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Health Care Trends

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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  1. Suzanne Clifford, CEO Inspiring Transformations Health Care Trends Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  2. Key Trends and Possibilities for Health Care Reform Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  3. 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, Clifford@InspiringTransformations.com, 317-507-0075

  4. 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, Clifford@InspiringTransformations.com, 317-507-0075

  5. 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, Clifford@InspiringTransformations.com, 317-507-0075

  6. Drivers of Change (cont.) • Affordable Care Act or its evolution • “Disruptive” medical & technological • innovation Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  7. 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, Clifford@InspiringTransformations.com, 317-507-0075

  8. 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, Clifford@InspiringTransformations.com, 317-507-0075

  9. Key Strategic Planning Questions Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  10. 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, Clifford@InspiringTransformations.com, 317-507-0075

  11. 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, Clifford@InspiringTransformations.com, 317-507-0075

  12. IN Integrated Care Action Alliance Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  13. 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, Clifford@InspiringTransformations.com, 317-507-0075

  14. 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, Clifford@InspiringTransformations.com, 317-507-0075

  15. Process map of integrated care in community mental health centers Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  16. Process map of integrated care in federally qualified health centers Suzanne F. Clifford, Clifford@InspiringTransformations.com, 317-507-0075

  17. 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, Clifford@InspiringTransformations.com, 317-507-0075

  18. 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, Clifford@InspiringTransformations.com, 317-507-0075

  19. 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, Clifford@InspiringTransformations.com, 317-507-0075

  20. 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, Clifford@InspiringTransformations.com, 317-507-0075

  21. 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, Clifford@InspiringTransformations.com, 317-507-0075

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