Coordinating Care For Efficient, Effective Services Statewide
By Amanda Griffith, Contributing Writer
Care coordination software provides the State of Kansas with a framework to effectively share medical information and better support its mental health patients.
On Aug. 1, 2014, the State of Kansas began a Health Home program for people with serious mental illnesses (SMIs). The goal was to improve health outcomes for those with chronic conditions, to reduce the number of people who are unnecessarily admitted to the hospital, and to reduce emergency room visits.
As defined in Section 2703 of the Affordable Care Act of 2010 — the Health Home (aka Medicaid Health Home) is an entity that offers coordinated care to individuals with multiple chronic health conditions, including mental health and substance use disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) views the Health Home as a team-based clinical approach that includes the consumer, their providers, and family members, when appropriate. The Health Home builds links to community support and resources. It also enhances coordination and integration of primary and behavioral healthcare to better meet the needs of people with multiple chronic illnesses while improving both the quality of care and health outcomes.
In Kansas, Community Mental Health Centers (CMHCs) are charged by statute with providing the community-based public mental health services safety net. In addition to providing the full range of outpatient clinical services, the 26 CMHCs provide comprehensive mental health rehabilitation services, such as psychosocial rehabilitation, community psychiatric support and treatment, peer support, case management, and attendant care.
The Health Home is not a new concept, but only certain states have adopted it and taken off with it, according to Talaya Schwartz, community support services director and Health Home director for The Center for Counseling and Consultation.
Sharing Information In A New Way
When the State of Kansas decided to implement an entirely new healthcare program, organizations like The Center for Counseling and Consultation in Great Bend, KS — a community resource where people with normal problems in living can receive help and guidance — knew they needed clinical software that would help staff on the ground to coordinate healthcare for all of its clients.
“The state’s CMHCs decided they wanted to use the same software to share information, coordinate care, and provide efficient, effective services to clients across the state,” remarks Schwartz. “These were brand-new services we were offering, and to a new population as well, so we all agreed any solution implemented had to help us coordinate healthcare across providers — from assessments, outcomes measurement and lab work, to appointments and referrals.”
Key features necessary for success included a software solution that operated with the user in mind. It had to be easy to understand, efficient, and flexible. Schwartz and her colleagues didn’t want to maneuver through multiple screens or struggle with reporting. They wanted to use the solution as a resource as they worked with their clients in the field. Supervisors wanted to be able to extract desired data, and executives sought something affordable.
“We knew some of our clients wouldn’t be mental health clients, but that they would still need us to help them coordinate care,” explains Schwartz. “Kansas is not the first to adopt Health Homes, but is ahead of the majority of states, so we wanted to get it right, but we didn’t have a lot of time.”
The Majority Speaks
Cognizant of the need for strong uniformity, the chosen vendor and all participating health centers would ultimately form a workgroup to represent the needs of all of the agencies involved. The Association of Community Mental Health Centers of Kansas (ACMHCK) compiled and reviewed presentations and quotes, including one from Netsmart. For the previous 20 years, The Center for Counseling and Consultation had used Netsmart’s EHR software and other services.
Ultimately, 23 of the 26 members of ACMHCK selected Netsmart’s CareManager care coordination software solution. “CareManager offered our staff what they needed to perform their jobs, including generating a download of data, instead of manual entry,” says Schwartz. “We knew we’d save steps and time, two critical items as we looked to implement a brand new system for the State of Kansas.”
CareManager aggregates clinical data to provide a broad picture at the population level, facilitates care coordination across providers, tracks clinical quality measures and outcomes, and manages authorizations and claims across care providers. Most importantly, it is not dependent on any EHR.
CareManager integrates into an existing clinical system to support an organization’s population management strategy. As a Web-based platform, users can access the software from any Internet connection to check their specific caseloads and generate necessary reports for day-to-day operations. It also offers billing management through revenue cycle management (RCM) software that can link to the care management software.
Record Time To Go-Live
NetSmart usually requires a three-month window to implement new software at an installation. However, in this instance, the vendor completed the process for 23 of the state’s 26 locations in seven weeks in order to meet the Aug. 1, 2014 go-live date.
“We had a chance to customize much of what was inside CareManager — such as dictionaries and definitions — so that it met requirements for the State of Kansas,” notes Schwartz. “Time was our biggest issue, though, so there were some items we couldn’t make unique for Kansas, such as a list of common problems for our clients.”
Schwartz appreciates the time the solution saves by alleviating data entry duplication. It’s too early to track return on investment, but Schwartz and her team remain confident they’ll quickly demonstrate not only the efficiencies of the solution but that people are receiving better care and experiencing better outcomes.
Making The Connection
The number of clinicians actively using the care coordination software more than doubled in the month after go-live. Additionally, on day one, more than 8,000 people receiving services were registered in the solution. One month later, that number was 1,400, and it is expected to continue to grow.
Schwartz acknowledges that The Center for Counseling and Consultation is not yet live on the Kansas Health Information Network (KHIN), the state’s health information exchange, but she anticipates this happening in early 2015. Her goal is to use her organization’s care coordination software to receive updated information and to provide real-time alerts.
CMS expects states’ Health Home providers to operate under a “whole-person” philosophy. Health Home providers must integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person. Schwartz and her colleagues can now feel confident in meeting these objectives.
“If one of our clients gets admitted to the ER, that visit will be on our screen the next day, and it will be the same with new medications or changes in care,” says Schwartz. “Our staff looks forward to being able to send records in a couple of clicks, so they can work efficiently with everyone else in the electronic world.”
By streamlining communication and monitoring outcomes, CareManager helps Schwartz and her colleagues improve their ability to treat the mind and body in one workflow, something that is instrumental in giving those individuals the treatment they need. “Using this care coordination software truly gave us a head start in the direction of what to do and how to do it, rather than forcing us to figure out how to record and document all of the new required information in our existing software,” says Schwartz.