Who Should Do What? Scope of Practice; Treatment Tech Shift Clinical Best Practices

By Monica E. Oss, Chief Executive Officer

There has been a long debate about the scope of health care practices. What type of licensed clinical professionals can perform particular functions? Should psychologists and/or pharmacists prescribe psychotropic medications? What supervision do nurse practitioners and physician assistants need? (Should ‘physician assistants’ be renamed ‘physician associates’?)

Psychologists can prescribe in five states: Louisiana, New Mexico, Illinois, Iowa, and Idaho (see Can Psychologists Prescribe Medications?). The scope of pharmacists’ practices is state-dependent and varies widely from state-to-state (see Mapping U.S. Statewide Protocols For Pharmacist Prescriptive Authority). Pharmacists may or may not give injections and immunizations and prescribe everything from naloxone, tobacco cession aids, travel medications, and more. Physician Assistants are licensed to practice in all 50 states, the District of Columbia, all US territories, and the uniformed services. Physician Assistants are authorized to prescribe medications in all jurisdictions where they are licensed, except Puerto Rico (see PA Prescribing and Assessing Scope of Practice in Health Care Delivery: Critical Questions in Assuring Public Access and Safety).

Executives of health and human service organizations need to plan to leverage the ‘value’ of their clinical team members by developing systems where they can work at the ‘top of their practice’—with most of their time going to the services that require their specific level of training. But that is easy to say and much harder to accomplish in practice. This type of service specialization is an essential part of the specialization needed to achieve maximum operational efficiency—and the highest value.

But there are two factors that complicate plans for specialization to increase value. The first is that in systems that are increasingly rewarded for a ‘whole person’ approach to care—which runs contrary to specialization. The second is that health care treatment technologies are reaching a level of sophistication that they can be a replacement for some of the work of licensed clinical professionals. The key for executive teams is using technology to address both of these issues. The first is ‘virtual integration’—creating a singular consumer data set that is available to all health care professionals. The second is to use data—both small data and big data—to develop algorithms that curate the recommendation of treatment services for specific consumers—both treatment technology and the most appropriate clinical professional. These are essentials to sustainability—building organizational efficiencies that result in competitive advantage.

For more on our coverage of efficiency and effectiveness in staffing models—and in emerging treatment technology, check out these resources in the OPEN MINDS Industry Library.

Scope of Practice Issues

Digital Treatment Trends & Strategy

Digital Treatment Developments

For more on managing and practicing at the top of your team’s skillsets, join me for The 2022 OPEN MIND Management Best Practices Institute in Newport Beach, California from August 30 to September 1, 2022.

Making Tech Work

By Monica E. Oss, Chief Executive Officer

Tech investment in health care is big. Eighty percent of health care provider organization executive teams are looking to make additional investments in technology in the next five years (see Future Of Healthcare Report: Exploring Healthcare Stakeholders’ Expectations For The Next Chapter). As a result, the health care tech market is expected to grow from $326.1 billion in 2021 to $821.1 billion by 2026 (see Healthcare IT Market by Products & Services, Components, End-User, and Region).

Currently, tech investments by specialty provider organizations have focused on EHRs (88%) and telehealth platforms (85%). About half of specialty provider organizations have invested in referral tracking systems, health information exchange technology, fundraising tools, ePrescribing tools, and clinical decision support systems (see The Computer Is A Moron and The 2021 OPEN MINDS Health & Human Services Technology Survey). But the changing landscape is changing the tech functionality that specialty and primary care provider organizations need to maintain competitive advantage and sustainability. According to The OPEN MINDS 2021 National Behavioral Health Electronic Health Record Survey, 56% of these provider organization executive teams report having tech functionality gaps—and 21% stated an intention to procure a new EHR (see The Times Have Changed. So Have Our EHR Concerns.). Our team at OPEN MINDS thinks this focus will be on integrated analytics, technologies supporting hybrid care delivery (scheduling, mobile, visit verification, etc.), consumer engagement, and managing alternate reimbursement contracts.

But with more technology come problems of implementation and optimization. First, there are privacy and security issues. About a third of behavioral health provider organizations were cited by Accreditation Commission for Health Care (ACHC) for having incomplete, substandard policies related to protection of patient data (see One-Third Of Behavioral Health Organizations Have Incomplete Policies For Health Information Protection). The ACHC also cited 26% of these organizations for missing documentation, 20% for missing information on staff background checks, and 20% for missing information on staff Hepatitis B vaccination. And the on-line apps in the behavioral health field are not doing much better (see Does Mental Health Privacy Really Matter To Consumers?).

Another issue—adoption of data-driven decision making. A recent survey found that 74% of health care provider organizations use clinical decision support technology—but in limited ways. The key uses of clinical decision support are medication orders (30%), lab orders (24%), and medical imaging orders (20%) (see The Process Matters). And, only 16% of community mental health center executives have adopted measurement-based care (MBC) technology (see 16% Of Community Mental Health Centers Use Measurement-Based Care, Despite Knowledge Of Value).

For more, I reached out to my colleague and OPEN MINDS Senior Associate Joe Naughton-Travers to get an understanding of why, when technology is so critical to the future competitive advantage of provider organizations, are there so many challenges in both adoption and implementation. “I think the biggest issue for health and human services is that organizations usually don’t have a technology strategy and roadmap,” Mr. Naughton-Travers said. “Some organizations are still struggling to get the basic data systems in place (EHR, human resources information systems, and general ledger systems) and others are still a long way off from achieving analytic and performance optimization. In terms of poor management practices, the problem is usually the lack of formal project planning and project management in both selecting and implementing technologies.”

How to plot a path to tech success? He had three recommendations—systematically identify technology gaps, adopt a deliberate adoption roadmap, and make sure you have the right staff to get the job done.

Systematically identify technology gaps—Provider organization executive teams should conduct a regular needs assessment to ascertain what functions they are lacking, and what tech can fulfill that need. This needs assessment should be concurrent with implementation planning for a strategic plan. Answering three critical questions should drive the process: what competency do you need, who on your team will be using the tool, and how will that technology adoption create and drive value for the consumer, the payer, and the care continuum?

Develop a deliberate tech adoption roadmap—Once an executive team has determined the technologies needed to achieve both strategic and business objectives, a timeline for selecting and implementing new tech tools is the next step. Managers need to look beyond “the basics” and identify the technology requirements needed to support strategic plan objectives.

Invest in the right staff—New technology brings new competency requirements among executives and managers. Success requires upgrading the skills of existing team members and/or finding new team members with the competencies to implement, manage, and optimize the new tools. Technology is no longer an afterthought—the entire executive team needs to be involved with ongoing technology planning and optimization.

Mr. Naughton-Travers concluded, “When technology implementations fail to achieve their goals, it’s a “double whammy”—you have spent a bunch of money and the problem you needed to solve still exists. Far too many organizations make this exact, costly mistake.”

For more on technology adoption and implementation, check out these resources in The OPEN MINDS Circle Library:

And for more on getting your “tech game” where it needs to be, mark your calendar for June 14-16 and The 2022 OPEN MINDS Strategy & Innovation Institute in New Orleans, Louisiana. Be sure to check out the session, Technology For Innovation: How Do You Know What You Need?, featuring Julie Sjordal, Chief Executive Officer at St. David’s Center for Child & Family Development, along with OPEN MINDS Senior Associates, Carol Clayton, Ph.D. and Sharon Hicks.

Certified Community Behavioral Health Clinics (CCBHCs) as a Diversion Strategy

Join us as we look at how a Demonstration CCBHC has implemented diversion strategies for people in crisis to decrease emergency department visits, decrease inpatient stays, and divert individuals from involvement with the criminal justice system. In this webinar you will learn about the relationships and communication processes this CCBHC has built with external entities such as hospitals and the police force. You will hear about the proactive steps the agency is taking, such as delivering “crisis intervention training” to the police and conducting primary care screening and monitoring for the clients they serve. And finally, agency leadership will share how they established relationships with social service agencies to mitigate social determinant of health issues for an individual that can contribute to increased ED visits and potential behavioral health crises. By attending this webinar, you will be able to take away diversion strategies that can work in your CCBHC as well.

Upon completion of this webinar, attendees will learn:

  • How to establish relationships and open communication with hospitals and law enforcement agencies
  • How to create response protocols for use when called upon by these external community-based entities
  • How to work with social service agencies to mitigate SDOH issues

Registration has been made available, free of charge, courtesy of Qualifacts + Credible.

Making Strategy Work – Mission, Growth, & Sustainability

Free web forum, sponsored by Qualifacts + Credible and OPEN MINDS

Michael Porter stated that strategy was really just answering the two most basic questions of an organization: Who do we serve and how do we serve them? While there is elegant simplicity in that phrasing, planned strategic change is a delicate balancing act of managing the present and the future in domains of finance, customer service, and internal efficiency and doing so without losing the commitment of board or staff. Its no wonder that McKinsey studies have shown that as high as 70% of these change efforts fail – even pre-COVID.  The pandemic has doubled the stakes and speed of the game. Margins are thinner, competitors are stronger and bigger, change is more urgent, and staff we need to lead this charge are tired.

Together in this discussion, we will explore the following issues:

  • How can I truly and honestly self-assess my organizations strengths and needs?
  • How can we pierce the fog of chaos and create a vision for the community that is engaging, efficient, and effective?
  • Can we still sell that vision? Will old communication styles still succeed?
  • What new day to day metrics and management habits can help in balancing the present and future?

Registration for this executive web briefing has been provided at no charge courtesy of Qualifacts + Credible.

Unable to attend? Still register! At the conclusion of the event, all registrants will receive a recorded copy of the executive web briefing and presentation slides.