Translating Data into Effective Communications

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Translating Data into Effective Communications

• September 1, 2009
• A Rural Mental Health Experience
• Dennis MacKay, CEO
• Northern Human Services

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Path to SustainabilityThe Challenges

• Creating a network of support
• Identifying stakeholder/partners who have a
  direct interest in the project and will benefit
  as a result of their involvement. The benefit
  that may be added include service value,
  financial gain or political advantage.
• Reimbursement
• Ensuring a viable source of income. May include
  contractual fee for services provided to partners
  (technical services and/or clinical) or direct
  reimbursement from insurance.
• Operational expenses
• Addressing the ongoing costs, staffing,
  connectivity and equipment replacement.

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Project Overview

• The organization
• Northern Human Services is a multiservice,
  private non-profit organization serving
  individuals with mental illness, substance abuse
  and developmental disabilities

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Project Overview

• The environment
• The catchment area covers half of the state of
  New Hampshire which includes only 8 of New
  Hampshires population.

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Project Overview

• The target issue
• The region is a physician shortage area with a
  critical lack of medical specialists. Our focus
  was to provide a service that had never been
  available in region, child psychiatry.

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Building internal support within the agency

• Board of Directors
• Selling the value added to our mission through
  tele-health. Outlining a plan for the
  sustainability of the service and the operational
  costs.
• Building the IT talent to execute the project
• Combination of staff development and
  subcontracting
• Building the support of clinical staff
• Gaining support for the clinical value and
  increasing the comfort level of staff with the
  equipment and process

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A Case for Network of Support

• Identified five key stakeholders
• 1. Governmental
• NH Commissioner of Health Human Services. NH
  Bureau of Behavioral Health, primary funding
  source and the manager of Medicaid behavioral
  health carve out.
• 2. Vendor
• Dartmouth Medical Center department of
  psychiatry- the only medical school in NH and an
  excellent reputation in child psychiatry
• 3. Legislative
• NH Legislative Leadership- the means to
  initiate legislation to require insurance payment
  for tele-health
• 4. Advocacy
• NH National Alliance on Mental Illness
  (NAMI)- consumers and family members providing
  grassroots support for services to the mentally
  ill
• 5. Peer Providers
• NH Community Behavioral Health Association.
  Shared interest in the project.

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Identifying Partner Interest

• All network partners had distinct as well as
  shared interests. All were engaged on an
  individual basis before the project was launched.
  
• Partner Interest
• Governmental service value, cost, integration
  of care, quality
• Vendor center of excellence, profit, business
  potential
• 
  
• Legislative value to constituency, cost,
  access to care
• Advocacy access to care, quality
• Peers portability, cost, service value,
  quality

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Matching Interest to Data

• Service value
• Comparison of client wait time for access to
  service
• Outcome data from satisfaction surveys
• Staff access to specialist consultation (time
  comparison)
• Number of clients accessing specialist (pre and
  post)
• Clinical outcomes are longitudinal will need to
  be measured over time
• Cost
• FTE child psychiatrist vs. hourly rate for vendor
  (annual expense)
• FTE hours available with travel (cost per hour of
  direct care) vs. vendor
• Utilize existing insurance codes (no new codes)
• Decreased cost to clients (mileage to clinic vs.
  mileage to specialist)
• Integration of Care
• Established outreach to NH Hospital Association.
  Applied and received pilot grant
• Applied and received 5 year grant for infant
  mental health in collaboration with local
  partners
• Joint application with Dartmouth Medical Center
  for tele-health services to neurologically
  impaired children

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Matching Interest to Data

• Center of Excellence
• Participation in electronic training
  supervision with Dartmouth funded by NH Bureau of
  Behavioral Health
• BA level staff participate in tele-health
  intervention (as clinically appropriate)
• Profit
• Contract with Dartmouth Medical Center for one
  year. Hourly rate and minimum hours per month.
• Contract has been renewed after third year of
  HRSA grant
• Business Potential
• Agreement with vendor to review outcomes after
  the contract period and explore development
• Value to constituency
• Satisfaction surveys
• Letters of support
• Cost data as listed above
• Participation of advocacy groups

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Matching Interest to Data

• Access to Care
• Comparison of wait time for service (tele-health
  vs. off site)
• Comparison of distance traveled for tele-health
  vs. off site (miles and time involved)
• Outcome data from survey re comfort with
  tele-health model
• Quality
• 360 degree evaluation (client, provider, treating
  MD and vendor)
• Portability
• Agreement with Peers to share all data including
  policies and procedures

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Reimbursement

• Medicaid
• Model presented to DHHS. Model limited to clients
  of NHS. Agreed to one year pilot as of July 1,
  2008.
• July 1, 2009 Medicaid reimbursement opened to all
  CMHC
• Private Insurances
• October 2008 legislative leadership agreed to
  sponsor SB 138 requiring all third party
  insurance companies doing business in NH to
  reimburse for tele-health. Advocates including NH
  Hospital Association, NH Community Behavioral
  Health Association, Dartmouth Medical Center, NH
  NAMI, testifying on behalf of the legislation.
  Passed into law on July 16, 2009.

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Operational Expenses

• Staffing
• Covered by a combination of reimbursement and new
  contracts.
• Currently exploring the utilization of
  contracting out in house resources to schools
  and hospitals
• Connectivity (the not so hidden cost monster)
• We participate in rural health care program of
  Universal Service Administrative Company (USAC
  website http//www.usac.org/rch)
• Also exploring other options in conjunction with
  DHHS and UNH
• Equipment replacement
• Grant opportunities (USDA Rural Utilities Service
  http//www.usda.gov/rus/telecom/) corporate
  offers and buying cooperatives

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Findings

• Internal
• The project required an investment/commitment
  from
• clinical, IT and administrative staff to work
  collectively to assure its success.
• The initial failures outweighed success. Positive
  client response was a critical turning point.
• External
• What began as a desire to address an unmet
  clinical need ended with a lesson in the value of
  networking.
• Building strong relationships became the driver
  that advanced the project.

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Questions?
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Contact Information

• Northern Human Services
• 87 Washington Street
• Conway, NH 03818
• 603.447.3347
• Fax [phone]
• http//www.northernhs.org/index.html