Coordinated Care: Primary Care Integration Processes and Initiatives

As you are experiencing, our world of Behavioral Health is being shaken and stirred with great vigor these days. From Federal incentive programs in the ACA and the Stimulus bill to State level initiatives designed to cajole providers into coordinating care, no one is being spared the dislocations brought on by Managed Care, Health Homes, Coordinated Care, primary care interoperability and on and on. But on the positive side, these changes encourage needed enhancements in the system within which we operate. In 2011 the Kaiser Foundation reported that $374 billion is spent annually on 52 million Medicaid beneficiaries, of which $201.9 billion is spent on 2.6 million beneficiaries with complex health needs. That is… 5% of Medicaid beneficiaries comprising 54% of Medicaid’s cost. Much of this spending can be attributed to unnecessary and repeated emergency room visits. These new changes we are seeing in our behavioral health landscape are aimed at improving care for these individuals with complex needs, thereby reducing these staggering costs.

Here at Foothold, we think of ourselves as much more than a software company. We aim to rationalize our changing world so that you, our clients, can continue to survive and thrive in our new coordinated care world. To that end, what follows is a detailed, though not exhaustive, list of the processes and initiatives we have expertise in and are helping our clients navigate. In addition, we have noted some of the new features and tools that are available in AWARDS to assist our customers in meeting the requirements of these various initiatives.

Health Homes / Medicaid Homes –
These are an initiative of the Affordable Care Act and they offer additional monies to States that establish them. They are virtual organizations comprised of a multitude of different kinds of healthcare providers. From hospitals and doctors to mental health professionals, labs, drug rehab counselors, and so on. The idea is to establish a common data set for the patients/consumers who are in the health homes and be able to track their progress across all care modalities. Participating may require access to our Interoperability Center, depending on how the Health Home wants to receive data.

DSRIPs – Another national program based on the Federal offer to states that they can keep a large percentage of the savings they create by redesigning their Medicaid program. Many states have done so and are therefore able to access additional Federal monies. These monies must be used to further the goals of Coodinated Care.

RHIOs/HIEs – Regional Health Information Organizations and Health Information Exchanges both serve the same purpose: To be a clearinghouse for all kinds of Healthcare Data across all care modalities – physical to behavioral. RHIOs/HIEs accept data from various providers and aggregate it into some kind of comprehensive electronic document – typically either a Continuity of Care Document (CCD) or a Comprehensive Clinical Document Architecture (CDA). This aggregated document can then be accessed by any authorized care provider to get an overall picture of a patient’s health. Our software, AWARDS, is already operating a data exchange with several RHIOs on behalf of our clients. Participating in a RHIO is an important way to be a part of the future of Coordinated Care and, as such, an important capacity for your organization to have if it is to survive and thrive in the new world of Coordinated Care.

DISCOs — Although there are currently fewer initiatives regarding Managed Care in the national Intellectual Developmental Disability (IDD) community, some states are moving forward with work in this area. For instance, the New York State budget has changed provisions in the Public Health Law and Mental Hygiene Law to offer several options for providing specialized IDD services within Managed Care. One of these options is a new type of Managed Care entity called a Developmental Disabilities Individualized Support and Care Coordination Organization (DISCO). DISCO’s will be responsible for providing individualized care coordination and long-term supports and services for individuals with IDD who voluntarily enroll.

HISPs – Health Internet Service Providers are, essentially, an ISP for Health Data. HISPs allow providers to make use of the Federal public-private partnership called Direct Protocol, which establishes security parameters for the secure emailing of private, personal health information (PHI). To use Direct Protocol, you must have an account with a HISP and your EHR must have the ability to email files in the appropriate formats. Our software is ready for you to exchange data this way.

MCOs and HARPS – These are just some of the managed care initiatives bearing down on Behavioral Health providers today. Are you ready for them? Before long, your revenue is going to come from them and they are interested in meeting outcomes benchmarks and saving money. That’s all. In order to communicate effectively with whichever managed care organizations you contract with, you’re going to need an EHR that can easily exchange that data. It may be claims data, but it may not. Many of the new managed care programs, such as the HARP program in New York State are looking for payors to take a more proactive stance towards increasing quality and finding robust clinical decision support tools and methodology.

MU Attestation – A federal program designed to incentivize Eligible Professionals and Hospitals to adopt and use an Electronic Health Record. This program was originally designed for physical health professionals and organizations only, but the definition of Eligible Professional includes psychiatrists and psychologists and some RNs. As a result, Behavioral Health organizations are able to access the incentive dollars. Foothold customers have already received hundreds of thousands of dollars through this program and if you have an eligible professional, you can too.

ePrescribing & eLabs – Two new pieces of embedded functionality in AWARDS that allow you to send and receive subscription and orders for medications and lab tests. Our ePrescribing is fully equipped to handle prescriptions for controlled substance.

Clinical Decision Support – A part of the vendor certification for Meaningful Use, CDS has always been solidly in the domain of primary care. No longer, Behavioral Health support is on its way and more and more payors are going to expect you to integrate this kind of decision-making support into your workflows.

Interoperability Center – A Foothold invention, our interoperability Center is where you go to send and receive any data file, in any format, to any target. From HL7 messaging, to CDA, CCD, CCDA and Direct Protocol, our Interoperability Center can do it all.

IMO – A best in class coding engine embedded into AWARDS that can take plain language text and return diagnostic codes from almost any set, from LOINC to SNOMED to ICD 10 and DSM5.

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