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January 6, 2015 ��| ��Market Intelligence Team

Almost every day, the senior team at OPEN MINDS brings you an analysis of the market developments shaping strategy for the organizations serving consumers with complex needs. This past year we saw many developments in need of analysis, many with far-reaching implications for executives.��What issues were top of mind in 2014?��This��list of the most-read executive briefings gives you an idea.

1.

Recent health care policy documents and trade magazines (and even newspapers) are full of discussion of the move to primary-care-focused medical homes. So, what exactly is a medical home? A medical home is a coordinated care model focused on acute care for all populations. Then, enter the term “health home.” Confused? I was, the first time I heard the term. But, I’ve learned a lot about the differences between the two – and opportunities in both models over the last year.

2.

Recently, we received a question from an OPEN MINDS Circle reader in response to my article – “Getting A Bead On The IMD Issue.” The reader wanted to know when and where the Centers for Medicare and Medicaid Services (CMS) announced an end to IMD waiver exclusions. In the original article, we discussed the difficulty that executives of both payer and service delivery organizations face in determining exactly which facilities are “IMDs” in their market, and — most importantly — subject to the IMD exclusion rule.

3.

Substance abuse treatment services are covered under “mental health care.” Reimbursement for substance abuse will be paid using the same benefit schedule as mental health, which is good news for provider organizations. These benefits are affected by the recently-enacted Medicare parity regulations. In general, Part A covers some drug and alcohol treatment received in a hospital, including room, meals, nursing, and other services.

4.

We recently reported on the final federal rule defining settings eligible for Medicaid reimbursement for home- and community-based services (HCBS). The rule was five years in the making and has been met with general approval by advocates, and provider and industry associations. Implementation is next, as the rule becomes effective March 17, 2014.

5.

Greetings from New Orleans and the opening day of the 2014 OPEN MINDS Planning & Innovation Institute! Our focus for the next three days is about the “seismic” changes in health and human services. This is not a matter of an adjustment to best practices or the addition of a new service delivery protocol. The changes we’re looking at are fundamental changes to the health and human service “value chain” – the remaking of the roles of stakeholders in the field and the resulting challenges of competitive advantage and sustainability.

6.

You may have missed it – on August 7, 2014, the Washington State Supreme Court ruled that the practice of “psychiatric boarding” for individuals under civil commitment violates state law. In this case, “psychiatric boarding” occurs when a patient in psychiatric emergency remains in a hospital emergency department while waiting for admission to a psychiatric facility. Why the ruling?

7.

Over the past few years, we’ve seen a shift in the use of “carve-out” financing in health plans. The shift? Away from carve-out by specialty (behavioral health, cancer treatment, radiology, pharmaceuticals, etc.) to a new carve-out by consumer type. A reader responded by asking what the current carve-out “map” looks like for Medicaid. To answer, our team at OPEN MINDS conducted an environmental scan of the 50 states plus the District of Columbia.

8.

Where systems “collide” is often where we have problems serving consumers in the health and human service field. Good examples are the corrections system and the mental health system; the educational system and the disability support system; and, I think, the foster care system and Medicaid managed care programs. But it is necessary for service provider organizations serving children in the foster care system to bridge this gap because the Medicaid managed care programs are here to stay.

9.

Strategic planning is the process of continually assessing your organization’s internal capabilities and external environment (customers, competitors and market) in order to determine how best to use your resources to meet your objectives. In the real world, many management teams formulate great strategic plans, craft sound strategies for allocating resources, but fail when it comes to implementation.

10.

We have reported on increased Medicaid coverage for justice-involved individuals in states expanding Medicaid. Connecting justice-involved individuals to services (both social and medical) upon release is widely acknowledged as critical to breaking the cycle of homelessness, reliance on emergency and crisis care, and re-arrest.

11.

Here are some quick numbers – readmissions cost Medicare $17.5 billion and each psychiatric readmission costs on average $7,494. That is why the federal Centers for Medicare and Medicaid Services (CMS) program to adjust hospital fees based on their readmission rates has been such an important topic for many health and human service executive teams. For a quick update – Congress enacted this program in 2010 and started handing out penalties to hospitals in 2013.

12.

In response to the ongoing federal investigation of appointment wait time issues in the Department of Veterans Affairs (VA) health care system, a reader asked about the potential for expanded opportunities to serve VA eligible populations. As is the case with any market assessment, the first step requires an understanding of the existing service delivery system. In the case of the VA health care system, that first step is a big one.

13.

Success in business planning and management requires that we move from a traditional model of providing purely financial and retrospective information and using best guesses for decision making to one of providing forward looking and insightful measurement and analysis that can be used to make key decisions. This measurement culture where business decisions are made based upon a careful blend of both data and intuition is an organizational environment where staff have a keen understanding of the information they need to do their jobs effectively, and how to obtain and use this data.

14.��

Here’s a quick question – how many executive teams of health care organizations are certain they are HIPAA compliant? And if those same teams “aren’t sure”, how do they find out for sure? Last month, the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR) released a new downloadable security risk assessment (SRA) tool, to help provider organizations seek “surety.”

15.��

Maybe quantifying the problem will help drive cross-system solutions. That was my reaction to the piece “Untreated Mental Health A Factor Behind Health Care ‘Superutilizers’”, from the Community Radio for Northern Colorado, that found that not treating mental illnesses cost every citizen in Colorado $1,000.The analysts took an interesting approach to this analysis, which was based on the following statistics.

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