Benefits of Multi-Agency Membership Consortium Discussion

1. Benefits of Multi-AgencyMembershipConsortium Discussion Presented by: Scott C. Lloyd, Vice President MTM Services, LLC P. O. Box 1027, Holly Springs, NC 27540 Phone: 919-387-9892 Fax: 919-773-8141 E-mail: mtmscott@aol.com Web Site: mtmservices.org

2. Benefits of Multi-Agency MembershipConsortium Topics for Today: • Who we are and What we do • Advantages of forming a Consortium • How do Consortiums Work? • How do I form a Consortium? • Case Studies: Consortium Success Stories

3. MTM Services Consultation History and Team: As a result of providing service delivery process change management consultation to over 400 community behavioral healthcare centers nationally, M.T.M. has developed specific assessment and consultation/training processes that have proven successful to support restructuring the service delivery processes to facilitate a more efficient work flow and/or EMR integration. The consultation efforts are focused on designing and implementing service process solutions to support timely movement from a narrative intense documentation model with multiple styles or genres of forms and service delivery flow processes across programs/units/populations/locations to a more objective and uniform service delivery documentation and flow process. 3

4. Previous Statewide/Regional Initiatives Managed by M.T.M. Services • 1996 – North Carolina MH/DD/SA Providers • 1996 – Alabama Statewide MH/MR/SA Boards • 1999 – Georgia Statewide MH/DD/SA Community Service Boards • 2000 – Northern Affiliation of Six MH/DD/SA Provider Boards in Michigan • 2001 – Three MH/DD/SA Provider Agencies in Allegheny County, Pennsylvania • 2001 – Three MH/SA Provider Agencies in Southern Indiana • 2001 – 2004 Ohio Department of Mental Health and Ohio Department of Alcohol and Substance Abuse Services Statewide Standardized Documentation Initiative (SOQIC) • 2004 – 2005 DuPage County Public Health Department • 2004 – 2005 Mental Health Council of Arkansas Statewide Documentation Initiative • 2007 – 2008 Statewide Massachusetts Standardized Documentation Project (MSDP) • 2009-2010 Statewide New York State Clinical Record Initiative (NYSCRI) 4

5. Benefits of Multi-Agency MembershipConsortium Advantages of Forming a Consortium

6. Benefits of Multi-Agency MembershipConsortium Provides Quality of Care Benefits • Promotes consistent assessment, planning & service documentation • Person-Centered and Strengths focus • Recovery/Resiliency focus • Promotes Information Sharing • Promotes effective collaboration with other providers & shared terminology for use by different disciplines • Less room for error; Decision support • Helps avoid common first-generation “enterprise” system error of automating current practice Vs. best practice 6

7. Benefits of Multi-Agency MembershipConsortium Provides Clinical Practice Benefits • Compliant with Federal Mandate for Electronic Health Records by 2014 & a wide variety of regulatory and payer requirements • Assists in protection against federal/state audit paybacks • Wide array of funders/payers support this initiative • Enhances Measurement & Outcomes Focus • Local Benchmarking (Pros & Cons) • Ultimately individual agencies are able to access a more sophisticated software system (with a higher level of consulting and implementation support) as a consortium member.

8. Benefits of Multi-Agency MembershipConsortium Financial Benefits • Standardized training to reduce costs • 2/3 of Implementation Services can be jointly delivered • Compliant with a wide variety of regulatory and payer requirements • Some protection against federal audits • Saves time and money • Reduces cost of individually developed EMR capacity at each provider agency • Reduces redundancy in collecting information • Concurrent documentation possible • Standardized revisions and updates in future

9. Benefits of Multi-Agency MembershipConsortium

10. Benefits of Multi-Agency MembershipConsortium $1,000,000.00 Was the difference/savings over 5 year period for the GA Consortium to create and utilize an ASP system as an IT Consortium.

11. Service Delivery Process Quality Care (ex. – Repetitive Paperwork, Meetings, long wait times, etc.) Benefits of Multi-Agency MembershipConsortium Delivery System Decision

12. Quality Care Benefits of Multi-Agency MembershipConsortium Delivery System Setup Service Delivery Process (ex. – Non Repetitive Paperwork, Fewer Meetings, Shorter Wait Times, etc.)

13. Benefits of Multi-Agency MembershipConsortium Form Reduction Examples: Case Study – Organization in Georgia: • After the mapping process, the organization was able to remove 66% of their assessment questions as they were not required by any funding source or accrediting body. Case Study – Organization in Illinois: • Was asking 252 questions of every client seen as a crisis event • After the mapping process, crisis workers will now only ask 35 questions, unless the client needs to be hospitalized.

14. Benefits of Multi-Agency MembershipConsortium • Access Redesign Grant Change Points - • Concurrent Documentation: Eradicating post session documentation time while increasing client buy-in for their care by involving them more and creating documentation that is much more compliant to assist with auditing concerns. • Walk-In Models: Offering more expedient access to care which helps increase engagement by reducing wait times and works to eradicate/greatly reduces no shows. • No Show Management: Work through policy changes and counseling clients to increase show rates/client engagement. • Maximizing Staff Productivity: Helping direct service staff maximize their time with clients by reducing the amount of time they spend performing non-billable activities.   • Employee Engagement: How providers were able to get staff buy in to changes

15. Benefits of Multi-Agency MembershipConsortium • Extrapolating this savings across all organizations who started the pilot would equate to an annual savings of $9,599,492.56

16. Assessment Appointment Trends by Days of Wait for all Centers (Over 16,000 Events) Days Wait

17. Benefits of Multi-Agency MembershipConsortium How do Consortiums Work?

18. Benefits of Multi-Agency MembershipConsortium Consortiums work to create a standardized practice model that utilizes a standardized form set to capture the data elements needed across multiple service delivery areas within an individual agency and/or multiple agencies in a regional or statewide standardization effort. Having this standardization work completed upfront represents 80% of the configuration associated with an EMR implementation and creates a much more favorable environment for the layout and design phases to go smoothly. Having the tough decisions made before coding starts works to ensure that the consortium’s members do not have to make a significant number of decisions that will affect their service delivery system on the fly; which effectively works to help combat some of the EMR implementation challenges that we have seen nationally. Example: An organization in Oregon worked to create 17 separate and unique interfaces for it’s new EMR to accommodate the paper model previously in place. 18

19. Benefits of Multi-Agency MembershipConsortium Who should form a Consortium?

20. Benefits of Multi-Agency MembershipConsortium All service delivery disciplines are eligible for this kind of effort. Form sets have been created and are currently in use every day around the country that encompass multiple service delivery areas like: • Mental Health • Substance Abuse/Detox • Emergency Care • Psychiatric Treatment • Community Support • Residential • Respite • Supported Employment • DD/MR • Transitional Services

21. Benefits of Multi-Agency MembershipConsortium

22. Benefits of Multi-Agency MembershipConsortium How Do I Form a Consortium?

23. Benefits of Multi-Agency MembershipConsortium • Ideal Traits for a Consortium Partner? • Structure of the Consortium • What type of agency should I avoid? • Entrepreneurial Opportunity? • ASO (larger provider provides administrative services to smaller agencies in your region) • What about inter-operability? • RHIO opportunity • The right software makes all the difference

24. Benefits of Multi-Agency MembershipConsortium • The right software makes all the difference • Get to know all of the players • Seek a lot of feedback from current users • Know what kind of functionality will work best for your organization – • Onsite Install vs. Internet Based: “The wave of the future is software delivered over the Internet rather than installed on company owned desktops and servers.” (Source: Money Magazine, January/February 2010 Issue) – but what works best for you?

25. Benefits of Multi-Agency MembershipConsortium

26. Benefits of Multi-Agency MembershipConsortium Case Studies: Consortium Success Stories

27. Presenter Michael Earl, President/CEO Oakland Family Services February 9, 2010 2

28. The Alliance: Who We Are 2

29. External Environment - 2005 • Economic Issues in SE Michigan • Struggling automotive sector • Rising unemployment • Forecasted economic contraction • Issues Affecting Non-Profit • Sector • Fewer grants & donations • Increased demand for services • Increasing pressure on existing resources Private, non-profit agency Time to think and act differently!

30. Internal Environment of a Non-profit Organization Increased operating complexity; do more with less

31. Now Multiply That Complexity by Four! • Redundancy • Inefficiency • Resource drain • Limited access • Mission creep

32. Efficiency: Consolidated Purchasing and Elimination of Redundancies Example: joint purchase and implementation of an Electronic Client Records System Savings for Alliance $271,000 ECR Start-Up Cost Comparison Shared FTE for systems administration Standardized processes and forms to support behavioral health practices Cost Per Agency 56.45% Cost Savings 8

33. Efficiencies & Features Risk Management QI Service Utilization Administrative

34. GAIT GEORGIA INFORMATION TECHNOLOGY CONSORTIUM

35. A presentation by: Glyn Thomas, Executive Director, Satilla Community Services www.satillacs.org

36. Topics for today • History and origins of GAIT Consortium • What worked well, and what didn’t • The challenges • Lessons learned • Recommendations

37. History and evolution • Six Georgia agencies all on the same electronic medical record (client server) • Common experiences • Good reports and billing modules • Non-intuitive and cumbersome clinical work-flows • Slow and inefficient for clinical end-users • Technically challenging to set up and maintain • Search for solutions via vendor’s user group

38. History and evolution • Non-intuitive and cumbersome clinical work-flows were the biggest problem • Creating an authorization request for batch submission took 2 hours in the EMR versus 40 minutes on payor’s website • EMR was “unforgiving” – data entry errors were easy to make, and time-consuming to fix. • Many items of data had to be entered multiple times. • Complex system navigation requirements discouraged concurrent documentation • Different set-ups across agencies restricted opportunities to share resources

39. History and evolution • Brief discussion of options confirmed that collectively agencies lacked expertise to make informed choices • RFP for consulting services to: • Determine our minimum data requirements for clinical and business operations • To standardize our work processes • To optimize our use of our electronic medical record • MTM Services selected as consultants

40. History and evolution • Clinical work flow team defined data requirements and optimum work flows • Technology team identified hardware options: • Software as a service – (ASP model) • Client server • Consortium server • Reached agreement on GAIT Consortium requirements for EMR

41. History and evolution • Issued RFP to the current vendor we were using at that time along with five alternate vendors. • Reviewed proposals for pricing and goodness-of-fit to GAIT Consortium’s clinical work flow requirements. • Selected Qualifacts as vendor for CareLogic system and software-as-a-service • Contracts signed February 2009- Go Live July 2009

42. What worked well • MTM Services Consultant Scott Lloyd provided good facilitation, helped set objectives, and provided needed information • Splitting into two work teams: • Technology • Clinical Work Flows • Setting and keeping to a timeline • Shared vision, goals and objectives

43. What worked well • Building “social capital” • Having the right people with the right skills on the work teams • Defining data requirements before addressing software questions • Brainstorming for solutions • Allowing graceful exits – 2 agencies left the consortium for lack of ‘organizational readiness”

44. What worked well • Clinical workflows well-received by clinicians • Evident efficiency gains for direct care staff • Qualifacts easier to learn and easier to use than previous system • System is more accessible in the community or for staff working from home • System is fast (given good internet connection)

45. The challenges • Different accreditation requirements across agencies (CARF and JCAHO) complicates standardization of work processes • Changes of personnel in the Consortium work teams very disruptive • Governance Boards may be skeptical of the consortium’s potential benefits – weakens agency engagement

46. The challenges • Aggressive timeline allowed set-up mistakes • Billing module and reporting currently less powerful (more labor intensive) than desired – enhancements “in the works” • Debugging some of the Georgia-specific components for authorizations and claims took some time

47. Lessons learned • The importance of “social capital” • Organizational “readiness” • Adequate resources (personnel and financial) for Consortium activities • The value of good consultation services • Leadership commitment

48. Recommendations • Assess your organizational readiness • Engage your Board • Prioritize the needs of direct care personnel • Pick your team carefully with regard to expertise and temperament • Be patient • Engage a consultant to facilitate the process • Focus on the long-term benefits

49. The prize! • A more efficient and user-friendly system for direct care staff (the majority of your users) • Cost and resource sharing • Efficiencies of well-planned and standardized work-flows • Leverage with vendors and with state

50. Growing your consortium • Benefits: • Greater leverage with state • Stronger negotiating position with vendors • Challenges: • Integrating new members • Sharing already acquired collective experience • Some ideas: • Screen potential members for “organizational readiness” • Use new member fees to pay for Consortium “project expeditor” • Require new members to implement the system “as is”, but allow new members equal status once implemented