April 6, 2021 | Monica E. Oss
Diversification of revenue streams and increasing revenues in value-based reimbursement are an integral part of the strategic plans of many specialty provider organizations. But most organizations have not designed their service delivery workflows—or their consumer data collection—for this reality. An example of the complexity? The average provider organization already tracks 151 performance measures at any given point in time. And there are at least 558 unique measures just for the Merit-Based Inventive Payment System (MIPS), Meaningful Use (MU), Certified Community Behavioral Health Clinic (CCBHC), Inpatient Psychiatric Facility Quality Reporting (IPFQR), and the Treatment Episode Data Set (TEDS) initiatives (see Reducing The Cost Of Reporting 558 Unique Performance Measures). Our recent survey of the adoption of value-based reimbursement (VBR) found that 53% of specialty provider organizations are participating in value-based reimbursement arrangements. The survey also found that data management and reporting was the number one challenge for provider organization executive teams in managing VBR arrangements (see The 2021 OPEN MINDS Performance Management Executive Survey: Where Are We On The Road To Value).
How to address this inevitable situation in a shifting market? There are one of two options. The first is to build a completely separate service delivery operation with different workflows and data collection for each group of consumers. But that is not a practical solution unless that consumer group is large enough to support the operation. The reality for most provider organization management teams is that consumers who are covered by multiple payment sources—with multiple performance measures—need to be served by the same service delivery system. How to make situation feasible was the focus of the session, Integrating Workflows & Technology To Meet Multiple Market Demands during the OPEN MINDS Technology & Analytics Institute. Katie Morrow, BSW, MPA, Vice President of Compliance for Streamline Healthcare Solutions and Kate Sanders, MA, Vice President of Systems Administration for Porter-Starke Services, shared best practices for using technology to create a workflow design that can handle multiple funding streams and reporting requirements.
The key to designing a system to serve consumers with multiple payers is all in the planning—designing workflows and integrating required data capture in those workflows. “You have to be strategic about how you’re capturing the data for various requirements. You have to standardize as much as possible across the organization. And you have to stop looking at your patients, your costs, your revenue, and your quality measures in silos,” said Ms. Morrow. She advised a holistic view and centralizing data and reporting procedures through the electronic health record (EHR) system as much as possible to “get the most for your money.” Ms. Sanders said that at Porter-Starke, “We strive to repurpose existing systems workflows and think creatively to reuse what we already have.”
Like most planning processes, starting at the end is key. What performance reporting is required for each payer contract? For assessing consumer needs and care planning? For tracking the cost of services and assuring long-term program viability? Workflow design needs to make arrangements for the capture of this data.
Porter Starke is a great example of the challenges faced by provider organizations with diversified revenue streams. Ms. Sanders explained that they serve as a federally qualified health center (FQHC) in two locations and recently got a certified community behavioral health clinic grant (which is federally administered in Indiana where they are located). They also have a number of state contracts and some substance use grants as well as community grants. They bill Medicaid and also participate in value-based contracts with health plans. And they offer outpatient as well as residential services, which are billed under different streams. To manage the dizzying array of reporting requirements from nearly a dozen disparate funding streams, Porter-Starke implements four best practices—adapting current consumer workflows, repurposing performance measures, creating longitudinal treatment plans, and coordinating staff efforts.
Existing consumer workflows can be adapted for new services. Don’t assume that a new grant or new payer means new data or new processes to collect the data. For example, their CCBHC grant required Porter-Starke to collect data from physical health screenings. But as one of their office locations was already conducting these screenings under a Temporary Assistance for Needy Families grant from the state, they were able to quickly repurpose the workflows (they only had to add a few screenings) and extend them to other locations. Under a previous grant, they had access to a population health dataset derived from our Medicaid claims. They were able to reuse this data to identify high-risk consumers they could target for the integrated care they could provide as part of the CCBHC grant. They also used state assessment data to target high-needs consumers for outreach through “engagement specialists,” for care coordination at the front end of the enrollment process. Ms. Sanders noted, “We consider how to pull information out of the system because there isn’t much point in putting information into the system that’s difficult to pull out. We establish consistency with data inputs to make it possible to look in one place for the information.”
Performance measures can be repurposed. While the format of reports required by different payers may differ, the specific measures to be reported may be common across many reports and it just takes “desiloing” and centralization of functions to find the synergies. Ms. Sanders said, “Whenever a new quality initiative is presented to us, we first look to see which of the measures we’re already working on as part of other reporting. And that way, we can focus on dovetailing the work between these different sources instead of trying to essentially double our work.” National Outcome Measures and Meaningful Use Measures were already built into their EHR so Porter-Starke could use all these measures to meet many of the CCBHC reporting requirements. They also had state reporting assessments built into the EHR so that assessment scores and other information entered by clinical professionals goes directly into the state data repository. But Porter-Starke also pulls this information into their internal data warehouse, and from there into standardized Microsoft Power BI reports so they can review the data for each consumer. “We recognize the value of having all things in one system as opposed to having to upload Word documents into a payer’s system,” said Ms. Sanders.
Longitudinal consumer treatment plan documents are key. Management teams need to focus on the consumer experience with the organization over time. Ms. Sanders said, “With our EHR, we could create shared documentation between our inpatient and residential facilities and the rest of our community mental health center. Sharing the same treatment plan document has made continuity of care crystal clear. New needs that have developed during the inpatient stay can continue to be reviewed and addressed on the outpatient side. This reduces the need to repeatedly ask the same or similar questions about something that won’t change very much like a client’s history.” Porter-Starke uses the same note types across services and programs and this helps with designing workflows, cross-training staff, and pulling data on consumers for billing roll ups. Ms. Morrow elaborated further, “If you’re offering integrated care, a psychiatrist may not have the exact same workflow as a primary care physician. But if they’re both focused on same patients, we can standardize the data capture, build consensus across the organization, look at the whole patient, and compare data across patients.”
Helping staff see beyond their service silos is key to growth. Helping staff across different programs see the endgame of outcomes reporting will encourage them to follow processes and be more engaged in care delivery. Porter-Starke has its own EHR system for most of its programs but uses a different system through a regional hospital for its FQHC services and a third system for dental services. To manage the differences, Porter-Starke keeps the workflows separate at the specialist level, but puts all the specialist staff under the same management team so their work follows similar direction. Ms. Sanders explained, “We have specialists dedicated to FQHC auditing and billing within our larger health information management and financial services departments. So we want to have people who are dedicated to the success of each particular initiative and feel ownership over it. Having the specialists helps us maintain quality and productivity but having the same director over them helps to coordinate efforts. We’re embedding data analytics staff within the FQHC programs as an extension of the work we already do to improve our quality measures and performance. So this helps to coordinate our efforts and understand where our processes could change to better accommodate funding requirements.”
At the end of the day, the most important takeaway is to not reinvent the wheel, Ms. Morrow said. “How do you use the technology that you already have in place? How do you use standardized tools that you already have in place? Consider that and then look at how to grow and scale.” She added, “Start small—instead of getting a whole new system that can integrate everybody’s records at once, look at other solutions, like taking a data warehouse and combining the data you need. Especially if it’s a grant, wait until you have a more sustainable reimbursement model before investing in all-new systems.” I agree wholeheartedly. Technology evolutions are critical to sustainability but technology needs a strategy, and a robust estimation of the return on investment before investments are planned.
For more on managing payer requirements and technology planning and budgeting, check out these resources in The OPEN MINDS Circle Library:
And for even more, join us on April 21 for the free webinar (open to all), How Your Organization Can Lead The Charge In Whole Person Care To Create A Better Community. Katie Morrow, BSW, MPA, Vice President of Compliance for Streamline Healthcare Solutions, will review a “whole person care” approach for provider organizations and discuss how to assess consumer needs and measure outcomes of care.