The CDR CANS project provides psychologists an assessment tool that produces real-time decision support. The decision support includes severity metrics (ex: riskiness and ASD level) and local Service Matches. Clients who are evaluated multiple times get a running outcomes graph of their trajectory, monitoring progress over time. The Service Match database is constantly updated with the local evidence-based programs, keeping evaluators up-to-date on the fluctuating services available in a community so that good treatment options are not missed. In fully participating counties, information is made available to the local medicaid MCO, providing unprecedentedly fast referral information, expediting the authorization process. Further, they can also identify programs that have open slots, thus reducing wait lists and wait times. Information from these evaluations is used to analyze outcomes for various programs, as well as to community needs and strengths analyses.
One of the root causes of access problems in behavioral health is that there is no central organizing entity that identifies the exact right program match for a client so that time isn’t wasted. Also, there is lost time due to the administrative shuffle of paperwork and authorizations. CDR’s online CANS application directly addresses both of these barriers. With the formal assessment of the client’s needs, our application pinpoints exactly what needs to be worked on and what local programs exist to meet the specific needs. This is particularly powerful when a client matches for an existing EBP which has been validated to treat the client’s unique profile effectively. Second, the online CANS is not just an assessment and referral tool, but is also an information exchange. Participating MCOs instantly learn of the evaluation and the evaluator’s referral, and can immediately act to authorize the care, speeding up the referral, authorization, and treatment.
The heart of the CDR CANS project is about helping clients get the right care at the right time. The formal assessment of the CANS ensures that all relevant information is gathered so an appropriate referral can be made. The application produces reports to summarize the data and support the evaluator to the best possible referral. Reports include a running graph of CANS scores over time, summary risk Severity Scores, a percentile rankings of various domain scores, and for children on the autism spectrum it provides an Autism Level commensurate with DSM-5. These scores help give concrete summary of children’s needs and strengths so that more pinpointed program referrals can be made. The application provides Service Match recommendations, which use algorithms to identify programs in the area that treat the client’s unique needs. When possible, these programs include local EBPs to provide clients the highest quality of care the system can allow.
By facilitating clients getting the right care at the right time, the CDR online CANS is a tool designed to reduce system inefficiencies, and thus waste. CDR already has evidence in multiple locations where our CANS project is in place and its decision support has been utilized, that individual Per Member Per Month costs have gone down. This has come in step with more of the high severity children getting more high intensity services than previously was occurring. The prices saving is not through the slashing of programs, but through getting the right care to the right person at the right time. Some of the real health care costs benefits from the CANS project is not just in the evaluation and referral improvements, but also in the way that the aggregate CANS data can be used by planners and managed care entities to develop appropriate programs for their unique community needs. With CANS data of the local population, clarity is gained to help system planning.
The CDR CANS project is one of the most innovative uses of data science in behavioral health today. Through advanced analytics it provides community behavioral health providers deeper insights into their clients’ needs, and then provides an up-to-date database of available services. Our project speeds up the evaluation process, facilitates assessment, provides real time information for decisions support, increases the communication of needs and conjoint decision making, speeds up the information that MCOs receive, and then provides necessary information for planners to make improved planning decisions. This is leads to the heart of our ingenuity - as a nonprofit organization, CDR is dedicated to ensuring that all collected data is for the community, none of the data is kept secret. All participants have access to non-protected data and share in its benefits collectively. This is an innovative “open data” model to ensure transparency, and forefronts the public good.
CDR does not just make an off-the-shelf software product, instead we lead communities in the process of setting up a rationalized system of care. We bring together all stakeholders, including providers, managed care, government and consumers to plan our strategy, operationalize the system of care, maintain an up-to-date database, and implement the model. We work to help providers know how to integrate CANS into their treatment plans and internal quality control processes, to help MCOs utilize CANS data to improve management, to help advocates identify what is working and what is not in their systems, and to help government meet their public responsibilities. The information from this project is used to analyze outcomes for various programs, and data is shared with the local community in public “roundtable” presentations, to help guide system planning.
CDR’s primary income is developed by contracts with government and managed care entities, as well as with providers (though on a smaller scale). We utilize grants and awards to kick start various project. The savings generated from our projects pay for themselves, so we are often an easy sell.
CDR’s model is already replicated into 8 different full county participations in Pennsylvania, which spans across two different MCO’s. We also have provider implementation in 23 other counties, which works with 3 other managed care companies. This is a sign of our ability to modify and transform our model to different areas, while still accomplishing our goals of improving evaluation and referral of clients to the right care at the right time.
CDR maintains outcomes on our efforts. We have put out a white paper on outcomes our project has developed in Pennsylvania’s Behavioral Health Rehabilitation Services system, which has showed how different subpopulations fare in BHRS. Further, we have documentation that shows that use of our product has helped get more high needs clients into BHRS, and appropriate evidence-based programs than the system was doing before our program went into effect. CDR’s outcomes have received note from international organizations like the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), which has invited us to present with the managed care company, PerformCare, and a HealthChoices group, BHSSBC, at their annual 2016 Convention.