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Tarrant County, TX: Measuring Up with Value-based Care

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Tarrant County, the third largest county in Texas, is also home to the second largest Local Area Mental Health Authority in the state, My Health My Resources of Tarrant County (MHMR). What began in 1969 as a small center providing mental health services, today MHMR provides mental health and intellectual and developmental disability services at more than 100 sites in Tarrant County and neighboring counties. In collaboration with public and private sector community partners, MHMR serves more than 50,000 persons each year.

In 2011, Texas received approval from the Centers for Medicare & Medicaid Services (CMS) for a new Medicaid demonstration 1115 Waiver, a major component of which authorized the establishment of a Delivery System Reform Incentive Payment (DSRIP) program. DSRIP is an example of a value-based care (VBC) model where payment is tied to measurable outcomes. DSRIP programs are designed to provide incentive payments to providers for investments in delivery system reforms that increase access to healthcare, improve the quality of care, and enhance the health of consumers and families. Providers in the Texas DSRIP program are required to implement a set of core activities to achieve established goals, and then measure, report and improve performance, based on those goals. 

Under the Texas 1115 Waiver, MHMR defined a Health Care Transformation Initiative that focused on specific populations in their community and encompassed key improvement milestones. To drive these improvements, MHMR adopted 29 measures (some required and others optional) on which to track and report outcomes, including nine measures from the Certified Community Behavioral Health Clinic (CCBHC) guidelines. For example, one of the targeted populations are individuals who are homeless with mental illness; and one of the improvement milestones is a reduction in incarceration.  One of several measures related to this population is that a housing assessment has been performed for individuals diagnosed with schizophrenia. 

MHMR was operating on seven disparate technology systems for their clinical, billing, operational and reporting needs, and realized there would be challenges in collecting the data needed to report on these measures. They also knew that simply reporting on the data would not be enough to achieve the desired outcomes; they needed real-time longitudinal views at both individual and population levels in order to improve outcomes and reduce costs. MHMR recognized the need for a single, integrated technology platform to support their journey to VBC.

MHMR is partnering with Netsmart and will deploy Netsmart’s cloud-based reporting and analytics solution to consolidate data from MHMR’s current systems and provide accurate measures reporting required by the 1115 Waiver program. MHMR will also implement Netsmart’s integrated electronic health record (EHR) system across its health network to connect healthcare data, analytics and billing services. As MHMR’s technology implementation project progresses, the new EHR system will plug into the reporting and analytics solution, providing a seamless transition from their legacy systems, and allowing for continuity of data collection and measures reporting.

By deploying a platform that supports VBC models, MHMR will gain the ability to provide connected, coordinated care to achieve its mission of treating the whole person, and demonstrating the results needed under the 1115 waiver program.

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