Getting ready for Certified Community Behavioral Health Clinics, value-based service delivery and payment models
What is the timeline for the planning CCBHC phases?
In October 2015, 24 states were selected to receive one-year planning grants to develop a CCBHC program and prospective payment system (PPS) reimbursement rates
In October 2016, a select number of states will be named to participate in a two-year demonstration program that runs from January 2017 through December 2018
Results of the program will be evaluated and a final report with recommendations will be submitted to Congress by the Department of Health and Human Services by December 2021.
What are the certification criteria for becoming a CCBHC?
Certification requirements cover six main areas:
Availability and accessibility of services
Scope of services
Quality and other reporting
Organizational authority, governance and accreditation
You can learn the specifics for each area in this SAMHSA document: Demonstration Program to Improve Community Mental Health Centers and to Establish Certified Community Behavioral Health Clinics
If my organization isn't located in one of the states selected for the two-year demonstration program, why should I start planning now?
Regardless of your location, CCBHC or similar value-based payment models will likely impact how you deliver services and how you will be paid for them in the future.
The states selected in Phase 1 are developing prospective payment system (PPS) reimbursement rates under one of two models for Medicaid reimbursable behavioral health services. In Phase 2, CCBHCs in the selected states will be billing under the PPS (as approved by CMS) established for their states.
Under the new PPS, a core set of quality measures are used to determine bonus payments (which are optional under PPS-1). The measures are a combination of process and outcome measures, such as follow-up after hospitalization, medication adherence for people with schizophrenia and depression remission.
Whatever the results of Phase 2, the move from fee-for-service payments toward value-based reimbursement will continue. Organizations should start planning now to be sure they're able to adapt to care integration, as well as measuring quality and improvement in outcomes.
Will my organization have to become certified in order to continue providing services?
In some states, such as Missouri and Colorado, if you are a community mental health clinic (CMHC) you have the opportunity to become a CCBHC. While in some states, such as Virginia, a select number of pilot CCBHCs were selected. Others, such as New York, used an application process for organizations to become a CCBHC. You can prepare by reviewing the scope of services and how you can provide them directly or via relationships with other providers.
If your organization chooses not to pursue certification, you will still likely be affected by the CCBHC program as a designated collaborating organization (DCO).
A DCO is more than a referral partner. As a DCO, your organization must align with the CCBHC requirements, such as licensing, timeliness of services, etc., for the services you provide. CCBHC quality measurement and reporting obligations may also require your organization to update technology and modify processes. More specifics on DCOs can be found on the SAMHSA web site. The CCBHC must have a formal relationship with each DCO – e.g., a contract or memorandum of understanding – and is responsible for coordinating referrals, handling follow-up and ensuring all services are delivered in a timely manner.
To begin preparing for the impact of the CCBHC models, what areas should we focus on?
Evaluate your technology and operations strategies to start getting your organization ready. Three key areas in which to start:
The goal of CCBHCs is to provide more effective care at lower costs. For your organization, it's absolutely critical to have processes and technology that connect to care providers outside of your organization. You may already have processes in place to do this, but you should start formalizing current partnerships and looking for ways to establish new ones with other organizations.
You’ll also need technology to help you make seamless connections:
Electronic health record (EHR) support for evidence-based practices
Workflows that support referrals, follow-ups and appointment alerts
ONC-certified health information technology that provides the integration of physical and behavioral healthcare services
Reporting capabilities to track timeliness and availability of services
Technology is available now to help you make those connections. Netsmart CareManagerTM is an EHR-agnostic care coordination solution that facilitates communication and information exchange among all care providers. Used with CareConnectTM, the web-based integration engine that powers interoperability with any EHR, you can send and receive information, while remaining compliant with confidentiality and privacy regulations.
The CCBHC program addresses physical and behavioral health, as well as the social services each individual and family need to achieve well-being. Treatment must be tracked wherever it takes place – from emergency departments and acute care, to post-detoxification step-down services and residential programs. Data and results must also be available for population health management.
Evaluate your current technology in these areas to gauge your ability to share data seamlessly and securely among all providers:
Is your EHR ONC-certified? Does it handle billing, tracking, scheduling and treatment planning?
Do you have advanced functionality, such as real-time alerts on events, e.g., emergency department visits?
Can you aggregate clinical data to provide a broad picture at the population level?
If you're not planning on becoming certified, Netsmart CareManager and CareConnect offer you a stand-alone option so you can provide the services, connectivity and data you’ll need to keep your organization viable.
Quality Measures and Reporting
Some aspects of data reporting will be the responsibility of the state, using Medicaid claims and encounter data. Other quality measures and reporting will be the responsibility of the CCBHC with the EHR as the source of data.
Continuous quality improvement (CQI) plans that cover the needs of specific segments of the population served, as well as a clinic-wide plan, will be required. Your organization will need the ability to track data, measure progress and generate reporting on performance management and quality measurement:
Data analytics solutions that are fully integrated with EHR and care coordination solutions to offer a full-fledged business intelligence platform and insights into clinical, financial and operational data
Dashboard for real-time performance monitoring that supports quality measures , allowing immediate action to initiate changes for improvement
Technology is available now to simplify reporting and analysis. Netsmart CarePathwaysTM suite of solutions includes AnalyticsTM, which streamlines tracking key performance indicators and includes automatic data extraction from your electronic health record.
As a DCO, the same requirements for data and quality reporting measures pass through from the CCBHC. The CCBHC is responsible for acquiring the data as legally permissible. As you begin formalizing DCO agreements with CCBHCs, be sure you fully understand this directive and what your role in supporting it will be.
Here's one more thing you can do to prepare: Choose a partner who understands the challenges you face.
Technology only works as well as the strategy and the company behind it. With Netsmart, you have a partner with the experience and technology to address the real issues that impact your organization.
We want to be more than your vendor. We're also an advocate for health and human services providers, working with legislators and policymakers in Washington, DC, and at the state level to make sure your voice is heard.
To find out how we can help you meet the challenges of value-based service delivery and payment models, contact us for a demo or consultation.