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TRANSCRIPT
Payment, Performance and Care Coordination in Children’s
Health Homes
March 2, 2016 Stephen Quirk, CEO
Youth Emergency Services and Shelter
Larry Seltzer, Gen. Mgr./Sr. Director
Netsmart
Overview: Youth Health Homes
Stephen Quirk
YESS (Youth Emergency Services & Shelter)
Chief Executive Officer, [email protected]
Larry Seltzer
Netsmart
General Manager & Sr. Director, [email protected]
Conflict of Interest
Stephen Quirk, Executive Director, YESS
None
Larry Seltzer, General Manager/Senior Director, Netsmart Technologies
Salary
Agenda
• Overview – Youth Health Homes
• Managed Care for Children Landscape
• Iowa Landscape
• Whole-Person Care: Youth with behavioral health and medical comorbidities
• IT Tools and Coordinated Care
• Barriers and Challenges
• Return on Investment
Learning Objectives
• Explain the topic of managed care for children
• Assess the impact of whole-person care on youth with behavioral health
and medical comorbidities
• Identify healthcare IT tools that support coordinated care
Savings Population Engagement
Population Management Satisfaction Treatment / Clinical Electronic
Secure Data
NOTE: In this presentation, S, T, P, S will be covered in more detail.
Realizing the Value of Health IT
Overview: Youth Health Homes
• Examine the concept of youth health homes.
• Presenters will focus on how to work with the judicial system and the
medical and behavioral health communities to save time and money.
• Keep youths out of jail and stable.
• Demonstrate the value of technology for tracking, analyzing and
managing consumer data.
• Speak to determining cost for services in an evolving, pay-for-
performance landscape.
The Iowa Landscape
12 shelters CLOSED in 2015
7,000 children are subject to
ABUSE/NEGLECT
YESS Expands from
60 to 92 beds
Many have physical and
mental health challenges
SOURCE: Iowa DHS and YESS
Which of the following statements are correct?
A. 80% of serious medical errors involve miscommunication
B. Medication errors harm an estimated 1.5 million people each year in the U.S.,
costing the nation at least $3.5 billion annually
C. $25-$45 billion is lost on poor transitions from the hospital to other care settings
D. Prolonged absences from the workplace have little impact on business
productivity; the average annual cost of sick leave for U.S. industry is less than
$10 billion
Whole-Person Care: Youth with behavioral
health and medical comorbidities
ANSWERS: A, B and C
A. 80% of serious medical errors involve miscommunication
B. Medication errors harm an estimated 1.5 million people each year in the U.S., costing the
nation at least $3.5 billion annually
C. $25-$45 billion is lost on poor transitions from the hospital to other care settings
INCORRECT: D
Prolonged absences from the workplace put a further financial strain on consumers, families
and caregivers, draining business productivity; the average annual cost of sick leave for U.S.
industry is $30 billion
Whole-Person Care: Youth with behavioral
health and medical comorbidities
Whole-Person Care: Youth with behavioral health and medical comorbidities
SOURCE: YESS
• Care Coordination
• Analytics and Quality Measures
• Health information exchange
IT Tools that Support Coordinated Care
Care Coordination Solution
Population
Health
Client
Tracking
EHR
Agnostic
Care
Planning
Care
Coordination
Alerts &
Notifications
Strategy
SOURCE: ©Netsmart
Health Information Exchange
• Inpatient Mental Health
• Substance Use Centers
• CMHC
• Social Service Departments
• Local Health Departments
Pharmacies
Health Information
Exchanges
• Hospitals
• Primary Care Practices
SOURCE: ©Netsmart
Interoperability
Creating a Safety Net
Creating a network for
Providers to communicate
helps ensure the consumer’s
needs are being met
FOR IMPROVED OUTCOMES
Legend
Provider
Behavioral Health Need
Physical Health Need
Social Health Need
P P
P
P
P
P
P
P
P
N
N
N
N N
N
N
N CONSUMER
N
N
N
SOURCE: ©Netsmart
Care Planning
Care Planning helps
coordinate the cross-
organizational Care Team
Objectives and
Interventions identified
across appropriate domains
• Behavioral Health
• Physical Health
• Social Health
• Care Coordination Activities
• Adherence
Adherence
Physical
Social
Care
Coordination
Activities
Behavioral
CREATING AN OVERALL CARE PLAN
SOURCE: ©Netsmart
Population Health Management KNOW THE PEOPLE YOU SERVE Analytics, data aggregation and notifications are critical to understanding your population
Data Aggregation
Re-Admit
ER Visit
Population Your Population Segment Identify
• Claimants > $$$
• ER Visits
• Re-Admission
High Risk !
Alerts & Notifications
QUALITY OPERATIONAL RISK
Analytics
SOURCE: ©Netsmart
Client Tracking
Costs increase as
consumers
come closer to providers
Costs decrease as
consumers
are served where they
live
SERVING CONSUMERS WHERE THEY LIVE
High Risk Consumer
Consumer
Care Coordinator
(manager)
Lead Agency
Acute Care Facility
Primary Care Office
Consumer’s Home
Healthcare Provider
SOURCE: ©Netsmart
Care Team Member
Questions on savings
True or False:
It costs more for youth to spend two nights at YESS than it does for
them to be spend one night in a juvenile detention center.
Questions on savings
ANSWER: False
One night at a juvenile detention center costs more than twice as
much as one night at YESS.
STEPS: Savings
$180 Per night cost 3
EXAMPLE
#1 TEXT
HERE
supporting text
MORE TEXT
Savings
• Detention @ $500/night 1
• Inpatient Psych @ $1,000/night 2
YESS Cost of Care
1 Iowa DHS Improve Safety, Well-Being, and Permanency for Iowa Children’s Report
2 Private Insurance averages 3 2014 Iowa DHS Audit/Cost Report
SOURCE:
• Determining cost per services
• Large but underutilized primary care community and effective
treatment models
Challenges for YESS
Question on possible ROI
Which of the following are expected soft return on investment from the coordinated
care model that YESS is putting into place?
A. Children will see better outcomes by receiving treatment in a less restrictive
environment
B. Fewer children will need clinical care
C. The community will hire fewer police officers
Question on possible ROI
ANSWER: A is Correct
Children will see better outcomes by receiving treatment in a less
restrictive environment
INCORRECT: B and C
B. Fewer children will need clinical care
C. The community will hire fewer police officers
REDUCTION
• Suicide ideation
• Substance use
STEPS: Satisfaction
93% Feel better
about
themselves
SOURCE: YESS Performance & Quality Improvement Reports (2013-2015)
STEPS: Satisfaction
66% Diverted from
a higher level
of care
SOURCE: YESS Performance & Quality Improvement Reports (2013-2015)
STEPS: Treatment/Clinical
88% Improved
overall
function
EXAMPLE
#2 TEXT
HERE
supporting text
MORE TEXT
93% Parents felt
better
equipped
SOURCE: YESS Performance & Quality Improvement Reports (2013-2015)
STEPS: Patient Engagement & Population Management
2,349 Crisis calls
answered
SOURCE: YESS Performance & Quality Improvement Reports (2013-2015)
• Cost savings by moving youths out of detention centers and hospitals
and under YESS case management
• Reduced hospitalizations and lock ups
• Increased high school graduations and higher test scores
• Reduced need for psychiatrists with increased clinical therapy and
community support plans
• Reduction in substance use and suicide ideation
Return on Investment
Recommendations
Savings
Population Engagement
Population Management
Satisfaction
Treatment / Clinical
Electronic Secure Data
Consumers and parents expressed increased
satisfaction when receiving whole person care5
16% reduction in use of services1, 30% reduction in
hospitalizations2, 80% decrease in cost of care3
Care Management solution to aggregate data at the
individual and population level
38% increase in consumer engagement4
Substantial cost savings to community if YESS keeps
youth out of detention centers and psychiatric hospitals
1Robert Wood Johnson Foundation 2New York State Office of Mental Health 3Robert Wood
Johnson Foundation 4PRISM-E 5Tarzana Treatment Centers Integrated Care Program
SOURCE:
Questions
• Stephen Quirk, YESS
• Email: [email protected]
• Larry Seltzer, Netsmart
• Email: [email protected]
• Twitter: @LNSeltzer
• LinkedIn: https://www.linkedin.com/pub/larry-seltzer/13/185/b64