INTEGRATION TREND DRIVES TODAY’S ACCREDITATION OUTLOOK
By Knopf, Alison | |
Proquest LLC |
Quality improvement must include collaborative efforts among providers
A ccrediting organizaL1 tions are paying JL JL close attention to the evolution of integrated care, raising the bar on what they expect from providers. Meanwhile, states have their own licensure rules, and managed-care
The main purpose of accreditation is to create systems to improve care for the patient. But payers are becoming increasingly interested in providers that are able to improve comprehensive care and thus reduce utilization, so health homes and integration are increasingly being used to measure quality.
The four main accrediting organizations in the field are on task to keep up with healthcare system demands and vet the providers that seek their seal of approval.
CARF
Formerly the
For example, one of the historic problems in the behavioral health market is a written document for succession planning. Johnson believes there are a significant number of CEOs planning to retire-some fairly soon-yet only 35 percent have groomed anyone in the organization to step into their shoes.
And the addiction field is ahead of the mental health field when it comes to accreditation, according to Johnson.
"When I go to addictionsfocused conferences, the organizations that are in the for-profit market or cater to the insurance industry recognize that they're in business," he says. "In the mental health world, it seems that unless someone is making them do it, it takes them longer to make the decision to become accredited."
For-profit programs often have to convince payers of their value overall, and accreditation is one way to do that, he says. But it's not just payers that want to see value.
Integration trends in the healthcare system as a whole call for behavioral health to align with medical providers. Most often a hospitalbased system in a particular market has the competitive advantage, and behavioral providers would be smart to create integrated models with the local leading system, according Johnson. However, the hospital system likely will want to align its efforts with behavioral health organizations that are accredited, he says.
Johnson says with any accreditation, organizations should maintain a focus on quality improvement. CARF allows for accreditation of individual services.
"You might operate 15 different programs, but might want to get only 10 accredited," Johnson says.
Accreditation is effective for three years, but there is also a one-year accreditation offered by CARF for providers who have "serious gaps that need to be addressed," he says.
In selecting accreditation, the treatment organization should take its own mission and values into account, she says.
Payers want to see national level accreditation in order to reimburse at higher rates, particularly when the provider has achieved health-home status. For example, in
Substance use disorder (SUD) treatment and eating disorder treatment are the top disciplines examined by insurance companies, Col- lander says, however, a low percentage of SUD treatment providers have such accreditation. For example, when Collander worked for Gateway prior to coming to
Because
In particular, organizations can monitor patients throughout treatment using
When there was a spike in patients leaving against medical advice during Collanders days at Gateway, leadership would look back at the experiences of the departing patients to find out where the organization went off track, she says. In addition, the data helped Gateway hone in on best practice treatment and techniques among the patients who continued on in recovery.
"The data you track and the leadership structure that
Far from a one-time test, accreditation creates a framework that drives the day-today practices of an organization. About 80 percent of organizations accredited by
Because
About half of the Federally Qualified Health Centers (FQHCs) across the country are accredited by
"There has been a great deal of interest in Joint Commission Behavioral Health Home Certification from a vast variety of service types," says Collander. "This tells me that integration is happening."
Community mental health centers, FQHCs, OTPs, and multi-service organizations have been particularly interested in health home status. For the certification, the annual fee is
"If you want to show you are meeting the triple aim, then why wouldn't you seek Joint Commission Behavioral Health Home Certification?" says Collander.
According to
"In order to have strong service delivery, you need to have a strong organization in place," says Pacinella. "Ethical practice, governance, quality improvement, risk prevention and management-you need all of those. If you aren't looking at your finances, budget planning and long-term strategic planning, you don't necessarily have what you need to support and sustain services."
COA accredits 150 types of programs, with standards for different populations: children, adults, case management, crisis intervention, day treatment, residential treatment, short-term diagnostic centers, group living, and sober homes. Its measures also include a standard for integrated care/health homes.
Recently, COA began issuing standards for primary care, used when an organization is providing an integrated model. Health homes that are eligible for federal reimbursement under the Affordable Care Act do not have to include the full array of behavioral health care, but must include comprehensive care management and health promotion, Pacinella says. COA standards reflect those federal models.
The peer reviewers are all volunteers, who review documents before and during site visits, interview staff and patients, and ask any questions that pertain to the level of implementation, which is also used to determine costs of accreditation.
The not-for-profit
Within its behavioral health component, organizations can be affiliated with a hospital, a FQHC, or any other provider-the ACHC standards stand separately. ACHC accredits the services selected by the provider, not the entire program, says Welch.
ACHC has standards for various services, not limited to clinical measures, such as supportive employment. These services are commonly used in behavioral healthcare, especially as integration moves forward. Helping patients find housing, for example, can help their overall health.
ACHC does not have standards for OTPs. However, ACHC standards do refer to medication management and systems in place when providers prescribe medication therapies. Also, ACHC is in beta testing of its behavioral health home accreditation.
"I'm really excited about this, because it ties into integrated care," says Welch. "It makes so much sense. Integration helps treat the whole person and create good outcomes with cost effectiveness."
ACHC accreditation is good for three years. Once accreditation is in place, the provider gets tools to use online "to make sure they are staying on task," says Welch. "I view this as a quality improvement process."
On the way to ACHC accreditation, providers can have different designations: accreditation-pending or accreditation-dependent. If accreditation is denied, there are opportunities for the provider to submit a plan of correction that could be approved, says Welch.
ACHC has a partnership with
carf INTERANTIONAL
COST:
TYPICAL SURVEY: 2 SURVEYORS, 2 DAYS
ACCREDITATION: 3 YEARS
PROGRAMS ACCREDITED: 24,061
SITES WITH PROGRAMS: 9,152
COST: INITIAL DEPOSIT OF
FEES: DETERMINED BY THE VOLUME OF SERVICES AND THE LEVEL OF INTENSITY OF THE TREATMENT
ORGANIZATIONS ACCREDITED: 2.080
SITES WITH PROGRAMS: 7.400
INITIAL COSTS: DOWNLOAD THE STANDARDS FOR
FEES:
SURVEY: TIME AND COST DEPEND ON THE NUMBER OF LOCATIONS /SERVICES
ACCREDITATION: 3 YEARS
COSTS:
FEES: SLIDING SCALE BASED ON REVENUE; FEES START AT A MINIMUM OF
SURVEY: FLAT FEE OF
MAINTENANCE FEE:
ACCREDITATION: 4 YEARS; OTP IS 3 THREE YEARS
More Online
Joint Commission:
http://www.jointcommission.org/
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