The Certified Community Behavioral Clinic Model (CCBHC) for Integrated Care Delivery

“The CCBHC model alleviates decades-old challenges that have led to a crisis in providing access to mental health and addiction care,” according to the National Council for Behavioral health. CCBHCs deliver integrated, evidence-based addiction and mental health services, including 24/7 crisis response and medication-assisted treatment (MAT) for addiction, while meeting stringent criteria regarding timeliness of access, quality reporting, staffing and coordination with social services, criminal justice and education systems. CCBHCs are funded to support the real costs of expanding services to fully meet the need for care in their communities.

Recognizing the promise of the CCBHC model, Congress in 2020 expanded the original eight-state Medicaid demonstration program to include two additional states, and since 2018 has appropriated grant funding to support CCBHC readiness. A growing number of states are moving to implement the model independently via a state plan amendment or Medicaid waiver.

“CCBHCs have dramatically increased access to mental health and addiction treatment, expanded states’ capacity to address the opioid crisis and established innovative partnerships with law enforcement and hospitals to improve care, reduce recidivism and prevent hospital readmissions,” the National Council states.

Becoming a CCBHC | What I Wish I Had Known, from an Executive Perspective | Webinar Highlights

The Western Mental Health Center (WMHC), in Marshall, MN, became a certified CCBHC through the  Minnesota Department of Human Services, under a 2019 SAMHSA grant. Along the way, WMHC needed to adapt its culture and workflows and start working in new ways.

Sarah Ackerman, MBA, the CEO of WMHC, has led the organization through its CCBHC transition, and multiple other changes, supported by the CareLogic EHR and its longstanding, specialized support for customers across the range of CCBHC grants and funding models. Ackerman is also a community leader, having served as the President of the Minnesota Association of Community Mental Health Programs.

“Previous to CCBHCs, a person diagnosed with a mental illness needed to work with several different organizations to receive necessary services, which could mean visiting a therapist, a primary care provider, a case manager and a chemical health counselor at different times,” Ackerman said. “The CCBHC model changes that by offering these services under our care. Now, each team and each area of specialization throughout the organization work together to understand what we are delivering as a CCBHC so that we can be successful long-term.”

Organizational Change Management for CCBHCs

To prepare WMHC for the changes that being a CCBHC would bring, Ackerman led committees that met regularly during the transition; they continue to meet today. “We incorporated individuals from our clinical team, our compliance team, our administration, our IS team, billing, and then our quality control,” Ackerman said. “We met twice weekly, then weekly, bi weekly, and now monthly as we went from understanding the challenges to doing status checks, and evaluating outcomes and client satisfaction, to understand where we are around the services people are receiving.”

Becoming a Data-Driven Agency Using Assessments and Evidence-Based Practices (EBPs)

To meet the evidence-based requirements of becoming a CCBHC and manage resources effectively, Ackerman recommends using analytics dashboards to support data driven decision making.

“Having an analyst and a strong report writer becomes really critical to your success, as a CCBHC,” Givens said.

”Providing transparency into outcome performance for providers is critical so that they can focus their efforts on where those outcomes need to improve,” Ackerman said. “We’ve moved to a dashboard model with the data from our EHR to drill down to each individual clinician and each individual client, which has proved to be extremely helpful.”

The agency also enhanced its patient portal, engaged more extensively with its regional Health Information Exchange (HIE) to interoperably share data, and gained visibility into when clients were in the emergency room, or hospitalized. “With enhanced data, we were able to more quickly and efficiently focus care and outreach from a mental health, SUD or primary care perspective, to help avoid hospitalization from the emergency room, and to send out our crisis teams,” Ackerman said.

Managing Workflow Change for Staff to Support EBPs

“To support new clinical practices that support evidence based practices, agencies adopting the CCBHC model will need to rethink and adjust their workflows,” Givens said.

Western Mental Health handled the change in staged steps: “We knew that we had to re-engineer workflows to allow for the accurate collection of all outcomes data,” Ackerman said. “That was the starting point. From there, we had a plan to test the new versions, deploy them, gather feedback, and repeat the cycle, until we arrived where we wanted to be.”

Then came education and training.  “We created a full fledged training plan to make the CCBHC model work, including our new workflow processes and EBPs,” Ackerman said. “If people were hospitalized or in the ER, the care coordination team provides wrap around services, and the CareLogic EHR has capabilities for us to utilize an integrated treatment plan.”

Assessments and outcomes are part of EBPs, and WMHC implemented the IMPACT tool within CareLogic, which includes a library of clinician completed tools and patient reported outcomes. “CCBHCs require quite a few assessments and outcomes measures, and IMPACT supports that,” Givens said.

“Clinical Decision Support (CDS) tools also support  EBPs, and CareLogic’s configurability allows teams to set their own triggers and flags,” Givens said. “The CDS tools and the follow up support the EBPs, which tie into patient engagement and scheduling, to inform your  data analytics and reporting.”

Data Capture for CCBHC Compliance and Reporting

While WMHC found that data already being collected for compliance supported some of the CCBHC requirements, updates were needed.  “We had to add some pieces for the specific SAMHSA federal reporting, but we were already collecting a lot of the information required, using the CareLogic EHR,” Ackerman said.

New Services, New Programs, and New Teams | Organizational Change for CCBHC Support

“Service line expansion under CCBHCs can mean new credential types like medication assisted treatment (MAT), new policies, and new protocols that have to be planned, developed, and marketed to the community through outreach and collaboration,” Givens said.

WMHC implemented a new SUD program under its CCBHC certification, with outpatient services for  adults and adolescents with individual services and intensive outpatient group therap, supported with Medication Assisted Treatment (MAT). New ways of working followed. “We require our clients in MAT to do a comprehensive use assessment and they have to utilize our on-site pharmacy so that we have a greater record and control over adherence and whether they’re filling too soon, or late, and so we can see red flags. Are they under utilizing, over utilizing or not taking it properly?”

The teams-based approach at WHMC gives providers a full view of where clients are succeeding, and where they need additional support: “We have our psychiatrist sit in on our team meetings with the SUD provider, a community-based provider, and the outpatient therapist to review case notes progress, and attendance,” Ackerman said. “If clients aren’t showing up for individual sessions, or for groups, the team members are informed and can give them that nudge and encouragement, to drive better outcomes.”

WMAC also requires lab work on MAT clients. “We keep monitoring to see that they’re complying with the program and having hopefully good results,” Ackerman said.

Managing CCBHC Relationships with Designated Care Organizations (DCOs)

“If you’re going to collaborate with a DCO, you need to have formal understanding in place as soon as possible,” Givens said. “The DCO relationships are not casual. They are very formal. If you choose to work with DCOs, the CCBHC is responsible for the quality and integrity of the services they provide.”

WMHC chose to provide services on its own. “It was a very conscious decision on our part,” Ackerman said. “When we evaluated the accountability for that, it looked like duplicate work. We decided to bring that in-house.”

Managing CCBHC Intake and Appointments

Offering a continuum of services means making workflow changes across intake, screening, and scheduling to support timely access to a CCBHC’s range of coordinated services.  “We reconfigured how we think about scheduling in the CareLogic EHR, and we implemented open access for our therapy clients, with  just in time scheduling for psychiatry appointments. It was a huge shift, and we are getting clients in for services much sooner,” Ackerman said.

Managing CCBHC Changes in Length of Episodes

WMHC developed new approaches to thinking about episodes, and the duration of care, for its CCBHC transition, moving to a brief therapy cycle model, and reducing the wait list.  “We created an initial 10 to 12 weeks timeframe to reach goal focused and outcomes driven movement toward a model of recovery, across our levels of care,” Ackerman said.  “They may move to a full intensive level, then to a moderate level, with some community based services, and then to fewer services. If they have a relapse we can move them back and adjust accordingly, based upon where they were at with their treatment levels.”

“Prior to CCBHC we were somewhat individualized or siloed in our individual programs. Now, we are focused on communication and collaboration to spend more time with the client and their support system, so we can focus on increased outcomes for the program,” Ackerman said.  “We also focused on training to prepare for the changes we needed”

“New program types and new service types are going to require a lot of training,” Givens said. “The introduction of more clinical decision support and evidence based practices can include new assessment tools and new screening tools.  A new CCBHC is going to introduce new workflows, and new roles.”

Moving to a prospective payments system was also a significant change. As a SAMHSA grantee, WMHC needed to adapt to a bundled payments approach, which included understanding its true costs. “Work closely with your state to understand which services are going to count towards that PPS bundle rate,” Givens said.

CCBHC Achievements

“We have seen huge progress and satisfaction, not only with our clients as they’re able to see their outcomes and have increased and better outcomes, but also with our staff — they are excited to see the progress and they’re really happy. They have concrete data to measure success,” Ackerman said.  “We have learned to plan and then be flexible and adaptable and roll with the changes as they come,” Ackerman said. “Even two years in, we continue to tweak and modify our processes. Just take it one step at a time, with all the new services and reporting, and you’ll see very shortly the great outcomes that you can provide with this program.”

CCBHC Services During the COVID-19 Public Health Emergency

While telehealth support for some MAT clients has been part of the service mix, WMHC has been offering face to face services to SUD clients through the COVID-19 pandemic to support a person’s decision to begin recovery, and to maintain recovery progress. “We do the face-to-face assessment to get their commitment, and we make sure they’re following through,” Ackerman said.  “We manage this with PPE equipment, social distancing, designated areas, and all that planning that requires, following the guidelines from the Minnesota Department of Health.”

Collecting vitals is best done onsite, as are group appointments, Ackerman said: “We work to hold people accountable for their services.”

Click here to learn more about our EHR solutions for Minnesota.

About Western Mental Health Center (WMHC)

Our focus is to work with clients to find balance between body, mind and spirit and supporting each individual to be the strongest and healthiest he or she can be.  Holistic care includes services such as outpatient therapy, medication management, substance use services, psychiatry, community programs, primary care and much more.

A non-profit organization, Western Mental Health Center focuses its efforts on providing comprehensive mental health services to meet varied community needs. Established in 1958, Western Mental Health Center began operating as a result of the Minnesota Community Mental Health Act. We have offices in the counties of Lincoln, Lyon, Murray, Redwood and Yellow Medicine.

At Western Mental Health Center, our mission is to promote and advance mental health, to treat persons with mental health or related needs, and to provide collaborative and educational services to the community. We work in collaboration with county, school, court, corrections, health care and many other professionals throughout the community.

CareLogic Support for CCBHCs

From clinical workflow flexibility that enables data capture and compliance reporting against evidence based practices, to revenue cycle management under complex payment models, CCBHC certified organizations need an EHR partner that meets organizational change, cross-team services, data capture, compliance reporting, and reimbursement with easy to use, configurable, integrated capabilities. CareLogic supports more than two dozen CCBHCs among 400 customers in 35 states.

CareLogic CCBHC User Group and Peer Leadership

The Qualifacts Community includes a national CCBHC user group led by experienced agency leaders, and supported by Qualifacts staff who are nationally recognized for CCBHC thought leadership. Members share information and best practices, both nationally and state by state. Qualifacts teams gather and post Federal and state updates on funding and support to the forum.

CareLogic Clinical Workflows, Assessments, Outcomes, and Field Support for CCBHCs

CCBHC providers offer specialized mental health and substance use disorder services across teams who need visibility into the continuum of care.

CareLogic EHR support for CCBHCs includes:

✓ Integrated workflows, configured to the best practices across specialized teams

✓ Clinical decision support triggers that teams can self-configure, with links available to the latest research-based, evidence-based, best practices, and to clinical references and patient education materials, through DynaMed.

✓ The IMPACT outcomes management platform, with a library of more than 80 industry-standard assessments and screening tools, with data  integration into clinical documentation. Patient Reported Outcomes, to support client engagement, are featured in IMPACT PRO.

✓ CareLogic MOBILE offers clinicians in the field disconnected documentation capabilities

CareLogic CCBHC Compliance Support with Outcomes Measures, Data Analytics and Reporting

Reports built specifically to comply with CCBHC outcome tracking measures include:

✓ Caseload characteristics data that can be modified to fit your workflows and business processes

✓  Out-of-the-box drillable dashboards support data driven decision making to manage clinical, financial, and revenue cycle management reporting

✓ More than 120 standard reports for actionable insights

CareLogic Interoperability for Care Coordination for CCBHCs, with ONC Certified Capabilities

Qualifacts has completed more than 80 integrations in the past two years, supporting CareLogic capabilities to:

✓ Exchange CCDAs with clients and external providers, using patient-portal messaging

✓ HIPAA compliant message exchanges

✓ Enable clients to access clinical summaries through an ONC API and third-party apps

✓ Exchange lab orders and results through e-labs

✓ Electronically prescribe medications, including controlled substances, with formulary and drug interaction checks at the point of care, with PDMP capabilities within the clinical workflow

CareLogic Support for CCBHC Specialized Billing, Claims, and RCM

✓ Client‐specific fee structure that can be copied forward for easy edits and management.

✓ Copy Authorizations feature copies forward Authorization information.

✓ Periodic Services Report to track and manage services.

✓ Individualized rates and periodic services for PPS billing with daily or monthly frequency

✓ Visibility into client mix, by programs and services

✓ Smart claims for periodic services: Scheduled by date, timeframe, or by number of services delivered

CareLogic Configurability for CCBHCs

CareLogic’s intuitive, one-click navigation allows users to quickly customize workflows for different roles through a user-controlled back end — agencies can self service add and update programs, services and locations without expert IT intervention. Configurable forms provide the ability to design your own service documents, to support required CCBHC services, which can include:

• Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization*
• Screening, assessment and diagnosis including risk management*
• Patient-centered treatment planning*
• Outpatient mental health and substance use services*
• Primary care screening and monitoring**
• Targeted case-management**
• Psychiatric rehabilitation services**
• Peer support, counseling services, and family support services**
• Services for members of the armed services and veterans**

*   CCBHC must directly provide

** May be provided by CCBHC and/or designated collaborating organization (DCO)

CareLogic Reports and Measures for CCBHC Support

CareLogic offers these reports and measures are, as well as reports that are specific to individual CCBHCs:

• Caseload Characteristics
• WCC-BH/ NQF-0024
• TSC/NQF-0028
• ASC  NQF-2152
• SRA-BH-C/NQF-1365
• SRA-A/NQF-0104
• CDF-BH/NQF-0418
• DEP-REM-12 NQF-0710
• I EVAL measure
• BMI-SF NQF-0421

CCBHC Results Data and Impact |The National Council for Behavioral Health | HHS | SAMHSA

CCBHC Impact Report (National Council for Behavioral Health, 2020)
Data Highlights: Certified Community Behavioral Health Clinics (National Council for Behavioral Health, 2019)
CCBHCs: Bridging the Addiction Treatment Gap (National Council for Behavioral Health, 2018)
CCBHC Demonstration Program: Report to Congress, 2018 (Office of the Assistant Secretary for Planning and Evaluation, 2019)
CCBHC Demonstration Program: Report to Congress, 2017 (Substance Abuse and Mental Health Service Administration, 2018)

About Western Mental Health Center (WMHC)

Our focus is to work with clients to find balance between body, mind and spirit and supporting each individual to be the strongest and healthiest he or she can be.  Holistic care includes services such as outpatient therapy, medication management, substance use services, psychiatry, community programs, primary care and much more.

A non-profit organization, Western Mental Health Center focuses its efforts on providing comprehensive mental health services to meet varied community needs. Established in 1958, Western Mental Health Center began operating as a result of the Minnesota Community Mental Health Act. We have offices in the counties of Lincoln, Lyon, Murray, Redwood and Yellow Medicine.

At Western Mental Health Center, our mission is to promote and advance mental health, to treat persons with mental health or related needs, and to provide collaborative and educational services to the community. We work in collaboration with county, school, court, corrections, health care and many other professionals throughout the community.

About Qualifacts

Qualifacts is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement. The company offers several EHRs – CareLogic, Credible and InSync – while collaborating to build an even brighter future for partner agencies and their clients.