Stage 1: “Contemplation and Planning” | Supporting the Five Stages of the CCBHC Experience
The “Contemplation and Planning Stage” is about research and assessing your readiness to be a CCBHC. It is also about establishing the foundation for the CCBHC, including adopting an organizational change process and completing a Technology Assessment.
In my role as the CCBHC Program Manager, I spend a lot of time meeting with the professionals of each of our CCBHCs, many at various stages of maturity, across 29 different states. This activity has enabled me to collect a wealth of information about how the different CCBHCs approach all the challenges of the CCBHC treatment model. A second vehicle for learning is the CCBHC Cohort. Our customers say the CCBHC Cohort is one of the most valuable secondary resources (with the EHR being the first) we offer.
There is no better vehicle for problem-solving, exchange of ideas, and learning that occurs through the CCBHC Cohort. This series of articles is my way of sharing this knowledge with you.
Let’s look in greater detail at each of the tasks Qualifacts recommends that you complete during the “Contemplation and Planning” stage.
Commit to a formal Organizational Change Process: Qualifacts recommends that you commit to a formal organizational change process. I personally recommend the Plan, Do, Study, Act (PDSA) process for managing change– a four-stage problem solving and process improvement methodology for organizational change.
- The “Institute for Healthcare Improvement” provides a PDSA worksheet for guidance in executing the PDSA process. If you are interested in the PDSA process, I also suggest you watch the Qualifacts webinar on applying the PDSA process to a CCBHC.
- Whether you choose to adopt the PDSA process or another change management process, the necessary understanding is to accept that transitioning to the CCBHC treatment model is a significant change and that you will need to formally manage that change. The PDSA process can also be used for managing changes in processes and workflows for improving outcome measures, which we will discuss in the Stage four article.
Form a CCBHC Work Group: Name a group of subject matter experts to undertake needed planning and review cycles for the launch of your CCBHC. We recommend at a minimum that you include leadership and staff from the following disciplines:
- Report Writing
- Human Resources
- Peer Professional
Once established, this group will be structured using a formal project plan facilitated by one member of the group functioning as the project manager. We will discuss the project plan in greater detail in the next article of this series. This group should have regularly occurring meetings whereby each member discusses their progress on each of the project plan tasks. This is a working group that will result in tangible deliverables.
Study the SAMHSA (Substance Abuse and Mental Health Services Administration) CCBHC Criteria: The SAMHSA CCBHC criteria are broken down into “6 Program Requirements” types:
- Availability and Accessibility of Services
- Care Coordination
- Scope of Services
- Quality and Other Reporting
- Organizational Authority, Governance and Accreditation
- Separate the groups of requirements
You will want to break the requirements out and divvy them up to the various named subject matter experts on your team. Your human resource professional and a manager might study the “Staffing” criteria, whereas the CEO or the COO may study the “Organizational Authority, Governance and Accreditation.”
As each team reads through their specific discipline’s criteria, ask them to notate if the agency currently has “met”, “partially met” or “not met” each criterion in their domain. This will serve as a foundation for your readiness assessment. You will come back to this work again and again in your review process post-launch, to understand your success and your areas for improvement.
Complete a Readiness assessment: This readiness assessment can be done by a third party, or you can do it yourselves. You will need to establish where your agency is currently at in meeting each of the criteria.
- For those criteria that are unmet or partially met, you will need to document what it will take to meet the criteria and assign target “met” dates. Be realistic when assigning the target met dates.
- During the readiness assessment, your agency may need to deliberate on the decision to utilize or not utilize designated collaborating organizations for some of the services. This is an important and very “personal” decision for the agency and there is no right or wrong answer.
- Your readiness assessment will also serve as the foundation of your project plan for launching your CCBHC. The more effort you put into it at the beginning, the better it will serve you later.
Complete a Technology Assessment: Never was there a more critical time to assess whether you have the right technology. The CCBHC treatment model brings with it a new way of doing business and having the right technology to support the CCBHC workflows and reporting and analytics requirements is critical to your CCBHC success. Qualifacts recommends you have the best of the following technology types:
- full scale enterprise EHR
- robust reporting and analytics capability
- sophisticated practice management functionality
Ideally, the enterprise EHR will sufficiently support all three areas of technology need, through configurable capabilities that support efficient workflows and the complexities of the Prospective Payment System (PPS) reimbursement model that underlies many CCBHC grants.
The EHR’s reporting and analytics capabilities need to be robust enough to create high level data visualizations for Executive stakeholders while still being able to show detailed views that include such things as “gaps in care” for front line providers.
You also need to have access to all of your clinical, operational, and financial data. Your CCBHC will have outcomes or “key performance indicators” across each of these areas. An example of types of outcome would be screening for alcohol use and if positive, providing follow up (clinical); number of days between first point of contact and initial assessment (operational); and number of paid services per client per day -total and average (financial).
Qualifacts provides you a checklist of the technology needs of a CCBHC you can download here: [Tool] Evaluate Your Tech Readiness to Thrive in the CCBHC Model
Qualifacts provides you with the right enterprise EHR to meet your CCBHC clinical, billing, practice management, reporting and analytics needs. From “point of entry” to batching claims and sending them out the door, Qualifacts has the right technology to support all of the CCBHC needs. Our flexible and configurable EHR systems allow for efficient workflows which enable your providers to collect the outcomes data consistently. Our robust reporting and analytics tools provide great insight and transparency into performance on outcome measures as well as financial key performance indicators and operational success indicators. Our platforms offer robust referral management workflows as well as strong interoperability capabilities including the option for custom integrations. Our EHRs offer a large library of assessments and screening tools including risk assessment, screening for depression, suicide risk assessments, and screening for alcohol misuse and substance abuse. Feel free to visit our website at www.qualifacts.com.
Educate the Board of Directors: My final tip for this stage of the CCBHC experience is to educate your board of directors on your intent to move to the CCBHC model and inform them why it is so important to the future of your agency. I suggest you create a PowerPoint using some of the most powerful data from the 2022 version of the “State Impact Report : Transforming State Behavioral Health Systems,” from the National Council for Mental Wellbeing. This report provides data from the Demonstration CCBHCs on their successes to date. Share with your board what the CCBHC model will mean to the lives of clients you serve and the community.
Some points to achieve your Board’s buy-in:
- Being a successful CCBHC can mean greater contract negotiation power with payers –quality up, cost down, and the data to prove the mission.
- Sustainment through cost based PPS reimbursement can strengthen your agency into the future including positioning you to retain providers because you can offer more competitive wages.
- You can gain stronger marketing content (positive outcome data) for potential clients and their referral sources.
Please look for the next article in this series where I will discuss in detail Stage 2 of the CCBHC experience – “Funding and Launch” of the CCBHC treatment model.
Mary Givens, MRA
CCBHC Program Manager
Mary Givens has been with Qualifacts for 13 years. She has a Masters in Rehabilitation Administration from the University of San Francisco. Before coming to Qualifacts, Mary was the CEO of a non-profit organization that served IDD, she was the Director of Client Services and a Director of Supported Employment for people with SPMI. Since coming to Qualifacts, she has been a Project Manager for Implementation and a Program Manager of Meaningful Use, and is currently the CCBHC Program Manager.