With health care reform encouraging greater consolidation among health service professionals and organizations, the trend is toward integrating mental health, behavioral health and substance use services in all kinds of treatment settings. But whether integration takes place in primary care or at the health system level, the “triple aim” goals are the same: enhancing the experience of care, improving the health of populations and reducing costs.
The Commonwealth Fund has put out a great paper, State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment:
“States across the country are promoting integrated care delivery as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with comorbid physical and behavioral health conditions. The Medicaid expansion authorized by the Affordable Care Act (ACA) brings greater import to these efforts, as millions of uninsured low-income adults, many at increased risk for behavioral health conditions, gain coverage and states are required to provide behavioral health services and meet federal parity laws.”
“Drawing on a review of the literature and interviews with diverse stakeholders, this report explores strategies states are deploying to address or eliminate system-level barriers to integrated care for this medically complex and high-cost Medicaid population.”
I would encourage checking out the SAMHSA-HRSA website as a resource for integrated health care models and guidance. http://www.integration.samhsa.gov/ .
It’s exciting to see how a vision can start to come together with hard work, sweat, commitment and passion! Mozzaz delivers a solution that helps individuals every day. Today we are proud to unveil our new website with our new messaging, branding and Mozzaz Care product line that delivers: “Patient-centric solutions to help individuals with complex healthcare needs live a better quality of life.” In early 2013 we launched TalkingTiles, our first “assistive care” app primarily helping those with a speech or communication disorder express themselves through AAC (augmentative & alternative communication).
Tens of thousands of downloads later and through some amazing success stories, we now launch Mozzaz Care – an app that includes TalkingTiles AND a new Activity Scheduling application all in one.
Key new features include:
• Capturing usage data on every Tile and Page click ie. how often does the individual click on a certain tile or page
• Scheduling visual activities with automatic reminder notifications-ie. reminding the individual to take their medication
• Creating your own observations with questions and answers including: multiple choice, single choice, Yes/No, a rating slider and a text box for typing in notes so you can create and measure tasks related to a specific individual
• A new Mozzaz Care Portal for managing your clients and their accounts
• And a new and improved user interface for a simpler user experience Over the next several weeks we’ll be posting various tips’n’tricks. Also, keep an eye out for our new set of video tutorials that will demonstrate all of these great features and how they’re being used in practice.
It’s encouraging to see bipartisan legislation being pushed to support new models of healthcare reimbursement that will solve real cost and quality problems. The introduction of a new bill, "The ACO Improvement Act" (H.R. 5558)”, being proposed by Rep. Peter Welch (D-Vt.) and Rep. Diane Black (R-Tenn.) as bipartisan legislation to build upon the progress of Accountable Care Organizations (ACOs) in shifting the reimbursement of health care providers away from the traditional “fee for service” model to a focus on improving the health outcomes of patients.
As proposed, the legislation would encourage ACOs to use telehealth and mHealth by removing current barriers to remote patient monitoring tools and store-and-forward technology, with reimbursement "in a manner that is financially equivalent to the furnishing of a home health visit."
“If we are going to reduce health care costs and increase quality, the incentives built into the provider payment system need to be changed. In short, we need to reward value, not volume,” said Rep. Welch. “Paying health care providers based on improvements in patient health rather than the number of procedures they perform is the way of the future. Our legislation will advance these payment reforms and is based on the experience of ACOs in Vermont and around the country.”
CMS may also soon unveil a next generation model of Medicare ACOs that could expand telemedicine, and Rep. Gregg Harper's (R-Miss.) Telehealth Enhancement Act (H.R. 3306), which was introduced last October and has been referred to the House Subcommittee on Health, would authorize ACOs to include telehealth and remote patient monitoring services as supplemental healthcare benefits equal to that offered by Medicare Advantage plans.
All in all, I applaud these initiatives as it will make it easier to adopt the advancements in technology that are really making a difference in the cost and quality of care that is being delivered.
In one of our recent training sessions with the Speech & Language team at Waterloo Regional District School Board we had a great conversation on the importance of data collecting in not just speech therapy but in special education in general.
I just wanted to share some of the conversations we were having the SLP (Speech & Language Pathologist) team:
Q: Why is data collection important?
SLP: How do you know if your student is making adequate progress in therapy? Regular education teachers are able to collect data on their student’s performance through classwork, homework assignments, and test scores. This data is important because a teacher can quickly see, based on the child’s performance on these tasks, if the child is making adequate progress or if the child may need some kind of individualized instruction. Data will tell you if your interventions are working or not. If you do not take data, you have no objective measure that your intervention is benefiting the students.
Q: What makes it challenging?
SLP: Taking data is very important and yet given all the responsibilities those SLPs working on the schools have, it can be a daunting task. Between all the IEP meetings, IEP paperwork, SST meetings, collaborating with other professionals, consultation, answering emails, planning therapy, implementing therapy, doing assessments, returning phone calls, staff meetings, bus duty…there is seriously barely time to use the bathroom and many of us eat lunch at our desk as we read our email (I know I have!!). Add the fact that within our therapy groups, we often have 3-5 children and it is common that they are all working on different goals. Taking data, analyze the data, and use the data to plan and implement therapy becomes very, very challenging.
Q: How do you take data today?
SLP: I take data nearly EVERY session on every child. The exception to this, is if I am using the session just for teaching the concepts. For example, I do not take measurable data on days that I am teaching placement on the /r/ (which sometimes can take several weeks) or days that I am teaching the meaning of several basic concepts, etc. On these teaching days, I will write notes on my Monthly Progress Notes Sheet regarding what we were teaching, what methods were working (if working on articulation placement), etc.
Q: How will Mozzaz Care help you in programming and data collection?
SLP: We see Mozzaz Care helping us in many ways – everything from content and lesson plan creation, to creating interactive activities and of course – AUTOMATIC DATA COLLECTION and OBSERVATIONAL notes and tracking. Our special-ed kids respond very well to tablets and computers, so using tablets for therapy and learning and be able to collect data from the app as they’re using will be a huge time saver and even more accurate. We also love the fact that you can incorporate videos and audio files into the tiles and pages – video modeling is very effective! As we progress with this team, I’ll continue to post updates on how Mozzaz Care is helping this team and the students achieve the speech and language goals.
Glenda Anderson has a great blog resource on everything “assistive technology” with great tips, ideas and resources to help people with disabilities lead more independent lives. I came across this post on writing goals for AAC users that can be included in an IEP as we are currently working with a number of school boards.
Here are a few points from her blog (of which there is more) so I would encourage you to check it out:
Remembering that goals must be specific, measurable, attainable, realistic and timely, when it comes to AAC, we must also consider that who, what, when, where and how.
- Who does our student need to communicate with?
- What do they need to be able to communicate for?
- When do they communicate?
- Where do they go in their lives?
- How are they going to communicate?
There are 4 primary functions of AAC. This should be the heart of your IEP goals:
1. Expression of wants and needs
2. Exchange of information
3. Social closeness
4. Social etiquette
Take into consideration where your client is in the communication process. What is important to him/her. Know the purpose (see Janice Light's questionnaire about picking the right vocabulary. This will help you to choose your goals. The purpose of the communication.)
Resources for writing AAC goals:
- Gail M. Van Tatenhove, MS, CCC-SLP has provided a powerpoint entitled, “AAC in the IEP”.
- The AAC Institute has provided: Writing IEP Goals? Start by Asking Questions by Robin Wisner, not specifically for AAC but more about asking ourselves questions that will help us to avoid those repetitive, testing type activities being used in conjunction with our kids’ IEP goals.
- Documenting Assistive Technology in the IEP Developed by the Georgia Project for Assistive Technology walks you through each step of the IEP process, including writing goals.
- Dynamic AAC Goals Grid provides a wonderful planning guide/checklist to help you walk through the process of seeing where the gaps are.
- DynaVox "Writing Goals" Tips providing the SMART approach: Specific Measurable Achievable Relevant Time Limited
- PrAACtical Suggestions: Writing Goals for People Learning AAC discusses AAC as a means to an end. A focus on language and communication means that we have to consider all of the various ways that the person communicates. PrAACtical AAC Goals Sample goals can serve as inspiration to develop specific, measurable, individualized AAC goals. They also have a nice, short article entitled: “I Made a Communication Board. Now What?” that can be very helpful in guiding your teaching approach.
- How I Do It: Writing IEP Goals for Students Who Use AAC with Lauren Enders providing a very valuable perspective on writing IEP goals for students who use or need AAC and some wonderful resources.
- Linda Burkhart has a guide, entitled: Writing IEP Goals and Objectives for Authentic Communication for Children with Complex Communication Needs
- SpeakingofSpeech offers an actual goal bank for supporting AAC use.
- USHAonline provides Sample AAC Goals:The goal is the measurable educational literacy goal. How to set goals for assistive technology in an IEP.
Great work Glenda and thank you for your contribution!
We applaud President Obama for signing a reauthorization of the nation’s primary autism legislation, the bipartisan Autism Collaboration, Accountability, Research, Education and Support Act, or Autism CARES Act of 2014 that includes more than a billion dollars in federal funding for the developmental disorder. Thank you!!
“Approximately $1.5 billion has been dedicated to autism spectrum disorders research over the past five years through the combined efforts of U.S. government agencies and private organizations. This investment has helped to support progress in key research areas such as identifying risk factors, treatments and interventions, services, and data collection.”
Signed on Friday, the law calls for $260 million annually through 2019 for autism research, prevalence tracking, screening, professional training and other initiatives.
At Mozzaz, we have made it our mission to continue building innovative solutions for individuals with developmental disabilities, including autism, and the care teams that support them.
Mozzaz Care supports personalized care plans, data tracking and observations for progress tracking and measuring outcomes – aligned to what government and healthcare organizations are demanding for accountable care.
More than 28 million people in the US alone are affected by impaired cognitive function such as intellectual disabilities, brain injury, Alzheimer’s disease, stroke and serious, persistent mental illness. People with cognitive disabilities have an equal right to technology and information access. At the most recent Thirteenth Annual Coleman Institute National Conference on Cognitive Disability and Technology, held October 2013, a coalition of disability organizations and individuals asserted this right in a formal declaration. The full declaration can be read here and we are grateful to all those who have endorsed this declaration with their support.
The mission of the Coleman Institute for Cognitive Disabilities is to catalyze and integrate advances in science, engineering, and technology to promote the quality of life and independent living of all people with cognitive disabilities.
Keep up the great work!
As we continue to work with community service providers across the US and Canada we are definitely seeing an increased trend on driving home health care initiatives as part of care delivery. As highlighted in a great paper by the OACCAC:
“Advances in health knowledge, practice, technology and pharmacology are helping people to live well longer and have more of their health care needs met in their homes and communities, rather than more traditional care in institutions. The profile of needs is changing from episodic illnesses to the long-term management of chronic diseases.”
“This will be a different generation of seniors, comfortable with technology and with different expectations for a health care system that engages them and adapts to their needs and preferences.”
Empowering informal caregivers to help individuals with complex care needs through the use of technology and information is what Mozzaz is all about. Over the next several months we will be embarking on a set of home care projects driven by community care organizations actively implementing remote patient care solutions. We will be helping caregivers deploy personalized care plans across mobile devices and then be able to capture data and observations to measure outcomes in real-time to support remote patient monitoring and care. Stay tuned as we blog about our progress and results.