Using Technology to Increase the Effectiveness and Efficiency of Community Based Services

Learning Objectives Identify what common barriers that behavioral healthcare and child welfare agencies face to simultaneously increase effectiveness (increased outcomes) and efficiency (decreased cost) of service provision and compute the monetary cost of those barriers. Describe in plain language what technological tools would circumvent those barriers and access technical expertise to design solutions. Implement technological solutions in a structured way and support the solutions long-term.

At a Glance: KVC Kentucky A Private, nonprofit leader in providing innovative, effective and compassionate care. Where: 8 Locations Impact: 12,000 people served annually Quality: Experienced leadership, highly skilled professional staff, quality training in evidence-based practices, innovative and outcome focused

Services INTEGRATED HEALTHCARE Community-Based Therapy Community-Based Psychiatry Family Preservation and Reunification Services School-Based Therapy Community Based Substance Abuse Treatment SOCIAL SERVICES Foster Care Case Management Adoption Child Placing Supervised Visitation EDUCATION Training Consultation Research Advocacy

Current Climate & Funding Mandate Provide more effective care with greater impact to more people for less cost.

For Instance. Value-Based Contracting Often combined with Fee-for-Service, at least part of a provider s payment is tied to patient outcomes Population Health/Capitated Rates Providers are responsible for the health outcomes of a target group, or cross-section, of people. Usually this is combined with a capitated rate so that any profit margin is tied to decreasing healthcare costs. Performance-Based Contracting Common in Child Welfare arenas, these contracts often consist of a combination of outcomes and best practice measures that determine the full payment for services.

Each of these models is fundamentally designed to limit the expenditures of the Payer while enforcing the highest quality of services.

Community-Based Services High quality services in the home and community Delivered in least restrictive setting possible Grew from Deinstitutionalization Positive Impacts of CBS include better quality of life, increased access to care, and lower costs than higher level placements

Office vs. CBS Cost Comparison

CBS Provider Overhead

Technology, Innovation and Implementation Science

Implementation Science The formula for success involves multiplication. If any component is weak then the intended outcomes will not be achieved, sustained, or used on a socially significant scale. http://nirn.fpg.unc.edu/learnimplementation/implementation-defined

IS - Technology Innovation Exploration Stage Exploration should be encouraged on an ongoing basis and embedded in regular program meetings. Exploration, and therefore program meetings, should include members who can form an ad hoc implementation team. This should include a mixture of disciplines: clinical, administrative and technology. (Technology representatives should be present at important program and business meetings. They need to know the business as well as anyone else - otherwise it is cheaper to outsource it!) The exploration process should attempt to 1) clearly identify the barrier to overcome (or opportunity to capitalize), 2) estimate the value of the innovation (effectiveness or efficiency), 3) agree upon the ideal solution and 4) estimate the cost of the solution.

IS - Technology Innovation Installation Stage Software development, IT infrastructure, special technological projects Most of the time, this should consist of technology members of the Implementation Team developing the solution explored in the Exploration Phase. This requires technology staff have a very strong grasp of the service programming and administrative processes of the agency. This is the value-added aspect of technology budgets.

IS - Technology Innovation Initial/Full Implementation Stage Always do initial, partial, implementation for new technology projects The implementation team should be on high alerts to identify and fix bugs The project is less than half finished when the technology is developed and ready to be implemented in production. The highest hurdle is always user adoption.

Decrease Office Travel Time Solution: iphones, PDFExpert and TurboScan Efficiency: Enables review of paperwork and signature capture with clients from a phone or tablet. Efficiency: Enabled KVC to eliminate one trip to the office per week. Effectiveness: Upload signed documents directly to electronic record from mobile device.

Weather-related Cancellations Solution: USDA RUS Grant and Vidyo Effectiveness: Appointments and treatment schedules are able to be maintained when the weather prohibits contact. Efficiency: Also enables a portion of supervision visits to be conducted via video conference. This decreases required trips to the office to 1 time every 2 weeks.

Documentation Time Solution: iphone Hotspots, Custom EMR, Concurrent Documentation Effectiveness: Concurrent documentation is best practice and can be done during session review with the client. Efficiency: Eliminates the need for providers to spend nonbillable time documenting sessions. Effectiveness and Efficiency: Providers have constant access to the electronic record system via their hotspot.

Caseload Management Solution: Custom Treatment Plan Dashboard and Treatment Hours-based Productivity

CBS Provider Overhead

Question & Answer

Contact Info Jarrod Dungan, BA Director of Business Technology jdungan@kvc.org (859)806-7361 Elizabeth L. Croney, MSW, LCSW President ecroney@kvc.org (859) 229-8473 Gina Klyachkin, MSW, LCSW Vice President gklyachkin@kvc.org (859) 559-2088

References The National Implementation Research Network. Implementation Defined. (n.d) Retrieved from http://nirn.fpg.unc.edu/learn-implementation/implementation-defined The National Implementation Research Network. Implementation Stages. (n.d) Retrieved from http://nirn.fpg.unc.edu/learn-implementation/implementation-stages

Thank You.