Becoming a Model Behavioral Health and Social Service Provider of the Future

1. Becoming a Model Behavioral Health and Social Service Provider of the Future Debra Rex, President and CEO, Beech BrookJean Solomon, VP Health Integration, Beech Brook 2014 OACCA Advocacy Conference

2. “We’re all using a cloudy crystal ball where we can’t see much more than 3-4 months out” Susan Dentzer Sr. Policy Analyst Robert Woods Johnson foundation

3. Health Care Reform – The Drivers “Waste” accounted for 34% to 50% of the $2.2 trillion spent nationally on health care in 2007 Individual behaviors e.g., preventable risk factors like smoking, obesity or non-adherence to Rx regimen ~10% Clinical diversity ~18% e.g., defensive medicine, uneven adoption of evidence-based medicine ~58% Operational inefficiency ~14% e.g., underuse of HIT, lack of process coordination across system, wasteful administrative overhead Financial/Resource Allocation e.g., dollars spent on inpatient/institutional care and FFS Appropriate Spending

4. Ohio • Seven of the 10 leading causes of death in Ohio are lifestyle oriented – most of which are avoidable – and approximately 75 percent of all health care spending goes to address chronic diseases. Payment systems are based on volume with no expectation of outcomes and the current system of care does not reward doctors for being comprehensive, thorough, or providing good continuity of care to patients.

5. Health Care Reform – The Drivers “Our nation is at a crossroad. The healthcare system we have simply cannot be sustained. If it does, our schools will fail, our roads will fail, our competitiveness will fail. Wages will continue to lag and, paradoxically, so will our health” Quote from Don Berwick former Administrator CMS.

6. It is better to be prepared for an opportunity and not have one, than to have an opportunity and not be prepared. Whitney Young, Jr.

7. So what does it all mean?

8. The focus will be on providing high quality care for more people with the same (or smaller) total budget

9. Expansion of Managed Care • Increasing use of managed care financing and service delivery models • Phasing out of fee for service with carve-in expected in 2016 (?): ACO’s and integrated health systems • More efficient treatment techniques focused on recovery and prevention/early intervention • More community-based diversion and alternative programming • More administrative requirements • More reporting requirements

10. Expansion of Managed Care FinancingBeech Brook Activities • Building relationships • Establishing contracting and marketing functions • Enhancing authorization functions • Expanding utilization management capacity • Developing payer preferred services • Learning about MCP outcome requirements

11. Payment Reform and Value-Based Purchasing • Introduction of global payment models: heightened risk and accountability • Increased transparency of performance • Linking reimbursement to desired outcomes • Introduction of incentives and penalties • Increased competitiveness in the marketplace • Increased focus on customer satisfaction

12. Payment Reform and Value-Based Purchasing Beech Brook Activities • Educating the agency about payment reform e.g., case rate, bundled and capitation models, and risk • Educating about the definition and importance of “value” • Tracking and analyzing the cost of each service at the activity level • Ensuring a strong compliance plan to combat fraud and abuse • Focusing on customer service

13. Business Infrastructure and Information Technology • Data driven decision support • Cross-organizational health information exchange • Care coordination and team communication • Efficient processes and rapid access • Cost-effectiveness • Accountability • Technology assisted therapies and tele-health services

14. Infrastructure and Information Technology Beech Brook Activities • Configuring workflows and the EHR to support centralized scheduling, access, prescribing, treatment planning, care coordination, etc. • Researching data warehouse capabilities to support clinical decision making, QI and effective financial management • Working to streamline and standardize operations • Driving a culture of measurement and accountability

15. High Performing Provider • Client satisfaction • Consumer engagement • Person-centered care • Culturally competent • Rapid access • Valued models of care • Transparent demonstration of high quality care • Accountability

16. High Performing ProviderBeech Brook Activities • Embedding the concept of whole health, recovery and resiliency deeply into the fabric or the organization • Using culturally competent staff and practices • Consistently measuring client satisfaction • Working to identify and demonstrate treatment effectiveness through measurement of client centered performance indicators

17. Community Based Coordinated CareThe case for one-stop shopping

18. Consider the Mom with three kids, depression and diabetes, who just lost her job. She is on the verge of homelessness, her kid has asthma and the other is due to appear in juvenile court

22. Managing a Disruptive Transition

23. Paradigm Shifts • Multiple unconnected separate providers • Provider centered care • Unconnected to PCP • Reimbursed for volume • Limited use of technology and data • Process outcomes • Limited experience in financial risk • Clinical “judgment” • Single client focus • Rapid cost growth • Formal or virtual system of care: connected to a multi-disciplinary team • Patient-centered care • Reimbursed for value • Data supported decisions and health information exchange • More efficient, evidence-based treatment techniques • Payment tied to quantitative demonstration of clinical and financial efficiency and effectiveness • Sustainability????? Before the Storm After the Storm

24. How Will You Survive the Change?

25. Endurance…….. • Will you have sufficient capital to weather the transformation? • How do you lead? • Will you remain niche? Work to build a larger system? Affiliate? Create or join an ASO? • What about the RT beds? • How will child welfare change as the dollars are managed? • What about the workforce? What are your thoughts?