February 2016 BHLG Record of Learning

Behavioral Health Learning Group February 10, 2016 Record of Learning

Behavioral Health Participants • John Campo MD, OSU Wexner Medical Center • Duane Casares, Directions for Youth and Families • Jamie McKenna, Directions for Youth and Families • Dustin Mets, CompDrug • Joe Niedzwiedski, North Central Mental Health Services

• • • • •

Coordinated by:

Anthony Penn, Columbus Area Integrated Health Services Jim Schmidt, OhioHealth King Stumpp, Netcare Access Dale Svendsen MD, OSU Wexner Medical Center Staci Swenson, PrimaryOne Health

Healthcare Collaborative of Greater Columbus • Michelle Missler • Krista Stock

NOTES Topic Discussion – Briefing: The National Quality Strategy – Why? What?

(Materials: NQS overview, NQS alignment snapshot)

What are your reflections or questions of clarity?

Learning from the discussion: ü A lot happening so framework helps to identify where there is the most interest and discuss where to go next. ü BH leaders have an opportunity to encourage funders to align with measures. ü This is good for self-assessment. Many are trying to keep head above water. But we recognize we need change to be effective. ü NQS framework providers a useful “lense” which helps understand where there has been progress and where there are still opportunities to improve. Can see where there are deficiencies in systems and where we can do better. ü Recognition that BH is somewhat behind in advancing quality work. ü There is still a culture of secrecy about quality performance; leaders will have to push hard for transparency. This will be challenging, but there is progress. ü Opportunity to move away from process measures toward more outcomes measures to understand what success looks like. ü Current quality work is focused on satisfying funders and payers and measures are not consistent. ü Multi-stakeholder representation in developing programs and initiatives is important to avoid disconnect and to help align to three aims. ü Overall there is not alignment across layers of care and payment.

ACTION ITEMS

HCGC and participants will incorporate learning into quality improvement work.

NOTES Shared Learning Discussion - Explore the Snapshot of Quality Improvement initiatives

What quality improvement activities should we consider adding to the snapshot? Which initiatives should we spend more time exploring as a Behavioral Health Learning Group? What opportunities exist for behavioral health providers to align with the NQS?

Learning from the discussion: ü Payment: Currently aware of readmission penalties, meaningful use. Need to learn more about pay-forperformance in the behavioral health industry. What are the various models? Is there a matrix to help understand? Will be important to help fund use of other levers. BH care will heavily impact payment in valuebased reimbursement system. Billing data can help create picture of provider’s work. Progress has been made using blended rates. New payments models may interfere with team-based care models. ü Public reporting: fear that organizations will lose funding if data is made public. We put patients at risk when we are not transparent. Reframe thinking about public reporting as doing what is best for the patient. Recognize where there is connection to payment, but “hold harmless” to encourage better reporting. Engage agencies to ensure alignment (i.e., ADAMH, OHMAS) ü Learning and technical assistance: BH professional associations currently provide resources here. (i.e., Ohio Council) Opportunity to further explore available resources. How does these align? ü Certification, accreditation, and regulation: Opportunities through JCAHO, FQHC, CARF. Is there alignment? What is the ROI for certifications? ü Consumer incentives and benefit designs: Little is understood about use of this lever as it relates to BH. What is happening now? How can we better engage patients to help them better manage their own care? ü Measurement and feedback: Data is powerful. Must be meaningful. How to use risk stratification to better understand progress? Important to use the right measures to help gauge success. Recognize pressure on providers to increase “clicks” to input data which takes away from the patient. ü Health information technology: How do we ensure patients don’t fall through the cracks? How can BH and primary care better connect? ü Workforce development: Current work is MEDTAPP, Star. Recognize there are gaps in workforce development.

There is lack of awareness about what is possible in primary care to integrate behavioral health care. ü Innovation and diffusion: Telemedicine, psychiatric emergency services. ü Other: o Where does patient engagement fit in? How do we weave patient-centeredness into all of the levers? o How effective are current QI initiatives? Do they work? How can they better align?

Next learning group session will be May 11, 2016, 9:00-10:30AM

ACTION ITEMS

HCGC/BHLG incorporate learning to help shape agendas for future work sessions based on areas where participants would like to learn more.