Translating Data into Effective Communications

September 1, 2009A Rural Mental Health Experience

Dennis MacKay, CEONorthern Human Services

Path to Sustainability“The Challenges”

Creating a network of support:Identifying stakeholder/partners who have a direct interest in the project and will benefit as a result of their involvement. The benefit that may be added include service value, financial gain or political advantage.

Reimbursement:Ensuring a viable source of income. May include contractual fee for services provided to partners (technical services and/or clinical) or direct reimbursement from insurance.

Operational expenses:Addressing the ongoing costs, staffing, connectivity and equipment replacement.

Project Overview

The organization:Northern Human Services is a multiservice, private non-profit organization serving individuals with mental illness, substance abuse and developmental disabilities

Project Overview

The environment:The catchment area covers half of the state of New Hampshire which includes only 8% of New Hampshire’s population.

Project Overview

The target issue:The region is a physician shortage area with a critical lack of medical specialists. Our focus was to provide a service that had never been available in region, child psychiatry.

Building internal support within the agency

Board of Directors:Selling the value added to our mission through tele-health. Outlining a plan for the sustainability of the service and the operational costs.

Building the IT talent to execute the project:Combination of staff development and subcontracting

Building the support of clinical staff:Gaining support for the clinical value and increasing the comfort level of staff with the equipment and process

A Case for Network of Support

Identified five key stakeholders:

1. GovernmentalNH Commissioner of Health & Human Services. NH Bureau of Behavioral Health, primary funding source and the manager of Medicaid behavioral health carve out.

2. VendorDartmouth Medical Center department of psychiatry- the only medical school in NH and an excellent reputation in child psychiatry

3. Legislative NH Legislative Leadership- the means to initiate legislation to require insurance

payment for tele-health4. Advocacy NH National Alliance on Mental Illness (NAMI)- consumers and family members

providing grassroots support for services to the mentally ill5. Peer Providers

NH Community Behavioral Health Association. Shared interest in the project.

Identifying Partner Interest

All network partners had distinct as well as shared interests. All were engaged on an individual basis before the project was launched.

Partner Interest Governmental service value, cost, integration of care, quality

Vendor center of excellence, profit, business potential Legislative value to constituency, cost, access to care

Advocacy access to care, quality

Peers portability, cost, service value, quality

Matching Interest to Data

Service value: Comparison of client wait time for access to service Outcome data from satisfaction surveys Staff access to specialist consultation (time comparison) Number of clients accessing specialist (pre and post) Clinical outcomes are longitudinal will need to be measured over time

Cost: FTE child psychiatrist vs. hourly rate for vendor (annual expense) FTE hours available with travel (cost per hour of direct care) vs. vendor Utilize existing insurance codes (no new codes) Decreased cost to clients (mileage to clinic vs. mileage to specialist)

Integration of Care: Established outreach to NH Hospital Association. Applied and received pilot grant Applied and received 5 year grant for infant mental health in collaboration with local partners Joint application with Dartmouth Medical Center for tele-health services to neurologically

impaired children

Matching Interest to Data

Center of Excellence: Participation in electronic training & supervision with Dartmouth funded by NH Bureau of

Behavioral Health BA level staff participate in tele-health intervention (as clinically appropriate)

Profit: Contract with Dartmouth Medical Center for one year. Hourly rate and minimum hours per month. Contract has been renewed after third year of HRSA grant

Business Potential: Agreement with vendor to review outcomes after the contract period and explore development

Value to constituency: Satisfaction surveys Letters of support Cost data as listed above Participation of advocacy groups

Matching Interest to Data

Access to Care: Comparison of wait time for service (tele-health vs. off site) Comparison of distance traveled for tele-health vs. off site (miles and time involved) Outcome data from survey re: comfort with tele-health model

Quality: 360 degree evaluation (client, provider, treating MD and vendor)

Portability: Agreement with Peers to share all data including policies and procedures

Reimbursement

Medicaid: Model presented to DHHS. Model limited to clients of NHS. Agreed to

one year pilot as of July 1, 2008. July 1, 2009 Medicaid reimbursement opened to all CMHC

Private Insurances: October 2008 legislative leadership agreed to sponsor SB 138 requiring

all third party insurance companies doing business in NH to reimburse for tele-health. Advocates including NH Hospital Association, NH Community Behavioral Health Association, Dartmouth Medical Center, NH NAMI, testifying on behalf of the legislation. Passed into law on July 16, 2009.

Operational Expenses

Staffing: Covered by a combination of reimbursement and new contracts. Currently exploring the utilization of contracting out “in house” resources to

schools and hospitals

Connectivity: (the not so hidden cost monster) We participate in rural health care program of Universal Service

Administrative Company (USAC website http://www.usac.org/rch) Also exploring other options in conjunction with DHHS and UNH

Equipment replacement: Grant opportunities (USDA Rural Utilities Service

http://www.usda.gov/rus/telecom/) corporate offers and buying cooperatives

Findings:

Internal:

The project required an investment/commitment fromclinical, IT and administrative staff to work collectively to assure its success.

The initial failures outweighed success. Positive client response was a critical turning point.

External:

What began as a desire to address an unmet clinical need ended with a lesson in the value of networking.

Building strong relationships became the driver that advanced the project.

Questions?

Contact Information

Northern Human Services87 Washington StreetConway, NH 03818 603.447.3347

Fax 603.447.8893http://www.northernhs.org/index.html