2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

The New Normal: How We Learned to Love and Understand Data

Data. The world today is all about data. With the transformation of the Medicaid payment system into a more value-based approach, the need for understanding data has taken a higher priority at many agencies, including ICL. Managed Care Organizations (MCOs) are making arrangements with agencies that can prove that their models of care result in improved health outcomes for clients. This value-based payment formula moves away from the more traditional fee-for-service models toward more financially risk-based arrangements. Outcome data will help transform agencies from a system in which the volume of services provided was prioritized to a system in which the outcomes from the services are foremost. Since ICL claims People Get Better With Us, how do we prove to the world that statement is correct? The answer lies in our data and the outcomes we can interpret from the information contained therein.

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. With that in mind, Managed Care Organizations and Behavioral Health Agencies must work together to achieve true system reform. How does data play into that? Quality outcomes can only be demonstrated with data—reliable data, aggregated from the client level.

Agencies have always collected data; however, this data was often locked in paper records and couldn’t be used in the aggregate, meaning for example, it couldn’t be gathered and then broken down according to gender, borough of residence, which managed care they use, or some other criterion. As Electronic Health Records (EHRs) grew, the power to collect data grew along with them. But much of the information was still not available beyond the client level—it couldn’t be easily presented in a way that had meaning and was useful to staff to enable them to make program-wide decisions. Furthermore, the information was often incomplete and therefore considered too unreliable to be useful beyond its function as an individual’s medical record.

So, the question then became: How do traditional agencies use existing technology to produce data that can be trusted and used to demonstrate outcomes? The traditional use of EHRs allowed for individual client health records and for billing. Any aggregate data was usually only available to specialist users—such as finance and data analysts. System reform created the need for all staff to be able to use and understand the information being recorded. One crucial strategic step was to democratize the data, making it meaningful and useful to the staff who are working with program participants and can put those numbers to their best use.

ICL recognized the need for a data revolution a number of years ago when it implemented an EHR in a way that could gather data specific to outcomes that would be needed to demonstrate value, such as emergency room visits and quality-of-life indicators. This proactive approach led to the creation of today’s Live Data Dashboard, which is changing the way data is used and understood, and aiding in the agency’s goal of working with MCOs to demonstrate the outcomes of our work. The Dashboard is updated daily, and staff can access it from their desktops. The data provides an understanding of services provided—whether it’s program-wide or specific to an individual.

The ICL Dashboards help staff, from Supervisors and Program Directors to the Executive Team, track program goals and understand treatment patterns, noting correlations between services and health outcomes. The data can be isolated to show patterns for the agency, a particular program, or an individual client. Additionally, clinicians can begin to set benchmarks for their program participants and track their recovery. These benchmarks become crucial as both clinical and management-level tools in that they can be used to make sure each person who’s part of, say, an ACT Team is getting all their required services or they can be used so that clinicians can track and monitor an individual’s progress toward achieving his/her goals.

So how does the data accessible in these Dashboards help individual program participants? How is the data that’s presented responding to the needs of system reform? Let’s take a look at one individual named Kevin. Kevin is a 20-year-old African American male with a diagnosis of schizophrenia. He resides with his mother in a shelter. Kevin has had multiple psychiatric admissions due to not taking his medication as prescribed, has difficulties accessing the proper healthcare, did not graduat‘e high school, admits to recreational marijuana use, and often isolates himself from contemporaries.

Kevin came to the ICL ACT Team in 2015. His team, comprising a psychiatrist, nurses, family specialist, vocational specialist, peer specialist and substance specialists, recorded the services he was initially receiving, which concentrated on mastering daily living activities, medication management, school and employment training, and problem solving. As his treatment progressed, staff added substance use, wellness and relapse prevention, and empowerment and self-help services. At the same time, staff entered into the EHR any incidents of ER and hospital use, as well as Kevin’s quality-of-life indicators.

Therefore, in addition to the pattern of changing services, we are able to see an increase in his quality-of-life responses over this time on the Dashboard. When first questioned in April 2015, Kevin felt he wasn’t connected to family or friends, he didn’t engage with mental health treatment, and he wasn’t pursuing any primary care doctors either. A year later, after being able to track and appropriately enhance the services he was receiving, Kevin now responds that he is well connected to family and friends, is following the advice of his mental health practitioner, and has started seeing a primary care doctor. Over the course of that same year, Kevin’s hospital admission and emergency room visits for mental health reason decreased substantially. Being able to demonstrate both the service pattern and the associated outcomes on the Data Dashboard allows ICL to demonstrate the quality of its treatment.

So, with an eye to the future of healthcare, ICL has harnessed the data within its EHR into an interactive Data Dashboard that gives staff the ability to understand all the nuances of the information it stores. The data elements range from census and individual life details through services and specific outcomes measures. This enables ICL to measure much more than what we have done—it enables us to understand the relationship between services and outcomes. The data is now accessed nearly every day by the people working directly with program participants as well those who help to create macro changes within the agency so that we can continue our mission and prove that People Get Better With Us.

Credits: Elisa Chow, PhD, is Director, Innovations, Outcomes and Evaluations; and Chris Copeland, MSW, is Chief Operating Officer, at ICL.

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