How Connecticut Behavioral Providers Built and Automated
A Regional Integrated Service System
In the last installment of a two-part Managed Behavioral Healthcare News Perspectives , we'll look at how a group of Connecticut providers crafted an Access Center to coordinate mental health and substance abuse treatment and planned the management information system crucial to its success.
The Access Center is a behavioral health program developed in the southwestern Connecticut planning region (Region 1) to serve the mentally ill, addicted and dually diagnosed clients. Developed as an outcome of an ongoing collaboration among the providers in the region, the center's staff and facilities were primarily contributed by the Southwest Connecticut Mental Health System (SWCMHS) composed of the Greater Bridgeport Community Mental Health Center (GBCMHC) and the F.S. Dubois Center (FSD) and fully owned and operated by the Department of Mental Health and Addiction Services (DMHAS) of the State of Connecticut. Co-located staff are also provided by two large nonprofit substance abuse providers, CT. Renaissance, Inc. and LMG Inc.
The goal of the Access Center is to implement a regional approach to behavioral health care management that facilitates easy access to services for clients and their families. Its designers were eager to maximize regional providers' ability to protect the continuity of care and to assure local accountability for both mental health and substance abuse services. To achieve that purpose, the Access Center includes locations in Bridgeport, Norwalk and Stamford, and set the goal of operating 24 hours per day, seven days per week. Individuals capable of providing assessment, crisis intervention and case management services are on staff to service recipients struggling with mental health and/or substance abuse problems.
Center Follows Three Steps to Implementation
Initially, the Access Center staff intended to assume responsibility for providing full utilization management of all State Authorized General Assistance (SAGA) clients in the region. That process is to be accomplished in three phases.
In Phase I, providers voluntarily worked with the Access Center to establish or change levels of care for service recipients presenting for treatment in the region. Access Center staff worked closely with the state's administrative service organization, ValueOptions/Advanced Behavioral Health, making recommendations concerning the most clinically appropriate course to follow. The ASO is fully responsible for all utilization management in Connecticut's four other planning regions.
The Access Center was also given responsibility for providing case management services to those service recipients among the targeted SAGA population deemed high utilizers of service, i.e., four or more detox visits in a six-month period. In addition, the Access Center was to provide crisis services to all service recipients in the region and manage all admissions to the three inpatient units at GBCMHC. Finally, the Access Center was given responsibility for managing the Basic Needs Program (BNP), a pool of approximately $800,000 in Region 1 designed to engage and address the basic needs of service recipients in active treatment.
In Phase II, the responsibility for processing all requests to establish and change levels of care was shifted to the Access Center. Phase III will include relieving the ASO of responsibility for prior authorizations in Region 1 and changes in levels of care. Ultimately, the Access Center will relieve the ASO of responsibility for authorizing continued stays. It was decided from the outset that the Access Center would not assume responsibility for continued stay reviews until Phase III, when it had demonstrated mastery of its other responsibilities.
Center's Information System Takes Flight
The Access Center began operation July 1, 1998, initially managing the BNP and providing case management to those service recipients deemed high utilizers of service. By October 1998, the Access Center began phasing in care management and prior authorization responsibilities. Since that time, the Access Center has provided care management for all providers in the region authorized to treat SAGA clients who voluntarily agreed to work with the Access Center. Those providers call the Access Center, instead of the ASO, in order to prior authorize or change levels of care.
As a part of the implementation process for the Access Center, DMHAS engaged Johnson Consulting Services, Inc. to provide assistance in evaluating its information management requirements. The first step in that process was to review and evaluate the proposed operations of the Access Center and offer their recommendations with regard to its information management and the exchange of data among the Access Center, DMHAS, ValueOptions and its contract providers. That "functional analysis" reviewed the following areas: incoming calls and emergency visits; eligibility determination; referral management; intake screening and assessment; crisis intervention; preauthorization; level of care changes and transfers; continuing care and discharge review; care/case management; denials and appeals; provider relations; quality assurance/improvement; organization structure and legal issues; and privacy and client confidentiality.
Plan Around Host of Legacy Systems
The functional Analysis discussed the impact of the Access Center's proposed structure and functions on information management and offered suggestions on how to manage the information more effectively. The results of the study were then used to develop a high-level information system design that included specific data elements, functions and reports.
Additionally, interfaces with existing management information systems were discussed. Some of the information systems that the Access Center's computer would need to interface with included the following:
In the second phase of the automation project, the consultants prepared a detailed strategic automation plan, which prescribed a comprehensive, fully integrated management information system for the Access Center.
The plan reviewed the information needs of both the Access Center and a typical provider. An information flow model was then developed that described the exchange of data between the providers, the Access Center, DMHAS, DSS and the ValueOptions ASO. That data flow model included an operational description of the exchange of information, some of the more salient data elements and reporting requirements.
Data Flow Model Untangles Relationships
The development of a data flow model proved to be very helpful in understanding the informational and functional needs for exchanging data among the various partners in the network. After the data flow model was prepared, the design team was able to create a set of specifications and functional requirements and budget for the proposed system.
Some of the general system requirements identified include real-time, on-line access to client information; standard query language-compliant database design; compliance with the NCQA HEDIS data set; compliance with the American Managed Behavioral Healthcare Assn.'s PERMS system; compliance with state DMHAS reporting requirements; a comprehensive set of modules; integration of all components; the capability for the electronic exchange of data (EDI) among "partners"; and flexibility to work with third-party payers.
After the functional specifications were developed, the Access Center and DMHAS management information system staff reviewed several managed care organization packages identified by the consultants. A detailed evaluation was conducted and a comprehensive, integrated information system was selected. The system selected was designed for a managed behavioral health organization and had the flexibility to accommodate the Access Center's present requirements as well as expand to incorporate other functions in the future. The applications available in the system selected include:
Membership management to enroll clients, collect demographic information, eligibility data and benefit details; Clinical applications to track changes and progress of members throughout their treatment; Claims subsystems to collect information regarding treatment from the providers and integrate it with the managed care organization's clinical applications to adjudicate claims; Provider management systems to track information and contracts for all organizations that interact with the managed care organization, including providers, contractors, licensing agencies, government agencies and other external organization; Report writers to create standard and ad-hoc reports on members, events, claims, providers and payers; and Finance systems for general accounting.
Because there are always changes in operations of any new organization, the consultants recommended delaying the installation of the software until the Access Center's staff had the opportunity to make initial adjustments and refine its policies, procedures and documents. Therefore, short-term solutions were proposed initially to serve as "stop-gap" measures through the implementation of a combination of manual and partially automated procedures.
Now that the Access Center has been in operation for a while and has had the opportunity to refine it operations, Phase III of the Automation Plan is being executed. At the time of this writing plans are being made for initial training and system implementation.
About the Authors:
Mr. Johnson is President of Johnson Consulting Services, Inc., based in Cincinnati, Ohio. His firm specializes in information management consulting for social service, healthcare and government organizations. He can be reached at (513) 520-2357-0934, on the Web at http://www.jcsconsultants.com or by e-mail at email@example.com.
Howard Benditsky, Ph.D., is the Access Center Director and Director of Integrated Services of the Greater Bridgeport Community Mental Health Center, He can be reached at (203) 551-7401.