CommunityDataRoundtable.org
New Partners in an Existing TCOM Implementation
Dan Warner, PhD, Community Data Roundtable
CommunityDataRoundtable.org
Speakers
−
Dan Warner, PhD,
− Executive Director of nonprofit Community Data Roundtable with experience implementing, supervising, and analyzing TCOM systems.
− Licensed clinical psychologist
−
Barbara Ann Dunn, LCSW, ACSW,
− Director of Program Innovation and Outcomes for Magellan Healthcare. Responsible for proposing,
implementing, and evaluating
innovative programs across the public sector.
− Master’s degree in Social Service Administration from the University of Chicago.
CommunityDataRoundtable.org
Learning
Objectives
• The key elements for managed care contract using a TCOM tool in a person-centered care process
• The challenges of transitioning to a new managed care oversight.
• Identify technology which enables optimizing TCOM project
• Effective partnership with a funder, TCOM vendor, managed care, and direct service providers.
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The Back Story:
CDR in Cambria …
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Timeline of Cambria County CANS Implementation
“Data Geneva”
January 2014 – July 2016
Providers in Cambria county participate on their own in the CDR CANS initiative
July 2016 – July 2017
Government/Oversight joins CDR, mandates use of CANS by all providers. MCO does not want to participate
• Oversight has to do the quality review and the outreach
• Oversight participates in Roundtables Summer 2016 Oversight initiates a re-procurement process
• CANS data cited to justify change.
• Requires new BH-MCOs to join the project. Winter 2017 Magellan wins the reprocurement and
establishes a contract with CDR. Begins data integration process.
July 1, 2017 Magellan begins paying Cambria claims, as well as integrates with the CDR DataPool
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TCOM Process
Before Magellan
Capture CDR DataPool TM Exchange(Oversight does data entry)
Review (No direct MCO
Participation) Act (No MCO participation = no muscle) 5
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TCOM Process
With Magellan
Capture CDR DataPool TM Exchange (automated between CDR & Magellan) Review (Magellan, Oversights, CDR) Act (Magellan, CDR & Oversight)CommunityDataRoundtable.org
The Back Story: Magellan response to county RFP
Requires participating in CDR
Brings resources with them!
Magellan CANS Reference Guide
Local Website Content
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The Implementation: Data Exchange
• MAID • Name • DOB • Race • Ethnicity • Eligibility date Eligibility SFTP (daily) • Service name • CPT Code • Modifier1 • Modifier2 • Unit duration Services/Claims SFTP (daily)
Vendor system
(e.g. CDR DataPool
TM)
Flat File of CANS and Referral Information
Documents
Professional Agreement (BAA) Statement of Work (SOW) Risk Assessment
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Seeing our
system
together
The interactive reports that we review bimonthly, to accomplish TCOM
CommunityDataRoundtable.org
Monthly CANS
submitted separated
by Risk Severity Level
•
Filters include
• CANS timeline differences
• Risk Severity
• ASD level
• Age
• Provider Groups
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Evidence Based
Programs Initiative
• Altering referral streams
• Building capacity
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Needs Profile and
Outcomes
• The Needs Profile for BHRS
• Outcomes for the program shared publicly.
• Outcomes for algorithm matches are consistently better
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Reflections after year one
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Year One Reflections
−
Working with evaluators
−
Give clear directions
−
Establish a simple process
−
Working with providers
−
Making the information public
−
Provide support for all steps (including data use!)
−
The MCO perspective
−
Using the Match algorithms to identify need
CommunityDataRoundtable.org
Oversight Perspective
Tanya Kvarta MSW – Executive Director Behavioral Health Services of Cambria County
− “Magellan’s transition into the CANS project was collaborative and smooth. With the CANS we are now able to work more closely with the Care Managers [than we did with our previous MCO]. We now have a shared language between us, the MCO and the provider.”
− “The CANS helps back up reviews by providing rationale and data behind decisions. We’re not just picking problems; there’s evidence and its more concrete about what meets medical necessity.”
− “The CANS data helps us see holes in our provider network, what trainings are necessary, and what programs
we should develop.”
CommunityDataRoundtable.org
Looking Ahead to Year
Two
• Access & Network capacity
• EBP Initiatives (PCIT, etc.) • BHRS Lengths of Stay Initiative
Algorithm adherence rates for EBPs hover at
only 10%
Lengths of Stay for BHRS can
average at 3 years
CommunityDataRoundtable.org
Looking Ahead to Year
Two
• Access & Network capacity
• EBP Initiatives (PCIT, etc.) • BHRS Lengths of Stay Initiative
• Getting the parents involved • Parent Report
Algorithm adherence rates for EBPs hover at
only 10%
Lengths of Stay for BHRS can
average at 3 years
CommunityDataRoundtable.org
Looking Ahead to Year
Two
• Access & Network capacity
• EBP Initiatives (PCIT, etc.) • BHRS Lengths of Stay Initiative
• Getting the parents involved • Parent Report
• Parent Portal
Algorithm adherence rates for EBPs hover at
only 10%
Lengths of Stay for BHRS can
average at 3 years
CommunityDataRoundtable.org
CommunityDataRoundtable.org
Looking Ahead to Year
Two
• Access & Network capacity
• EBP Initiatives (PCIT, etc.) • BHRS Lengths of Stay Initiative
• Getting the parents involved • Parent Report
• Parent Portal
•
Evaluator Report Card
Algorithm adherence rates for EBPs hover at
only 10%
Lengths of Stay for BHRS can
average at 3 years
CommunityDataRoundtable.org
Lessons Learned
Be clear on expectations and roles – set up in contract and
regular meetings with county.
Bring in a BH MCO with CANS experience and capability for
data sharing.
Meet regularly with transparency and bringing respective
expertise to the table.
CommunityDataRoundtable.org
dwarner@communitydataroundtable.org
badunn@magellanhealth.com
Q&A
CommunityDataRoundtable.org
References
Lyons, JS, Weiner, DA (2009). (Eds.) Strategies in Behavioral Healthcare: Assessment, Treatment
Planning, and Total Clinical Outcomes Management. New York: Civic Research Institute.
Kaiser Family Foundation. Medicaid Delivery System and Payment Reform: A Guide to Key Terms and Concepts. June 22, 2015. Retrieved from http://kff.org/medicaid/fact-sheet/medicaid-delivery-system-and-payment-reform-a-guide-to-key-terms-and-concepts/
Institute for Healthcare Improvement. Science of Improvement: How to Improve. April 12, 2017. Retrieved from
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx
Lippitt, M. (1987). The Managing Complex Change Model. Enterprise Management, Ltd. Retrieved from
https://www.the-registry.org/Portals/0/Documents/Credentials/Administrator/Documents/managing%20complex%20cha nge.pdf