Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. G. Information Systems and Data Infrastructure


CCNC's work relies heavily on data and information systems at the program, network, and provider levels. At the program level, CCNC uses Medicaid claims data, real-time hospital data, and other clinical information from provider EHRs, along with proprietary risk-adjustment software developed by Treo Solutions, Inc., to identify "priority patients"--those with preventable hospitalizations or those who are outliers for cost of care based on condition severity. Priority patients are communicated to the local networks and are targeted for care management. Network care managers use CCNC's Care Management Information System to access patient information, document the patient care plan and note progress toward goals, and access screening tools. This system is available to CCNC's care managers as well as to local health department care managers. At the provider level, CCNC has built a provider portal, a web-based secure site that displays patient service and medication use across care settings. This tool is accessible to all providers and case managers--including PCPs, behavioral health providers, hospitals, and the CCNC and LME care managers--and enables them to deliver more targeted and appropriate care. Providers can't input data into this system, but they can use it to see what services and medications their patients have been using. Providers are highly encouraged to make use of the provider portal (and to use EHRs), but they are not required to do so. Networks and physician practices can also use the provider portal to generate demographic, cost, utilization, and quality monitoring reports on the population of patients they are responsible for as a means of informing quality-improvement activities.

Concerns regarding privacy and data sharing. In constructing its informatics center, the time and resources CCNC required to address legal concerns related to data sharing, data protection, and compliance with state and federal laws were greater than anticipated. CCNC's informatics center must adhere to Health Insurance Portability and Accountability Act provisions, the Health Information Technology for Economic and Clinical Health Act of 2009, and federal regulations related to the disclosure of substance abuse information. North Carolina also has state laws governing the confidentiality of mental health, developmental disabilities and substance abuse information as well as the confidentiality of information related to HIV and other communicable diseases. These steps required the involvement of legal counsel from multiple stakeholder groups and a thorough analysis of statutory authority and contractual relationships among CCNC, state agencies, LMEs, providers, and local health departments (CCNC 2013f). In addition, CCNC has invested many resources into establishing the required contracts, supports, and safeguards and conducting the necessary training to ensure that users have access only to permissible data.

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