1. Where do we (you) go from here? Framing the issues. Dave Wanser, Ph.D., Senior Clinical Consultant, Intellica dave.wanser@intellicacorp.com dave.wanser@gmail.com 1

2. What you already (should) know There are tightening budgets and increasing demand The Washington budget debate and subsequent cuts will continue the trend Healthcare Reform (ACA) will increase competition and require the use of new and emerging technologies Many of the HHS agencies and their constituents are benefitting from the additional funding for technology (CDC, HRSA, CMS, ONC, WIC, ACF) 2

3. The Challenge: So much to do, so little time to do it HIPAA Title II MITA 2.0 NHIN Phase2 ARRA / HITECH HIPAA 5010 ICD-10 State Health Insurance and Benefit Exchanges 1996 2005 NPI CMS SMHP 200620072008200920102011201220132014 MITA State Self-Assessment Statewide Health IT/Exchange State Medicaid Health IT Plan PPACA Medicare/Medicaid Provider EHR Incentive Program State Health Information Exchange Each of these distinct but complementary activities has been sequentially released to meet specific policy or program objectives but without a unifying architectural framework. 3

4. Meaningful Use and HIE: why it is important to you Meaningful use will require sending linked claims and quality data through HIEs for claims payment and other purposes Payers will all move in this direction, as will ACOs The quality measures will be applicable to all, eventually There are health measures that are already in use and your providers should be utilizing Linking claims and quality data will require flexible and scalable technology Stage 1 2011 Transmit screening data through EHR to HIE X of my clients were screened for tobacco use Stage 2 2013 Transmit cumulative data through EHR to HIE to payer X clients screened positive for tobacco and I intervened with Y Stage 3 2015 Transmit cumulative data through EHR to HIE to payer X clients screened, Y clients intervened and as a result ∆ quit smoking 4

5. Break Out Sessions: ACTION Planning Behavioral Health EHR landscape Performance Reporting: State BH agency and Federal Requirements Statewide Interoperability: HIEs and Medicaid 5

6. Framing the conversation The changes resulting from ACA and HITECH are fundamental and comprehensive. Incremental steps will have limited utility. Will your agency make this transition? In 5 years? How? 5 Questions to ask of your State colleagues 6

7. 1.What are the threats? Are leaders ready to lead? Are the right people at the table for policy and technical development activities? Is there a clear path forward? Will lack of a coordinated effort between MH and SA leaders and providers leave us behind? Do we assume that we are indispensible? 7

8. 2. Do you and your team understand EHR and HIE implementation needs in context? The requirements for EHRS, HIES and ACA are inextricably intertwined Health Information Technology and Quality are now linked If your strategy is to maintain the ground you hold, you will you will lose ground It is essential for leaders to understand the policy implications of these 3 issues in terms of HIT requirements – Purchasing and payment changes – Eligible populations – parity and Medicaid expansion population – Cross system coordination 8

9. 3.What is the goal of Integration between primary care and BH? How do you define Integration? 9

10. Knowledge and Information Integration to improve patient outcomes

11. 4.What do you bring to the table? What ensures your relevance? 11

12. 5. What is the single most important thing I need to do when this meeting is over? You need a strategic plan for behavioral health IT (If you don’t know where you are going, you won’t know how to get there) Evaluate your state’s current health IT Plan. Where does behavioral health services and its information systems fit in the overall health care delivery system? Does the plan support quality outcomes for the behavioral health population? What is the experience of the people who receive those services? 12

13. Break Out Sessions: Questions to ask Policy Leaders - You need to speak a new language! Behavioral Health EHR landscape – HIT is the currency of health reform. How will providers in your system succeed without full implementation of EHRs in 5 years? Performance Reporting: State BH agency and Federal Requirements – Standardized data taxonomies and quality reporting using these taxonomies will be required for reimbursement. What are the implications for current State and Federal reporting? Statewide Interoperability: HIEs and Medicaid – Linked systems of care such as ACOs and linked claims and quality data will become the norm. How will behavioral health agencies adapt? Will your agency play a role in helping them or keep hands off? 13

14. Wrap up SAMHSA can provide some assistance but you need to ask for it Very few State MHSA agencies have a clear understanding of the implications of the changes inherent in ACA and HITECH Yes, it is overwhelming – but no one is going to simplify this for you Think CCD and what is relevant to BH 14

15. Three things to write down 1.Less is more - FOCUS 2.Soft stuff is the hard stuff 3.The caravan can’t stop for every barking dog 15