Computer-based registries, Integration and FQHCs

I bet you're all way ahead of me on this. But recently I have begun to realize the essential role computer-based registries will play in the integration of behavioral healthcare and primary care. As you know, the Federally Qualified Health Centers (FQHCs) will be key players on the primary care side for our patients. FQHCs will screen for and even provide some SUD/MH services. They'll refer some patients to specialty agencies for more in-depth treatment, while providing some medication management along with treatment for co-occurring illnesses such as diabetes, depression, heart disease, and chronic pain.

So how will information flow back and forth between an FQHC and a SUD specialty agency? In some cases it will be through a common electronic health record (EHR). In many cases, the two agencies will have different EHRs. In yet other cases, the FQHC will have an EHR and the SUD agency won't. But in all these cases, one thing is true. Patients will receive better treatment if each agency knows what the other is doing. The substance abuse confidentiality regulations such as 42-CFR Part 2 present a challenge to this information sharing. Electronic registries offer one way to partially meet this challenge.

Registries are cool because they can work with all sorts of record systems, electronic and otherwise. What's more, they're not very expensive to develop and operate. I'm not saying they're cheap, but they are reasonably priced. Providers at all sites can enter data on services provided and patient response. With patient permission, that information can be easily shared across sites. The registry can send an alert if the patient is not responding well. For example, when an FQHC refers a patient to an SUD specialty agency, the registry provides a convenient means for transferring important information as part of care coordination.

These data can be used for a variety of populations and patient-specific purposes including tracking and status monitoring. Providers could enter treatment, adherence, and response data on a routine basis and have it displayed (numerically and graphically over time) for not only the SUD but also for key co-occurring illnesses.

The registry could also analyze data. From the registry, both agencies can easily aggregate and examine information about their patient population in several different ways (i.e. by patient, health problem, appointment dates, attendance at medical appointments, medication adherence, and behavioral adherence, over time and within a certain period). For instance, the registry could examine the full list of patients; print out a summary table of their status (e.g., appointment attendance), and identify patients needing attention.

Alerts. Providers could receive summary data before a patient's visit along with notifications if patient's indicator exceeds pre-defined thresholds. This would allow a timely intervention.

Treatment communication. The registry can store data on key treatments and outcomes at and between FQHC or SUD specialty visits and automatically share that information between agencies.

It's easy for an engineer who knows nothing about treatment to say, but these capabilities seem pretty important. If you agree, it might be useful to explore an electronic registry. I bet a lot of you already have. If so, share your thoughts with us.

Dave Gustafson
Director, NIATx

SAMHSA Business Operations Webinar - HIT: Overview of CMS Final Rule on Meaningful Use and Gap Analysis

Thursday, May 26
2:00 pm EST/1:00 pm CST
Register for this webinar

This session will provide an overview of the CMS rule on Meaningful Use and Medicare and Medicaid Provider Incentives for the use of health information technology.

The session will review which providers are eligible for incentive payments and review the specific Meaningful Use Criteria that must be met in order to obtain Medicaid and Medicare Incentive payments.

The presenters will identify how this information can be used to conduct a gap analysis and implement a plan to meet Meaningful Use.

Speakers:

Michael R. Lardiere, LCSW
Director HIT; Sr. Advisor Behavioral Health

National Association of Community Health Centers
mlardiere@nachc.com

Susan Chauvie, RN, MPA-HA
Vice President, Quality for Practice Transformation
OCHIN
chauvies@ochin.org

Michele Russell
Vice President, Business Development
Health Choice Network
MRussell@HCNetwork.org

Angela Strain, GPC
Organizational Advancement Director
CHC Alliance / AHIT
angela@chcalliance.org

Click here for more information on the Business Operations for Behavioral Health Collaborative.

SAMHSA Business Operations Webinar - HIT: Benefits & Economies of Scale in Working with an HCCN

Thursday, April 28, 2011 at 2:00 pm EST/1:00 pm CST

Register for this webinar

There are a number of functions that are required when implementing health information technology, including:

• Training
• Systems back up
• Template design
• Server maintenance and upgrades

Providers have a choice of taking on these responsibilities themselves or working with an organization that can leverage existing relationships and competencies to provide these services. Health Center Controlled Networks (HCCNs) provide Economies of Scale that individual organizations cannot.

This session will provide examples of how providers working with an HCCN can benefit from these economies.

Register for this webinar

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The National Council for Community Behavioral Healthcare, the National Association of Community Health Centers, NIATx, and the State Associations of Addiction Services have come together with SAMHSA funding to form the Business Operations for Behavioral Health Collaborative.

Its mission is to provide cross-cutting, high quality training, educational opportunities, and resources for service providers to implement efficient and cost effective business solutions.
The four primary training areas are:

• Health Information Technology
• Billing Operations
• Compliance
• Patient Eligibility/Access

Finding the perfect Summit workshop

With all the change going on in the world of healthcare it's no surprise that this year's Summit will focus on preparing for healthcare reform. Once again we've put together an impressive list of speakers and workshops for you to attend. But with all the different workshops sometimes it's hard to know which one will be most beneficial to you and your agency. To help you choose, we've created a couple new tools on the Summit and NIATx websites.

First, the NIATx Health Reform Readiness Index is an easy-to-use online assessment of 13 conditions that an organization needs to thrive in the new healthcare environment. Complete the HRRI anytime before the NIATx Summit and SAAS National Conference. An online report will tell you what conditions you need to work on.

Next, go to the list of conference workshops on the Summit website. By selecting the HRRI conditions that apply to your agency you'll see a list of workshops most relevant to you. We'll also list workshops by HRRI condition in the conference program to help you plan your day.

We hope you'll find these tools useful and look forward to seeing you in Boston.

Are you ready for health reform?

Are you ready for Health Reform?

Or other major trends impacting how behavioral health will be delivered in the future?

NIATx has developed a Health Reform Readiness Index that is easy to complete and free. The brief tool assesses your readiness based on the organizational processes you need to have in place to participate in accountable care organizations or Medicaid; achieved desired clinical outcomes; and participate in the general health care system. Complete the Health Reform Readiness Index today and begin making your plans for pending changes in how behavioral health services are delivered.

The "Health Reform Readiness Index" was developed and tested in the twenty-two organization national "Accelerating Reform Initiative" project. The Accelerating Reform Initiative gives behavioral health care organizations the tools and peer supports they need to respond to the sweeping changes that parity, health care integration, and decreased grant funding may bring. Click here to see a list of additional Accelerating Reform Initiative resources.

Victor Capoccia on health reform and the Accelerating Reform Collaborative

With the announcement of the NIATx Accelerating Reform Collaborative, we asked NIATx Senior Scientist Victor Capoccia to share his views on health reform and how NIATx will position itself within that new environment.

1. What is your view on the current state of affairs in behavioral health?

Without question, this is the most exciting period I have experienced in my 40-year career in social welfare and behavioral health. Here is why:

• There is greater knowledge about mental and substance based disorders and successful treatments. We have medications as well as counseling protocols that are tested and efficacious.
• Despite a slow economy, there are more resources to prevent and treat mental and addiction disorders than ever before; and there are more to come with the provisions of the Accountable and Affordable Care Act.
• There is greater understanding and awareness of addiction as a treatable health condition than at any previous period. Stigma still exists, but it exists in tandem with a better public understanding of mental health and alcohol and drug misuse.

Take these three forces, and they shout: OPPORTUNITY! Shame on us if we fail to make the changes needed to reach those who continue to suffer with untreated addiction and mental health conditions.

2.What kind of opportunities do you see health reform presenting to behavioral health organizations?

I feel that health care reform presents the following opportunities:

• Coverage of 32 million uninsured Americans that largely include a mental health and addiction benefit; this coverage includes dependents up to 26 years of age and low-income adults up to 100% of the federal poverty level.
• Insurance coverage if these conditions existed prior to coverage.
• Parity with general medical care for addiction and mental health treatments.
• Medical homes for chronic and acute patients.
• Prevention screening and intervention for Mental Health and Addiction disorders.
• Workforce development and training for behavioral health professionals.
• And many others...

3. What is the NIATx Accelerating Reform Collaborative?

The Accelerating Reform Collaborative comes from a simple premise: in a period of great opportunity where the "stars have aligned", we need to transform our treatment systems to reach more of the 20 million untreated people with addiction disorders and the 1/3 untreated of those with mental illness. Our current system is designed to reach 10% of 23 million people with addiction disorders, and 66% of people with mental illness. "Every system is perfectly designed to produce the results that it produces".

Only transformation of the system will reach beyond current performance.

The Accelerating Reform Collaborative is a collection of innovators from provider, academic, consumer and policy groups who are willing to share their ideas and experience to redesign the system to reach the untreated.

4. What's special about this collaborative? Why should organizations join?

It's the PEOPLE. The colleagues, the experience, the ideas. This is where the leading edge is being cut.

5. What is NIATx's future role with health care reform?

NIATx has and will continue to focus on the customer, understand the patient experience, and design systems that will help meet those patient needs.

That is our core, our soul.

Ideas from Outside the Field: Surviving Market Changes

As we face continued market disruption with reduced grant funding and increased fee for service and other reimbursement structures through parity and health care reform, here are some ideas from outside the field on how companies in other industries are surviving similar market changes.

• Dell's Extreme Makeover (BusinessWeek)
• The Hard Sell (BusinessWeek)
• How GE is Disrupting Itself (Harvard Business Review)
• Major League Innovation (Harvard Business Review)

New NIATx Learning Collaborative Opportunity

Are you interested in making sure you can meet the needs of clients in a changing funding environment? Health Care Reform will change the way we do business. Reimbursement structures, relationships with other health care systems, who provides what care, what levels of care will be offered, how we process clients, what information we collect and where we store it, how we make treatment plans and what goes into them will all be affected.

NIATx will be putting together a learning collaborative to help agencies identify needs, develop skills and make changes in their programs that enable them to better serve clients/patients in a transformed funding and service delivery environment.

Look for the application announcement coming soon.