The COVID-19 pandemic has led to many technology innovations in health care. The most noticeable transformation is the rise of telehealth with claims skyrocketing from less than 0.01% of total visits to 80% of behavioral health visits during the first quarter of the pandemic (see How’s That Strategic Plan Going?). We predict consumers and payers alike will continue to expect virtual service delivery as part of everyday service long after the pandemic has ended. How can organizations can continue innovating after the pandemic has passed?

There are two big trends  to focus on—the first is virtualization and the second is digital transformation. At Qualifacts + Credible, the focus continues to be on helping behavioral health and human services agencies improve clinical outcomes, enhance operations, and activate their full potential through the use of an EHR.

Not only will consumers continue to engage virtually with their providers post-pandemic, but consumers will continue to expect some level of integrated telehealth functionality. Not all provider visits lend themselves well to telehealth and not all consumers will want to meet virtually, but everyone will expect to see some telehealth options for routine care. And provider organizations will find a way to use artificial intelligence and machine learning to streamline routine tasks like notetaking.

Organizations have to be strong operationally at their core business in order to be effective and successful. At the same time, they have to have a somewhat less structured environment for managing innovation. To set your provider organization up for success and continue to innovate you should:

1. Empower employees to innovate. Managers sometimes fear that encouraging innovation among their staff will distract them from their everyday jobs. If you want your teams to innovate, make sure you include those expectations on job descriptions. There are too many organizational constraints available that deter innovation—and the best way to overcome them is for the C-suite has to sponsor the innovation.
2. Incentivize innovative thinking/ideas. Empowering employees usually isn’t enough—think about ways to incentivize them through bonuses, contests, and/or unstructured time off. The reward doesn’t have to be an all-expenses-paid trip to the Caribbean, just something to show employees you value their ideas, such as gift cards to restaurants or retailers.
3. Designate an innovation leader. Not every staff member is a born innovator so rather than ask everyone to dedicate 5% of their time to it, consider making it a job responsibility for the staff member in charge of innovation for the organization. An empowered, dedicated leader can make a big difference.
4. Be open to failure. Make sure you cultivate a culture that is willing to accept that not all ideas can be homeruns and failures will happen. Innovation requires being brave enough to be willing to experiment and tolerate failures.
5. Foster collaboration. Many employers have had to scramble this past year figuring out telework solutions on the fly to keep businesses running. This has disrupted how we previously brainstormed. With the expectation that clinicians and staff will continue to work remotely, businesses must find ways to foster collaboration and relationships when there is no shared water cooler for gathering and sharing ideas.
6. Hire with an eye toward innovation. One question to ask is if the organization has the competencies necessary to innovate or needs supplemental competencies. When hiring for a position, think about which candidate would bring new ideas and challenge current thinking. Consider adding innovation case studies or scenarios to the hiring process to see what ideas candidates come up with. Even if the candidate does not ultimately take the job, you may still find some good ideas.
7. Talk to your customers. No one knows more about your business than your current customers. Make it a regular part of the job to check in with your clients to see what’s happening for them and ways your organization can help. Due to the pandemic, we haven’t had the luxury of attending business networking events so use these customer check-ins to find out what’s happening in the market.
8. Innovate, innovate, innovate. Just because you have well-liked product offerings now, doesn’t mean it will always be that way. There will always be someone else coming along that is better, faster, and/or cheaper. To stay at the top of the game, you need to constantly be looking to innovate.

To hear more about the innovations happening in health and human services technology, listen to Joe Naughton-Travers, Senior Associate at OPEN MINDS and Eric Arnson, Chief Product Officer at Qualifacts + Credible discuss how performance and outcomes play a critical role in your future success in a recording of the session, “Why Measuring Performance & Tracking Outcomes Are Your Roadmap to Success: A Discussion With Eric Arnson, Chief Product Officer, Qualifacts + Credible.”

National Quality Forum recently endorsed four behavioral health quality measures. The measures address maximum hours of physical restraint use or seclusion, and separately address timeliness of follow-up after an emergency department visit for an alcohol or other drug abuse or dependence, and timeliness of follow-up after an emergency department visit for mental illness or intentional self-harm. The latter two measures had previously been a single measure.

The endorsed measures are:

• 0640 HBIPS-2 Hours of Physical Restraint Use: This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting were maintained in physical restraints. The data comes from electronic and paper medical records. The measure is reported as the number of times that physical restraints are used for more than two hours divided by the number of psychiatric inpatient days.
• 0641 HBIPS-3 Hours of Seclusion Use: This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting who are held in seclusion. The data comes from electronic and paper medical records. The measure is reported as the number of events divided by the number of psychiatric inpatient days.
• 3488 Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence: This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence and who have a follow-up outpatient visit for AOD. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.
• 3489 Follow-Up After Emergency Department Visit for Mental Illness: This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of mental illness or intentional self-harm who have a follow-up visit for mental illness. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.

The recommendations were issued in “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” by National Quality Forum (NQF). During the spring 2019 project cycle, the Behavioral Health and Substance Use Standing Committee evaluated six measures. The following two measures were not endorsed during this cycle: NQF  0560 HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification; and NQF 1922 HBIPS-1 Admission Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths Complete. Each Behavioral Health and Substance Use project cycle aims to endorse measures of accountability for improving the delivery of behavioral health care in the United States.

NQF is a consensus-based healthcare organization created in 1999 that works with all members of the healthcare community to drive measurable health improvements. Its mission includes promoting and ensuring consumer protections and healthcare quality through evidence-based measurement and public reporting. NQF-endorsed measures are used by the federal government (Medicare and Medicaid), states, and private-sector organizations to evaluate performance and to share information with consumers. To endorse measures, NQF committees evaluate the evidence-base for measures submitted by measure developers. NQF reconsiders endorsed measures and considers new measures during project cycles. Previously endorsed measures relevant to the project are reconsidered to assess their ongoing importance, validity, reliability, feasibility, and utility .

The full text of “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” was published in February 2020 by National Quality Forum. A free copy is available online at http://www.qualityforum.org/Publications/2020/02/Behavioral_Health_and_Substance_Use_Final_Technical_Report_-_Spring_2019_Cycle.aspx (accessed March 30, 2020).

OPEN MINDS last reported on this topic in “National Quality Forum Endorses Four Behavioral Health & Addiction Disorder Safety Measures,” which published on June 13, 2018. The article is available at https://www.openminds.com/market-intelligence/bulletins/national-quality-forum-endorses-four-behavioral-health-addiction-disorder-safety-measures/.

For more information, contact: Information Office, National Quality Forum, 1099 14^th Street Northwest, Suite 500, Washington, District of Columbia 20005; 202-783-1300; Fax: 202-783-3434; Email: info@qualityforum.org; Website: http://www.qualityforum.org/.

Accreditation is identified as a component of value-based reimbursement in the OPEN MINDS VBR Readiness Assessment. Organizations can leverage accreditation in their contract negotiations with payers.

Benefits of Accrediting Behavioral Health Organizations

Achieving health care accreditation lets your consumers, payers and the community know that your organization has a commitment to quality and meets industry quality standards. Benefits of accreditation:

1. Provides a clear structure for behavioral health services to build infrastructure that will facilitate quality of care and outcomes.
2. Increases accountability to the community and policymakers.
3. Facilitates quality to be integrated in the organization’s governance structure, down to the front line. It improves management processes.
4. Enables organizations to be more competitive in payer negotiation, particularly with value-based payment agreements. It may support other funding opportunities.
5. Standardizes operating and clinical policies and procedures, thus increasing quality, improving efficiencies, and reducing costs.
6. Enhances consumer satisfaction, by adherence to patient-centered standards and monitoring.
7. Improves patient safety through the implementation of industry standard infection control, mediation safety, diagnostic accuracy, and clinical documentation.
8. Improves care coordination and transitions of care.
9. Demonstrates compliance with all regulatory requirements.
10. Establishes greater accountability and reduced risk for lenders.
11. Provides quantifiable results and demonstration of ongoing clinical quality improvement.

Common Accreditation Bodies in Behavioral Health

• Accreditation Association for Ambulatory Health Care (AAAHC)
• Commission on Accreditation of Rehabilitation Facilities (CARF)
• Council on Accreditation (COA)
• The Joint Commission (TJC)

Emerging Accreditation

The National Committee for Quality Assurance (NCQA) has recently granted its first accreditation for electronic clinical quality measures (eCQM) Certification of quality reporting software. NCQA is also known for its Patient Centered Medical Home (PCMH) recognition. The Utilization Review Accreditation Commission (URAC) was the first organization to accredit telehealth services, formally launching its telehealth standards in 2016.  Alternatives to The Joint Commission for acute hospitals to demonstrate Conditions of Medicare Participation DNV GL, which incorporates ISO 9001 standards, and The Center for Improvement in Healthcare Quality (CIHQ).

Choosing and Accreditation Organization

Accreditation costs money both in application and survey fees, as well as leadership, consulting and clinical staff resources. It’s important to choose wisely. The preferences of your major payers is a critical consideration. Also consider how the standards of different accreditation bodies apply to the scope services that you offer in outpatient, inpatient and residential settings. Most accreditation bodies require an onsite survey, (except for NCQA PCMH recognition). The tone of accreditation surveys can vary greatly. Some are consultative and others may lean towards inspection and being more punitive.

Preparing for Accreditation

Preparing for accreditation generally takes about 12 months. Most accreditation bodies will offer live or online workshops on the accreditation process and overview of their standards. You will begin by conducting a gap analysis of the standards and then develop a plan for building the infrastructure to meet them. A mock survey is highly advised prior to completing the final application so that an organization can be confident that they are meeting the standards and that leaders have practiced the rigors of a survey. Most accreditation agencies want to observe that staff follow operating procedures related to their standards. Ongoing staff orientation to accreditation standards and procedures is important.

Accreditation Fees

All accreditation bodies will charge an application fee. Application fees range from $750 to $1,700. Onsite survey fees may vary according to organization size and the number of surveyors required. Some accreditation bodies will assess additional fees for improvement plan reports if deficiencies are found; others will merely follow-up on deficiencies in the next survey cycle.

Length of Accreditation

It may take a few months between the time a survey is completed, and formal accreditation is granted. Once accreditation is approved, it will generally last for 3 years. Provisional status (one year) may be granted for start-up organizations that do not yet meet all operational requirements, such as experience with quality and process improvement. Provisional status may also be granted to organizations with significant deficiencies, and a survey must be repeated with in a designated amount of time.

Below is a crosswalk of accreditation bodies for review. All accreditors serve health and human service organizations. Further detail on their scope is listed. Links to their Web sites are listed for readers to further review their benefits and market position.

Accreditation Crosswalk