winning business and improving care outcomes · 2017-11-10 · patient diagnosed with schizophrenia...
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Winning Business and Improving Care
Outcomes
Dr. Carol Clayton and Thomas
Friedman III, MPA
Our Mission
Relias strives to
measurably improve the
lives of the most
vulnerable members of
society and those who
care for them.
The Relias Foundation and Evolution
Behavioral Health, IDD, Corrections,
Law Enforcement
PT, OT, SLP Post-Acute Care
Post-Acute CarePost-Acute Care Post-Acute Care, Therapies
Autism
Acute Care: Hospitals,
Military Hospitals
Acute Care:
Publications, CE, CME
Analytics Assessments,
Data Analytics
Acute Care,
Post-Acute Care
Hospice
Analytics
The new world of healthcare is
creating a critical demand for high-
performing organizations.
Why Relias is Evolving: Meeting the Demands of your
Work Environment
The Evolution of Relias Content
Compliance
• Regulatory
• Annual requirements
Professional Development
• Continuing Education
• Staff Development
Strategic
• Care Delivery
• Changing Reimbursement structures
5
The Evolution of Relias’ Market
Emergency
Departments
Hospitals
HomeWellness
Centers
Physician &
Specialty
Offices
Urgent Care
Centers
Diagnostics,
Lab, Rad
Ambulatory
Procedure
Centers
Inpatient & Outpatient
Rehab/Treatment Centers
Extended Care Facilities
Assisted Living
Home,
Home Health & Hospice
Skilled Nursing
Care Coordination, Managed Care
Behavioral
Health Care
Pre-Acute Acute Post- Acute
Continuum
Ac
uit
y
Intellectual and Developmental Disabilities
Market participant Market leader
The History of CMT, a Relias Learning Company:
“When Chocolate Meets Peanut Butter”
Phase Two – Using Data to Drive Quality of Care
7
# 8
CMT’s Analytic Solution:
Population Health, Clinically Driven, Evidence-Based
Patient
Population
Payers,
and
Behavioral
Care
Providers
# 9
CMT: 15 Years of Clinical and
Technical Innovation
.Net Workflow
Clinical Data Warehouse
Online Analytics
2002 2006 2011 2014
Opioid Risk Reduction Analytics
Population Health Analytics
Risk Stratification; Risk Modeling
Provider and Patient Adherence Solutions
Integrated Care Gap Alerts
Behavioral Pharmacy Best
Practice Solutions
Performance Measurement
Medical Services Claims Processing
Web Based
Intervention and
WorkFlow Support
Non-claims Data
Integration
HIE Integration
EHR Interoperability
2018
CCBHC Measures
IDD Health Alerts
Care Coordination
Tools
Data Driven Care and
Training
Across the HealthCare
Continuum
Relias Is Ready to Address Future Demands
• Population Health Management tools
• Risk Stratification Capabilities
• Data Use and Data Transparency
• Decision Support Tools
• A Data Driven Value Story
• Organizational Change—workforce and
technology enhancements
CMT: Data Tells the Value Story
11
3.5 years
12%
46%
61%
80% 80%88%
97%
0%
20%
40%
60%
80%
100%
120%
Metabolic Syndrome Screening(All HCH Enrollees)
Feb'12BaselineFeb'1312 MonthsJune'1318 MonthsJan'142 YearsJune'142.5 YearsAug'153.5 YearsNCMMCAug'15
76%
10/
CMT supports the two most prominent Medicaid Health Homes
in the nation.
• Saved over $36M year one (10:1
ROI)
• Saved close to $100 million over five
years
• Reduced hospitalizations by 31%
in the first year
• Reduced duplicative prescribers
by 17%
• Awarded “Patient Registry” Data
Analytics contract OK BHH for
Children
Partnership Value Story
Data Tells/Stories Sell –The Missouri Story
2015
The National Association of State Chief Administrators (NASCA) selected Missouri Health Homes as their 2015 Case Study conducted by Harvard University
The American Psychiatric Association (APA) awarded the Missouri CMHC Health Home program the Psychiatric Services Gold Achievement Award
2008
SAMHSA Science and Service Award - For the implementation of one or more evidence-based interventions improving psychiatric prescribing practices.
URAC Best Practices in Consumer Empowerment and Protection Award; -Health Information Technology Category: Silver Award, “Behavioral Pharmacy Management Program”
2006
American Psychiatric Association Bronze Achievement Award - Improving psychiatric prescription practices
13
Relias’ High Performance Model Driving Results Across the Continuum of Care
Pre-Acute Acute Post- Acute Behavioral Health
Assessments: We Don’t All Have the Same
Education Needs.
• As Relias moved beyond compliance, we wanted to
respect the learner’s time.
• “Physicians spend two hours doing administrative tasks
for every hour spent working with patients such as EMR -
- and they likely spend another 2 hours at home doing
charts or working with families.” • We need to analyze what people need to learn.
15
Assessment-Driven Learning Approach
16
PCP PA NP RN
Assess1
Deploy robust clinical knowledge assessment at high-
risk practices
Identify knowledge gaps across your network….
…and at the clinician level
System-wide low
scores on med rec
best practices
Dr. Johnson
Nurse Kim
Dr. Fleming
Teach2
Clinicians receive personalized online education
based on individual needs
Personalized Learning Path for Dr. Fleming
• Antidepressant medication management
• Blood pressure screening
• Cardiac rehab referral
• …
+
Relias recommends additional coaching and
remediation for low performers
Scenarios
17
Dr. Johnson Nurse Kim Dr. Fleming
11 "snacks" = 55 minutes 28 "snacks" = 2.3 hours6 "snacks" = 30 minutes
Dr. Johnson has been
part of the hospital for
20 years
Nurse Kim graduated top
of her class
Dr. Fleming is returning to
practice after a hiatus
As
se
ss
me
nt
pro
file
Focus training on the new
topics and able spend more
time with patients
Focus training on stimulations
that apply knowledge and
concepts
Combination of refreshers
and stimulations that
practice critical thinking
Total Solution –Using Data to Drive Care
Improvements and Workforce
Competency Enhancement.18
“Across the country anyone you talk to
wants to know – ‘How do we drive out
unwanted clinical variation?’ One
aspect is creating processes in the EHR
and clinical decision support tools. But
another aspect is how to change
continuing education to make it
meaningful and drive change…Whether
it’s the business side or clinical
leaders, driving out clinical variation
is a top 3 strategic priority regardless
of whether the organization is still
100% fee for service or shifting to
value. Driving out risk is variation is
critical to safety, patient satisfaction, and
the bottom line.”
What do people need to do? What do they need
to know to accomplish it?
• It is one thing to improve your skills, it is another to
improve performance
• Especially in value-based reimbursements
• Start with Analytics
• Figure out what you need to do better to improve care and
succeed in value based reimbursement, then assess where your
staff is, then train
19
Improving Care for People with ReliasThe Opioid Epidemic
Improving Work Force Performance with ReliasThe Opioid Epidemic
Identify issues before they become victims
Using Machine
Learning and Risk
Prediction Modeling,
all patients in a
population filling an
Opioid Rx the last 90
days are evaluated
using clinically
identified risk factors
to determine potential:
1. % Risk of
Problematic Opioid
Use - next 90 Days
2. % Risk of Overdose
3. Regional breakouts
4. Provider level
breakouts
Option to Export a list of patients for intervention
Available to CMT Clients Q1 2018 and
all Analytics Clients 2H 2018
• History and Evolution of Pain Management and
Opioid Use In America
• Overview/Introduction to Opioid Abuse
• Clinical Practice Guidelines for Prescribing Opioids
• Opioids: Behavioral Health Literacy for the Primary
Care Provider
• Emerging Practices in Opioid Addiction Treatment
Relias Library – Care Team Instruction. Assign in a Data
Driven Work Flow.
# 24
Analytics and Brief Education Impact on Gateway
Opioid Outcomes
Use of Opioids for 60+ Days in the Absence of a
Diagnosis Supporting Chronic Use in Adults decrease of
17%
Use of Opioids for 60+ Days in the Absence of a
Diagnosis Supporting Chronic Use in Elderly Adults
decrease of 14%
Multiple Prescribers of Opioids Without a Malignant
Cancer Diagnosis decreased by 11% (p=0.07)
Jun 2013 Jan 2014
CMT opioid intervention
Jun 2014
Randomized control trial over 6 month period found
statistically significant 21% decrease in triggering post
intervention.
0%
20%
40%
60%
80%
100%
Intervention
Opioid Campaign – Education Plus Analytics
Hospital admissions reduced 17.2%
Average number of opioid prescribers per capita down 19.5%
Average number of opioid pharmacies per capita down 18%
Average monthly dose of opioids (in morphine equivalents)
dispensed reduced 10%
$800,000 in annual savings
Jan 2012 Feb 2013
CMT opioid intervention
Apr 2014
Services for 55,000 enrollees in Missouri State Medicaid
Agency studied over 8 intervention cohorts.
Relias Case Study
Macomb County MI PIHP
26
Macomb County MI PIHP: Targeted Measures
ProAct Measure # HEDIS/Community Health Measure Description
902Adherence to Antipsychotic medications for individuals with Schizophrenia (SAA)
904
Presence of a diabetes screening test during the measurement year for a patient diagnosed with schizophrenia or bipolar disorder who was dispensed an antipsychotic medication
931Presence of a HbA1c and LDL-C tests during the measurement year for a patient diagnosed with schizophrenia and diabetes.
932Presence of a follow-up visit within 30 days after hospitalization for mental illness
933Presence of a follow-up visit during the 30 day initiation phase for 6-12 year old prescribed ADHD medication
936Use of two or more concurrent antipsychotic medications in children 1-17 years of age
940Presence of metabolic testing in children 1-17 years of age that had two or more antipsychotic medications
27
Custom Macomb Training Plan—Payer and Provider
28
Macomb Targeted Measures Course Title Hours
• Presence of a diabetes screening test during the
measurement year for a patient diagnosed with
schizophrenia or bipolar disorder who was dispensed
an antipsychotic medication
• Presence of a HbA1c and LDL-C tests during the
measurement year for a patient diagnosed with
schizophrenia and diabetes.
• A First Look Into Integrated Care for Primary Care Staff
• Managing Medicaid Members with Chronic Behavioral
and Physical Health Conditions
• Building Care Teams and Establishing Check Points:
Diabetes
• Payer Perspective: Diabetes Management
1.25
0.75
0.75
1.00
• Presence of a follow-up visit within 30 days after
hospitalization for mental illness
• Preventing Unnecessary Hospital Admissions and
Readmissions
1.00
• Adherence to Antipsychotic medications for
individuals with Schizophrenia (SAA)
• Psychotropic Medications: Antipsychotics and Beyond
• Medications Related to Schizophrenia and Other Psychotic
Disorders
1.00
1.00
• Presence of a follow-up visit during the 30 day
initiation phase for 6-12 year old prescribed ADHD
medication
• ADHD: Diagnosis and Treatment 2.00
Training Hours: 8.75
Sample Custom Training Plans: NCQA Quality Pathway
Subheading NCQA Code Course Title
Quality Improvement Activities QI6A • Diabetes and CVD: Metabolic Syndrome
• Laboratory Assessment: Cardiovascular Disease, Diabetes and
Metabolic Syndrome
• Behavioral Health Screening Tools
• Risk Screening best practices
• Substance Use Screening in the Emergency Department
QI8J • Quality Improvement: The Basics
• Advanced Quality Improvement for Leadership
Care Coordination QI8A
CC1:ABC&D
CC4A
• Chronic Disease Management: Systems that Effectively Address
Chronic Disease
• Care Coordination: Principles and Best Practices
• Integrating Care Series
EBP Care QI6C
QI8E
QI19A&B
QI10: Element
C
• Evidence Based Practices in Treating SUD
• Nutrition and Diabetes Evidence Based Research
• Nutritional Interventions -Nutrition and Diabetes Evidence Based
Research
29
“Just a shout out to say how
awesome the CMT team is. I
have sincerely never before
had the level of trust, faith,
respect I have for CMT with
any other IT vendor.”
Bradley Casemore, CEO SOUTHWEST MICHIGAN BEHAVIORAL HEALTH
“I have fantasized about the day a
mental health clinician could print
out a histogram of metabolic
screening data in order to activate
good care. Well, voila! I have it at
my fingertips with the CMT ProAct
Tool.”
CEO LARGE MIDWESTERN CMHC AGENCY
“[I] can get performance
specific reporting... I cannot
imagine trying to create an
I/DD health home without
access to CMT.”
Sam Hedrick, CEO RHA HEALTH SERVICES
“The SaaS Solution cut my time
in half for preparing reports.”
Stephanie G. Julian, RN
Assistant Director HCH/Nurse Care Manager BURRELL BEHAVIORAL HEALTH
“[This] is a process that promotes
evidence-based care while helping to
save valuable healthcare dollars.
NCCBH supports these kinds of
initiatives.”
Linda Rosenberg, President & CEONATIONAL COUNCIL FOR BEHAVIORAL HEALTH
Customer Stories
Assessment Tool
31
THANK YOU!
Carol Clayton, PhD111 Corning Road, Suite 250
Cary, North Carolina 27518
Direct: (919) 491-0819
cclayton@reliaslearning.com
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