Free Executive Web Briefing Courtesy Of Topaz Information Solutions
Those accountable for a system of care have an interest in managing services to maximize the potential for wellness in community settings. Not only are higher levels of care costlier, but promoting care in the least-restrictive environment possible is more recovery-oriented and has been enshrined into law by the U.S. Supreme Court’s Olmstead decision. Thus, payers and providers have aligned incentives for reducing possible excessive use of acute care services such as emergency and inpatient care. Payers have developed many sophisticated data-driven methods for monitoring network performance.
However, these analyses are often based on financial claims data, which suffers from a 90-day lag, making it challenging to address problems early. Furthermore, such efforts may not fully realize the potential for providers on the ground to contribute additional context and ideas. This session will describe how a crisis provider (Connections Health Solutions) and payer (Cenpatico Integrated Care) collaborated to develop a quality improvement process based on crisis utilization data. In our model, a crisis visit is considered a potential missed opportunity for community stabilization. Daily data on crisis visits is sent to the payer for more up-to-date trending analysis. Leaders from both organizations meet regularly to review the data and develop multiple rapid-cycle improvement projects for both adult and youth services. In the first year, we achieved a 30% reduction in crisis readmissions and a 40% reduction in the number of high utilizers presenting for crisis services.
- Discuss the importance of using data to evaluate network performance
- Describe how rapid-cycle quality improvement can be used to decrease readmissions and service overutilization
- Apply lessons learned to problems in his/her own setting
Margie Balfour, MD, PhD, Chief of Quality & Clinical Innovation, Connections Health Solutions
Dr. Margie Balfour is a psychiatrist and national leader in quality improvement and behavioral health crisis services. She is the Chief of Quality and Clinical Innovation at Connections Health Solutions, which provides 24/7 access to mental health and substance use care throughout Arizona, and an Associate Professor of Psychiatry at the University of Arizona. Dr. Balfour was named the Doctor of the Year by the National Council for Behavioral Health for her work at the Crisis Response Center in Tucson and received the Tucson Police Department’s medal of honor for her efforts to help law enforcement better serve the mentally ill population. She is a co-author of the book People with Mental Illness in the Criminal Justice System: Answering a Cry for Help and serves on the board of directors of the American Association of Community Psychiatrists, The American Association for Emergency Psychiatry, and NAMI Southern Arizona. She received her M.D. and Ph.D. in Neuroscience from the University of Cincinnati and completed residency and fellowship in Public Psychiatry at the University of Texas Southwestern Medical Center in Dallas.
Johnnie Gasper, Crisis System Partner Specialist, Arizona Complete Health
Johnnie Gasper is the crisis system partner specialist for Arizona Complete Health, the regional behavioral health authority providing oversight and delegation of federal funding in Southern Arizona. Gasper has 7 years of experience working in the Southern Arizona behavioral health system. Before joining Arizona Complete Health, he served as a Family Support Specialist for Casa De Los Niños and as a Crisis Professional and Reports Analysist for the Envolve Crisis Line. Gasper holds a Bachelor of Arts from the University of Arizona in the College of Social and Behavioral Sciences. In his current position, he applies analytical models to information gathered from crisis observation clinics, residential crisis facilities, and psychiatric inpatient units to identify community-wide trends in the crisis system. Gasper works quickly to address any negative systemic trends and outcomes, working with system partners to proactively and continually provide excellent services to our community.