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Better Data, Better Decisions, Better Outcomes: The Future is You! Tara Larson Cansler Collaborative Better Data, Better Decisions, Better Outcomes: The Future is You! Tara Larson Cansler Collaborative Resources NYSACRA and NYSRA Leadership Conference December 1, 2017 1

So what is the Vision? Managed Care? Block Granting? To use data? IT Systems So what is the Vision? Managed Care? Block Granting? To use data? IT Systems talking to each other? To do whole person care, all in an environment that has questions and uncertainty? How do all the dots fit together? 2

Sustainability thru Managed Care Increased Demand for Services and Supports Whole Person Care Medicaid Sustainability thru Managed Care Increased Demand for Services and Supports Whole Person Care Medicaid Transformation 3

Why is Data So Important Now? The shift to Managed Care for Individuals with Why is Data So Important Now? The shift to Managed Care for Individuals with IDD The shift to value based purchasing (VBP) or pay for performance (P 4 P) Whole Person Care 4

North Carolina - Managed Care and IDD The question in NC today is no North Carolina - Managed Care and IDD The question in NC today is no longer if IDD should be in managed care – IDD has been in managed care since 2006 (in one region) and statewide beginning in 2011. The discussion now is about how IDD fits into the broader picture…Medicaid and Healthcare ◦ Mandated requirements for Health Information Exchange The discussion for managed care is what do you want the health plans or regional plans to be required to do… ◦ The RFP ◦ The contract terms and conditions ◦ The transition period 5

Lessons Learned in NC About Data Providers of IDD services and supports, even though Lessons Learned in NC About Data Providers of IDD services and supports, even though part of the “behavioral health system” -unless it was clearly said “it” applied to IDD, the thinking was ◦ they were left out ◦ it wasn’t relevant ◦ didn’t pertain to the area. There was/is a need to do MUCH 101 training and technical assistance Financial and staff resources are not at the same level across the IDD providers as in behavioral health and certainly not healthcare There can be leveraging of training and expertise that can occur across systems but to assume one size fits all or to use “existing” PPTs will be problematic 6

Lessons Learned Examples must be IDD specific Set the date, flip the switch and Lessons Learned Examples must be IDD specific Set the date, flip the switch and not expect perfection Allow for correction within a reasonable timeframe Coordinate activity with licensing agency and policy agency ◦ Reduction in emergency room use example 7

What is the Data Vision and Getting There? Consensus on the Desired Outcome Started What is the Data Vision and Getting There? Consensus on the Desired Outcome Started out as a pilot in one health plan and is now rolling out health plan by health plan ◦ Health Plan in NC for Behavioral Health/IDD are the local management entities (LMEs) – Regional agencies that are at full risk Provide care coordination, UM, manage the provider network, contracting, pay claims, etc. ◦ Involved individuals, providers and practices 8

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Complex Care Management Data received from sources CCP Functions Care Coordination Platform Periodic Updates Complex Care Management Data received from sources CCP Functions Care Coordination Platform Periodic Updates • • Eligibility Enrollment Claims Medications Labs Health Risk Assessment SIS Etc. … • • • Shared Treatment Plan With Integrated Care Team Shared with Community Users Via Provider Portal or Direct Access Primary Care Providers Hospitals Key Integration Point Social Service Agencies Housing Behavioral Health or IDD Providers • • • Client Centered Plans Goals & Objectives Assessments UM Queues/Alerts Advanced Analytics to Determine High Risk Integrated Case Notes Automated Workflows Authorizations Health Information Exchange (HIE/CCD) Mobile Communications with Providers and Clients Community Support Services Provider Performance Reporting FULLY INTEGRATED CLIENT FOCUSED CARE COORDINATION 11

We Had… The Vision and goals The platform for data Identifying what the data We Had… The Vision and goals The platform for data Identifying what the data would be used for and how There needed to be a value for the individuals, value for the providers, value for the health plans and value for the state 12

Data Sources Today and Their Use Most data sources in today’s market are claims Data Sources Today and Their Use Most data sources in today’s market are claims based Limited IDD sites are pulling information from EHRs or other case management systems The increase expectation to the move to integration or whole person care is bringing in the need to merge MCO data/health data in “real time” Being used for ◦ ◦ Population Management Financial and Forecasting Benchmarks and Outcomes (System and Individual) Provider Management and Performance ratings 13

Managed Care and Data Needs In Fee for Service ◦ State established fee schedules Managed Care and Data Needs In Fee for Service ◦ State established fee schedules ◦ May or may not have used providers to do cost modeling of rates or cost reports ◦ Access to data through paid claims In Managed Care ◦ Able to have different rates and incentive different or various outcomes IMPORTANT to know the TRUE cost of service, not what the Fee Schedule rate is or what you get reimbursed at A position of knowledge in negotiating rates or alternative payment structures Case rates, episode of care, etc. Different rates for same services in different geography 14

Managed Care and Data Needs Managed Care allows for the use of Medicaid funds Managed Care and Data Needs Managed Care allows for the use of Medicaid funds to pay for services or supports that typically were not medicaid reimbursable Especially important for IDD since typically the medicaid benefit is limited to HCBS waivers ◦ B-3 Services ◦ In Lieu of Services ◦ Social Determinants of Health Must have data that documents cost neutrality, capitation payments or uses “savings” to cover the costs of “new services and supports” and to show VALUE or change for the INDIVIDUAL or system 15

Moving to the Next Financial Level Most people think direct and indirect cost – Moving to the Next Financial Level Most people think direct and indirect cost – overhead and administration (ICF cost reports) Do you know your: This was an area of much technical assistance ◦ Total cost per patient ◦ Cost per complex patient – what is complex ◦ Cost per visit or episode of care ◦ Change in net assets to expense ratio ◦ Working capital to monthly expense ratio ◦ Long term debt to equity ratio ◦ Cost of workflows in place Alternative Payment models (future) ◦ Case rates ◦ Episode of care ◦ Subcapitation arrangements 16

Pay for Performance or Value Based Purchasing Payers establish what value is Able to Pay for Performance or Value Based Purchasing Payers establish what value is Able to differenate quality - can provide an edge in the competitive market place Able to produce date that shows value Stakeholder input – ◦ What are the required metrics or pay for performance indicators? Are they acute based or long term care. ◦ CMS will push for quality measures that support ADA, Olmstead and other HCBS quality measures Practice before tied to payment 17

IDD P 4 P Outcomes in NC Physical health – rational is to address IDD P 4 P Outcomes in NC Physical health – rational is to address medical or dental care to meet the needs of individuals with IDD ◦ has been identified as gap in care both in availability and expertise ◦ a reason for lack of movement from state facilities or ICF placements Life Transition planning (episode of care for first 6 to 9 months) ◦ School transition to adult system ◦ Movement from facility (IDD placement or physical health) Meaningful Day ◦ Supported Employment ◦ Retirement 18

Whole Person Care and Data This is the most exciting part and the real Whole Person Care and Data This is the most exciting part and the real difference data can make ◦ Timeliness of support or intervention ◦ Looking at all the venues of services and supports Ability to inform the discussion with the individual based upon information and not just on the understanding by the individual or family More wholistic approach to resources available to not available to support the individual More efficient use of time Establishing IDD health homes with targeted resources both financial and subject expertise 19

Develop a Healthcare Analytics Strategy The strategy must be effective which means ◦ The Develop a Healthcare Analytics Strategy The strategy must be effective which means ◦ The right approach to gathering and organizing data ◦ Getting the right data to the right people to drive improvements Experienced Analytics expertise CAN be bought BUT be cautious about marketing Using a healthcare enterprise data that combines programmatic, clinical and financial data is a good method for aggregating and optimizing data for analysis. The infrastructure must allow for the delivery of the linked programmatic, clinical and financial data to staff on the frontlines of care and support. 20

QUESTIONS? Cansler Collaborative Resources, Inc. Tara Larson tlarson@canslermail. com (919) 271 -2767 www. canslercollaborativeresources. QUESTIONS? Cansler Collaborative Resources, Inc. Tara Larson [email protected] com (919) 271 -2767 www. canslercollaborativeresources. com 21