RecoveryNet: Merging Behavioral Healthcare with the Patient-Centered Health Home

Ask Bob Lebman, President of RecoveryNet, where the large hospital behavioral health providers are failing patients and he’ll say “Access to treatment.”

“Right away, when a patient walks into a large hospital seeking alcohol or substance abuse treatment, you’ve lost them,” states Mr. Lebman. “They get the sense that it’s no loner personal, it’s no longer about them.”

In other words, patients become disengaged.

That’s why Mr. Lebman and several other substance abuse treatment facility leaders in the Rochester area started RecoveryNet 13 years ago. RecoveryNet began as a project to save Rochester’s community based substance abuse treatment centers. Since then, it has evolved into an innovative collaborative of 10 behavioral health providers, leveraging the power inherent in numbers to make a difference.

RecoveryNet’s main goal is to advocate for and protect community based substance abuse treatment as a care option for patients. The collaborative accomplishes this through several objectives. The first objective is to ensure uniformity among clinical documentation in use by all RecoveryNet partners. This allows the collaborative to track and measure outcomes among each individual partner agency as well as across the collaborative as a whole.

With the help of a grant from SAMHSA, RecoveryNet was able to mobilize all partner agencies to decide on and implement a common format for all clinical documentation. Additionally, the grant provided funds toward the implementation of an electronic medical record.

Three years after RecoveryNet began, the collaborative implemented Netsmart’s Tier, an EMR geared toward behavioral health care. Immediately after the implementation of Tier, one of the first health information exchange endeavors RecoveryNet embarked upon was an exchange between the Tier application and Monroe County’s Addiction Recovery Employment System. The Addiction Recovery Employment System, or ARES, is a web-based application that links to the County Department of Social Services. The exchange automated the electronic reporting of RecoveryNet’s ARES client outcomes directly into ARES.

Soon after, the collaborative was awarded a grant from New York State’s HEAL 5 initiative. The grant provided the resources to set up and administer cloud computing capabilities to the smaller RecoveryNet partner agencies that did not have the infrastructure in place to host the EMR locally. Additionally, the grant provided funding for the implementation of a RecoveryNet IT helpdesk.

The collaborative recruited a helpdesk technician, a database developer / administrator, and a network administrator to provide daily EMR support to partner agencies. Additionally, the RecoveryNet IT team is tasked with keeping tabs on any changes required in the EMR due to changes that occur at the state or federal level.

“This allowed the collaborative to bring EMR expertise in house, allowing us to improve the quality and timeliness of service to the partner agencies,” states Mr. Lebman.

Besides the economies of scale leveraged by having all partner agencies on the same EMR, the collaborative provides cost savings and efficiencies in other areas. For example, smaller partner agencies that do not have the resources to manage their revenue cycles can contract their billing functions to the larger partner agencies. Additionally, all partner agencies can take advantage of trainings, consultations, and knowledge transfer from other partners.

“The cost of these types of activities is included in the monthly fee all partners pay into the collaborative,” states Mr. Lebman.

Currently, RecoveryNet is implementing a primary care clinic on-site at one of the larger partner agencies. The clinic is slated to open this fall. The clinic will provide primary and OB/GYN care on site. Other RecoveryNet partner agencies can refer their clients to the primary care clinic while still continuing to provide substance abuse treatment services for the patient.

“We’re essentially building a patient-centered health home for our patients,” says Mr. Lebman, “That way, there’s no wrong door when patients come to us seeking treatment.”

This “no wrong door” approach works well for the other services the partner agencies provide. 

“If a woman with children and unstable housing walks into one of our outpatient substance abuse treatment clinics for treatment, we might refer her to the residential substance abuse treatment program at another partner agency instead,” says Mr. Lebman.

Perhaps the most useful thing to come out of RecoveryNet is the ability to track, measure, and report outcomes because in today’s behavioral healthcare environment, it’s all about outcomes.

“We know our programs work,” says Mr. Lebman, “But by working together, we can measure and report on the tremendous impact we have on the over 7,000 patients we see each year.”

For more information, please visit: http://www.asapnys.org/PDF/HealthcareReform/RECOVERYNETSMART.pdf

What’s the Next Big Thing in HIT?

Results versus relationships. Are the two mutually exclusive? Absolutely not, especially when one of the overarching goals of HIT project management is to develop and maintain relationships.

This is where some of the major players in the EHR field are failing. The larger EHR companies may have implemented enterprise EHRs in some of the larger health systems, however the lack of customer relationship management has caused their success quotient to decrease. What’s a success quotient, you ask? John Jantch, author of Duct Tape Marketing, defines it as “the value you create over the cost of the charge.”

In the case of the large EHR players, it can be stated as the level of customer satisfaction over the total cost of ownership (TCO) of the product. As the TCO of an EHR increases, even with customer satisfaction remaining unchanged, the company’s success quotient will decrease. But let’s face it, when the TCO of a product increases, customers usually begin to get pretty ornery. And the realities of the TCO of an EHR will only become more clear to hospitals and providers as the Meaningful Use money well dries up and they’re left footing the ownership bill. Couple the increasing TCO of EHR’s with poor customer relationships, and EHR company execs may find themselves spending increasing amounts of time conducting damage control. (Click here to read how Allscripts CEO, Glen Tullman, plans to improve customer satisfaction at his company.)

Obviously solutions that can easily interoperate and smart, intuitive user interfaces are some of the advancements on which EHR vendors must continue to concentrate. There is no doubt in my mind that we will get there. The evolution of information technology in any industry is always sloped upward towards increased innovation, more accelerated adoption and greater use. The healthcare industry is no exception.

However, a recent conversation with a practice administrator of a large anesthesiology group in Rochester, NY got me thinking about the future of HIT. During our discussion, she began to complain about her EHR vendor. “They’re just not responsive,” she stated, “When I call to ask if they could do something very specific and seemingly very simple to make our use of the system flow more smoothly, I was told no.”

I’ve heard similar stories of change requests falling into a “black hole.” As an HIT Project Manager, I can relate to the fact that when it comes to EHR’s, no change is simple. These are complex systems, and a change in something as simple as reconfiguring an input field on a medication form can have a profound effect on other areas of the system. However, telling your customers ‘No’ is akin to telling them that you don’t value their business. Simply not communicating with them is even worse.

Here is the point: if you value your customer’s expertise and experiences, they will trust you. And if they trust you, they will follow you and your technology. Even when your investors sue you.

So what’s the next big thing in HIT? Customer relationships, baby.