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CommunityDataRoundtable.org

New Partners in an Existing TCOM Implementation

Dan Warner, PhD, Community Data Roundtable

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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.

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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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CommunityDataRoundtable.org

The Back Story:

CDR in Cambria …

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CommunityDataRoundtable.org

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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CommunityDataRoundtable.org

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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CommunityDataRoundtable.org

TCOM Process

With Magellan

Capture CDR DataPool TM Exchange (automated between CDR & Magellan) Review (Magellan, Oversights, CDR) Act (Magellan, CDR & Oversight)

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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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CommunityDataRoundtable.org

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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CommunityDataRoundtable.org

Seeing our

system

together

The interactive reports that we review bimonthly, to accomplish TCOM

(11)

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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CommunityDataRoundtable.org

Evidence Based

Programs Initiative

• Altering referral streams

• Building capacity

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CommunityDataRoundtable.org

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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CommunityDataRoundtable.org

Reflections after year one

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CommunityDataRoundtable.org

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

(16)

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.”

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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

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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

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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

(20)

CommunityDataRoundtable.org

(21)
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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

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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.

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CommunityDataRoundtable.org

dwarner@communitydataroundtable.org

badunn@magellanhealth.com

Q&A

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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

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