National Council for Behavioral Health

1. National Councilfor Behavioral Health Hill Day Realizing the Promise of Health IT for Behavioral Health Michael R. Lardiere,LCSW VP HIT & Strategic Development September 16, 2013

2. This presentation at a glance • Role of data in the healthcare system of the future • How will information be used and data shared under health reform • Using Data for Population Management • Health Information Exchange/DIRECT Secure Messaging • Meaningful Use – opportunities now • Meaningful Use – Opportunities in the Future • Strategies to Position your Organization

3. Innovations under CMS • Payment reform; fundamental shift away from fee-for-service • Delivery system reform: encourage reorganization of system to take out waste and deliver high‐value care • Different opportunities for providers based on readiness • Strategic partnerships with data • Robust quality monitoring • Emphasis on multi‐payer strategies and approaches Jonathan Blum, CMS

4. …and from a business planning perspective • Shifts in revenue sourcesas more people become eligible and enroll in new insurance options • Increased competition as health providers meet new value-based purchasing standards built on health system partnerships and accountability for clinical outcomes

5. Connect with other providers • Coverage expansions are ONLY sustainable with delivery system reform • Collaborative Care • Patient Centered Healthcare Homes • Accountable Care Organizations • Accountability and quality improvement are hallmarks of the new healthcare ecosystem

6. Using Data for Population Based Interventions

7. Sharing Information is the Standard • Health Information Exchange RULES! • Integration and improved outcomes will only be successful if we can share information

9. Table of top cost by diagnosis, January-March,2006

10. Cost By Service Type

11. Cost Data by Primary Diagnosis

12. Using Data for Individual Interventions

13. High Utilizer Report • 3 consumers with an average cost of $272,652 each • Drill down: Consumer with brittle diabetes and personality disorder - frequent ER and inpatient • 4 consumers with average cost of $236,434 each • Drill down: Consumer with SUD without motivation & personality disorder; multiple complex medical conditions • 4 Consumers with average cost of $85,867 each • Drill down: Consumer with SUD- frequent detox ;lack of community services

14. Case #1

15. Case 1: Continued

17. Measuring Disparities

18. CDC Sortable Stats http://wwwn.cdc.gov/sortablestats

19. Chronic Medical Conditions •  At Risk Criteria • Blood pressure combined • Systolic greater than 130 OR Diastolic greater than 85 • BMI • Greater than or equal to 25 • Waist circumference • Male, greater than 102 cm • Female, greater than 88 cm • Breath CO • Greater than or equal to 10 • Fasting Plasma Glucose • Greater than 100 • HgbA1c • Greater than or equal to 5.7 • Cholesterol • HDL, less than 40 • LDL, greater than or equal to 130 • Triglycerides, greater than or equal to 150 • Others that the organizations determine

28. Sharing Information is the Standard • Health Information Exchange RULES! • Integration and improved outcomes will only be successful if we can share information

29. Flavors of Health Information Exchange

30. September 9, 2013 Office of the National Coordinator (ONC) Issued: Certification Guidance for EHR Technology Developers Serving Health Care Providers Ineligible for Medicare and Medicaid EHR Incentive Payments

31. Purpose: Guidance is meant to serve as a building block for federal agencies and stakeholders to use as they work with different communities to achieve interoperable electronic health information exchange.

33. Exchange Among Providers in One system Somewhat Difficult but Occurring Nationally

34. Exchange Among Providers in Multiple Systems More Difficult but Occurring Nationally

35. Secure Messaging Exchange Uses DIRECT Protocols Meets Meaningful Use Requirements Easy I encourage ALL providers to obtain and DIRECT Address!! Even if you DO NOT have an EHR!!

36. Addressing Confidentiality • Common Barrier • If not addressed, promotes stigma • RI leads the nation through its work with the SAMHSA/HRSA Center for Integrated Health Solutions • MH & SU Information can be shared securely in RI • KY will follow soon • There are ways to work within 42 CFR Part 2

37. Meaningful UseOpportunities Now

38. Revised Definition of CEHRT Effective Dates There is no such thing as being “Stage 1 Certified” or “Stage 2 Certified” – 2014 Edition EHR technology would be able to support the achievement of either meaningful use Stage.

39. 2014 Edition CEHRT Easy as 1, 2, 3 + C* EP/EH/CAH would only need to have EHR technology with capabilities certified for the MU menu set objectives & measures for the stage of MU they seek to achieve. What varies is the quantity of EHR technology certified to the 2014 Edition EHR certification criteria that would be necessary to be used to meet MU EP/EH/CAH would need to have EHR technology with capabilities certified for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP/EH/CAH can meet an exclusion. Base EHR 1 EP/EH/CAH must have EHR technology with capabilities certified to meet the Base EHR definition.

40. 2014 Edition EHR Certification Criteria Mapped to the 2014 CEHRT Definition for EHs & CAHs Seeking to Achieve MU Stage 2 in and after CY 2014 • 2014 Certification Criteria associated with a Base EHR: • CPOE (170.314(a)(1)) • Demographics (170.314(a)(3)) • Problem list (170.314(a)(5)) • Medicationlist(170.314(a)(6)) • Medicationallergylist(170.314(a)(7)) • Clinicaldecisionsupport(170.314(a)(8)) • Transitions of care (170.314(b)(1) & (2)) • Data portability (170.314(b)(7)) • Clinical quality measures (170.314(c)(1) - (3)) • Privacy and Security CC: • Authentication, access control, authorization (170.314(d)(1)) • Auditable events & tamper resistance (170.314(d)(2)) • Audit report(s) (170.314(d)(3)) • Amendments(170.314(d)(4)) • Automatic log-off (170.314(d)(5)) • Emergency access (170.314(d)(6)) • End-user device encryption (170.314(d)(7)) • Integrity (170.314(d)(8)) • Accounting of disclosures* (170.314(d)(9)) 2014 Certification Criteria associated with MU Core Stage 2: • Drug-drug, drug-allergy interaction checks (170.314(a)(2)) • Vital signs, BMI, & growth charts (170.314(a)(4)) • Smoking status (170.314(a)(11)) • Patient list creation (170.314(a)(14)) • Patient-specific education resources (170.314(a)(15)) • eMAR (170.314(a)(16)) • Clinical information reconciliation (170.314(b)(4)) • Incorporate lab tests & values/results (170.314(b)(5)) • View, download, & transmit to 3rd Party (170.314(e)(1)) • Immunization information (170.314(f)(1)) • Transmission to immunization registries (170.314(f)(2)) • Transmission to PH agencies – syndromic surveillance (170.314(f)(3)) • Transmission of reportable lab tests & values/results (170.314(f)(4)) • 2014 Certification Criteria associated with MU Menu Stage 2: • Electronic notes (170.314(a)(9)) • Drug-formulary checks (170.314(a)(10)) • Image results (170.314(a)(12)) • Family health history (170.314(a)(13)) • Advance directives (170.314(a)(17)) • eRx (170.314(b)(3)) • Transmission of e-lab tests & values/results to providers (170.314(b)(6)) 2014 ed. certification criteria for which certification may be required: • Automated numerator recording (170.314(g)(1)) • Automated measure calculation (170.314(g)(2)) • Safety-enhanced design (170.314(g)(3)) • Quality management system (170.314(g)(4)) * optional

41. Do you have EHR Technology that meets the new Certified EHR Technology definition for Meaningful Use Stage 1? START HERE Do you have a 2014 Edition Complete EHR for the Ambulatory (EPs) or Inpatient (EHs/CAHs) Setting? Is your EHR technology certified to the following certification criteria to support the MU1 EP Core Objectives you seek to achieve and for which you cannot meet a MU exclusion? § 170.314: (a)(2) – DD/DA (b)(3) – eRx (a)(4) – Vitals (e)(1) – VDTx3 (a)(11) – Smoking (e)(2) – Clinical Sum Is your EHR technology certified to the following certification criteria to support the MU1 EP Menu Objectives you seek to meet? § 170.314: (a)(10) – RxFormulary (b)(5) – Incorp Lab (a)(14) – Pt List (f)(1) – Immz Info (a)(15) – Pt Edu (f)(2) – Immz Tx (b)(4) – ClinInfoRec (f)(3) – Syn Surv Do you have EHR technology that has been: Certified to ≥ 9 CQMs  ≥ 6 from CMS’ recommended core set  Address ≥ 3 domains from the set selected by CMS for EPs? Is your EHR technology certified to the following certification criteria required to meet the Base EHR definition? § 170.314: (a)(1),(3)&(5-8) – CPOE/Demogfrx/ProbList/ MedList/MedAllergyList/CDS (b)(1),(2)&(7) – TOC/Data Port (c)(1)-(3) – CQMS (d)(1)-(8) – P&S Is your EHR technology certified to the following certification criteria to support the MU1 EH/CAH Menu Objectives you seek to meet? § 170.314: (a)(10) – RxFormulary (b)(5) – Incorp Lab (a)(14) – Pt List (f)(1) – Immz Info (a)(15) – Pt Edu (f)(2) – Immz Tx (a)(17) – AD (f)(3) – Syn Surv (b)(4) – ClinInfoRec (f)(4) – ELR Is your EHR technology certified to the following certification criteria to support the MU1 EH/CAH Core Objectives you seek to achieve and for which you cannot meet a MU exclusion? § 170.314: (a)(2) – DD/DA (a)(11) – Smoking (a)(4) – Vitals (e)(1) – VDTx3 • Do you have EHR technology that has been: • Certified to ≥ 16 CQMs from CMS’ selected set for EH/CAHs •  Address ≥ 3 domains from the set selected by CMS for EH/CAHs? EH/CAH Note: To meet the CEHRT definition, EHR technology will need to have been certified to:  Automated numerator recording (170.314(g)(1)) or Automated measure calculation (170.314(g)(2));  Safety-enhanced design (170.314(g)(3)); and  Quality management system (170.314(g)(4))

42. Stage 2 Resources CMS Stage 2 Webpage: • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Links to the Federal Register Tipsheets: • Stage 2 Overview • 2014 Clinical Quality Measures • Payment Adjustments & Hardship Exceptions (EPs & Hospitals) • Stage 1 Changes • Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

43. Clinical Quality Measures

44. CQM Alignment with HHS Priorities All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains: • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

45. CQMs in 2014 and Beyond CQMs change in 2014: * Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014.

46. Clinical Quality Measures Behavioral Health Specific Clinical Quality Measures