As the idea of Certified Community Healthcare Clinics (CCBHC’s) matures, we will begin to see leading organizations moving toward this new structure. This type of client-focused attention will improve the overall health of the Medicaid population by integrating primary care, establishing evidence-based practices, and actively coordinating services outside of their four walls. The criteria for certification falls into six areas of focus:

1) Staffing

Since a high percentage of Medicaid recipients have a number of health issues, it’s important to move towards the next level of multidisciplinary teams. At the base, these teams will need to work together and coordinate service plans for better connections, and thus better outcomes. With the inclusion of family members, peer specialists, and staff at all levels of care, it will be vital that staff have a working electronic platform to communicate and review updates in real-time. This includes expanding direct client documentation into the health record, medications reminders & alerts, telehealth services, and a continual commitment of the team to stay connected. This will provide better focus on specific care plans and more immediate actionable items increasing value (See prior post on better defining Value in Healthcare).

2) Availability and Accessibility of Services

The Medicaid population is not only in crisis from 9 to 5. Centers will begin to have 24/7 clinics and walk-in urgent care centers – similar to what we’ve seen for physical health for the last twenty-five years. Staff that work in these organizations will expect to not only see a care plan, but also up-to-the-minute healthcare information, client assessments, if and when medications have been picked up, and lab results. They will also be able to securely connect with team members by phone, telehealth, text, or chart note. Updates to the record will be seamless to all members including outside referrals and insurance eligibility and treatment team metrics like identifying urgent needs within ten days, or following up with all referrals to other providers.

3) Care Coordination

With the passing of the Mental Health Parity and Addiction Equity Act, insurance companies should treat all illnesses as, well, illnesses. If a client has congestive heart failure and also has bi-polar disorder or a drug addiction, they will be offered the same level of services. Integrative care will become the norm and treatment silos will become a thing of the past. The use of structured data will provide the ability for better communication via continuity of care documents or secure texting to all team members including Designated Collaborating Agencies (DCO’s). As care becomes more and more decentralized, organizations such as Hospitals, Urgent Care Centers, Residential Crisis Centers, Detox Facilities, Homeless Shelters, Housing Agencies, and Employment Services will need to work together, all assuming risk for the client. There should be no gaps in any organization’s understanding of where the client is in the treatment process.

4) Scope of Services

Comprehensive, continuous, connected person-centered plans will be pushed as the norm throughout organizations of care. At first this will be a daunting task for individuals and teams to be connected. As both staff-facing and client-facing applications like Fitbit or Wellframe become more integrated into the technology platform, communication and connection will become easier. Organizations will be expected to provide a wide-range of services including mental health services, physical health, and community outreach services. Client screening, assessments, and planning processes will be validated and standardized so clinical staff across a city or across the country can speak the same language as far as client progress or regression. Universal “next steps” in the caregiving process will begin to materialize for specific population types.

5) Quality and Other Reporting

What comes in must go out. To provide this level of care and service coordination, it will require a lot of data to be captured, communicated, and transferred across all provider types and agencies. Staff will need to be able to “read the story” of an individual client, or a client population. All follow-up activities and total cost of services will need to be easily accessible to providers and Medicaid enrollees. DCO’s will need to report outcome data, or log into a system and complete the documentation process,  and other federal required data like MIPS and TEDS data will need to be gathered and reported. All organizations will have to take a continual real-time view of the populations they service for a continual improvement of service outcomes.

6) Organization Authority

Organizations are required to be not-for-profit organizations and have board and management input from the people they serve. Not only will the organizations need to be certified by state and local authorities, but also by national accreditation agencies like CARF, Joint Commission, and the Council on Accreditation (COA). Processes will need to be standardized at all organizational levels across town or across the country.

Undoubtedly the marrying of process and technology will move us closer to the goal of deep population health. Community mental health centers will branch out and connect with outside providers to meet clients “where they are” and provide care. As mental health providers move towards more of an outpatient urgent care and meeting place, they will need more extensive training and investment in technology to adhere to these requirements. Medicaid dollars are reimbursed at just 61% of commercial plans and under stricter and stricter regulations and differ across states. The idea of CCBHC’s will help the neediest populations to better health through expanded teams and communication, but we have a very long way to go to realize the goals of CCBHC’s.

Offering 25 years of expert leadership in the health systems information technology field, Ted Wright has an unending passion for the healthcare process. He meets daily with healthcare executives and providers to better understand their delivery processes and structures. Ted and his team at Streamline Healthcare Solutions provide innovative tech solutions that improve quality, safety, and efficiency, while engaging clients and enhancing overall care coordination.