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Suzanne Clifford, CEO Inspiring Transformations. Health Care Trends. Key Trends and Possibilities for Health Care Reform. Just the Facts. US health care system is one of the most expensive and is not achieving good outcomes

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Health Care Trends

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Suzanne clifford ceo inspiring transformations

Suzanne Clifford, CEO

Inspiring Transformations

Health Care Trends

Suzanne F. Clifford, [email protected], 317-507-0075


Key trends and possibilities for health care reform

Key Trends and Possibilities for Health Care Reform

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Just the Facts

US health care system is one of the most expensive and is not achieving good outcomes

Premature, preventable deaths of people served by the public mental health system

5/50 Population: 5% uses approx. 50% of the health resources

1% uses approx. 20% of the resources

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Philosophical Differences & Power Struggles

Current system/institutional care vs. Prevention/early intervention

Universal health care coverage vs. taxes vs. debt vs. spending

Primary care vs. specialists

Federal vs. state rights

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Drivers of Change

  • Financial necessity: Transformation critical

  • for economic development

  • - Suboptimal health outcomes

  • DCS evolution (Very different customer!)

  • Parity (especially re: substance use disorder)

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Drivers of Change (cont.)

  • Affordable Care Act or its evolution

  • “Disruptive” medical & technological

  • innovation

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Affordable Care Act

Increased demand due to access to essential benefits (Medicaid expansion)

Patient-centered health homes/integrated care

Accountable Care Organizations

Workforce development

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Affordable Care Act (cont.)

Health insurance exchanges & health insurance cooperatives

Electronic health records & health information exchanges

Payment reform & shared savings

Innovation opportunities

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Key Strategic Planning Questions

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Thriving in the New Environment

Effective Strategic Positioning Translated into Action Plans in the Budget that are IMPLEMENTED

Positively Impact the

Triple Aim: Better Health, Better Care & Lower Costs

Environmental Monitoring, Strategic Planning & Identity Shift

Streamlining Processes &

Increase Efficiency/ Effectiveness

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

No Matter What Happens…

Demonstrate how your organization can impact the 3-part aim of better health, better care and lower costs

Develop strong partnerships

Delight current customers AND position your organization for future opportunities

Suzanne F. Clifford, [email protected], 317-507-0075


In integrated care action alliance

IN Integrated Care Action Alliance

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Action Alliance Approach

Community Mental Health Centers

Health Centers (Rural Health & FQHCs)

BHMI

IN Council of Community Mental Health Centers

IN Primary Care Association

IN Hospital Assoc.

Managed Care

SAMHSA/HHS, Medicaid & DMHA

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Deliverables of the IN Integrated Care Action Alliance

Clearly defined list of positive health and cost data that can demonstrate the impact of integrated care

Process map of integrated care in community mental health centers

Process map of integrated care in federally qualified health centers

Un-funded steps in the process and other issues

Training needs assessment

A clear action plan with owners and due dates indicating how the group will work to resolve critical issues

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Process map of integrated care in community mental health centers

Suzanne F. Clifford, [email protected], 317-507-0075


Process map of integrated care in federally qualified health centers

Process map of integrated care in federally qualified health centers

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Key Issues Identified

Finding willing partners

Reimbursement/Financial Viability

Same day billing

Integrated medical record, document recognition, and information sharing

Cross-training

Credentialing, valid license in IN, Medicaid, Managed care – for both mental health & primary care

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Additional Key Issues Identified

Demonstration of costs of care savings in order to influence policy and funding

Telemedicine (20 mile radius issue)

Language barrier costs

Paperwork/ Administration/ Process inefficiency

Transportation

Provider shortages (primary care, nurse practitioners, mental health, etc.)

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

More Issues Identified

Medicaid provider requirements, 96510 codes

Need to partner with emergency rooms to build community care collaborations

Differences in treatment plan documentation requirements between primary care and mental health (Primary care often utilizes the medical note)

Lack of access to FQHCs in certain parts of the state

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Training Priorities Based on the CMHC & FQHC Needs Assessment

Financially viable models

Training medical staff on behavioral health issues & Rxs

Training behavioral health providers on chronic disease management

Moving from co-located to integrated care

Coordinating care among the CMHC, FQHC and community hospital

Suzanne F. Clifford, [email protected], 317-507-0075


Health care trends

Accomplishments of the

Integrated Care Action Alliance

Increased cross-system collaboration

HHS committed to funding training as a result of the Integrated Care Action Alliance’s training needs assessment

Created an initial business case of integrated care

Working with the Medicaid Claims Taskforce to resolve the top priority billing issues

Working to address health information sharing issues

Working on over 30 other action items

Suzanne F. Clifford, [email protected], 317-507-0075


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