Leadership Musts for CBHC Survival Workshop · decision focused leadership/ management at all levels of ... • CMHCs to begin using the Level of Care ... Leadership Musts for CBHC

Leadership Musts for CBHC Survival Workshop

David Lloyd, FounderMTM Services

Phone: 919-434-3709E-mail: [email protected]

Mike Garrett, CEOHorizons Mental Health Center

Hutchinson, KSE-mail: [email protected]

Co-Presenters:

mailto:[email protected]

mailto:[email protected]

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Leadership Challenge to Support Shift to Value Based Reimbursement Model

1. Services provided – Timely access to clinical and medical services, service array, duration and density of services through Level of Care/Benefit Design Criteria and/or EBPs that focuses on population based service needs

2. Cost of services provided based on current service delivery processes by CPT/HCPCS code and staff type

3. Outcomes achieved (i.e., how do we demonstrate that people are getting “better” such as with the DLA-20 Activities of Daily Living)

4. Value is determined based on can you achieve the same or better outcomes with a change of services delivered or change in service process costs which makes the outcomes under the new clinical model a better value for the payer.

Presented By: David Lloyd, Founder

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Justification for Strategic Business Development

1. The pace of change underway in the American healthcare system can be overwhelming as payers, employers and policy makers continue to experiment with the way that healthcare is delivered and paid for around the country.

2. States are continuing to move more and more services and populations into managed care; Accountable Care Organizations are being implemented by Medicare and Medicaid; Medical and Health Homes are spreading; and all the while all providers are being asked to quantify the value of the services that they provide while reducing the cost of care.


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Planning Vs. Strategic Business Development

1. Strategic Planning efforts historically have been typically subjective focused - narrative based and not action oriented. (i.e., typical assessed level of attainment in implementing plans has been low)

2. Strategic Planning was all that was needed historically in an increasing funding and low transformational change requirement environment

VS.1. Strategic Business Development is a disciplined and to a large

extent “risk based” effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does and why it does it.

2. Strategic Business Development is essential in a decreasing funding, disruptive innovation and transformational change environment


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Strategic Business Development Core Elements

1. “How will we earn the revenue to support the strategic initiatives?” – Focused on cost based financial realities

2. “Who, what and when are important implementation elements!”

3. Addresses the organizational structure/management cultural changes that will be required

4. Must be supported by a more “risk-based” and timely decision focused leadership/ management at all levels of the organizational structure

5. Requires assessment of operational processes and costs6. Includes market share/branding/customer service awareness/

needs7. Essential element is ability for outcome data measurement,

reporting and management’s use of the data capacity


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Core Elements of Strategic Business Development

• First Step is the need to identify and adopt a “Business Model”- focused on either: How to earn additional revenues to support expenses

in a changing shared risk funding environment; and/or How to reduce costs through process re-

engineering/increased staff performance; and/or Willingness to participate in partnerships and

mergers to grow your market base; and/or Ability to diversify your services to attract a large

share of the current market base with new service types.

7Presented By:

David Lloyd, Founder

Core Elements of Strategic Business Development• Key Elements of a Business Plan:

1. Business Vision and Mission2. Primary focus of Business Model that will be used

(i.e., diversification, mergers and partnerships, reduce costs, enhance revenues, etc.)

3. Market Research: Market Segmentation and Targeting (i.e., benefits,

demographics, geographic, etc.) Confirmation of needs of the customers/clients Competitive Environment – Strengths, Weaknesses,

Opportunities and Threats (SWOT) on Primary and Secondary Competitors

4. Description of service(s) needed based on research

8Presented By:


Core Elements of Strategic Business Development

• Key Elements of a Business Plan (Cont’d):5. Strengths, Weaknesses, Opportunities and Threats

(SWOT) analysis for current organization to deliver identified services including what are the “Unique Factors” your organization can bring to your business case (i.e., Same day access, Just in Time Medical Appointments, outcomes achieved, etc.)

6. Assessment of current organizational structure to determine if the current structure needs to be changed

7. Branding and Marketing Plan to develop an awareness of your new business model

8. Implementation Plan including Timeline, Strategic Action Plan development and confirmation of benchmarks that need to be achieved to demonstrate the plan is working

9Presented By:


Core Elements of Strategic Business Development• Key Elements of a Business Plan (Cont’d):

9. Rapid Cycle transformation change plan that supports empowered top down and bottom up decision making strategies One Year Action Plan Goals 45 Day Action Plan Goals and Accountability to design and

implement10. Financial analysis of the business plan including

investment required short term and long term, return on investment targets and timeframe benchmarks for determining when the plan is not working for the organization

11. Evaluation of the outcomes achieved on an ongoing basis

10Presented By:


CBHC’s “Business Case” Core Elements for ASOs/MCOs

1. Incorporate as much objective data as possible to support awareness of service delivery capacity being delivered by association members

2. Provide demographic, diagnostic and population groups served information.

3. Provide service locations/clinics by county/region with a companion service array table to support awareness of services/programs available

4. Identify qualitative outcomes that provide a shift from “providing services” to focus on “VALUE of Care”

5. Identify the cost of services delivered and outcomes achieved to objectively measure “Value”

6. Identify “unique factors” that association members can provide (i.e., historical community based case management/ coordination of care experience, etc.)

11Presented By:



• Association of CMHCs of Kansas (ACMHCK)– 2008 Costing Study; determine cost/revenue by CMHC– 2011 Costing Study; determine cost/revenue by provider

type– 2015 Costing Study; determine cost/revenue by

CPT/HCPCS codes• Goal was to demonstrate the Value of Care

• CMHCs to begin using DLA-20 Outcome data (2015)• CMHCs to begin using the Level of Care model (2016)• Goal: for CMHCs to have the ability to determine

Costs/Revenue by CPT/HCPCS code, diagnosis or LOC and determine Outcome to Treatment

Presented By: Mike Garrett, CEO

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• Horizons Mental Health Center• Use the DLA-20 for Intake and 90 day Treatment Plan

reviews (2011)• Open Access for Intake Assessments (2011)• Collaborative Documentation (2012)• No Show Management (2012)• Walk In Clinic for therapy No Shows (2012)• Level of Care Implementation (2014)• Walk In Clinic for Med Management No Shows (2014)• Just In Time for Medical Services (2016)

o Walk In Clinic for initial Medical Assessment (2015-10hrs/wk.; 2016 -24hrs/wk.)

o NSNAP for No Shows for Med Management Appointments


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ACMHCK Statewide Averages

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Horizons Mental Health Center


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CPT/HCSPCS Code Sum of Total Hours Per Code

Average of Average Cost per Code

Average of NET Revenue per Code Per Hour

H0036 25902.57 $78.48 $115.52HA 19423.97 $74.35 $122.06HB 6478.6 $82.61 $108.97H2017 16777.94 $77.56 $53.70NR 6000.03 $69.26 $53.45HQ 1824.78 $85.23 $53.38TJ 8953.13 $78.19 $54.26S5150 12911.01 $32.34 $22.3390837 10429.35 $112.84 $84.67T1017 7162.87 $79.91 $36.90H2021 4258.53 $87.89 $69.2690791 4060.62 $130.53 $51.54T1019 2328.72 $78.62 $23.95HK 891.79 $71.17 $23.33HE 1436.93 $86.07 $24.56H2011 2274.625 $108.52 $122.52NR 276.16 $80.31 $90.46HK 1568.42 $105.79 $125.09HO 430.045 $139.47 $152.0190834 2185.94 $112.37 $79.7390847 1891.75 $126.97 $72.24NR 1690.57 $113.77 $69.08HK 201.18 $140.16 $75.4199366 1667.13 $112.37 $24.9499214 1449.19 $267.46 $184.7899213 1407.17 $237.02 $115.8496101 1320.93 $123.98 $67.9390832 1300.17 $118.57 $59.88


Horizons MHC

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Sample Report


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26Presented By:

Mike Garrett, CEO


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30Presented By:

Mike Garrett, CEO


14.5% 15%

10%

8%

17%

12%

9%

3.7%

12%

10%

1.5%

15.5%

19% 19%18%

17%16%

15%

17.2%16% 16%

15%

19.8%21%

20%19%

20% 20%21%

20%

16%

21%

18%18.3%17%

18%

12%

8%

6% 6% 5.7%

11%

7%

9.7%

FY14Q4 FY15Q1 FY15Q2 FY15Q3 FY15Q4 FY16Q1 FY16Q2 FY16Q3 FY16Q4 FY17Q1 FY17Q2

No Show Percentages FY14Q4-FY17Q2

Initial Face-to Face Appointment Ongoing Appointment for services

Psychiatric Medication Management Appointment Psychiatric Evaluation Appointment


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Value of Care Equation

Minimize Costs + Good Outcomes = Value


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MCO Contract Performance Standard Compliance, Payer Diversification and Revenue Cycle Management• Develop locally the capacity to meet the typical MCO Contract

Performance Focus Areas:– Access to Treatment Focus– Compliance Focus– Internal UM Requirements– Claim Submission and Denial Rates– Customer Service Focus

• Payer Diversification Needs• Revenue Cycle Management Training• Back Office Capacity Assessment and Re-Organization• Collection of Sliding Fee Scales and Claim denial Rates• Key Performance Indicators for Financial and Admin Staff• Onsite audits of clinical charts to support appropriate E&M billing

codes

34Presented By:


Thank you for attending…

• Questions and Answers?• Next Steps?

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Documents

Leadership Musts for CBHC Survival Workshop · decision focused leadership/ management at all levels of ... • CMHCs to begin using the Level of Care ... Leadership Musts for CBHC