing the headlines lately and has been a topic of our strategic planning as well.  We have been looking at where we see the economic downturn impacting our clients and what they are doing about it.   We recently had an executive symposium with the CEOs of our Florida clients (one of the worst hit states) to see how they were handling state budget cuts, and I just returned from California where I attended the SATVA member’s meeting where the economy was a topic of interest. 

The result of these discussions is a dichotomy.  On the one hand, the states are looking at huge budget deficits (approximately $50B this year, with rumors of $100B next year).  On the other, Medicaid dependent providers typically weather a downturn better than non-Medicaid providers.   Some states are raising eligibility requirements to try to manage their costs, but at the same time the Congress is working on a stimulus package that is rumored to contain an increase in the federal share of Medicaid dollars to pump money into the states which should benefit behavioral and public health providers.

In our Florida discussions we saw that progressive providers were looking at ways to help their state (and themselves) through the budget crisis.  They talked about finding areas where the state was having problems (for example in the prison population where they offered to provide services directly in the prison versus having to move the prisoner into an inpatient unit).   Several of them were affiliating with primary care providers or FQHCs to provide a medical home to the consumer while at the same time being able to contract their staff to the FQHC to share costs.   It was encouraging to see the creative strategies being developed.

I am interested in hearing what your agency may be seeing and/or doing about the economy so that we can share your best practices with other clients.

As we discussed at the Executive Symposium at Netsmart Connections, Netsmart has been working hard in Washington with several other groups to get Congress to provide incentives to providers to adopt e-Prescribing.  Last night our efforts were rewarded when Congress passed legislation as part of the Medicare bill.  

This legislation provides a 2% incentive for physicans who use e-prescribing.  For those of you using InfoScriber already please review this legislation to make sure you are prepared to capture the extra revenue.  For more information take a look at the story at HealthCare IT News.   For those of you considering it, this helps increase the ROI of integrating it with your Avatar, MIS or Insight electronic health records.

Supporting NCCBH in Washington

Last week I attended the NCCBH Hill day in Washington, D.C. to lobby on Capitol Hill for legislation that supports the mental health community.  We addressed many issues effecting the industry (a list of the agenda we addressed can be found at the National Council for Community Mental Health website), but I particularly focused on one that effects the users of our Electronic Medical Record systems:  The Support the Community Mental Health Services Act (H.R 5176/S. 2182).  

This act addresses the need to provide funding to co-locate primary care/chronic care services at CMHCs; to integrate treatment for co-occuring mental heath and substance abuse disorders; to provide funding for workforce recritment and retention; to enhance behavioral health eduction and training; to provide funding for telepsychiatry and patient education; and finally one that directly impact users of electronic health records, psychiatric software, and medication management systems.  This final measure would require the Secretary of HHS to collaborate with the Office of the national coordinator to develop a plan to ensure that components of the National Health Information Infrastructure address the needs of behavioral and substance abuse providers.  

I met with Senator Hilary Clinton, Senator Charles Schumer and Congressman Steve Israel and got very good response from all offices.  We requested that they co-sponsor the legislation and endorse it.  I recommend that each of you communicate with your local legislators and request the same.  It is easier than you think.   

When/Will Consumer Directed Healthcare Impact Behavioral Health?

At Netsmart Connections we spent time talking about the trend toward consumer centric care and involving the consumer in the care process.  We discusssed consumer portals that provide consumers with access to their electronic health record and medication histories.   

As part of that discussion we looked at how the cost of healthcare is impacting the US economy and several changes to the system that are being proposed to address the problem.  Yesterday I had a conversation with Ryan Daniels from William Blair, Netsmart's investment banker.  I have attached two of Ryan's market analyses (his 2007 and 2008 updates on the CDHC impacts to the healthcare provider markets) in which he looks at how Consumer Directed Healthcare (CDHC) is or will be affecting the primary care marketplace.  Although these reports look at primary care primarily, he does speak about how some behavioral healthcare providers are well positioned going forward because they are less dependent on government funding.  This does not apply directly to many of you, but is a trend worth following as we often see funding approaches that are first tried on the primay care market work thier way into the behavioral health markets.

The question to be discussed is if and/or when this trend will impact behavioral health and public health.  I have had several discussions down in Washington as to how these trends will impact the medicaid and indigent populations and I have gotten several different answers:  1) it wont; 2) they will be treated differently; 3) thier HSAs will be managed by someone for them.   It is not clear where this is going, but it is a trend very much worth watching. 

If anyone has any input please contribute to the group.

External Connected Care

In my last blog entry I discussed Internal connected care.  To truly have connected care, internal connected care is the enabling technology to facilitate external connected care.  External connected care is the ability to share clinical data between disparate providers.  It allows a discharge summary to arrive at another provider before the consumer arrives to give the agency the consumer's diagnosis, active medications, reason for referral, demographic data and much more.  We call this new product CareConnect, and are using the evolving national standard called a Continuity of Care Document (CCD) transfer information between Avatar, MIS and Insight systems.  

Many behavioral health and public health agencies do not have the resources to Develop and maintain interfaces to various RHIOs and other providers.  The Netsmart CareConnect system will allow them to make a single connection to CareConnect and have Netsmart manage the interfaces to other providers and RHIOs.  Connecting care in this fashion will provide better service to the consumer by reducting potential medication errors and by reducing inpatient admissions by emergency rooms by providing the clinicians with the information they need when they need it.

We are continuing to define and extend the CCD to add behavioral and public health extensions.  At Connections a few weeks ago we had some discussions about these extensions.  Some preliminary ideas were to add components of a substance abuse assessment, a risk assessment and a suicide assessment.  What are your thoughts?

Intenal Connected Care

When I think of Connected Care I think of it in three parts:  Internal Connected Care, External Connected Care and Consumer Connected Care.  Today I want to discuss Internal Connected Care.  When I talk about internal connected care I am talking about connecting what were previously independent silos of information in a healthcare organization.   For example, If you can integrate your schedulers, with your front desk, with your clinical staff and finally with your billing department you will make your organization more efficient.  If your system can connect the clinical process with the financial (i.e. require the correct progress note before a service is billed) you will reduce internal overhead.  We have heard repeated stories from clients who have increased their revenues significantly after implementation of an EHR because they were now cpaturing services, and billing for them, that had fallen through the cracks previously.

Yet internal connected care does not stop there.  As we strive to improve the efficacy and outcomes of the treatment provided, implementing electronic medication mamangement systems like e-prescribing and computerized physician order entry (CPOE) allows the clinician to check for adverse drug interactions and to reduce clinical errors caused by transcription or handwriting errors between the physician and the pharmacist. When you add document scanning and management to the mix, you allow the clinical staff to have the best quality information when they need it. 

Internal connected care is designed to increase communication internally to an organization, to remove friction from the process and to allow for the provisioin of the highest level of clinical care possible in the most efficient manner.

I would like to hear your views of internal connected care and how you have implemented systems that help provide higher quality care.

The Vision of Connected Care

Connecting care between departments in an agency, between agencies and between different types of care givers (behavioral health, public health, primary care, social services etc) is designed to improve the quality of care provided to consumers, to reduce the quantity of medical errors (and the costs associated with them) and to improve national defense by more rapidly identifying disease outbreaks.

In addition, Connected Care is designed to achieve another major goal:  bringing the consumer into the care process using consumer portals to provide access to their electronic health records and eventually connecting them to personal health records. 

The genesis of Connected Care at the national level started in 2004 when President Bush outlined his vision of every American having an electronic health record within 10 years and has accelerated as agencies begin to envision the benefits to their clients (listen to what providers are saying).  The figure below provides a real world scenario of how a consumer could use Connected Care:

As consumers move between community mental health centers, county behavioral health agencies, state inpatient psychiatric hospitals, and local public health departments, the goal is to seamlessly transfer clinical data between electronic health records.  Initially this information would contain diagnosis, active medications and reason for referral.  If we can accomplish this, we can dramatically reduce medication errors which cost the country nearly $100 Billion annually.  In future blogs we can discuss each of these areas in more detail.  If you would like to see more information right now visit some of our pre-recorded webinars.