42
CMS Transforming Clinical Practice Initiative and The Southern New England Practice Transformation Network (SNE-PTN): Focus on Behavioral Health Clinicians (BHCs)
CMS Transforming
Clinical Practice Initiative and
The Southern New England Practice
Transformation Network (SNE-PTN):
Focus on
Behavioral Health
Clinicians (BHCs)
2
Ronald Adler has practiced and taught Family Medicine at UMass
Medical School for more than 20 years. His interests include
women’s health, Quality Improvement, Behavioral Health
integration, shared decision-making, and reduction of waste with
an emphasis on avoiding over diagnosis and overtreatment.
Dr. Adler has created and led improvement initiatives that have
focused on diabetes, hypertension and CAD. He has also led local
and state-wide initiatives to transform practices into Patient-
Centered Medical Homes. He currently leads recruitment and
engagement activities for the Southern New England Practice
Transformation Network, funded by CMS as part of the
Transforming Clinical Practice Initiative.
Ron Adler, MD, FAAFP – Biography
3
Alexa Connell, Ph.D. - Ali is a psychologist and Assistant Professor of
Family Medicine and Community Health. She completed her
undergraduate studies at Clark University in Worcester MA and her
Doctoral degree in Clinical Psychology from Duke University in
Durham, NC. Her pre-doctoral internship in Behavioral Health was
completed at the Medical University of South Carolina and she
completed a two year post-doctoral fellowship in Primary Care
Behavioral Health at the University of Massachusetts Medical School. In
addition to her teaching and clinical duties, she holds a leadership
position in the Center for Integrated Primary Care (CIPC) at UMass
Medical School and has consulted with practices across the state to assist
in developing collaborative and integrated behavioral health and primary
care.
Alexa Connell, PhD – Biography
Agenda August 4, 2016
4
• Context: A Rapidly Changing Health Care Environment
• Implications for BHCs (Behavioral Health Clinicians)
• Opportunities: BH ↔ Primary Care integration
• Overview: TCPI and the Southern New England Practice Transformation Network (SNE-PTN)
• What’s in it for Behavioral Health Clinicians?
Non-Prescribing Mental Health Professionals
• Psychologists
• Licensed Clinical Social Workers
• Licensed Professional Counselors
• Licensed Alcohol and Drug Counselors
• Marriage and Family Therapists
“Behavioral Health Clinicians (BHCs)”
Terminology: Professional Designation
5
Non-Prescribing Mental Health Professionals
• Psychologists
• Licensed Clinical Social Workers
• Licensed Professional Counselors
• Licensed Alcohol and Drug Counselors
• Marriage and Family Therapists
“Behavioral Health Clinicians (BHCs)”
Terminology: Professional Designation
6
Current State Near-Term Future
Long-Term Future
?
?
?
Behavioral Health Clinicians :
Challenges and Opportunities
7
• Expand coverage: mostly done
• Reform insurance: mostly done
• Practice/system transformation: in progress
(what we’re doing)
– Patient-Centered Medical Homes (PCMH)
• Payment reform: in early stages
– Bundled payments, quality incentives …
ACOs
Affordable Care Act: 4 Main Objectives
8
Affordable Care Act
• Mental Health coverage mandate for most
• Mental Health Parity
– Large increase in individuals with insurance
coverage for mental health
• Behavioral, substance abuse and depression
screening in Primary Care
• Reimbursement for care management and social
supports
Healthcare Reform & Behavioral Health
9
Continuum of Payment Methods:
Moving to Value Based Payments
Fee-for-Service (FFS)
FFS and Care Management Fee
Bundled Payments
Global Payments
10
MACRA (Quality Payment Program) Timeline
What does this mean for BHCs?
12
What does this mean for BHCs?
13
What does this mean for BHCs?
14
• Global payments
– Person Centered Health Homes (PCHH)
– Integrated Patient Centered Medical Homes (PCMH)
• Bundled payments / Prospective Payment Systems
– Federally Qualified Behavioral Health Centers
(FQBHCs)
– Certified Community Behavioral Health Clinics
• Partner with Primary Care
• Case Rates – Specialty Behavioral Health Clinics
• Many clinicians and health care organizations are not
ready
Payment Reform
15
• How can your organization best measure, showcase, &
continuously improve quality, cost, & outcomes?
• Quality indicators
– Collaborative care and documentation
– Clinically integrated “Treat to target” brief therapy
• Value Indicators
– Link outcomes to cost of services necessary to produce
identified outcomes
• Outcomes Indicators
– Ability to collect, measure and compare how patients
benefit from services
– Implementing an academic, valid and inter-rater reliable
functional assessment tool
Preparing for Payment Reform
16
There is evidence that:
• Robust, coordinated primary care
improves quality and reduces cost.
• BH problems increase medical costs far
beyond the cost of BH treatments.
• BH problems reduce workforce
productivity far beyond the cost of health
care
Transformation in healthcare is
increasingly evidence-based:
17
PHQ-3000 Merillac 500
Major Depression 10 % 24 %
Panic Disorder 6 % 16 %
Other Anxiety Disorders 7 % 21 %
Alcohol Use Disorders 26 % 50 %
Any Mental Health Dx 28 % 52 %
Prevalence of MH Disorders in PC
18
Due to access issues, Primary Care is the
default provider for many of these patients.
• Behavioral issues can increase medical
expenditures in all health care settings:
primary and specialty ambulatory care,
EDs, and in-patient.
• You have the expertise to address these.
• Common examples:
– When depression is co-morbid with other
conditions, medical outcomes are worse
– Anxiety drives excess utilization
BHCs Add Value: We need you on the team!
19
• Access to PCPs to discuss
– Psychopharm Rx
– Chronic pain
– Emergency Dept use (was it cardiac or anxiety?)
– Assess somatizing symptoms
– Chronic illness treatment regimens for the patient
• Input and access for relevant testing and
assessments
• Identify prescription substance abuse problems
• Current medication lists
BHCs Get Value:
20
When PCPs cannot provide ready access to
a BHC, their patients may experience sub-
optimal care:
• Unable to benefit from BH care
• PCPs may have a lower threshold to
prescribe psycho-active meds when
counseling might have been better
Addressing Behavioral/Mental Health
Conditions: Challenges for PCPs
21
A robust multi-disciplinary network designed to:
• Facilitate sharing of best practices
• Provide technical assistance:
– QI methods to help you achieve your
transformation agenda
Funded by CMS as part of TCPI
→ No cost to participate!
An Opportunity: Join SNE-PTN
22
Overall Aims of the TCPI Model
23
1. Transform
Practice
Support more
than 140,000
clinicians in
work practice
transformation
2. High
Performance
Improve health
outcomes for
5M Medicare,
Medicaid & CHIP
beneficiaries
4. Scale
Build the evidence
base on practice
transformation so
that effective
solutions can be
scaled, if successful
3. Reduce
Utilization
Reduce unnecessary
hospitalizations &
over utilization of
other services for 5M
Medicare, Medicaid
& CHIP beneficiaries
5. Savings
$1 - $4B in savings
to the federal
government over
4 years through
reduced Medicare,
Medicaid & CHIP
expenditures
6. Value Based
Move clinicians
through the
TCPI phases
to participate in
incentive programs
& practice models
the reward value
Clinicians
Beneficiaries
System Impact
Logic Flow
• Doctor of Medicine
• Doctor of Osteopathy
• Doctor of Podiatric Medicine
• Doctor of Optometry
• Doctor of Oral Surgery
• Doctor of Dental Medicine
• Doctor of Chiropractic
• Clinical Pharmacist
• Physician Assistant
• Nurse Practitioner
• Clinical Nurse Specialist
• Clinical Social Worker
• Clinical Psychologist
• Registered Dietician
• Nutrition Professional
• Audiologists
• Physical Therapist
• Occupational Therapist
• Qualified Speech-Language Therapist
• Certified Registered Nurse Anesthetist
• Certified Nurse Midwife
TCPI Eligible Clinicians
24
- Have a National Provider Identifier (NPI)
- Not participating in a Medicare shared savings ACO
• 29 Practice Transformation Networks (PTNs) – State and regional hubs for TA, shared learning,
practical resources for practice transformation
• 10 Sustaining and Alignment Networks (SANs) – National Associations that support recruitment of clinicians in PTNs
– Spread and institutionalize PTN learnings
– Offer additional benefits to member-participants (APA, ACP, ACEP, AMA)
• National faculty and shared learning
• Website as a communication hub
• Data aggregation and reporting
CMS TCPI Funds
25
1. Better patient experience
2. Better population health
3. Lower costs
4. Better work-life for clinicians and staff
SNE-PTN focus: The Quadruple Aim
26
1. Better patient experience
2. Better population health
3. Lower costs
4. Better work-life for clinicians and staff
SNE-PTN focus: The Quadruple Aim
27
SNE-PTN geographical focus areas:
MA and CT
28
Southern New England Practice Transformation
Network – The Value Proposition
Achieve the Quadruple Aim and Bring Joy Back to Your Clinical Practice!
Strengthen
Connections
to Community
Partners
Improve coordination
across primary
and specialty
care, hospitals,
behavioral health
and community-
based providers
Free Technical
Assistance
Quality
Improvement
Advisors
Faculty Experts
Professional
Resources –
CMEs, etc.
Optimize
Use of Health
Information
Technology
Calculate and report
clinical quality
measures
Give clinicians
actionable care
gap information
Succeed in
Value-Based
Payment
Optimize current
revenue
Prepare for
alternative
payment models
29
Southern New England Practice Transformation
Network – The Value Proposition for BHCs
Achieve the Quadruple Aim and Bring Joy Back to Your Clinical Practice!
Strengthen
Connections
to Community
Partners
Improve coordination
across primary
and specialty
care, hospitals,
behavioral health
and community-
based providers
Free Technical
Assistance
Quality
Improvement
Advisors
Faculty Experts
Professional
Resources –
CMEs, etc.
Optimize
Use of Health
Information
Technology
Calculate and report
clinical quality
measures
Give clinicians
actionable care
gap information
Succeed in
Value-Based
Payment
Optimize current
revenue
Prepare for
alternative
payment models
Negotiate payment with a MoU.
Streamline insurance documentation,
e.g., requests for additional sessions
30
Southern New England Practice Transformation
Network – The Value Proposition for BHCs
Achieve the Quadruple Aim and Bring Joy Back to Your Clinical Practice!
Strengthen
Connections
to Community
Partners
Improve coordination
across primary
and specialty
care, hospitals,
behavioral health
and community-
based providers
Free Technical
Assistance
Quality
Improvement
Advisors
Faculty Experts
Professional
Resources –
CMEs, etc.
Optimize
Use of Health
Information
Technology
Calculate and report
clinical quality
measures
Give clinicians
actionable care
gap information
Succeed in
Value-Based
Payment
Optimize current
revenue
Prepare for
alternative
payment models
What to document.
Documentation that facilitates data extraction.
31
Southern New England Practice Transformation
Network – The Value Proposition for BHCs
Achieve the Quadruple Aim and Bring Joy Back to Your Clinical Practice!
Strengthen
Connections
to Community
Partners
Improve coordination
across primary
and specialty
care, hospitals,
behavioral health
and community-
based providers
Free Technical
Assistance
Quality
Improvement
Advisors
Faculty Experts
Professional
Resources –
CMEs, etc.
Optimize
Use of Health
Information
Technology
Calculate and report
clinical quality
measures
Give clinicians
actionable care
gap information
Succeed in
Value-Based
Payment
Optimize current
revenue
Prepare for
alternative
payment models
Sharing PHI with medical providers:
- Knowing what can be shared.
- How to share PHI.
- Receiving helpful info from medical providers.
Building The Medical Neighborhood
32
REFERRALS DISCHARGE
SUMMARY
TEST
REPORTS MEDS CONSULTS
HOSPITAL
REHAB
SPECIALISTS
COMMUNITY
SERVICES
PATIENT CENTERED
MEDICAL HOME
COMMUNITY
HEALTH TEAM
PHARMACY
ELECTRONIC
HIGHWAY
Building The Medical Neighborhood
33
REFERRALS DISCHARGE
SUMMARY
TEST
REPORTS MEDS CONSULTS
HOSPITAL
REHAB
SPECIALISTS
COMMUNITY
SERVICES
PATIENT CENTERED
MEDICAL HOME
COMMUNITY
HEALTH TEAM
PHARMACY
ELECTRONIC
HIGHWAY
34
• Free technical assistance
– You articulate the agenda
– SNE-PTN offers support, guidance, best
practices
• QI Resources
– Opportunity to learn data-driven QI skills
• Access to a robust network that includes PCPs:
– Enhanced referrals
– Better “Medical Neighborhood” integration
SNE-PTN: What’s in it for Behavioral Health
Clinicians?
Transformation Support Intervention
35
SNE-PTN
Clinicians will:
Create and
coordinate
local medical
neighborhoods
Implement and
sustain practice
transformation
Reduce
unnecessary
hospitalizations
Improve clinical
and operational
measures
Achieve
financial
success
Clinician
Recruitment
Quality
Improvement
Advisor
Assigned
Practice
Readiness
Assessment
Practice
Transformation
Plan
Development
Practice Transformation
Transformation Toolbox:
Implementation
• Technical assistance
• Faculty experts
• Useful resources
• Sharing best practices
• Data optimization
• Patient engagement
• Activities focused on improving quality and
becoming prepared for alternative payment
methods
• Initial qualitative assessment with 6 month follow
up to provide practices a snapshot of
performance
• Practice and QIAs use this assessment to create
a transformation plan and tactics
• Collect de-identified data for clinical quality
measures
How will my QIA guide me through the transformation
process?
36
37
• Collecting data on measures can show
progress and identify areas for improvement
• Quarterly reporting on 2 measures
• Possible BH Measures:
– Communication with prescribing clinicians
– F/u after hospitalization for mental illness
– Depression remission at 12 months
– Access to care
Why do I need to submit data on my clients?
38
• You may remain in SNE-PTN as long as
you find it valuable
– funding through Sept 2019
• No long-term or binding commitment
• Some clinicians will “graduate” out of SNE-
PTN by virtue of joining an ACO
• Clinicians may dis-enroll at any time
How long is the commitment?
39
• BHCs are uniquely positioned to become
integral, indispensable members of health
care teams under payment reform.
• SNE-PTN offers free technical assistance.
Conclusions
40
• Sign and complete the participation
agreement found on our website:
www.sneptn.org or contact us at
• A QIA will then be assigned to your
practice
How do I get started?
41
Type into the chat box or unmute your line
by pressing *6.
Please take our brief survey at
https://www.surveymonkey.com/r/tcpi_webin
ar_160801
Questions or Comments?
42
Southern New England Practice
Transformation Network – Key Contacts
David Polakoff, MD, Msc
Director, Center for Health Policy and Research
Chief Medical Officer and Associate Dean
Email: [email protected]
Phone: 508.856.6737
Ronald (Ron) Adler, MD, FAAFP
Physician Lead, Recruitment and Engagement
Email: [email protected]
Phone: 508-856-4877
Jay Flanagan
Director of Practice Transformation
Email: [email protected]
Phone: 508-856-2754
Valerie Konar, MBA, MEd
TCPI PTN Project Manager
Email: [email protected]
Phone: 508-856-4079
http://www.sneptn.org/
