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Knowledge platform envisions better clinical, operational decisions

September 14, 2012
by Dennis Grantham, Editor-in-Chief
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For CEO Michael Valentine, acute-care past is prologue to a vision for behavioral health’s future
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When Michael Valentine, former COO at acute-care technology giant Cerner joined Netsmart Technologies as its new CEO in May 2011, many in the field wondered exactly what changes might be in store for Netsmart, which has the largest installed base of EHR customers in the behavioral health field.

In succeeding months, the pattern of changes led by Valentine has become clearer. In August, Netsmart acquired Behavioral Pathway Systems (BPS), the industry benchmarking arm of Centerstone Research Institute, and in September, announced a deal with CRI to collaborate in developing and mining the field’s largest database of de-identified patient data.

Netsmart envisions creating and promulgating cloud based services that will 1) consolidate and continually refine clinical approaches that improve decision-making, treatment, and outcomes; and 2) provide a growing base of benchmark, quality, and performance data that will help provider organizations improve the business of treatment delivery.

While unveiling this vision in an exclusive interview with Behavioral Healthcare magazine, Valentine and other Netsmart executives said that such services are essential to enable behavioral health and human services providers to meet the dual challenges of healthcare reform and re-integrating their specialties with the broader healthcare field. At present, they estimated that behavioral health was “about a decade behind” the rest of healthcare in the development and use of such tools.

Valentine also suggested that clinical standards and benchmarking services for behavioral health could have the kind of impact that that the Premier alliance has had in the broader healthcare field.  This alliance of healthcare organizations is at the center of data-collection and benchmarking efforts that now reach to one in four hospital discharges nationwide.  The participation of Premier alliance members in the six-year HQID (Healthcare Quality Incentive Demonstration) program was so successful that it formed the basis for today’s Medicare’s  Value Based Purchasing (VBP) program, one of three critical requirements for inpatient healthcare organizations under the Affordable Care Act.  

It all starts with data

“Our vision is to use an asset, our large installed base, to define of standardized outcome measures, assessments and benchmarks that customers can use to prepare for accountable care,” says Kevin Scalia, Netsmart’s EVP of corporate development. “We expect that there will be some form of pay-for-performance, but that payments will also be based on whether or not you can prove that you’re improving clinical outcomes.  So, the challenge is to make organization more efficient and improve clinical processes at the same time.

“The acute care side is way ahead of us in this area. There is, for example, wide agreement there on what the best practice is when someone walks into an ER with a stroke or a heart attack, whereas in behavioral health there is little unanimity on what the best clinical path would be for a particular individual,” he continues.

“Our strategy says:  if we’re going to advance the field of behavioral health, we have to greatly improve the clinical content of our EHRs—and those across the industry.  We felt that we could do that today by aggregating the voices of our customers.”  Netsmart did this, he says, by acquiring industry rival Sequest Technologies, along with its customer base and core of skilled clinicians, and by bringing in Denny Morrison, PhD, the former CEO of CRI—another new Netsmart customer—who, Scalia says, combines the skill set of a CEO with a clinician’s sense of “how to deliver improved clinical tools in a way that doesn’t disrupt the clinical workflow.”

Scalia explains that when Netsmart’s search for existing national standards, assessments, or measures among its behavioral health customer base for behavioral health, the company approached Tom Doub, the new CEO at CRI, hoping that CRI’s resources might provide an answer.  They didn’t find one, but they did make an important insight: “We quickly realized that while a major national study might have results from 300 individuals, [Netsmart and its customers] were sitting on an installed base of 20 million individuals,” says Scalia. “We began to think, if we could work with CRI to mine that real-world data, they might well be able to develop all sorts of CDS algorithms that we hadn’t even thought of.”

With that approach in mind, Netsmart began construction of a central database that would allow its customer/users to voluntarily contribute de-identified individual data. At the same time, the company is developing additional methods to monitor and communicate with customer EHRs so that it can “layer on” new clinical information and decision tools incrementally. This, Scalia continues, is the first step in a broader effort to expand database access to a much wider circle of would-be contributors, starting with current Netsmart and BPS customers, but extending to others, such as  academic and other institutions that would contribute data, suggest new decision support algorithms, and new data-mining strategies.

Through a just-announced agreement with Centerstone Research Institute, Scalia adds that “Netsmart has agreed to make CRI the first ones to have access to this new database.  They are going to adapt their predictive models—models already under development through the Knowledge Network—to see if they can better inform treatment decisions being made at the point of care.”

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