1. Luis Velasco (CIO)- lvelasco@mhchealthcare.orglvelasco@mhchealthcare.org Jania Arnoldi (CFO) – jarnoldi@mhchealthcare.orgjarnoldi@mhchealthcare.org Emily Jeffery (HIS Manager) ejeffery@mhchealthcare.orgejeffery@mhchealthcare.org Visualutions 2015 User Group Conference

2. “Move Fast, Break Things …” “You will miss 100% of the shots you never take.” Execution is Strategy Whoever tries the most stuff WINS. No Matter. Try Again. Fail Again. Fail Better.

3. Welcome To The MHC Healthcare Family Who is MHC ? A Federally Qualified Health Center established in 1957 THE OLDEST FQHC IN AZ We provide excellent Integrative services at our network of 14 clinics located throughout the Tucson region We have approximately 40 Medical Providers 20 Licensed BH Practitioners and we serve over 42,000 Patients in Southern, AZ Experienced GIGANTIC Growth in the last 10 years. ( 4,427 -- > 42,000 Patients) with 160,000 visits / year

4. Welcome To The MHC Healthcare Family MHC Healthcare (MHC) is the O L D E S T community health center in Arizona - incorporated in 1957.

5. NEW MHC Healthcare Family

6. MHC INTEGRATED SERVICES Medical  Internal Medicine  Family Practice  Pediatrics  Quick Care  Obstetrics & Gynecology  Pharmacy  Laboratory  Radiology  C.T. Scan – Mammography – Ultrasound, Dexa Scan Medical Specialists  Cardiology  Nephrology  Ophthalmology  Oncology  Gastroenterology  Orthopedics  Physical Therapy MHC Counseling and Wellness Center  Crisis Services, Therapy, Alternative Medicine  Massage, Energy Therapy, Acupuncture  Work Adjustment Program  Integrated Behavioral Health Other Services  WIC  DENTAL

7. Mental illness population increased health risks: 3.1% 15% 1.7% 1.3% 7% 5.1%

8. INTEGRATION is EMBEDED into MHC Mission MHC Healthcare is dedicated to providing excellence in integrated health services to the communities we serve.

9. Medical BH Dental “Integrative medicine is clearly becoming mainstream. And one day we can drop the word integrative and it will just become medicine.” Andrew Weil University of Arizona Center for Integrative Medicine

10. Existing Situation

11. Existing Situation - Disconnected BH System Dental System Medical EMR GAPS in CARE: Multiple Repositories of Patient Information Multiple Scheduling Systems Multiple Clinical records Meds, Allergies Scanned Documents/Faxes Hospital Discharges Clinical Info Scattered Referrals / reports Cumbersome Coordination of Care Problematic use of Guidelines In Summary, POOR Patient Support

12. New “Truly Integrated” Environment Medical BehavioralHealth Dental

13. New “Integrated” Environment Behavioral Health Registration in Steroids New Demographics process CareTrax/Service Plan & Clinical Content Group Manager Data Extraction Management for State Compliance

14. Intake Workflow Process Front Desk Reception Front Desk Reception Intake Specialist Process Client Intake Specialist Process Client Intake Specialist Schedule Intake Specialist Schedule Consent Forms Receive: Information Packet Receive: Information Packet Core Assessment Crisis Plan Schedule Client with Appropriate Personnel Schedule Client with Appropriate Personnel Client receives verification of appointment Service Plan Applicable Consent Forms signed by Client Part A: PMH / SH / RF Part B: Safety/ Behaviors / SI Part C: Violence Part D: Developmental Completed by Intake Specialist Signed by Client Completed by Intake Specialist Referral to Licensed Provider Unlicensed Therapist Licensed Therapist Start Demographic Process Card Text Reminder Call

15. Registration on Steroids Demographic Initial Assessment / Recurring Updates

16. Service Plan Via CareTrax - Integrated Workflow

17. Care Plan- Signatures

18. Caretrax - Dashboards

19. Group Management

20. Clinical Content

21. Integration With CPS

22. IMPLEMENTATION TIMELINE Sevilla#1

23. Implementation Time: Go Live 10/1/2015 Financial Implementation:  Facilities  Providers  Insurances  Financial Classes  Fees / Codes / Fee Schedules  Allocation Sets Schedule Training: More than 150 Users  Training Back Office  Definingnew Workflow  Training Front Office  No Demographics system Operational Implementation:  Encounter types  Document types  Custom Orders  Custom Problems  Custom Medications  Custom Flowsheet  Scheduling Templates  Caretrax Setup  Group management Setup Timing- of events Coordination ex: Schedules and facilities creation

24. Clinical Content Development  Hired a dedicated developer to develop necessary clinical content  She has developed over 50 forms in VFE  Some Technological issues  No patient signatures available in the Centricity chart  Obstacles:  No BH Experience  No Collaboration from the BH Operation  No VFE Experience

25. Project Management Project Manager Assign by “GIC” –Guy in Charge POSITIVE ATTITUDE ++ Project Manager 1.- Understands and sees the end goal - Previous implementation experience proffered 2.- Accountability – Holding Staff accountable including myself Operations needs Clinical needs 3.- Positive attitude From the top down 4.- Visibility of the project manager

26. Bad Staff Walking out Clients/Patients walking out Turnaround spikes New Job titles and duties Increased appointment times Increased documentation Practitioner frustration Good Improved Processes/workflows Staff retention New Job titles and duties Staff bonding – we got through this we can get through anything Quality patient care Reporting Provider eficciency DC vs Marvel

27. Financial Implications: Diversity of Payment Models: There is a continuum of models, ranging from activity based reimbursement to full risk-sharing

28. What Is Next  Redefining PCMH  Patient Centered Approach to Health  Effective Case Management  Effective Calculation of Health Risk  Health Conditions  Preventive Care Compliance  Social Factors Ex: Depression, Bipolar, Anxiety, Incarcerations, Substance Abuse  Economic Factors – Employment, Insurance, Family size etc.

30. Luis Velasco (CIO)- lvelasco@mhchealthcare.orglvelasco@mhchealthcare.org Jania Arnoldi (CFO) – jarnoldi@mhchealthcare.orgjarnoldi@mhchealthcare.org Emily Jeffery (HIS Manager) ejeffery@mhchealthcare.orgejeffery@mhchealthcare.org