Mike Lardieri, LCSW, is a licensed clinical social worker with a 30-plus year history leading behavioral health organizations. He has led some of the largest behavioral health organizations in the nation, including for-profit, not-for-profit, and managed care organizations.
Mike Lardieri: There are many clinical requirements for CCBHCs. CCBHCs must not only meet these requirements, but also perform well in these areas and have the ability to track all the services they're providing to achieve and maintain compliance.
There are also requirements for CCBHCs concerning quality measurement. Depending on your CCBHC model, you may have nine or five different measures your clinic must report on. It's imperative to use technology systems that gather the data on your measures and then provide it back to you in a way that's easily accessible so you can report on it and track your progress.
This quality measurement reporting is important. The reports CCBHCs use should be business reports. They may be focused on quality, but they're business reports in that they will help with organization management and ongoing business requirements for all the organization's programs, not just the CCBHC. These can be reports that support grants and value-based payments, for example.
Then there's the significant matter of prospective payment systems, which many states have adopted. A prospective payment system pays an organization for its cost of services. For CCBHCs to get paid through a prospective payment system, they need a sophisticated way of capturing all those services and identifying their costs in a cost report. Accurate data helps ensure a CCBHC is reimbursed for all its costs and can cover the costs of treatment and support. Any shortcomings here will likely lead to lost reimbursement.
ML: CCBHCs have nine defined services that must be provided under the CCBHC umbrella. A CCBHC itself does not need to provide all nine of those services. They must provide some fundamental services, with recent regulations stating that 51% of all encounters must be provided by the head agency of the CCBHC. That means the remaining 49% of encounters can be provided by other partners in the CCBHC called designated collaborative organizations (DCO). The CCBHC requires the ability to track services provided by DCOs and pay them according to their fee arrangement.
As an organization develops and begins supporting a system of care, there are requirements concerning improving access. CCBHCs need to evaluate how their systems support expanded access. One way could be through a schedule and giving referring DCOs access to the platform with the schedule. With access to the schedule, a referring site would know that they have a 9:00 a.m. appointment with a client tomorrow that the CCBHC booked today.
This scheduling would feel like a seamless experience for a client or patient, but the process requires a lot of tracking across multiple providers and/or tax IDs. CCBHCs need systems that can assist with crossing those boundaries so they can coordinate care across a system of care. That kind of technology is essentially a requirement if you're going to operate a successful CCBHC.
Technologies to support a system of care, especially one that uses the CCBHC model as a framework, should be considered standard today, although they're not. Hopefullywe will see this change in the near future.
ML: Using DCOs is probably one of the tougher aspects of operating as a CCBHC. A CCBHC may work with several DCOs. They may be on several different electronic health record (EHR) solutions. The designated CCBHC needs the ability to pull everybody into the ecosystem, so whatever technology the CCBHC chooses and uses needs to be able to support that integration.
At the root level, there may be opportunity for interoperability. Some states are further ahead in this area than others, with organizations having the ability to share information through a health information exchange, but we're not there yet with all states in the nation. That means a CCBHC needs the ability to provide secure role-based access to the DCO designees. The CCBHC needs the ability to allow collaborating organizations enough access to its system so the DCOs can provide the care collaboration required.
The trick here is that the CCBHC's system must be architected in a specific way. You need to be able to structure permissions and roles within the EHR so only people who are assigned to a particular client or patient can see that client's or patient's information. You may have a few different collaborating organizations working with a particular client or patient. They all need to see that individual. They all need to communicate with each other. To support that individual, they don't need to communicate with anybody else in the ecosystem or any other client or patient. A CCBHC must have the ability to control roles, permissions, and rights to access data down to the level of one particular client or patient.
Core Solutions is architected this way. We're able to provide this level of flexibility. These abilities are crucial to successful care coordination.
ML: First, CCBHCs should want an EHR that's perceived to be easy to use. I say "perceived" because what's easy is subjective, and people may want to see different features and capabilities to support ease of use. Ultimately, the EHR should check a lot of the boxes that translate to staff ease of use.
Second, CCBHCs should want an EHR with sophisticated real-time or near-real time reporting to support financial performance, operational performance, and clinical quality measures.
Third, the EHR needs a robust revenue cycle management module. If you're in a state that pays on a prospective payment system, that revenue cycle module needs to be able to track all the services provided and roll them up into one payment for the client or patient to ensure proper, complete billing.
ML: The good news for CCBHCs is whatever artificial intelligence can do for the general population of providers, it can probably do for you. Let's look at a few examples.
AI can help with cost reporting. There are sophisticated revenue cycle management modules that use some form of artificial intelligence to scrub and clean claims prior to their submission. Core Solutions has a scrubbing solution that reviews numerous edits before a claim is sent to processing. Thanks, in part, to this AI solution, some of our providers have a 98% clean claim submission rate, which is very high. This is the kind of sophistication a CCBHC needs to help ensure strong cash flow and reduce expense associated with denials.
Another area where AI can help CCBHCs concerns clinical decision support. Core provides this through its symptom/diagnosis tracking and social determinants of health (SDOH) or health-related social needs tracking solutions.
Then there's anomaly detection. This is where AI is leveraged to examine differences in treatment patterns or areas like scheduling. The AI identifies outliers across huge data sets. We're not talking about data from just a few different clients. We're looking at data across hundreds or thousands of your client encounters at the same time.
An area of AI being commoditized more now is ambient dictation and being able to accurately capture and assess the words used during a client or patient session and then efficiently and effectively summarizing that session.
Finally, a less sophisticated but still very important and powerful tool is the integration of dictation and note reporting into a platform. Many providers do not want to have a translation of the entire session summarized and a note generated. They just want to dictate their note. Using this technology helps by knocking off several minutes for each encounter they must document. Voice dictation empowers providers to get over that hurdle.
ML: When you look at the Core Cx360 platform, you find a platform that provides all the functionality needed to be successful as a CCBHC. This includes functionality that helps clinics establish new CCBHC programs and strengthen existing programs to better ensure equitable access to services.
Many of our customers find the platform easy to use. There's integrated real-time or near real-time reporting embedded in the platform. We're able to produce all the quality measures required for CCBHCs. Cx360 includes the security and role permission capabilities needed to share information across the ecosystem in a care coordination platform.
Underneath the electronic health record technology, the essence of Cx360 is that it's a care coordination platform. We believe Cx360 provides all the essential ingredients for CCBHCs to be successful — including supporting efforts to secure grants that further help CCBHCs prosper.