Providers Growingly Concerned About EHR Functionalities & The Technologies Needs For Future Service Delivery & Reimbursement: Top EHR Trends From The 2021 OPEN MINDS National Behavioral Health EHR Survey

Originally presented on October 19, 2021.

We’re bombarded with stories about electronic health records (EHR) evolving to become more flexible and use more services like blockchain, cryptocurrencies, and artificial intelligence, but what do your peers report firsthand? We recently concluded the sixth annual OPEN MINDS National Behavioral Health EHR Survey and found that 53% of provider organizations report their EHR does not have all the functionalities they need. Only 19% report their clinical, scheduling, billing, and reporting and analytics functionalities as meeting their needs. These Core 4 functionalities are crucial to service delivery and organizational sustainability.

In this webinar, OPEN MINDS Senior Associate, Joe Naughton-Travers, shared the results of the 2021 OPEN MINDS National Behavioral Health EHR Survey and discussed what organizations can do to plan for the next advances in health care technology and service delivery. Mr. Travers also discussed the growing concern among providers and what functionalities to be looking at for future service delivery and timely reimbursements.

Download Presentation (PDF)

Top EHR Trends In 2021: Results Of The Annual Behavioral Health EHR Survey

We’re bombarded with stories about electronic health records (EHR) evolving to become more flexible and use more services like blockchain, cryptocurrencies, and artificial intelligence, but what do your peers report firsthand? We recently concluded the sixth annual National Behavioral Health EHR Survey and found that only 19% of provider organizations report their clinical, scheduling, billing, and reporting and analytics functionalities as meeting their needs. These Core 4 functionalities are crucial to service delivery and organizational sustainability.

Join OPEN MINDS Senior Associate, Joe Naughton-Travers, for a free webinar on October 19 at 1:00pm ET to hear the results of the 2021 National Behavioral Health EHR Survey and what your organization can do to plan for the next advances in health care technology and service delivery. Mr. Travers will also discuss the differing needs of small and large provider organizations when it comes to EHRs for service delivery and timely reimbursements. Join us to learn:

  • Results of the 2021 National Behavioral Health EHR Survey
  • How small and large provider organizations differ in their EHR needs
  • Best practices for finding an EHR that is the right fit for your organization

Maximize Your Organizational Effectiveness With Analytics & Reporting: Unique Case Studies As Told By Monarch & Options Counseling & Family Services

Originally presented on 9/28/2021

Improving value, competitive advantage, and sustainability are top of mind for executives of most behavioral health and human services provider organizations. None of these improvements are possible without consistent, high-quality reporting and analytics. Implementing analytics and reporting is much easier than you may believe.

During this webinar, Scott Budzien, Data Scientist at Monarch; Adam Falk, Chief Information Officer at Options Counseling and Family Services; and Christy Winter, Senior Product Manager, Analytics, at Qualifacts + Credible dove into the world of reporting and analytics, and how they can benefit an organization. Our panelists discussed the difference between reporting and analytics and the value each provides to your organization. They also discussed several key strategies for successfully implementing reporting and analytics in your culture. Monarch and Options Counseling & Family Services also shared their journeys into the world of reporting and analytics and how they implemented processes and tools to become more data driven.

Thinking Sustainable New Services? Think Integration

By Monica E. Oss

How to navigate through these uncertain times? When planning for future sustainability, health and human service executive teams have to track three factors related to future competitive advantage—the drivers of change and how they affect their specific market; the emerging new opportunities and the strength of the competition in their market in these areas; and the efficiency and resilience of their organization to navigate through and succeed given these changes. In my keynote at last month’s 2021 OPEN MINDS Management Best Practices Institute, I discussed this roadmap to sustainability in my closing remarks, Best Practices For Success In The ‘Next Normal’ – Building A Foundation For An Efficient & Resilient Organization.One key area for building new service lines that capitalize on emerging opportunities is services that “fit” in the emerging integrated care/whole person care model. The Patient Protection and Affordable Care Act ushered in the era of integrated care with no preexisting condition clauses, no annual/lifetime limits, and behavioral health parity. These new requirements changed the clinical and financial playing field. And, finally, many payers (employers, health plans, units of government) are concluding that “whole person” approaches to care are not only a better consumer experience and lead to better consumer outcomes, but they decrease costs as well.

At last month’s institute, we heard presentations of three different models to achieve that same end. Many health plans are building their own internal integrated care coordination teams. Raphael Gonzalez-Amezcua, M.D., Chief Medical Officer at Aetna Better Health of California, in his opening keynote, A Payer’s Perspective On Crucial Integrated Health Components In The “Next Normal”, pointed out that health plans are focused on “high needs, high cost” consumers—those with three or more chronic conditions and challenges with activities of daily living. They have moved to a consumer-prioritized multi-health determinant integration model that assesses health, behavioral, and social support needs to assist these consumers in their planning their care. This intensive approach is driven by the fact that more than 60% of these complex consumers receive conflicting recommendations from their care team.

Caroline Carney, M.D. Chief Medical Officer at Magellan Health, shared with us the roadmap to a new “next generation” model of behavioral health carve-outs—an analytics-intensive model where behavioral health takes the lead in overall consumer wellbeing and early intervention. She described Magellan’s whole health management model, MPath, based on an integrated digital ecosystem with multiple functionalities, in which aggregated consumer data from various sources is used to drive targeted interventions with consumers. This new approach also features a wellbeing solution, resiliency training, a curated suite of health care-adjacent apps, eCBT, and high-risk care coordination. (For more, see a recording of Dr. Carney’s keynote, A Time For Transformation: Reimagining The Partnership Approach For Behavioral Health, at The OPEN MINDS Health Plan Partnership Summit: An Assessment Of Payer Partnership Priorities In The “Next Normal.”)

And, Michelle Berthon, Behavioral Health Clinical Operations and Government Sector Product Development at Optum and Kimberly Macakiage, Medicaid Waiver Director at Integral Health, presented their provider partnership model for integrated care coordination in “P” Is For Payers, Priorities, Partnership … & Platforms. The model integrates the data-driven centralized management at the plan with a delegated, value-based arrangement with local provider organizations to provide the in-the-field care coordination with consumers.

The key for provider organization executive teams is tracking the direction of preferred integrated care coordination models by dominant payers in their market—and determining the best strategies for partnership with those payers and health plans based on their model.

Maximize Your Organizational Effectiveness With Analytics & Reporting

Improving value, competitive advantage, and sustainability are top of mind for executives of most behavioral health and human services provider organizations. None of these improvements are possible without consistent, high-quality reporting and analytics. Implementing analytics and reporting is much easier than you may believe.

Join Christy Winters, Senior Product Manager, Analytics, of Qualifacts + Credible on September 28 at 1:00pm ET, for a deep dive into the world of reporting and analytics, and how they can benefit your organization. She will discuss the difference between reporting and analytics and the value each provides to your organization. She will also discuss several key strategies for successfully implementing reporting and analytics in your culture. You will also explore two organizations’ journeys into the world of reporting and analytics and see how they implemented processes and tools to become more data driven.

During this 60-minute executive web briefing, you will:

  • Discover concrete strategies to better incorporate reporting and analytics into your organization
  • Understand the unique value analytics and reporting provide your organization
  • Hear firsthand how two provider organizations implemented processes and tools to become more data driven

Top 6 Best Practices For Staying Human While Keeping Your Distance

One of the major developments of the COVID-19 pandemic has been the phenomenal growth of telehealth use, especially in behavioral health care. Telehealth became ubiquitous during the pandemic, and it is predicted that a large percentage of health care will continue via telehealth even after the public health emergency eases. A recent survey by Qualifacts and the National Council for Behavioral Health found that:

  • Before the pandemic, telehealth utilization in behavioral health care was relatively low, with only 2% of organizations providing 80% or more of their care virtually (See COVID-19 and Value-Based Reimbursement: What Do We Know? Where Will it Go?).
  • At the height of the pandemic, 60% of behavioral health organizations were providing 80% or more of their care virtually – due to policy changes reducing barriers to telehealth.
  • A majority of behavioral health care executives expect the increased utilization of virtual services to continue, with an estimated 40% to 60% of their overall services being provided via virtual platforms (See The New Role of Virtual Care in Behavioral Health).

Before 2020, health care was poised to start using more technology to allow consumers to make appointments, share records, and connect with their clinical professionals electronically. However, COVID-19 forced the rapid adoption of many of these services, particularly telehealth (See 21st Century Cures Act Paves The Way For Telehealth To Bloom During Pandemic). It turns out, consumers appreciate the ease of telehealth, especially because it allows them to avoid traffic and waiting rooms. Clinical professionals have also benefited from telehealth, finding that it allows them to see how their consumers are living day-to-day. Another advantage of telehealth is the ability to reduce barriers to care, such as time away from work and the stigma associated with seeking care (See What You Should Be Thinking About Now).

Mental health services were among the quickest health care specialty to switch to online treatment. With data collected between November 2020 through February 2021, 33% of all mental health appointments were conducted virtually. Primary care followed behind, holding 17% of its visits virtually. Pediatrics held 9% of its visits virtually, cardiology 7%, and OB/GYN visits were at 4%.

But despite the popularity and advantages of telehealth, clinical professionals must recognize that telehealth does not work for all consumers and all conditions. Regardless of age, many individuals are uncomfortable using technology, especially for sharing private health information. Also, not all consumers have access to high-speed internet, and therefore must resort to telephone appointments when an in-person visit is not an option. Above all, clinical professionals need to deliver the same personal, human interaction over the internet or the phone as they do in person. To ensure your clinical staff are maintaining a high quality of care without losing the personal touch while virtual, be sure to follow these key best practices:

  1. Establish a baseline for in-person versus virtual visits. Take a hard look at your service lines and consumer populations, as well as any payer requirements, when considering how often to require in-person versus virtual visits once the current pandemic ends. Even if your consumers love telehealth, make sure requirements are clear on how frequently they should be seeing consumers in-person — such as once every four telehealth visits — or whatever is determined to be best for your organization, clinical professionals, and payers. Advise your staff to be up front with consumers about the in-person/telehealth requirements from the office. Many people have anxiety as the world re-opens, and it is best to give people advanced notice of plans and expectations for future meetings.
  2. Acknowledge previous statements. Just like in an in-person visit, encourage your clinical professionals to spend a moment to chat with their consumers, perhaps following up and checking in on what you discussed in your last visit to make sure you both understand where you left off. This also works for clinical professionals as they move from topic to topic during consultations – spending a moment to reiterate an earlier conversation confirms you’re both on the same page. This helps the conversation stay on topic and helps your consumers build a connection with their clinical professionals, even if they have only ever met virtually.
  3. Listen to your consumers. As the world starts to re-open, advise your clinical professionals to check in with their consumers to see whether they would like to continue virtually, start meeting in-person again, or some combination of the two. Staff should realize it is also important to acknowledge any frustrations consumers may have regarding the platform or anything else in their lives. Even during a virtual appointment, it is obvious if someone is upset by the tone of their voice. Acknowledging these frustrations will demonstrate to consumers that their clinical professionals are present, even if they are not physically in the same room. This person-centered care approach will help your consumers feel more connected to their clinical professionals and actively involved in their treatment, which can positively impact health outcomes.
  4. Different policies for different diagnoses. As an office policy, it is also important to think about the consumer diagnoses your organization handles to see what works well digitally. Some treatment plans focusing on talk therapy may lend themselves naturally to telehealth, while others requiring injections or blood samples must be conducted in person. Think through the consumer population your organization treats and set some guidelines for your clinical professionals about how they should plan to handle future visits. For example, children being treated for attention deficit hyperactivity disorder (ADHD) are typically weighed to make sure they are not losing weight due to appetite loss from medication. Set a policy for parents to weigh children at home or develop a schedule for in-person visits.
  5. Explain the technology. All these tech tools are great, so long as everyone can use them. As an organization, be prepared to offer some training to your staff on how to effectively use technologies. If consumers are intimidated by a patient portal, they may be too shy to continue with treatments. It is important for your staff to be respectful of consumer’s tech knowledge and offer guidance without being condescending. Depending on your practice, you could even designate someone in the office to handle tech support for all consumers. Whatever you decide–just make sure you have someone available and willing to reach the consumers where they are.
  6. Do not be afraid to ask questions. Even on a virtual visit, your staff must be able to talk with consumers and engage with them as they would in person. Encourage your staff to make simple small talk to start a conversation, such as commenting about the weather or compliment a new hair style. Even in a virtual world, consumers need to feel connected to clinical professionals, so it is important to show attention to the consumer’s person. Teach your staff basic techniques to recenter and engage again with the conversation should their focus wane briefly.

As the world and industry change and we approach the next normal, provider organizations must embrace the fact that virtual care is here to stay. Incorporating a person-centered approach to care is incredibly important during these times when most of our care is being delivered virtually. To learn more about person-centered care and how to keep your consumers actively engaged in their own health care, view this recent archived webinar, A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Care Connections Personal in a Virtual World.

The full text of “athenahealth Creates Online Telehealth Insights Dashboard to Help Practices Benchmark Their Performance and Find Opportunities to Better Meet Provider and Patient Needs” was published March 9, 2021, by athenahealth, Inc. A free copy of this and access to the Telehealth Insights Dashboard are available online at https://www.businesswire.com/news/home/20210309005235/en/athenahealth-Creates-Online-Telehealth-Insights-Dashboard-to-Help-Practices-Benchmark-Their-Performance-and-Find-Opportunities-to-Better-Meet-Provider-and-Patient-Needs (accessed July 23, 2021).
The full text of “Help patients adjust to telehealth by remembering the human touch” was published June 23, 2020, by the American Medical Association. A free copy is available online at https://www.ama-assn.org/practice-management/digital/help-patients-adjust-telehealth-remembering-human-touch (accessed July 12, 2021).

How To Manage The 5% With Multiple Chronic Conditions & Complex Support Needs

By Monica E. Oss
There is a lot of investment money going into the mental health field—in fact, $14.7 billion in the first half of this year (see Why Are Digital First Mental Health Companies So Popular?). Much of that investment is focused on digital behavioral health systems and tools for both professional and self-care.

However, these new platforms and tools are not the perfect fit for every consumer with a mental illness. In fact, 25% of consumers with any mental illness have a serious mental illness (SMI). In all, 13.1 million consumers, or 5% of the total United States population, have an SMI (see Key Substance Use & Mental Health Indicators In The United States: Results From The 2019 National Survey On Drug Use & Health). Of consumers with SMI, 27% have co-occurring substance use disorders. We also know that SMI consumers on average tend to die 10 to 25 years earlier than the general population—and have a mortality rate that is twice as high as that of the general population because of chronic physical medical conditions such as cardiovascular, respiratory, and infectious diseases; diabetes; and hypertension (see Premature Death Among People With Severe Mental Disorders). 20% of the SMI population lives in poverty Approximately 20% of jail inmates and 15% of state prison inmates have an SMI (see Mental Health & Criminal Justice). 33% of the homeless population has an SMI (see 250,000 Mentally Ill Are Homeless. 140,000 Seriously Mentally Ill Are Homeless).

For the approximately 5% of the population—those with multiple chronic conditions and complex support needs—that use a majority of the health care resources, a different approach is needed to assure good consumer outcomes and prevent inappropriate use of resources. That population was the focus of our recent discussion with Carole Matyas, Vice President, Operations at Sunshine Health, and the keynote speaker at the upcoming 2021 OPEN MINDS Executive Leadership Retreat.

On September 22, Ms. Matyas will deliver the keynote address, The Future Of Managing Care For Consumers With An SMI—What Works. The cornerstone of progressive interventions for the high-risk/high-needs population with a serious mental illness is based on a “whole person” treatment strategy that encompasses medical, behavioral, pharmacy, social needs, and caregiver collaboration and coordination. Ms. Matyas will review Sunshine Health programs that are showing promising positive outcomes such as reduced use of acute/crisis care, better engagement with primary care that improves medical health outcomes and addresses high comorbidity issues, stabilized community-based living environment by addressing social needs for the enrolled Medicaid and Medicare members served. She will provide an overview of their Long Acting Injectable (LAI) program with data that demonstrates reductions in emergency department and inpatient services, and increase in community-based and medical services for members.

My takeaway from our pre-Institute discussion with Ms. Matyas? The Sunshine Health approach to optimizing the management of consumers with an SMI has four key components—intensive case management to assure care coordination, leveraging long-acting medications, a focus on primary care, and addressing social support needs.

Intensive case management to assure care coordination. One approach that has improved outcomes for SMI consumers is intensive case management. Sunshine Health took its top 400 high-needs, high-risk consumers (who have 30+ hospital admissions a year, go to the emergency room every other week, and reject any type of community-based treatment) and had its staff provide proactive and intensive case management services in collaboration with a host of community provider organizations and stakeholders. For example, case managers work closely with a telehealth provider organization that Sunshine Health contracts with to ensure that consumers discharged from hospital have their seven-day follow up appointment virtually and then connect them with an outpatient provider organization for ongoing care.

Leveraging long medications. Sunshine Health has been encouraging provider organizations to use long-acting injectables (LAIs) for antipsychotic medication administration. Ms. Matyas shared that SMI consumers receiving monthly LAIs have shown significant stabilization in their mental health and also do better at getting care for their comorbid medical conditions, engage with peers socially, and are even able to have part-time employment. She said, “We are promoting use of LAIs and really going a long way in working with hospital systems, primary care physicians, and mental health providers to make it easy to obtain those medications, administer them, monitor, and do outreach so members continue treatment. While the medications can be expensive, the results definitely show reductions in hospitalizations, readmissions, and emergency room visits as well as better outcomes from community-based treatment.”

Sunshine Health has a number of strategies to increase the use of LAIs. They do not require provider organizations to obtain prior authorizations to administer LAIs. In addition, if clinical professionals start an LAI when a consumer is in the hospital, case managers make sure to follow up with the consumer to make sure they get to the outpatient provider organization for their next dose when it’s due. They also have a “concierge program” within their pharmacy network and customer service representatives call members to schedule an appointment for their next LAI dose. Some pharmacies are also authorized to administer the LAIs. Sunshine’s provider relations team is charged with providing information about LAIs to community mental health and primary care provider organizations.

Ms. Matyas said, “We have a goal of increasing long acting injectables 25% year over year. During the pandemic, we had interruptions with folks getting their long acting injectables, but we are working towards getting back to normal state, which is encouraging.” And now there are two barriers to overcome to extend the use of LAIs, she added. The first is adherence which becomes challenging when consumers are say, cycling in and out of homelessness and are not stable in their environment or engaged in their treatment. The other issue is that there’s a history of long acting injectables not getting authorized by managed care. So provider organizations need to be educated and learn that “they don’t have to jump through a lot of hoops” to be able to prescribe LAIs if appropriate for the consumers.

Focus on primary care. Sunshine Health is encouraging provider organizations to go the integrated care route by participating in health home models and value-based reimbursement (VBR) models. They are also leveraging data to encourage collaborations and equipping primary care provider organizations to better address the needs of SMI consumers. Recently, they launched a behavioral health home program and seven community mental health centers have signed up to date. These centers have co-located primary care and behavioral health services and are delivering whole-person care under value-based contracts.

VBR is the cornerstone for integrated care. Sunshine Health offers incentives for provider organizations to address “gaps in medical and behavioral care.” In the behavioral health homes program, the incentive program is contingent on preventive health screenings being conducted for all consumers and on addressing the comorbidities that SMI consumers have. All provider organizations in Sunshine’s network—whether they are primary care practices or community mental health centers—are expected to address comorbidities and to report on the array of HEDIS measures related to both medical and behavioral care. Ultimately, Ms. Matyas explained, “The goal is to move more to value-based care, where we can impact members by having them in a health care environment so that they don’t have to go eight different places to get the care they need. They should be able to be more easily referred and seen, for whatever service it is they need. Value-based care incentivizes providers to work together without dictating a one-size-fits-all model.”

Sunshine Health embeds behavioral health services in primary care and offers psychiatrists who can consult on prescribing patterns and other issues in the care of SMI consumers. Ms. Matyas explained, “Every member covered by us is assigned a primary care provider regardless of whether they have an SMI diagnosis or not. So every one of the 5% of our 2.6 million members with SMI has a primary care physician. We take the data to our primary care practices and say, ‘Here are the demographics of the population assigned to you and here are the care gaps.’ The primary care practices will tell us whether they can handle the whole-health needs of these SMI members or want us to move them to a different provider. Or the practices may say they are equipped to handle some things but not others. So then we bring in behavioral health quality practice advisors to work with them, or we move the SMI members to a primary care practice that is better suited to work with this population.”

Addressing social support needs. Sunshine Health addresses social determinants of health (SDOH) in a variety of ways. Many of their behavioral health provider organizations have robust case management programs and the case managers connect consumers to social supports as needed. The health plan maintains a database of community resources that these case managers can access on request. They also offer micro grants to small community projects that support social needs. Some of their Medicaid programs, like the SMI specialty plan, have expanded benefits such as housing rental deposit or one month’s advance rent to help consumers get into housing. They’ve distributed cell phones and tablets for consumer use. SMI consumers get $35 a month in over-the-counter benefits from CVS to buy non-prescription items.

The fact that health plans are looking at primary care as the hub for SMI treatment should be a wake-up call for specialty provider organization executives who believe that their niche in serving this population assures a steady stream of business. Assuming responsibility for the whole-person care (medical, behavioral, and social) of the SMI populations served and participating in value-based arrangements are becoming the basics for sustainability planning.

Addressing Social Determinants As A Path To Revenue Growth

By Monica E. Oss

Over the last 15 years, there have been many pilot projects by payers, health plans, and public and private entities to address social determinants of health (SDOH). In the past couple years, we’ve heard from several health plan executives about their SDOH initiatives (see Mind, Body, Community: Kaiser Permanente’s Unique ApproachInnovation: Tag, You’re It‘Leaning In’ To Medicare: Social Needs OpportunitiesWill Investing In Social Determinants Pay OffHousing = Health: The Five Levers, and Medicaid Wants More Than Health: Be Prepared For Contract Changes). We’ve seen many new SDOH program launches by health plans—UnitedHealthcare’s recent Empowering Health grants, Humana’s Bold Goals program, Horizon Blue Cross Blue Shields of New Jersey’s Neighbors in Health program, and North Carolina Medicaid’s Healthy Opportunities Pilots, to name just a few. And there are the requirements to address SDOH under new Medicaid managed care contracts in a number of states (see Medicaid Authorities & Options To Address Social Determinants Of Health).

For specialty provider organizations, the question is how to address SDOH—and find a funding stream to do just that. Previously, we outlined the two paths to adding social service supports and supports coordination to traditional service lines. One way is to add a social supports coordination element that will get more referrals or improve reimbursement under value-based reimbursement arrangements—and pay for itself as an enhanced service feature with more total revenue for existing services. The other way is to build social supports programs that health plans or government payers will reimburse—and build a new revenue stream. Whatever option an executive team chooses, return-on-investment analysis is key. I wrote recently about our six-step model for assessing the effectiveness (both proactively and in practice) of enhanced social service programming in Building An ROI For Social Service Referrals.

We heard two great case studies of provider organizations that are taking the second path— building service lines for social services with payer/health plan revenue—during the session, Incorporating Social Determinants Of Health Into Your Practice To Improve Patient Outcomes & Increase Reimbursement at last week’s 2021 OPEN MINDS Management Best Practices Institute (session recordings and decks are available at https://openminds.com/live-mbpi/sessions/ until September 27). June Simmons, President and Chief Executive Officer of Partners in Care Foundation and Karin Annerhed-Harris, Vice President, Business Development at Resources for Human Development (RHD), shared how they are working with health plans on unique initiatives to address SDOH for complex consumers.

June Simmons, President & CEO, Partners In Care Foundation

Partners in Care Foundation builds community networks to provide a single point of access for consumers. Partners in Care contracts with health plans—and sometimes with health systems—to provide care management and home and community-based social services. Their goal is to integrate all community health resources and supports into a seamless delivery system for easy access and management. Ms. Simmons said, “If you’re just referring Ms. Smith to go down the street where they provide meals, it’s one thing. But if you’re paying for something, it’s a whole new paradigm. And sometimes you’re going to have to pay for care coordination and concrete services on a targeted basis.”

Partners contracted with Blue Shield of California (BSC) in 2014 to provide SDOH services to BSC consumers through primary care practices. BSC pays Partners for specialized staff—community health advocates (CHAs)—who are trained and supervised by PIC, and embedded in medical practices. To date, Partners has trained and placed 70 CHAs in three years. CHAs assess and analyze consumer needs, work with consumers on care planning, connect them to services, follow up, and track outcomes. The relationship with BSC has grown since over time, with Partners providing a variety of SDOH-related services.

Partners also operates specialized Outreach and Engagement Centers for Anthem in California, Georgia, Colorado, and Virginia. Through these centers, they develop care plans, engage with consumers, and make sure they get the needed social services. “You can take a horse to the water but you can’t make it drink. So engagement is crucial to ensure that consumers actually use the services they are connected to and that’s why the health plans partner with experts like us.”

For health plans, the benefit is in contracting with a single entity that manages the comprehensive network of social care. Access to supports becomes easier for consumers. Data sharing between the health plan and community-based organizations is also streamlined and simplified. Ms. Simmons said, “So if you’re a health plan and want to address a certain population—maybe it’s young moms and kids, maybe it’s frail elders and keeping them out of the nursing home—are you going to go out and identify all the agencies involved, organize them, and contract with them? Or would you like a lead entity that’s going to do that for you—curate the services, qualify the agencies, be the central intake, the oversee the quality, and do the billing?” Working with a trusted local entity is a far more practical and efficient route for health plans in Ms. Simmons’ opinion. She said, “A more mature community entity can bring their neighboring health and human service provider organizations into an organized delivery system, so consumers don’t have to be referred to multiple entities.”

Karin Annerhed-Harris, VP, Business Development, Resources for Human Development

Resources for Human Development addresses food and housing needs. RHD provides outpatient and residential services for consumers with mental illness, substance use disorders, and intellectual and developmental disabilities. RHD partnered with Temple University Hospital and two managed care organizations (MCOs)—Health Partners Plans and Keystone First—to pilot the Housing Smart program. The program was intended to reduce avoidable emergency room utilization and hospital readmissions among homeless individuals through peer outreach, supportive services, and subsidized housing resources.

The MCOs agreed to criteria for eligibility and generated a list of member referrals for RHD. RHD provided the high-users experiencing homelessness with access to housing vouchers that are good for two years. The consumers were housed in apartments across Philadelphia and local food banks provided three meals a day for three months, followed by cooking classes. The pilot resulted in a 74% drop in emergency room use, 48% reduction in hospitalizations, and a 76% increase in outpatient hospital visits. And with stable housing, 12 consumers in the program are actively engaged in behavioral health outpatient services.

At the outset of the program, Temple generated a list of eligible people using target population criteria and shared that with the MCOs. They enrolled 25 high utilizers prioritizing consumers with opioid use disorder, persistent mental illness, and co-occurring physical health conditions. RHD used an MCO-funded team comprising a peer support specialist, care coordinator, and tenant services coordinator to engage consumers in services. While the MCOs reimburse for services, 36% of the program is grant funded and goes toward housing, Ms. Harris said. RHD is exploring expanded health plan funding, now that Pennsylvania allows health systems and MCOs that can save money through a value-based agreement to use the profits to fund housing.

Lessons learned—partnership, evidence-based interventions, data sharing, and more. Ms. Simmons shared the four key elements for successful integration of SDOH—strong partnerships to form a comprehensive community network of care, the capacity to deliver home-based services, the use of good screening tools to assess consumer needs and preferences, and the delivery of evidence-based interventions for SDOH.

At RHD, Ms. Harris attributes the success of their pilot to robust partnerships and collaborations (between provider organizations, a health system, health plans, and other community organizations); cross-sector tools and training; and data sharing to enable a holistic view of consumer needs, goals, and care gaps.

The takeaway for provider organization executives? As my colleague and OPEN MINDS Senior Associate Cathy Gilbert, who moderated the session, said, “Entrepreneurial provider organizations have the opportunity to package many consumer support services that were previously not reimbursable and turn them into new revenue streams in partnership with plans. Providing these services drives better outcomes for consumers and ultimately reduces overall costs.”

Massachusetts FQHC Centers Surpass One Million Telehealth Visits

The Massachusetts Federally Qualified Health Center (FQHC) Telehealth Consortium’s 35 community health center members have conducted more than one million telemedicine visits since the start of coronavirus disease 2019 (COVID-19) in March of 2020. This achievement comes at the same time the Consortium has passed the halfway mark of its Phase II $12 million fundraising goal – thanks to a major grant from the Gordon and Betty Moore Foundation – to attain sustainable telehealth capacity at health centers and address health disparities in the communities served by them.

Consortium data measuring telehealth use between May 2020 and May 2021 show that telemedicine visits have provided safe and convenient access to primary care for communities of color, which have been disproportionately impacted by COVID-19. Of the 767, 234 Massachusetts health center consumers who accessed primary care via telemedicine visits during that year-long period, more than 52% were white, nearly 21% were Black/African American, more than 6% identified as more than one race, more than 5% were Asian/Pacific Islander, and 1% were Native American. Of those identified by ethnicity, nearly 31% were Latinx/Hispanic.

According to the data, the same held true for behavioral health care services. Of the total number of consumers taking part in behavioral health telehealth visits during the same one-year period, nearly 56% were white, more than 23% were Black/African American, more than 5% were of more than one race, 4.65% were Asian/Pacific islander, and less than 1% were Native American. By ethnicity, 31% again identified as Latinx/Hispanic.

Phase II of the Consortium’s campaign is focused on ensuring that FQHCs have what they need to fully develop, deploy, sustain, and integrate telehealth modalities into primary and behavioral care, while also addressing the digital divide in their communities. This includes providing better access to broadband and remote monitoring equipment, increased digital literacy training, peer learning, outreach in communities that health centers serve, and online dissemination of best practices.

Phase II of the campaign launched in the fall of 2020 with $1,040,000 received from an anonymous donor to create skilled bandwidth at nine pilot sites required to integrate advanced, durable, and mature telehealth capabilities into member FQHCs. Another $3.1 million grant awarded by the U.S. Federal Communications Commission (FCC) in January as part of the FCC Connected Care Pilot Program is providing equipment and hot spots for consumer broadband access. The grant from the Gordon and Betty Moore Foundation ($878,000) is designed to increase the number of consumers with controlled hypertension, particularly for African American/Black consumers, and to test the additional value of telehealth navigators and clinical intervention over federal funding of remote monitoring.

The Consortium is a partnership of Community Care Cooperative (C3), the accountable care organization (ACO) that advances community-based care for MassHealth members, and the Massachusetts League of Community Health Centers, the state-based association of health centers.

Community Care Cooperative (C3) is a not-for-profit ACO that leverages the proven best practices of ACOs throughout the country and is the only ACO in Massachusetts founded and governed by Federally Qualified Health Centers (FQHC) and exclusively focused on advancing integrated and coordinated community-based care for MassHealth members. C3 works with its 18 member FQHCs to strengthen health centers across the state, and continued growth enables C3 to better serve MassHealth members across the Commonwealth. To view a list of C3 health centers, click here.

The Massachusetts League of Community Health Centers (the League) is a not-for-profit membership organization supporting and representing the Commonwealth’s 52 community health centers, which offer primary and preventive care to more than one million residents. The League serves as an information resource on community-based primary care to policymakers, opinion leaders, and the media. It provides a wide range of technical assistance to its health center members, including advocacy on health policy issues, support for workforce development, clinical care and technology initiatives, and guidance to state leaders and community-based organizations seeking to open health centers.

The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, consumer care improvements, and preservation of the special character of the Bay Area.

This was reported by The Massachusetts FQHC Telehealth Consortium on August 24, 2021.

Contact information: Abby Akoury, Chief of Staff, Community Care Cooperative, 75 Federal Street, 7th Floor, Boston, Massachusetts 02110; 857-302-4261; Email: aakoury@c3aco.org; Website: https://www.communitycarecooperative.org/

Contact information: The Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, Massachusetts 02108; 617-426-2225; Email: massleague@massleague.org; Website: https://massleague.org/

Contact information: The Gordon and Betty Moore Foundation, 1661 Page Mill Rd, Palo Alto, CA 94304; 650-213-3000; Email: communications@moore.org; Website: https://www.moore.org/

WellSpan Health & Gateway Health Launch Value-Based Partnership For Medicaid Members

On July 29, 2021, Gateway Health, a Pennsylvania Medicaid managed care plan, and WellSpan Health a health system in central Pennsylvania launched a value-based partnership focused on connecting Gateway Health members with primary care professionals. Gateway Health and WellSpan are proactively contacting Gateway Health’s Medicaid members who visit the health system through emergency or urgent care visits, but do not have a relationship with a primary care provider organization. WellSpan case managers will work one-on-one with the Gateway members to address barriers, such as transportation and cost, to establishing an appropriate primary care relationship. Financial details about the partnership have not been disclosed. The goal is to reduce the number of potentially preventable emergency department visits among Gateway members.

Through this value-based partnership, Gateway Health and WellSpan aim to deliver an enhanced level of care, improve health outcomes, and lower health care costs for Gateway Health’s Medicaid members receiving care at WellSpan’s 200-plus health care locations. The partnership will utilize data insights and value-based programs to proactively manage the health care needs for more than 24,000 Gateway Health Medicaid members living in South Central Pennsylvania.

This partnership expands on an existing relationship between Gateway Health and WellSpan. For the past 18 months, they have partnered together for better maternal care and coverage through Foundations Pregnancy Support Services, a program offering coordinated, comprehensive care for mothers and their children with opioid use disorder. WellSpan partners with other Medicaid insurers to provide this support. However, WellSpan said that the commitment and innovative partnership with Gateway Health has resulted in more than double the number of members enrolled than with any other insurer.

Gateway Health was founded in 1992 as a Medicaid managed care plan. It currently provides Medicaid and Medicare Advantage plans. It covers health care services for nearly 340,000 members annually.

Non-profit WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. It has more than 1,600 employed physicians and advance practice professionals; a regional behavioral health organization; a home care organization; eight hospitals, and more than 200 consumer care locations.

For more information, contact: