Population health strategies remain a focal point of healthcare industry efforts to improve quality outcomes. Like all stakeholders, those in the behavioral health sector must implement the best infrastructure to support information sharing, collaborative care and accurate analytics.
Technology is a critical enabler of efforts to mobilize data and promote greater provider-payer collaboration through electronic information exchange. As executives on both sides of the equation work in tandem to improve outcomes and rein in costs, forward-looking strategies must consider interoperable infrastructures that overcome the challenges of data silos and support meaningful data sharing.
In truth, the need for these frameworks has never been greater as the behavioral healthcare community at large endeavors to improve the outlook on the growing national opioid emergency. Notably, empirical data reveals that longer-term engagement—as opposed to short-term acute treatment—is the most effective at maintaining long-term recovery for those facing substance use issues. Consequently, payers, providers and patients need tools that will empower proactive management of conditions as part of ongoing treatment strategies.
Yet, behavioral health brings with it additional challenges around the protection of sensitive patient information such as mental health and substance abuse. Without strong safeguards in place, healthcare organizations face potential civil liability risk. As such, behavioral healthcare organizations need a line of sight into infrastructures and strategies that ensure all sensitive health data is identified and protected while advancing population health initiatives.
Sensitive health information: The population health challenge
Most financial and clinical executives working in the behavioral health space understand the population health challenge as it relates to data silos. Substance use, for example, tends to follow a sequence of events. A patient enters a treatment center and is discharged once stabilized. Without a proactive support system in place, the patient often relapses and then chooses to enter a different treatment center. All too often, there is minimal interaction between providers and no strategy to get ahead of the problem.
This ongoing cycle is exacerbated by data silos created by disparate IT systems that limit data exchange and keep critical patient information locked away. This lack of transparency hinders payer-provider collaboration, resulting in less-than optimal treatment impact and higher costs.
Effective population health initiatives rely strongly on clean, accurate analytics to promote workflow efficiencies and help clinicians get out in front of potential issues. In the case of the substance use patient, analytics and information sharing must overcome an additional hurdle by first addressing compliance with sensitive conditions.
Federal regulations outlined in 42 CFR Part 2 limit the use and disclosure of sensitive health information—including substance abuse patient records—and identifying information. Because state regulations regarding sensitive health information vary, it’s important that information sharing apply safeguards that address the highest level and expectation of security. This requires tight controls on consent and disclosure including: identification of the entity of individual receiving the information; an explicit description of the information to be shared; and an acknowledgement that the patient understands the terms. 42 CFR Part 2 explicitly requires written consent.
In addition, patients can selectively authorize who can receive their data when it pertains to mental health and substance abuse disorders. This nuance presents notable challenges for HIEs sharing patient information.
Without an effective means of identifying all sensitive health information, behavioral health organizations run the risk of improperly disclosing information when engaging in population health initiatives.
Compliant, meaningful exchange of behavioral health data
Advanced population health platforms exist that support not only high-level information sharing across the behavioral health continuum, but also address the nuances and challenges of sensitive health information. The most effective solutions promote interoperability by establishing a “single source of truth” that ensures data coming from disparate sources is normalized to an industry standard or proprietary code group. When this framework exists, providers and payers can trust that data aggregation is complete and accurate for analytics and reporting.
Content that comprehensively addresses sensitivity codes is an important part of any analytics infrastructure that supports efficient roll-out of a population health strategy in the behavioral health sector. Without an automated method for accurately identifying and filtering sensitive information, providers and payers must resort to manual methods of data extraction that minimize and slow down proactive outreach.
For instance, consider the challenge associated with proactive care coordination following a patient’s discharge from a psychiatric hospital. The goal for the hospital is to keep the patient from relapsing and having to be readmitted. Thus, the psychiatric provider will want to make appropriate referrals to community resources and keep communication lines open with primary care providers and other key stakeholders. Before any patient information can be shared electronically, patient consent to release sensitive information must be validated. Typically, this requires manual intervention each time data is requested. These processes are not only resource-intensive, but they open the door for errors and omissions.
The ability to automate the redacting of sensitive data provides both behavioral health providers and patients peace of mind that data is only shared at the direction and explicit permission of each patient. Since patient data that have a primary or secondary diagnosis of substance use disorder is rich with sensitive conditions, from the co-occurring mental health diagnoses to diseases associated with prolonged substance use, a robust platform to assist with managing the exchange of this sensitive information is paramount to efficiency and accuracy of the referral process.
With the appropriate data building blocks in place, including the necessary infrastructure, governance, and ability to normalize data, behavioral health organizations and HIEs can more fully leverage the power of their data assets—and remain confident that sensitive health information is safeguarded. Platforms that address interoperability and establish a single source of truth for analytics are best suited to optimize analytics and align with evolving regulatory expectations and value-based care.
Jacob Levenson is CEO at MAP Health Management. Cheryl Mason, MSHI, is Director, Clinical Informatics Consulting, Wolters Kluwer, Health Language.