assessing organizational ability to provide navigation ... · 8/23/2017 · assessing...

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Assessing Organizational Ability to Provide Navigation Services

Credit Information§ If you would like to receive continuing education credit for today’s event via the

Centers for Medicare & Medicaid Service’s Learning Management System, please visit this link for more information: https://www.resourcesforintegratedcare.com/sites/default/files/Navigation_Webinar_1_CMS_CEU_Guide.pdf

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https://www.resourcesforintegratedcare.com/sites/default/files/Navigation_Webinar_1_CMS_CEU_Guide.pdf



August 23, 2017

Behavioral Health:Assessing Organizational Ability to

Provide Navigation Services

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Overview

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§ This is the first session of the “2017 Navigation Webinar Series”

§ Each session will be interactive (e.g., interactive chat functions), with 50 minutes of presenter-led discussion, followed by 10 minutes of presenter and participant discussions

§ Video replay and slide presentation are available after each session at: https://www.resourcesforintegratedcare.com

https://www.resourcesforintegratedcare.com/


Accreditation

§ The Centers for Medicare & Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET). The Centers for Medicare & Medicaid Services complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, the Centers for Medicare & Medicaid Services is authorized to issue the IACET CEU.

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Continuing Education Information

§ Complete the post-test through CMS’ Learning Management System and score a 80 percent or higher by midnight on September 11, 2017§ https://www.resourcesforintegratedcare.com/sites/default/files/

Navigation_Webinar_1_CMS_CEU_Guide.pdf

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Support Statement

§ This webinar is supported through the Medicare-Medicaid Coordination Office (MMCO) in the Centers for Medicare and Medicaid Services (CMS) to ensure beneficiaries enrolled in Medicare and Medicaid have access to seamless, high-quality health care that includes the full range of covered services in both programs. To support providers in their efforts to deliver more integrated, coordinated care to Medicare-Medicaid enrollees, MMCO is developing technical assistance and actionable tools based on successful innovations and care models, such as this webinar.

§ To learn more about current efforts and resources, visit Resources for Integrated Care at: https://www.resourcesforintegratedcare.com

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Assessing Organizational Ability to Provide Navigation Services

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§ Developed by:§ The Lewin Group

§ Hosted by: § The Medicare-Medicaid Coordination Office (MMCO)

Resources for Integrated Care


Introductions

§ Alice Geis DNP, APN, PMH-NPDirector of Integrated Healthcare, Trilogy, Inc. Assistant Professor, Rush University College of Nursing

§ Kimberly Smathers, MBAManaging Consultant, The Lewin Group

§ Mindy Klowden, MNMDirector, Technical Assistance and Training, The National Council for Behavioral Health

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Webinar Outline/Agenda

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§ Polls§ Overview of Navigation Services§ Review of Navigation Services Organizational

Assessment Tool (NAV OAT) § Using the NAV OAT to Assess Capacity for Navigation§ Best Practices for Implementing Navigation Services§ Questions & Answers (Q&A)§ Post-webinar Evaluation


Webinar Learning Objectives

Upon completion of this webinar, participants will be able to:

1. Understand the importance of navigation services in providing integrated care to clients managing mental illness and/or substance use conditions;

2. Recognize their organization’s ability to provide navigation services using the NAV OAT; and

3. Identify concrete next steps for expanding their organization’s capacity to integrate navigation services.

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Overview of Navigation Services

Alice Geis DNP, APN, PMH-NPDirector of Integrated Healthcare, Trilogy, Inc.

Assistant Professor, Rush University College of Nursing

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Why are Navigation Services Important?

§ People with serious mental illness (SMI) - a vulnerable population

§ Barriers to care are higher for individuals with SMI § Poorly coordinated care can harm health and is inefficient

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Defining Serious Mental Illness (SMI) “adults who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities”

-- SAMHSA (2006)


Navigation Services in Behavioral Health -Definitions

§ Navigation services refer to the process of helping clients obtain high quality, coordinated care through linkage, advocacy, and education. § Navigators overcome barriers to care through one-to-one

working relationships with clients and developing relationships across the care team.

§ Elements include:§ Linkage§ Identification of barriers to care§ Support for overcoming barriers§ Enhanced communication and coordination

§ Who provides these services? This depends on…§ Complexity/type of need§ Type of system – service or reimbursement focus§ Budgetary constraints

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What Is It About Systems That Can Make Navigation More Difficult?

§ Fragmentation of services§ Compartmentalization (behavioral vs. general health)§ Educational or discipline-centric silos§ Geographic access issues

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Navigation Services in Behavioral Health -Key Elements

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Navigation Services in Behavioral Health - Staffing

§ Case workers, recovery counselors, care managers§ Nurses, APRNs, Pharmacists, MDs§ Social Workers/LCPCs/Psychology Interns§ Peer Counselors/Wellness Coaches/Medical Assistants


Navigation Services in Behavioral Health - Key Functions

§ Use targeted outreach models § Meet clients where they are§ Provide a patient-centered or recovery model focus § Practice cultural awareness§ Ensure client access to best practices, evidence-based care§ Communicate, follow-up, and close the loop§ Model persistence and teach self-advocacy

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Review of Navigation Services Organizational Assessment Tool (NAV OAT)

Kimberly Smathers, MBAManaging Consultant, The Lewin Group

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NAV OAT: Background

§ Developed by RIC with input from subject matter experts§ Individuals with SMI have higher rates of chronic

conditions and need coordinated services that recognize the§ Interconnectedness of mental and physical health§ Effects of adverse childhood events§ Impact of adult physical illness

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NAV OAT: Objectives

§ Aims to help administrators, providers, and other service delivery staff in organizations that serve individuals with SMI or substance abuse conditions to:§ Assess their capacity for delivering navigation services

and§ Connect identified gaps to tangible next steps in the form

of a customized action plan

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NAV OAT: Structure

§ Section 1: Organizational Capacity to Support Navigation Services§ Population Considerations§ Organizational Infrastructure § Partnerships § Program Processes

§ Section 2: Pillars of Navigation Support Services § Building Client Relationships§ Health Literacy§ Health Coaching and Wellness Planning § Care Coordination§ Linkages to Community Services

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Using the NAV OAT

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§ Two versions available§ Downloadable PDF§ Interactive excel tally form

§ Ask at least two staff complete the assessment tool with the following instructions§ Choose one response for each question§ Be candid – answers are for internal use

§ Don’t focus on terminology differences

§ Be clear about scope – entire organization? One site?


Using the NAV OAT (continued)

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Using the NAV OAT (continued)

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NAV OAT: Additional Information

§ The NAV OAT can be found on our website: https://resourcesforintegratedcare.com/Behavioral_Health/Navigation_OAT

§ We also have additional navigation resources at https://resourcesforintegratedcare.com/concepts/navigation-services

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https://resourcesforintegratedcare.com/Behavioral_Health/Navigation_OAT




https://resourcesforintegratedcare.com/concepts/navigation-services





Using the NAV OAT to Assess Capacity for Navigation

Alice Geis DNP, APN, PMH-NPDirector of Integrated Healthcare, Trilogy, Inc.

Assistant Professor, Rush University College of Nursing

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Assessment Process: Administering the Tool

§ Convene small group of staff with diverse roles§ Can administer full tool or just a section§ Agree on time frame to consider§ Think about framework, for example

§ Rapid Cycle Quality Improvement§ aka Plan/Do/Study(or Check)/Act

http://www.healthworkforceta.org/wp-content/uploads/2016/06/RCQI_Resource_Guide.pdf

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Administering the Tool: Participants

§ RN experienced in navigation in all agency settings§ Outreach – higher acuity client population§ Clinic§ Residential

§ Program director with leadership experience§ Teams of recovery counselors§ Residential programs§ Drop-in center§ Peer staff

§ Integrated health director§ Wellness/health behavior change group leader§ Provides consultation/leadership to RN and OT groups§ Develops coordination of care and wellness service provision models

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Assessment Process: Issues Identified

§ Challenge of having dual electronic health record systems§ Tracking and sharing information§ Releases of information

§ Timely access to records for transitions in care§ Training and workflows for navigators§ Access to integrated health assessments

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Assessment Outcome: Using Results for Quality Improvement

Ways to use information learned from use of NAV OAT:§ Incorporate findings into new employee orientations§ Use in updates to existing staff, e.g. through team meetings§ Update training materials, e.g. create new module(s) in

training software§ Adjust communication practices with managed care

organizations§ Realign staff roles if needed

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Best Practices for Implementing Navigation Services

Mindy Klowden, MNM Director, Technical Assistance and Training,

National Council for Behavioral Health

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Determine the “Who”

Navigation: Linking patients

and family members with

essential health and community

services.

Nurse Care Manager

(Health) Care

Coordinator

Case Manager

Peer Specialist/

Peer Health Coach

Therapist

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Integrated Care Team

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§ A group of multidisciplinary providers working together with the patient usinga shared treatment approach and assistingthe patient to achieve specific physical and behavioral health outcomes (AHRQ, 2013)

§ Best practice: include navigators on the team


Integrated Care Team Communication

§ Daily huddles§ Weekly care team meetings§ Shared care plans§ Access to a common EHR, supplemented as needed with

care management software, access databases, etc.§ Urgent communication mechanisms (e.g. texting, red alert

secure emails, pagers)

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Invest in Staff Training and Development of Core Competencies

§ Convey the value of navigation (the why)§ Establish key processes and procedures§ Train staff in team-based care§ Train staff in cultural competency§ Educate staff on social determinants of

health§ Train staff on population health principles

and the use of data and technology to inform care

§ Train staff on assessment and development of whole-person goals

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Develop the Necessary Data Infrastructure

§ Assessment of Patient Needs§ Health Information Portability and

Accountability Act (HIPAA)§ 42 CFR Part 2: governs

sharing of information related to substance use disorder treatment

§ Tracking of Referrals Made§ Tracking of Referrals

Completed/Follow Up§ What Metrics Will You Use?§ Continuous Quality Improvement

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Maintain Up to Date Information on Resources and Referral Processes§ Information maintained electronically

and as handouts§ Share with patients AND staff

§ “Help line” approach§ Importance of community

collaborations§ Dedicate staff resources to this!§ Develop Memorandum of

Understandings, Care Compacts, Coordination of Care letters, Referral Agreements and procedures

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Paying for Navigation Services

§ Assess staff capacity and capitalize on existing resources§ May require workflow redesign

§ Pursue grant funding (start-up only!)

§ Coordinate billing§ Determine which, if any,

navigation services are reimbursable by Medicaid, Medicare, or through a 3rd party payer

§ Utilize alternative payment/value-based payment contracts

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Common Pitfalls

§ Lack of leadership§ Process change without culture change§ Inadequate investment in staff training§ Poorly defined roles§ Lack of policies and procedures§ Inadequate documentation and/or use of data§ Inadequate investment in community relationships§ Poor communication (internally and/or externally)§ Funding challenges

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We Can Help!SAMHSA-HRSA Center for Integrated Health Solutions§ Extensive resources on integrated care models,

evidence-based programs, financing, health and wellness, operations, and workforce

§ 1 hour consultations available to providers at no cost

Email: [email protected] [email protected]

Call: 202-684-7457

Visit Our Website: http://www.integration.samhsa.gov/

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mailto:[email protected]


http://www.integration.samhsa.gov/


Questions & Answers

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Evaluation Form and Post-test

§ Thank you for joining our webinar. Please take a moment to complete a brief evaluation on the quality of the webinar

§ For more information about obtaining CEUs via CMS’ Learning Management System, please visit:

§ Video replay and slide presentation are available after each session at: https://www.resourcesforintegratedcare.com

§ Questions? Please email [email protected]

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