Navigating The New Normal With COVID-19: A Year In Review & Predictions For The Year To Come

Free Webinar, Sponsored by Qualifacts + Credible

This year has been one unlike anything we have ever experienced. This essential webinar will help attendees gain a thorough understanding and deep perspective on the changes, challenges, and strategies that health and human services organizations have experienced and utilized over the last year. Our faculty will take a deep dive look into the various strategies that have been utilized to create stability, resiliency, and success in weathering the ‘new normal’ created by COVID-19.

Budgeting For Technology To Support Value-Based Care

Technology expenditures for health and human service organizations used to be an afterthought. A few decades ago, the technology required was focused on relatively inexpensive administrative functions, but that has changed.

Technology is now strategic and mandatory – the ability to leverage technology is now essential to competitive advantage and strategic success.

And it’s expensive. Stats on implementing an electronic health record (EHR) range from $15,000 to $70,000 per provider. Budgeting for technology is no longer optional – and shouldn’t be done in isolation by tech staff.

Ray Wolfe, JD, OPEN MINDS senior associate, outlines best practices for budgeting. First, assess what technology functionality is mandatory for current operations and what investments are required for future strategy. “Whether we think we can afford it or not, whether we can manage it—technology, and especially an EHR—is a mandatory purchase. This is something we simply have to do,” he said.

EHRs enhance the clinical experience and improve back-end efficiencies, Mr. Wolfe said. For example, EHR dashboards allow teams to shift from an intuitive, creative approach to medicine “when we thought we knew best and everyone had their own approach,” to capturing relevant and meaningful data at each patient interaction. “We can assess whether what we’re doing is truly helpful and, if not, change it,” said Mr. Wolfe. “That’s impossible to do without a tech tool.”

And what you can’t assess, you can’t be reimbursed for by health plans when negotiating contracts.

Costs fall into two buckets: Upfront (the biggest investment), which includes training, equipment, and implementation; and ongoing costs that include license fees, technical support, hardware, staffing, and application specialists. And you need to show the rationale behind the expenditures –the return-on-investment, which can add 3% to 5% to the bottom line. An EHR is not an expense for its own sake, or for the sake of technology – it’s to help organizations improve both clinical care and financial results.

The key is to remember that with technology purchases, “You don’t get what you pay for; you only have the opportunity to get what you pay for,” which is why a strategic approach matters. It also begs the question, does your organization have the capital required to make this investment? Or, as Mr. Wolfe, asked, can you afford not to?

To answer that question, executives should review assets-to-debt and debt-to-equity ratios to ensure they don’t borrow more than they should to finance technology. Consider debt to equity (well-run organizations have a larger equity-to-debt share with a ratio of 1 or less) and compare assets to debt (you want to see a ratio of 2 to 1 or better).

And ask how effectively the organization covers the costs of liability. “You need a 2-to-1 ratio,” said Mr. Wolfe. If assets are higher than 2 and the assets-to-debt ratio is less than 1, you have assets you can use for an EHR system purchase, the costs of which can be spread out over several years.

When you consider the upfront cost of technology, you must find a way to manage it within these ratios. Most executives underestimate them, warned Mr. Wolfe. But don’t forget cost savings in this equation—from cloud storage to outsourcing tech staff, improved productivity and collecting 95% of what is billed.

Adding up cost savings associated with technology investments reinforces what a growing number of subject matter experts call a mandatory investment in EHRs. This way of thinking will ensure health and human service agencies survive an increasingly competitive market that requires sophisticated data collection and reporting.

Technology Planning For Integrated Care & Value-Based Reimbursement

OPEN MINDS Senior Associate Ray Wolfe, J.D. and Chief Executive Officer Monica E. Oss delivered this executive web briefing on April 2nd, 2020.  In this session, we explored building a plan that helps executives make choices with confidence, manage them financially, and overcome VBR’s most challenging task: the development of an EHR system that can optimize results.

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Technology Planning For Integrated Care & Value-Based Reimbursement

Knowledge Partner Session at The 2020 OPEN MINDS Performance Management Institute

Providers are becoming more aware of and involved in the changing reimbursement landscape. While many can build the internal talent and resources needed to win in the VBR world, technology often seems a barrier that can’t be hurdled. The executives, who often have no technical background, are faced with expensive choices that will require focus and effort to implement. In this session we will explore questions that providers have about their technology decisions:
• How can they determine if they can afford these options?
• What are alternative options if they can’t afford technology at this time?
• Which options will bring the best return?
• Are there some that can be delayed?
• How can they allocate internal resources to tech projects without overwhelming their staff?

In this session we will explore building a plan that helps executives make choices with confidence, manage them financially, and overcoming VBR’s most challenging task, the development of an EHR systems that can optimize results.

Solving Value-Based Reimbursement Challenges With Real Data: One Provider’s Story For Leveraging Technology & Data To Drive Performance

Organizations who want to position themselves for the future need to identify ways to leverage current technology to capture and analyze data and create a culture where staff use metrics to drive consistent, high-quality results. No matter where you are on the path to value, this session will give you insight into three key competencies:

Technology – from harnessing the right technology for organizational needs to integrating that technology to drive performance results – your technology choices are a key element to success in a value-based reimbursement environment.

Data – performance management, driven by data is crucial for value-based care because organizational growth, new contracts, and financial sustainability are all tied to delivering quality service results.

Culture – create a culture of performance where continuous improvement and optimization is embraced as the ultimate support to your overarching mission.

Roy Leitstein, CEO, at Legacy Treatment Services shared how his organization created a culture focused on using data and technology to drive organizational growth – in services, contracts and community impact.

Ken Carr, Senior Associate, OPEN MINDS facilitated the discussion and shared key competencies tied to positioning agencies for the technological, data-driven and cultural changes necessary to transition to Value-Based Reimbursement models.

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Addiction By The Numbers

How should addiction treatment programs be evaluated? That was the focus of the session, Quality Measurement In Addiction Treatment: Advancing Adoption Of Best Practices, at The 2019 OPEN MINDS Management Best Practices Institute, featuring Samantha Arsenault, MA, Vice President of National Treatment Quality Initiatives, Shatterproof; Eric Bailly, LPC, LADC, Business Solutions Director, Anthem, Inc.; and Doug Nemecek, M.D., MBA, Chief Medical Officer – Behavioral Health, Cigna.

Shatterproof, with a coalition of payers and other interested stakeholders, is taking on the challenge of quantifying the effectiveness of addiction treatment programs. Why? There is large variation in the use of evidence-based practices in addiction treatment programs and currently, provider organizations don’t have a standardized research tool to assess and benchmark themselves. Consequently, individuals don’t have reliable or unbiased sources to identify addiction treatment options.

To address these issues, Shatterproof is creating ATLAS (Addiction Treatment Locator, Analysis, and Standards Tool) an online tool available to the public, provider organizations, and payers to identify high quality addiction treatment provider organizations. (For more on ATLAS see, Are You Ready For The Shatterproof Addiction Treatment ATLAS?) This initiative will take addiction treatment program evaluation beyond its current state through  claims data and data provided by the treatment facility and patient experience surveys in order to present a more complete picture of treatment program effectiveness.

Both Cigna and Anthem are moving toward value-based reimbursement for addiction treatment and both are using claims data as the initial framework. The collaboration with Shatterproof will likely add to the data available for the evaluation of the cost and effectiveness of treatment – and this will improve the VBR models.

Mr. Bailly explained that Anthem’s value-based initiatives for substance use disorder (SUD) treatment are influenced by the work of The Alliance for Addiction Payment Reform (Alliance), and have helped to shape Anthem’s SUD strategy outlined in three pillars focused on improving access to high quality SUD treatment services which are efficient and cost effective, and lead to improved health outcomes. Anthem has successfully launched value-based incentives with numerous provider organizations across the country, and is currently developing Addiction Recovery Medical Home Alternative Payment Model proof of concept pilots in several markets, with a goal to launch one of these pilots by the end of 2019.

Dr. Nemecek presented Cigna’s behavioral health network strategy – a strategy that also includes value-based reimbursement elements. The network strategy includes improving access to care through virtual solutions and network growth, promotion of affordability and quality, integration via accountable care organization support, creating provider organizations of choice with differentiated service models, and preferred provider organization network alignment.

To promote affordability and quality, Cigna has already begun selecting Centers of Excellence (COEs) for addiction treatment. The network currently consists of 302 behavioral health provider programs – 133 inpatient and residential facilities and 169 partial hospitalization/intensive outpatient programs. These programs were found to have lower costs for admissions and per customer than both other in-network provider organizations and out-of-network provider organizations. Readmission rates at COEs were also 24% lower than other in-network provider organizations and 87% lower than out-of-network provider organizations.

The collaboration of 21 health and human service stakeholders with Shatterproof on standardizing performance measurement is a significant step forward in creating an improved national approach to addiction treatment program evaluation. For more on the state of metrics-based performance evaluation, join us at The 2019 Technology & Informatics Institute in Philadelphia on October 29 for the session, Data Makes The Difference: Using Data To Manage Care Coordination & Value-Based Arrangements featuring Ken Carr, Senior Associate, OPEN MINDS.