THINK TANK | Spring Travels Illuminate Common Themes

June 8, 2017

David Bucciferro

Healthy Agencies Create Healthy Communities

Every spring and fall, my calendar fills with travel to various regional and national behavioral health conferences. On some stops, I’m presenting workshops with colleagues and on other stops I’m there to learn and share my expertise. It’s always a very enriching experience. As I enter the summer months, I wanted to take a moment to pause and reflect on some trends I’ve observed lately.

Healthy agencies create healthy communities through good data
As the behavioral health landscape continues to change, we know providers are seeking stability and tools to maneuver change, while maintaining the best possible support and care to those they serve. We also know changes are causing us to examine what we do, how we do it, how we evaluate the work we do, and how we can improve.

At a policy level, some of today’s most frequently used buzzwords include the concepts of Population Health and Social Determinants of Health. Without going into great detail, Population Health refers to improving and maintaining the health of the entire population you serve across the full continuum of care. This includes supporting low-risk healthy individuals to high-risk individuals with one or more chronic conditions. Social Determinates of Health refers to the conditions in which people live, learn, work, and socialize and/or recreate. These determinants can play a major role in one’s health across the board, from health risks to treatment outcomes. For example, if we look at these concepts in relation to outcomes of the current system, we see that people with mental illness often die significantly earlier than the general population. We know suicide rates remain high and people with behavioral health issues are typically unemployed at significantly higher rates than local and national unemployment rates.

Despite these trends, many agencies continue to provide services the same way, with the same workflows, with the same expectations, and thus, experience the same results as 20 years ago. This is not due to lack of effort or determination. Behavioral health providers are some of the most dedicated and passionate workers in healthcare. I think it has more to do with the lack of good data, and more importantly, how data is being used (or not) to drive decision-making. In this changing landscape, agency outcomes are being scrutinized more than ever, and data is the key to ensuring stability and success at the agency level and for the community as a whole.

At the annual National Council conference, the largest gathering of behavioral health organizations in the country, data was a hot topic of discussion. More specifically, conversations focused on the use of data as an effective approach to supervision. The data that one uses in this approach is both a combination of outcome and process data. Both types are important, both will impact your effectiveness, and both will help your agency achieve its goals and mission. Outcomes are critical to measure effectiveness, but you also have to look at the process in which services are provided, from engagement to goal achievement and beyond, or else you’ll only have a partial view.

To support data driven supervision, agencies expect to have quick and accurate availability of data, visualization of information to inform the supervisor, the development of a culture of data driven management throughout the system, and establishment of metrics and benchmarks that provide the necessary insight and information to make informed decisions. Although much work is taking place to establish metrics and benchmarks for behavioral health, it lags behind at the national and regional level. This makes it more crucial for agencies to establish metrics and benchmarks to inform programs and guide change within the organization.

Adapting to Changing Mandates

Like many states across the country, Ohio providers are facing a move to carved in Managed Care, Medicaid restructuring, new service initiatives, and regulatory reforms. The new directives and mandates have created anxiety, concern, and fear. As I prepared for my presentation at the OACCA Conference with my co-presenter from Mended Reeds, a Foothold Technology customer in Ohio, this anxiety was evident. To begin our presentation, I shared some tips. First, take a deep breath and embrace change and change theory. How you deal with the fact that you must make changes is just as important to the changes you make. The good news is, there are some basic principles that can help: Leadership, Data, and Workforce Development.

Leadership: Successful programs have leaders that champion each change and ensure that it is well designed and implemented. Our tendency is to do what we know, and when we need to act differently, we look for someone to lead and support.

Data: As I’ve mentioned before, successful organizations use their data strategically, or more precisely, the information and knowledge they glean comes from data analysis. Managing with data provides an assurance and comfort that the decisions being made will result in the outcomes they expect. Those who do not use data to drive decision-making are playing a game of roulette with their outcomes.

Workforce Development: Most of the changes happening throughout the country will also create a need for newly trained workforce. Whether it is new administrative skills on how to properly use an electronic health record (EHR), fiscal skills required to create cost corridors and service cost analysis, or top-notch clinical skills to deliver the desired evidence-based practices, skilled individuals who can interpret data and create useful informational reports will be essential.

As I often tell attendees at my workshops and webinars, while change can present obstacles, it can also present opportunities for improvement. Lead by example, use data to drive your decision-making, and use a good system and process to manage that data and develop new skills. You can and will succeed no matter what changes come your way.

Collaboration, Collaboration, Collaboration

When my travels took me to Niagara Falls for the New York State Care Management Coalition Conference, I found myself looking at the base of the falls and thought about the churning and chaos of millions of gallons of water flowing over the falls. I thought about the churning and sometimes chaotic world in which service providers live on a daily basis, especially when it comes to coordinating care. What words or tools could I share to help? One thing both governments and agencies can do to drown out the noise and reduce unnecessary barriers is collaborate.

Greater collaboration at all levels is required
First, federal and state governments need to look at some of the unnecessary barriers that providers must overcome to be successful. Because of current government regulatory requirements, many providers feel that double data entry is an obstacle to providing more efficient and effective services, especially in an environment calling for greater collaboration. If government, technology vendors, and providers collaborated more efficiently, this barrier could be eliminated. For example, if there were policies and regulations to require Health Homes and other care management entities to adopt consistent policies, data sets, and information exchange protocols, this could help reduce the administrative burden of having to meet multiple data set requirements and eliminate the need for double data entry. Data management systems, like Electronic Health Records (EHRs), that can exchange data with Health Homes, Health Information Exchanges (HIEs) and other similar entities in a consistent way would be optimal. One does not need to have different data and administrative functions across each Health Home. If states want to ‘improve engagement’ and increase opportunity for ‘client and care manager time’ then it’s my belief that it’s time to reduce unnecessary barriers for agencies. On the provider level, I encourage agencies to seek out fully connected and interoperable data management systems to reduce unnecessary administrative tasks that can be accomplished through seamless information exchanges.

Secondly, for providers, the need to change and adapt to the evolving world of healthcare, whether it be changes in regulations, implementation of new or different required assessments and practices, a shift to a value-based payment (VBP) structure, or any of the other multitude of changes agencies face, collaboration and the coordination of care is more critical than ever. Providers face not only unprecedented change, but in some cases, equal uncertainty in direction provided by federal and state entities. Agencies must continue to look at ways of reducing administrative and programmatic burden caused by the multitude of obligations they face, and seek ways to use data and a collaborative approach to inform decision making. For example, using a data management tool and an internal strategy to identify the obligations of an agency and the subsequent lines of accountability for each staff member and program, can help to both reduce duplication of effort and also create refined practices to meet these obligations. Implementing an information-based decision making practice where all levels of an organization can communicate and collaborate across programs is key to ensuring that the best possible approaches to management, supervision and service delivery are in place. This approach coupled with a process where decisions based on data is fed back into the agency operations helps people at all levels of an organization stay informed, flexible, and readily able to adapt.

Agencies today cannot operate on an island. Agencies should look for collaboration opportunities, both within and externally, to further their missions, ensure success and create the greatest impact possible in today’s ever-changing and sometimes turbulent environment.