Data Strategy for BH/IDD Tailored Plan Care Management

The ability to share data is one of the most important capacities that the State, payers and providers must demonstrate to thrive in the future.  To take it a little further, some would say that the care manager is at the hub of data sharing.  The care manager is responsible for assessing, monitoring and coordinating the Medicaid beneficiary’s services in multiple areas, including physical and mental health, substance use disorders, intellectual and developmental disabilities and long-term services and supports, as well as pharmacy and unmet health needs.    

NC DHHS published a paper on data strategy as it relates to the BH/IDD Tailored Plan care management function.  The focus of the strategy paper is on the data sharing capacity of any organization that serves as an Advanced Medical Home Plus (AMH+) or Care Management Agency (CMA) under the Tailored Plan.  Of course, since Tailored Plans may also be the care manager, they will also have this additional data capacity.  The Department states that the critical reason that the data management strategy for the BH/IDD Tailored Plan care management must be in place is because, “Integrated and well-coordinated care management depends on care team members having the ability to efficiently exchange timely and actionable member health information, and use that information to monitor and respond to medical and nonmedical events that could impact a member’s well-being.”  Although the paper does not include required methods for transmitting risk data, it does state that NC DHHS may develop standardized data sharing formats and protocols at a later date.  In addition, any organization providing care management services under the BH/IDD Tailored Plan is expected to comply with all federal, North Carolina and Department privacy and security requirements regarding the collection, storage, transmission, destruction and use of data including Medicaid claims and encounters.

Here is a review of some of the requirements for data capacity of organizations conducting Tailored Plan Care Management: Organizations conducting Tailored Plan Care Management will have a number of requirements related to data management, including the capacity to do the following:

• Calculate and share:

risk scores: the likelihood of a single health event in a certain timeframe

risk stratification: the process of combines several individual risk scores to develop a profile of consumer needs

• Accept data from BH/IDD Tailored Plans, including risk scores and recommendations on how to use this data, encounter data, pharmacy data
• Interface with any Clinically Integrated Network with which the AMH+ or CMA has contracted
• Receive up to 24-months of historical member, medical encounters and pharmacy data for each Medicaid beneficiary assigned to them
• Electronically develop a care plan and a comprehensive assessment
• Interface with other community organizations to gather data such as medical records, screenings and other clinical data
• Accept and store data from Level of Care assessment tools such as ASAM, CALOCUS, LOCUS and NCSNAP
• Facilitate “warm hand-offs” between and among plans
• Access automated, real-time notifications when members have been admitted to, discharged from or transferred from a hospital, emergency department or other critical care setting, and use this information to activate outreach and inform ongoing care planning

BH/IDD Tailored Plans are required to have capacity to do all of the above, and they are responsible for the auto-assignment of Medicaid beneficiary members to a care manager, including taking into account member preferences on assignment to a care manager.

Through the initial certification process that DHHS will conduct with every organization wishing to be an AMH+ or CMA, DHHS will evaluate the data capacity of the organization.  On an ongoing basis, the BH/IDD Tailored Plan will ensure that the AMH+ and CMAs have data sharing and storing capacity sufficient to meet all standards. 

A guideline for care management under the BH/IDD Tailored Plan is expected to be published soon and is expected to provide more details into roles and responsibilities of AMH+ and CMAs.  Individuals can also attend the i2i Center conference in Pinehurst to learn more about BH/IDD Tailored Plan care management.  The pre-conference event on Tuesday, December 3^rd will include a segment on care management for both the Standard and BH/IDD Tailored Plans.  A concurrent session on Thursday, December 5^th from 9:30 a.m. – 11:30 a.m. will provide more detail regarding BH/IDD Tailored Plan care management.