Texas 1115 Waiver: Using Technology to Prove Outcomes

As payment models in healthcare continue to innovate and test new ways to lower costs and deliver quality outcomes, initiatives like the Texas Medicaid 1115 Waiver program become a vital route for organizations to maximize their Medicaid payments. The goal of the 1115 Waiver program is to allow Texas the ability to “expand Medicaid managed care, while preserving hospital funding. It also provides incentive payments for healthcare improvements and directs more funding to hospitals that serve a large number of uninsured patients.”

Local Mental Health Authorities (LMHAs) in Texas will be eligible to receive funding from a $25 billion bucket over the next five years if they can prove they have met or exceeded specific quality measures. Each quality measure is given a weighted score and each LMHA will have a minimum score to meet. Measures include screenings for clinical depression, body mass index, substance use disorders, medication compliance and chronic disease management.

So, how do organizations prove their outcomes yet remain efficient and maintain a high level of staff satisfaction? We talked with one of the largest LMHAs in the state, My Health My Resources of Tarrant County (MHMR) about how they are tackling the challenge.

“Part of our decision to implement the Netsmart system was their ability to accommodate the very specific requirements of the Texas 1115 Waiver program,” said Susan Garnett, CEO of MHMR. “The reporting requirements for proving outcomes can be a cumbersome one, especially if an organization doesn’t have an integrated EHR system. Netsmart is building the reporting directly into the workflows so it’s part of our process.”

In this day of bundles and outcomes-based payment models, basic automation from an electronic health record (EHR) just doesn’t cut it. Organizations need an integrated platform that gives them real-time access to information from across different providers and care settings, while providing insights and analytics that meet all outcome and regulatory requirements.

LMHAs in Texas have a tremendous opportunity to demonstrate results with the 1115 Waiver program by deploying connected, coordinated care models that lower costs for their organizations and improve outcomes for the individuals they serve.

“1115 is about healthcare transformation, soon we will have the technology to truly track our progress in serving people and supporting their health and wellness,” Garnett said.

About the Author

Scott Green, Senior Vice President / Managing Director, Care Dimensions

Scott Green leads the Care Dimensions business unit at Netsmart. He leads a team focused on building a comprehensive suite of solutions designed to support organizations as they digitize operations beyond the EHR. Green has been with Netsmart for 10 years and has held many roles during that time, including leading the Human Services business unit.