www The National Council org National Council for

www. The. National. Council. org National Council for Behavioral Health Hill Day Realizing the Promise of Health IT for Behavioral Health Michael R. Lardiere, LCSW VP HIT & Strategic Development September 16, 2013 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

This presentation at a glance Ø Role of data in the healthcare system of the future Ø How will information be used and data shared under Ø Ø Ø 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 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

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 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 Jonathan Blum, CMS

…and from a business planning perspective • Shifts in revenue sources as 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 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

Connect with other providers Ø Coverage expansions are ONLY sustainable with delivery system reform Ø Collaborative Care Ø Patient Centered Healthcare Homes Ø Accountable Care Organizations Ø Accountability and quality improvement are hallmarks of the new healthcare ecosystem C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org Using Data for Population Based Interventions C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 5

Sharing Information is the Standard Ø Health Information Exchange RULES! Ø Integration and improved outcomes will only be successful if we can share information C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 6

Cost Rank Total Charges No of members Treatment Type Average Charges per Member 1 Community Support Services/15 min $2, 890, 038 218 $13, 257 2 Community Support Services /day $1, 916, 375 181 $10, 588 3 Personal care per diem $1, 394, 614 123 $11, 338 4 Habilitation, prevocational/15 min $758, 157 104 $7, 290 5 Supported employment/15 min $713, 680 154 $4, 634 6 Inpatient room and board $699, 602 90 $7, 773 7 Targeted case management/15 min $557, 154 689 $1, 009 8 Inpatient- ancillaries $494, 577 81 $6, 878 9 Case management/ 15 min $438, 577 470 $1, 052 10 Emergency room $356, 478 247 $1, 776 11 Psych medication management $356, 478 1, 086 $328 12 Inpatient-facility charges $288, 479 52 $5, 548 13 Labs $287, 935 437 $659 14 ACT program $286, 773 115 $2, 494 15 Medical supplies $241, 812 156 $1, 550 16 Family therapy $221, 136 181 $1. 222 24 Office visits – primary care $154, 773 616 $215 29 Surgery $105, 085 98 $1, 072 36 Ambulance $54, 581 67 $815 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 7

Table of top cost by diagnosis, January-March, 2006 Cost Rank Primary Diagnosis Total Charges No of Members Average Charges Per Member 1 Schizophrenia and Affective Psychosis $6, 167, 527 1, 102 $5, 597 2 Depression/Anxiety/Neuroses $1, 710, 759 347 $4, 930 3 Moderate Mental Retardation $1, 040, 669 112 $9, 292 4 Severe Mental Retardation $1, 032, 094 74 $13, 947 5 Profound Mental Retardation $982, 760 39 $25, 199 6 Mild Mental Retardation $709, 344 131 $5, 415 7 Alcohol and Drug Abuse $283, 077 177 $1, 599 8 Pregnancy $183, 653 39 $4, 709 9 Congestive heart Failure $168, 130 7 $24, 019 10 Chest Pain $161, 260 65 $2, 481 11 All Fractures and Dislocations $137, 901 19 $7, 258 12 Diabetes Mellitus $134, 161 42 $3, 194 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 8

Cost By Service Type C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 9

Cost Data by Primary Diagnosis C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 10

www. The. National. Council. org Using Data for Individual Interventions C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 11

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 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 12

Case #1 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 13

Case 1: Continued C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 14

Timeframe Charges Jul 2005 Aug 2005 Sep 2005 Oct 2005 Nov 2005 Dec 2005 $49, 010 $52, 632 $18, 050 $27, 376 $42, 493 $8, 058 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 15

Measuring Disparities C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 16

CDC Sortable Stats http: //wwwn. cdc. gov/sortablestats C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 17

Chronic Medical Conditions At Risk Criteria Ø Blood pressure combined Systolic greater than 130 OR Diastolic greater than 85 Ø BMI Greater than or equal to 25 Ø Waist circumference Male, greater than 102 cm Female, greater than 88 cm Ø Breath CO Greater than or equal to 10 Ø Fasting Plasma Glucose Greater than 100 Ø Hgb. A 1 c Greater than or equal to 5. 7 Ø Cholesterol HDL, less than 40 LDL, greater than or equal to 130 Triglycerides, greater than or equal to 150 Ø Others that the organizations determine C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 18

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Sharing Information is the Standard Ø Health Information Exchange RULES! Ø Integration and improved outcomes will only be successful if we can share information C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 27

Flavors of Health Information Exchange 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 28

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 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 29

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. 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 30

2014 Edition EHR Certification Criterion Short Description 3 45 CFR § 170. 314(b)(1) 45 CFR § 170. 314(b)(2) Transitions of Care These two certification criteria require EHR technology to be, at a minimum, capable of: A) electronically creating and receiving summary care records with a common data set in accordance with the Consolidated Clinical Document Architecture (CCDA) standard; and B) electronically exchanging in accordance with the Direct transport specification. 45 CFR § 170. 314(b)(4) Clinical Information Reconciliation Require EHR technology to allow a user to electronically reconcile the data that represent a patient’s active medication, problem, and medication allergy list. 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 31

Exchange Among Providers in One system Somewhat Difficult but Occurring Nationally 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 32

Exchange Among Providers in Multiple Systems More Difficult but Occurring Nationally 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 33

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!! 3/18/2018 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 34

Addressing Confidentiality Ø Common Barrier Ø If not addressed, promotes stigma Ø RI leads the nation through its work with the SAMHSA/HRSA Center for Integrated Health Solutions Ø MH & SU Information can be shared securely in RI Ø KY will follow soon Ø There are ways to work within 42 CFR Part 2 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 35

Meaningful Use Opportunities Now C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 36

Revised Definition of CEHRT Effective Dates EHR Reporting Period FY/CY 2011 FY/CY 2012 FY/CY 2013 FY/CY 2014 MU Stage 1 or MU Stage 2 All EPs, EHs, and CAHs must have: 1)EHR technology that has been certified to all applicable 2011 Edition EHR certification criteria or equivalent 2014 Edition EHR certification criteria adopted by the Secretary; or 2) EHR technology that has been certified to the 2014 Edition EHR certification criteria that meets the Base EHR definition and would support the objectives, measures, and their ability to successfully report CQMs, for MU Stage 1. All EPs, EHs, and CAHs must have EHR technology certified to the 2014 Edition EHR certification criteria that meets the Base EHR definition and would support the objectives, measures, and their ability to successfully report the CQMs, for the MU stage that they seek to achieve. 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. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

2014 Edition CEHRT Easy as 1, 2, 3 + C* 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 Base EHR 1 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. 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. EP/EH/CAH must have EHR technology with capabilities certified to meet the Base EHR definition. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

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 Certification Criteria associated with a Base EHR: 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)) • e. MAR (170. 314(a)(16)) • Clinical information reconciliation (170. 314(b)(4)) • Incorporate lab tests & values/results (170. 314(b)(5)) • View, download, & transmit to 3 rd 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)) * optional > > > > > CPOE (170. 314(a)(1)) Demographics (170. 314(a)(3)) Problem list (170. 314(a)(5)) Medication list (170. 314(a)(6)) Medication allergy list (170. 314(a)(7)) Clinical decision support (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: o Authentication, access control, o o o o 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 Menu Stage 2: 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)) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 > > > > 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)) e. Rx (170. 314(b)(3)) Transmission of e-lab tests & values/results to providers (170. 314(b)(6))

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? 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 to support the MU 1 EP Core Objectives you seek to achieve and for which you cannot meet a MU exclusion? § 170. 314: (a)(2) – DD/DA (a)(4) – Vitals (a)(11) – Smoking (b)(3) – e. Rx (e)(1) – VDTx 3 (e)(2) – Clinical Sum Is your EHR technology certified to the following certification criteria to support the MU 1 EP Menu Objectives you seek to meet? § 170. 314: (a)(10) – Rx. Formulary (b)(5) – Incorp Lab (a)(14) – Pt List (f)(1) – Immz Info (a)(15) – Pt Edu (f)(2) – Immz Tx (b)(4) – Clin. Info. Rec (f)(3) – Syn Surv 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/Prob. List/ Med. List/Med. Allergy. List/CDS (b)(1), (2)&(7) – TOC/Data Port (c)(1)-(3) – CQMS (d)(1)-(8) – P&S EH AH /C 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? Is your EHR technology certified to the following certification criteria to support the MU 1 EH/CAH Core Objectives you seek to achieve and for which you cannot meet a MU exclusion? § 170. 314: (a)(2) – DD/DA Smoking (a)(4) – Vitals (a)(11) – (e)(1) – VDTx 3 Is your EHR technology certified to the following certification criteria to support the MU 1 EH/CAH Menu Objectives you seek to meet? § 170. 314: (a)(10) – Rx. Formulary (a)(14) – Pt List (a)(15) – Pt Edu (a)(17) – AD (b)(4) – Clin. Info. Rec 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)); C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 Safety-enhanced design (170. 314(g)(3)); and Quality management system (170. 314(g)(4)) (b)(5) – Incorp Lab (f)(1) – Immz Info (f)(2) – Immz Tx (f)(3) – Syn Surv (f)(4) – ELR

Stage 2 Resources CMS Stage 2 Webpage: • http: //www. cms. gov/Regulations-and. Guidance/Legislation/EHRIncentive. Programs/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) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

Clinical Quality Measures C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 42

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 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

CQMs in 2014 and Beyond CQMs change in 2014: Core Objective EPs Measure 2014 and Beyond* Complete 6 out of 44 Complete 9 out of 64 • 3 core or 3 alt. core • 3 menu Choose at least 1 measure in 3 NQS domains Recommended core CQMs include: • 9 CQMs for the adult population • 9 CQMs for the pediatric population • Prioritize NQS domains Eligible Hospitals and CAHs Complete 15 out of 15 Complete 16 out of 29 • Choose at least 1 measure in 3 NQS domains * Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org Clinical Quality Measures Behavioral Health Specific Clinical Quality Measures C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org Title: Anti-depressant medication management: NQF 0105 (a)Effective Acute Phase Treatment (b)Effective Continuation Phase Treatment Description: The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported. a)Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks) b)Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org NQF 0004 Title: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement Description: The percentage of patients 13 years of age or older With a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported: a) Percentage of patients who initiated treatment within 14 days of the diagnosis b) Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org NQF 0028 Title: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND received cessation counseling intervention if identified as a tobacco user C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0022 Title: Use of High-Risk Medications in the Elderly Description: Percentage of patients ages 65 years and older who received at least one high-risk medication. Percentage of patients 65 years of age and older who received at least two different high-risk medications. a: Percentage of Patients who were ordered at least one highrisk medication b: Percentage of Patients who were ordered least two high-risk medications during the measurement year C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0101 Title: Falls: Screening for Fall Risk Description: Percentage of patients aged 65 years and older who were screened for future fall risk during the measurement period C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0104 Title: Major Depressive Disorder (MDD): Suicide Risk Assessment Description: Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0108 Title: ADHD: Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication Description: Percentage of children 6 -12 years of age and newly dispensed a medication for attention deficit/hyperactivity disorder (ADHD) who had appropriate follow up care. Two rates are reported a. Initiation Phase: Percentage of children who had one follow up visit with a practitioner with prescribing authority during the 30 -day Initiation Phase b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0110 Title: Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use Description: Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0418 Title: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Description: Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow up plan documented is documented on the date of the positive screen. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0419 Title: Documentation of Current Medications in the Medical Record Description: Percentage of specified visits for patients 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over the counter, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0421 Title: Adult Weight Screening and Follow-Up Description: Percentage of patients aged 18 years and older with a calculated body mass index (BMI) in the past six months or during the current reporting period documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past six months or during the current reporting period. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 Age 18 -64 years BMI ≥ 18. 5 and < 25 C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0710 Title: Depression Remission at Twelve Months Description: Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 0712 Title: Depression Utilization of the PHQ-9 Tool Description: Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4 month period in which there was a qualifying visit. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org 1365 Title: Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Description: Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org Not yet endorsed Title: Dementia: Cognitive Assessment Description: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 -month period. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

www. The. National. Council. org https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment -Instruments/Quality. Measures/Downloads/Eligible-Providers-2014 Proposed-EHR-Incentive-Program-CQM. pdf C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

How Will the Data be Shared? C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 62

Data Integrity Follow the Continuity of Care Document / C-CDA C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

Psychotherapy Notes are not Sent C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7

What Will This Data Look Like? C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 67

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 68

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 69

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 70

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 71

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 72

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 73

Meaningful Use Opportunities in the Future C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 74

Mental Health and Addiction Policy Agenda The National Council promotes a mental health and addiction policy agenda that supports a strong mental health and addiction safety net. Our public policy agenda includes: Establishing federal status for community behavioral health organizations, as outlined in the Excellence in Mental Health Act Promoting federal initiatives that support public education on mental illness and addiction such as the Mental Health First Aid Act Working to ensure that behavioral health providers are eligible for health information technology incentives, as in the Behavioral Health IT Act Ensuring behavioral health’s full inclusion in health reform implementation Protecting federal funding for Medicaid and protecting beneficiaries and providers Preserving funding for other important behavioral health programs such as those funded by the Substance Abuse and Mental Health Services Administration C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 75

www. The. National. Council. org C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 76

Strategies to Position Yourself to Effectively Use Data C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 77

Ø Focus on Interoperability Ø Obtain a DIRECT Secure Messaging Address Ø Speak to your vendor about compatibility with the C-CDA Ø Select Clinical Quality Measures that the rest of health care is using Ø Then add your own Ø Begin sharing data with your health care partners C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 78

These Changes are Coming!!!! www. The. National. Council. org C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 79

www. The. National. Council. org C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7 80

Michael R. Lardiere, LCSW Vice President, HIT & Strategic Development Mike. L@thenationalcouncil. org • • • Website: www. thenationalcouncil. org CIHS: www. integration. samhsa. gov Blog: www. mentalhealthcarereform. org Twitter: @nationalcouncil Facebook: www. facebook. com/The. National. Council C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l. o r g | 2 0 2. 6 8 4. 7 4 5 7