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Emerging Models of Integrated Care Coordination

As behavioral health providers strategize on where they can fit in healthcare reform, I see care coordination as an obvious role where many providers could thrive. Central to healthcare reform is improved coordination and navigation of the complex healthcare delivery system to ensure whole-person, whole-life prevention, early intervention, supports, and care. Some of the models for care coordination read like good old fashion social work, while other more intensive models sound like modified ACT teams.

Sure, to really excel at this “new” care coordination, behavioral health providers will need to makes some changes but bottom line, this work should be in the wheelhouse of behavioral health core competencies. Likely behavioral health provider development needs include:
~ Shift of staff resources from “therapies” to care coordination
~ Robust training, development, and supervision in medical management
~ Effective partnering with primary care organizations
~ State of the art care coordination data management system

The Institute for Healthcare Innovations published a white paper in 2011 IHICareCoordinationModelWhitePaper2011 which provides a great overview of successful care coordination models.

New Proposed Meaningful Use Recommendations

On January 12, the Health Information Technology Policy Committee published its proposed Stage 2 and 3 Meaningful Use recommendations for public comment.  The comment period ends Feb. 25 and the Health IT Policy Committee will consider all of the comments in making its final recommendations this summer to the Office of the National Coordinator for Health Information Technology at HHS.  It’s helpful to have at least some general direction where the MU requirements may be headed after 2012.  The link below has a good summary.  http://geekdoctor.blogspot.com/2011/01/proposed-stage-2-and-3-meaningful-use.html

EHR Return on Investment Webinar

Parker Dennison and Qualifacts Systems, Inc. hosted a webinar on January 21, 2011 discussing the return on investment analysis on implementing an electronic health record for behavioral health.  Presenters Susan Parker and Craig Fair, discussed:

  • Operating metrics that will be positively influenced with the use of an EHR
  • How you can predict the impact on your bottom line
  • Examples of behavioral health providers who have experienced net financial improvement as a direct result of implementing an EHR

Download the handouts from this presentation here.

Goodbye UR, Hello “Quality Improvement”

With the interim final rule (MLRFinalInterimRule 11-22-2010) defining allowable costs to meet the health plan medical loss ratio (MLR) requirements under healthcare reform published on December 1, 2010, the federal Department of Health and Human Services (HHS) has given the managed care industry a significant incentive to evolve their utilization management practices.  Under the Rule, health plans can include the costs of quality improvement activities as a medical expense toward the MLR, but not the costs of retrospective and concurrent utilization reviews.

Some health plans will no doubt attempt to re-label and slightly modify UR activities and argue that it is quality improvement but the most plans will likely shift focus to more pro-active care management, and clinical consultation for protocol outliers.  This will also be consistent with the growing focus on evidence-informed and evidence-based practices.

Now is the time for providers to start the process of revamping their own utilization review processes to focus on quality improvement rather than utilization controls or singular cost containment.

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