A statewide approach to CCBHC

In 2017, Missouri became one of eight demonstration states to participate in the Certified Community Behavioral Health Clinics (CCBHC) program. Missouri CCBHCs are now providing services for more than 160,000 individuals annually in 109 of the state’s 115 counties.

The widespread adoption and success in transforming care with the CCBHC program in Missouri has been led by the Missouri Behavioral Health Council (MBHC). Founded in 1978, MBHC represents Missouri’s not-forprofit community mental health centers, as well as alcohol and addiction treatment agencies, affiliated community psychiatric rehabilitation service providers and a clinical call center.

MBHC and its 33 member agencies work together to improve the system of care in Missouri and provide treatment and support services to more than 250,000 clients annually. They decided to go “all in” in 2017 when selected as a demonstration state for the CCBHC program.

“One of the long-standing operating principles in Missouri is that we understand there is power in numbers. From advocacy to operational excellence, we try to speak with one voice.” Brent McGinty, CEO of MBHC said.

Understanding that all participating providers would be better served by a unified approach leveraging shared technology, MBHC led a selection process for a population health management platform, to support all MBHC-led programs, inclusive of the CCBHC program.

Since adopting the CCBHC model, Missouri has seen tremendous benefits from the program. When funding for the program was in question as the demonstration period neared an end, they worked together to pass a State Plan Amendment (SPA), to rename the program (CCBHO) and ensure its continuation (see footnote). With the extension of funding for the program as a result of the SPA, MBHC’s vision for a statewide CCBHO data and care coordination platform is driving great efficiencies and outcomes.

Missouri CCBHO data goals

The efficiencies realized across the state are being created by ensuring alignment to three important goals that have guided the state’s investments of time and resources:

Create efficiencies in the data reporting requirements for all statewide programs, inclusive of CCBHO
Create a platform where real-time data transmission enhances clinical care and enables quality improvement strategies
Leverage all provider and state CCBHO data in a single database for financial and operational analysis to establish and share best practices
Share data to increase state and provider alignment and buy-in

Missouri providers report the CCBHO program has allowed for a more comprehensive treatment approach by addressing the whole person, inclusive of their medical, behavioral health and social needs. A big step toward accomplishing this was developing a population health management approach with technology capable of aggregating data from multiple sources. This data allows providers to gain a full perspective of an individual’s health.

“Up until partnering with Netsmart, our data was in disparate systems, which meant staff had to document in multiple places across different systems,” said Rachelle Glavin, senior vice president of clinical operations for MBHC. “Reconciling health information and medications was a manual process rife with potential errors and misinformation.”

“Care managers were spending up to 40% of their time searching for data. We needed them to spend that time managing care,” said Glavin. “For example, an average Nurse Care Manager would log into three to four disparate systems to prepare for an interaction with a client. Now all that data is presented in one platform and presented at the caseload and individual level in real time.”

The solution

In 2016, MBHC implemented Netsmart CareManager™, a population health management platform that provides care coordination, interoperability, analytics, outcomes and risk stratification to eliminate manual tasks, improve the delivery of care and reduce costs.

Given that MBHC members use different electronic health record (EHR) platforms (11 different EHRs are in use across the 33 member agencies), it was important to ensure that the approach didn’t require anyone to change their current platform. The CareManager platform is deployed in an EHR-agnostic fashion, enabling speed to value and minimal disruption for MBHC members.

“Since deploying CareManager, we now have an aggregate data set that allows us to eliminate many previously manual and duplicative tasks,” said Glavin. “For example, we can now automate the calculation of risk for our population, leveraging both encounter and claims data to create a living risk profile for the attributed population.”

As a result of MBHC members using a shared system with near real-time data, risk can be identified and addressed to divert a potential acute crisis. Doing so saves time, improves outcomes, reduces costs and increases staff and client satisfaction. The CareManager system has also streamlined state reporting, such as hospitalization follow-up. By automating the submission of required outcomes data, this is no longer a manual process.

Additionally, MBHC has been able to share costs for technology and training and drive the widespread participation in the program via economies of scale.

Reducing costs, increasing access

Because of the success of CareManager and the ability to pull information from disparate EHRs into a shared platform, the Council is now expanding the data set by establishing the CLIVE data warehouse built on the Netsmart population health platform. CLIVE is an enterprise data warehouse and analytics solution that will provide enhanced ability to review and share data, giving the state a strong position in the value-based care and payment environment. Data will be leveraged to negotiate with payors and develop pay for performance models that will attribute patients and produce outcomes to the payors real-time. All 33 member agencies will have near real-time access to their data for analysis and optimization efforts.

"Expanding from our success with CareManager to a statewide data platform is a game changer in terms of what we’re doing and where we’re going with CCBHO and all our programs.

Rachelle Glavin, Senior Vice President of Clinical Operations, Missouri Coalition

The graphic on the next page shows the design of data flow and value of information viewable and actionable in one place. This allows for a whole-person view of individuals and populations to make clinical and business decisions at the right time and the right level.

ER/hospital alerts: Allows for successful transitions of care and hospital follow-up reporting
CBHL/YBHL, DM, ERE, BHCC assessments: CCBHO programs managed in one place
Metabolic screening: labs/vitals as well as alerts when out of range
Department of Mental Health: Information on clients, including program participation and social determinants of health (employment/housing)
Health Risk Profile (HRP): Ability to create a risk profile to identify high-risk individuals
Medicaid claims: Daily claims feed, which allows for accurate measures, risk profiles and analytics
CarePathways™: Measures Reporting and Key Performance Indicators (KPI) for all CCBHOs
EHRs: Ability for agencies to enter data one time in the EHR, regardless of vendor

Missouri CCBHO program 2022 results

$15.4M
in savings on hospital costs

14%
lower hospital costs

156%
increase in medication-assisted treatment

$484
in savings per individual

16%
decrease in ED visits

35%
overall increase in access to care

Source: Missouri CCBHC Year 5 Impact Report. Prepared by the Missouri Behavioral Council, August 2022

State of Missouri Population Health Management Data Platform

Key benefits

Ability to benchmark across clinics to improve performance and outcomes for individuals served
Creates efficiencies in the data reporting requirements from the state
Providers can use the information to enhance clinical and operational decisions and apply quality improvement strategies
All provider and state-led CCBHO measures included in one place

About the Missouri Behavioral Health Council

Founded in 1978, the Missouri Behavioral Council is a statewide network that is leading the way to accessible behavioral healthcare in Missouri.

With 33 member agencies, the Council uses the continuum of care model, which offers the benefits of receiving individualized types and levels of treatment while helping people progress through a quality, cost-effective and least restrictive system of care.