The Department of Health and Human Services recently awarded $22.9 Million in Planning Grants to 24 states to be used to develop Certified Community Behavioral Health Clinics (CCBHCs). A CCBHC can be described as a behavioral health specialty center of excellence. This center partners with a wide array of health and social service entities to provide high-value, whole-health care to people with complex conditions.
During a two-year “planning period” that will begin in January 2017, these states will need to work to certify clinics, expand or develop services, establish a Prospective Payment System (PPS), enhance their reporting capabilities, and prepare for a national evaluation. Many organizations will have significant hurdles to overcome to reach the level of excellence required to become a CCBHC. One of the biggest obstacles that organizations may face is establishing a Prospective Payment System (PPS).
PPS will affect every aspect of how CCBHCs do business – from organizational structure to payment models and service delivery. PPS requires that CCBHC’s calculate and receive Medicaid reimbursement for their anticipated cost of delivering allowable services and support. This means that organizations will be able to establish a payment rate that reflects your anticipated costs and is inclusive of many activities that have not been reimbursable in the past, such as care coordination or services delivered.
However, this reimbursement rate is based on an estimated cost. Organizations who are able to accurately calculate their costs of providing services during the planning year will have the potential to be very successful. On the other hand, organizations that are unable to correctly measure and project costs will face financial struggles. The rates must consider budgeting for growth, staffing levels, documentation requirements, and more.
Imagine a system that helps you break down labor expenditures by program so you can analyze costs and revenues at a granular level. This would act as a single solution that can centralize data from multiple systems to measure the productivity and effectiveness of your programs, produce robust data to meet new reporting and collection requirements, and effectively manage your financial efficiencies. Since employee salaries are the largest expenditure for most organizations, calculating PPS rates will mean breaking down the silos of EHR, HRIS, and GL systems to gather essential data.
Utilizing a fully unified Human Capital Management system can enable organizations to centralize data from multiple systems including EHR, HRIS, and GL, in order to identify and optimize the financial efficiencies of each and every program. This can provide organizations with a level of reporting granularity that would be otherwise unachievable.
Whether or not your organization is working to become a CCBHC, this simple and modern approach can gather the robust and innovative data needed to transform your organization into a center of excellence.