Using HIT to Support Integrated Care

by Michael R. Lardiere, LCSW

Vice President, Health Information Technology & Strategic Development
SAMHSA - HRSA Center for Integrated Health Solutions 

Sharing Information is the Standard

  • Health Information Exchanges RULE!
  • Integration and improved outcomes will only be successful if we can share information


Addressing Confidentiality

  • Common Barrier
  • If not addressed, promotes stigma
  • Information can be shared securely in RI
  • RI leads the nation through its work with the SAMHSA/HRSA Center for Integrated Health Solutions

Using Data for Population Based Interventions

CostRank Treatment Total Charges No of members Average Charges per Member
1 Community Support Services/15 min $2,890,038 218 $13,257
2 Community Support Services /day $1,916,375 181 $10,588
3 Personal care per diem $1,394,614 123 $11,338
4 Habilitation, prevocational/15 min $758,157 104 $7,290
5 Supported employment/15 min $713,680 154 $4,634
6 Inpatient room and board $699,602 90 $7,773
7 Targeted case management/15 min $557,154 689 $1,009
8 Inpatient- ancillaries $494,577 81 $6,878
9 Case management/ 15 min $438,577 470 $1,052
10 Emergency room $356,478 247 $1,776
11 Psych medication management $356,478 1,086 $328
12 Inpatient-facility charges $288,479 52 $5,548
13 Labs $287,935 437 $659
14 ACT program $286,773 115 $2,494
15 Medical supplies $241,812 156 $1,550
16 Family therapy $221,136 181 $1.222
24 Office visits - primary care $154,773 616 $215
29 Surgery $105,085 98 $1,072
36 Ambulance $54,581 67 $815

Table of top cost by diagnosis, January-March,2006

Cost

Rank

Primary Diagnosis Total Charges No of Members Average Charges Per Member
1 Schizophrenia and Affective Psychosis $6,167,527 1,102 $5,597
2 Depression/Anxiety/Neuroses $1,710,759 347 $4,930
3 Moderate Mental Retardation $1,040,669 112 $9,292
4 Severe Mental Retardation $1,032,094 74 $13,947
5 Profound Mental Retardation $982,760 39 $25,199
6 Mild Mental Retardation $709,344 131 $5,415
7 Alcohol and Drug Abuse $283,077 177 $1,599
8 Pregnancy $183,653 39 $4,709
9 Congestive heart Failure $168,130 7 $24,019
10 Chest Pain $161,260 65 $2,481
11 All Fractures and Dislocations $137,901 19 $7,258
12 Diabetes Mellitus $134,161 42 $3,194


Cost Data by Primary Diagnosis

Total Charges By Primary Diagnosis, January-March, 2006 (ppt) 

Cost By Service Type

Top Cost By Treatment Type, January-March,2006 (ppt) 

Using Data for Individual Interventions 

High Utilizer Report

  • 3 consumers with an average cost of $272,652 each
    Drill down: Consumer with brittle diabetes and personality disorder - frequent ER and inpatient
  • 4 consumers with average cost of $236,434 each
    Drill down: Consumer with SUD without motivation & personality disorder; multiple complex medical conditions
  • 4 Consumers with average cost of $85,867 each
    Drill down: Consumer with SUD- frequent detox ;lack of community services
  • Case #1 - Service Primary Diagnoses, Diagnoses Description, and Charge (ppt) 

MU Stage 2 Behavioral Health Outcome Measures 

Center for Disease Control and Prevention, Sortable Statistics (ppt)

Measuring Disparities 

 At Risk Criteria

  • Blood pressure combined
    Systolic greater than 130 OR Diastolic greater than 85
  • BMI
    Greater than or equal to 25
  • Waist circumference
    Male, greater than 102 cm
    Female, greater than 88 cm
  • Breath CO
    Greater than or equal to 10
  • Fasting Plasma Glucose
    Greater than 100
  • HgbA1c
    Greater than or equal to 5.7
  • Cholesterol
    HDL, less than 40
    LDL, greater than or equal to 130
    Triglycerides, greater than or equal to 150
  • Others that the organizations determine 
    Indicator Percentages Measuring Disparities (ppt) 

Issues to Consider

  • Who will collect the data?
    • Sharing Lab data is a significant workflow issue to resolve
  • How will it be shared with the partner organization?
    • Via the HIE
    • Via Direct
    • Other secure method
  • Use a standard CCD
    • What if the partner does not have a certified EHR?
  • Use Meaningful Use Measures

MU Stage 2 Measures

National Quality Forum

Measure number and name

Clinical Quality Measure Description

0105

Antidepressant medication management:

(a) Effective Acute Phase Treatment

(b) Effective Continuation Phase Treatment

The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.

(a) Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks)

(b) Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months)

0004

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:

(a) Initiation

(b) Engagement

The percentage of patients 13 years of age or older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported.

(a) Percentage of patients who initiated treatment within 14 days of the diagnosis

(b) Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit

0028

Preventive Care and Screening: Tobacco Use-Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND received cessation counseling intervention if identified as a tobacco user.

0022

Use of High-Risk Medications in the Elderly

Percentage of patients ages 65 years and older who received at least one high-risk medication. Percentage of patients 65 years of age and older who received at least two different high-risk medications.

(a) Percentage of patients who were ordered at least one high-risk medication

(b) Percentage of patients who were ordered least two high-risk medications during the measurement year

0101

Falls: Screening for Fall Risk

Percentage of patients aged 65 years and older who were screened for future fall risk during the measurement period.

0104

Major Depressive Disorder (MDD): Suicide Risk Assessment

Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period.

0108

ADHD: Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder Medication

Percentage of children 6-12 years of age as of age and newly dispensed a medication for attention deficit/hyperactivity disorder (ADHD) who had appropriate follow up care. Two rates are reported.

(a) Initiation Phase: Percentage of children who had one follow up visit with a practitioner with prescribing authority during the 30-day initiation phase

(b) Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the initiation phase ended

0110

Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use

Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.

0418

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool AND, if positive, a follow up plan is documented on the date of the positive screen.

0419

Documentation of Current Medications in the Medical Record

Percentage of specified visits for patients 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over the counter, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency, and route of administration.

0421

Adult Weight Screening and Follow-Up

Percentage of patients aged 18 years and older with a calculated body mass index (BMI) in the past 6 months or during the current reporting period documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past 6 months or during the current reporting period.

Normal Parameters: Age 65 years and older BMI = 23 and < 30.

Age 18-64 years BMI = 18.5 and < 25.

0710

Depression Remission at 12 Months

Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at 12 months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.

0712

Depression Utilization of the PHQ-9 Tool

Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit.

1365

Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

Percentage of patient visits for those patients aged 6-17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.

Not Yet Endorsed

Dementia: Cognitive Assessment

Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period.

Where will the Data Come From?


Data Integrity - Follow the Continuity of Care Document / C-CDA (ppt)
MU CCD Sample 

Data Elements Recommended by the 5 States & Their Workgroups

What is Needed to Provide Better Quality Care?


Personal Information

  • Guardian
  • Emergency contact
  • Crisis plan

Encounters

  • Psych admission

Family History

  • Marriage status
  • Children

Functional Status

  • Housing status
  • Risk status for suicide/homicide
  • History of Risk of Violence
  • History of Risk of Suicide

Social History

  • Court orders

Medications

  • Specialty of prescriber
  • History of psychiatric medications
  • Medication history

Advance Directives

  • Behavioral Health Advance
  • Directive

Insurance Status

Plan of Care

  • Treatment plan

--DSM Diagnosis (all 5 Axis)


HIPAA & 42 CFR Part 2 


Contact Information:
Michael R. Lardiere
VP HIR & Strategic Development
MikeL@thenationalcouncil.org