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, quirks@yessiowa.org

Larry Seltzer

Netsmart

General Manager & Sr. Director, lseltzer@ntst.com

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: Quirks@yessiowa.org

• Larry Seltzer, Netsmart

• Email: Lseltzer@ntst.com

• Twitter: @LNSeltzer

• LinkedIn: https://www.linkedin.com/pub/larry-seltzer/13/185/b64