Maryland Behavioral Health Solutions Recovery Support Services Data Modernization Research Project

Project Lead: Shannon Hall, JD

Background

For behavioral health providers to succeed, they need access and know-how to analyze complex data across multiple systems, produce actionable insights, and adapt to new evidence-based practices. The Maryland Behavioral Health Solutions (MBHS) is a provider network that launched in 2019 and is composed of 26 behavioral health providers. The goal of MBHS is to improve quality and access to care, and one way to achieve this is by launching quality improvement initiatives to maximize the network’s capacity.

The MBHS Recovery Support Services (RSS) Data Modernization Research Project aimed to examine if and how client RSS data can be used to track treatment outcomes and inform the implementation of multi-provider initiatives to improve the quality of care. Data-driven quality improvement helps discover faulty processes, compare outcomes among programs and encourage better performance, drive standardization of service definitions, and generate revenue as new funding models require metric-driven outcomes. To ultimately improve data quality and system efficacy, this research pilot project aimed to examine prevalence of behavioral health disorders among those receiving treatment services, as well as related agency Electronic Health Record (EHR) service codes and their potential for payment.

Methods

Of the 26 members of MBHS, 7 agreed to make their data available and participate in this project. In December 2021, MBHS conducted a review of the network’s multi-provider data warehouse to identify current reporting capacity on individuals with opioid use disorder (OUD). Using data from EHR and Chesapeake Regional Information System for our Patients (CRISP), the MBHS team reviewed the prevalence of substance use disorder (SUD), mental health disorder (MH), and co-occurring disorders (SUD and MH) for those receiving treatment services. In addition, a survey and two interviews were conducted with staff from data warehouse member organizations to better understand which RSS service codes were captured and whether they were coded with potential for payment. The MBHS team worked with these SUD providers to review lists of RSS service codes (Current Procedural Terminology/CPT and Healthcare Common Procedure Coding System/HCPCS). For codes which were not present in their EHR, the team identified a correlated natural service code from their EHR system.

Results

There were 11,811 clients who were receiving treatment services during the period covered, January 1, 2021 through May 3, 2022. There were 8,533 clients (72.25%) who only had a MH diagnosis, 40 (less than 1%) who only had an SUD diagnosis, 1,289 who had co-occurring MH and SUD diagnoses (11%), and 1,949 (16.50%) who had neither a MH nor SUD diagnosis on record. Results from the two interviews demonstrated that provider A identified 129 RSS service codes, and provider B identified 162 RSS service codes. There were 40 CPT codes and 2 HCPCS codes that both providers identified as RSS. The remaining codes were either not identified by both agencies or were unique to a single agency’s EHR. There were 25% of RSS provided by provider A that were coded without potential for payment while provider B had 82% of RSS provided that were coded without potential for payment.

Discussion

This exploration of data from seven behavioral health provider organizations indicates there is an opportunity to review and standardize service classifications as well as use a consistent CPT/HCPCS coding methodology. In addition, results related to payment potential point to a need to examine current billing practices to ensure providers are receiving appropriate fees for their RSS services. Ways to improve the use of RSS data collection and their use of quality improvement projects, on both an agency and MBHS level are listed below.

Individual Provider Initiatives

Initiate standard approaches to service coding that can guide improved documentation in the EHR system.

Review services that are billable and non-billable to identify financial barriers to increased use of a wider array of recovery support services.

MBHS Data Warehouse Initiatives 

Develop additional coding dashboards to further examine RSS service utilization

Facilitate a learning community initiative focused on standardizing the approach within agencies for more consistency and more efficient data analysis.

Future coordination with providers could improve data input, advance coding, and quality of RSS data. Ultimately, the analysis makes clear the value of data analytics as a tool to track RSS, which can ultimately be used to improve access to and quality of these vital services.