30 Dec Is Your EHR Ready for the Changes Coming with Value-Based Care?

Can your Electronic Health Record add, subtract, multiply and divide?

I can remember standing at the back of the room waiting for Sister Theresa to give me a math problem that I would have to figure it out before I got to the front of the room.  As behavioral health moves closer to value-based payment, your software is going to be standing at the back of the room waiting for the question, and then be expected to figure it out. The question you have to ask yourself is: Is your software ready for the changes in treatment planning and payments that are coming as we move to a value-based economy?

Your EHR will be one of the tools that must be exceptional in order for you to be successful in the new age of value-based care, and it’s only as good as what goes into it. Let’s talk about what will be different in relationship to developing value-based treatment plans.

Yes, there will be goals, objectives, interventions, and outcomes in a plan designed to improve a person’s ability to function. At the moment, most plans are written around the client diagnosis with some attention paid to functionality. When we talk about improving function what does that involve? If I am a therapist in an outpatient mental health clinic, what will I need to do that is different from my current plans? Today, when a patient comes in to see the therapist, they discuss what has happened since their last visit, and then they begin to evaluate why some things worked and others did not. The therapist then discusses what should happen before they meet again and sets the next appointment. 

As a private therapist receiving value-based payment, what will need to be different in that scenario?  First, the care plan must be built around improving the functionality of the patient. To make that happen, the therapist would need to have all the necessary support systems for the patient. In other words, other agencies that provide different programs would need to be a part of the care plan. For example, consider a patient suffers from depression, is an alcoholic and also happens to work near a bar. Part of that person’s plan would include having someone at his place of work at lunch time to support him in his goal to not drink. I know this sounds simple, but this would be one way to improve function, hopefully quicker, than only coming in for individual sessions. These kinds of interventions will be used to evaluate if the patient is able to function at a higher level in the community.

The software should be able to help the clinician assess the patient and measure if the care plan is working. The assessment tool you use must tell the therapist more than basic information such as their patient is depressed and has a substance abuse diagnosis. It will need to give the therapist a measure of the patient’s ability to function in the community. The software will take that information and make it available when the patient’s care plan is being created. The goals and objectives in the plan would reflect the results of the assessment tool. When the plan is reviewed, the assessment will be given again to determine if progress was made by the patient. When evaluating the plan, the assessment will help determine if the plan is working or needs to be changed. The individual patient data can be shown in a dashboard and will also provide a comparative for other patients on the therapist’s caseload. 

To be successful in a managed care environment, programs must learn how to work together to manage individual patient care plans. The EHR will need to communicate with other programs that are also working with the same patient. It should be able to easily create a link from your platform to another program that allows an outside agency to participate in the care plan. This would include creating the plan, charting to the plan, and evaluating patient progress. All of this must be done in a manner that allows meaningful data collection to demonstrate that patients are getting better.

Payers will ask you how long will it take to improve the patient’s functionality, if they need less services, or no services at all. Measurement of care will be needed from your EHR to answer that question. The software will need to look at a plan by individual goals, and determine if the patient is progressing in the right direction. This will be accomplished by regular review of the plan and using consistent function-based assessments to measure progress. Depending on how you are being paid, it may be necessary to tell the payer how long you need to work with any one patient to accomplish change. Again, you will need to show what has been done, any necessary changes in the care plan, and justification if you need more time to work with the patient.

Providing a care plan that is not measurable, does not give back meaningful data, and doesn’t include like-minded partners offering support to the patient will not be successful in a value-based environment. If your organization is using an electronic health record, ask yourself: does it add, subtract, multiply and divide? If it does not, consider replacing your current system. Value-based care is a new world both in terms of treatment and payment and it isn’t going away. Hopefully you are prepared!

Bonus Content! Download our free white paper, “Value-Based Payments in Behavioral Healthcare” now.