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Table 1 Summary of health reform readiness index categories, conditions and indicators

From: The readiness of addiction treatment agencies for health care reform

CATEGORY: BUILDING BLOCKS
Condition Score and progression of reform readiness indicators (summary)
Patient/Family Role 0 = Patients and family are not involved in treatment decision-making.
  1 = Patients and family are somewhat involved but clinicians make all decisions.
  2 = Patients are actively involved in treatment decision-making and goal-setting; families are invited to some sessions/events.
  3 = Patients and clinicians are full partners in treatment decision-making and goal-setting; families are involved in treatment sessions/events.
Evidence-Based Treatment 0 = Does not use National Quality Forum (NQF) practice standards.
  0 = Does not use National Quality Forum (NQF) practice standards.
  1 = Clinicians have access to prescribing medications and learning about NQF clinical interventions through training.
  2 = Has on-staff prescribing capacity. Offers in-service training for NQF clinical interventions.
  3 = On-staff prescribing capacity is widely used. Has in-service training and mechanisms for reviewing fidelity to NQF clinical interventions.
Accountability for Patient Care 0 = Documents care provided within organization over time.
  1 = Documents care provided within organization and elsewhere – information shared by patient.
  2 = Documents care provided within organization and elsewhere – information shared by patient and/or other healthcare organizations.
  3 = Documents care provided within organization and elsewhere – information shared by patient and/or other healthcare organizations). Patient identifies organization as medical home.
Integrated Continuum of Care 0 = Offers a single level of care.
  1 = Controls/has direct access to multiple levels of addiction or mental health care.
  2 = Controls/has direct access to all levels of addiction and mental health care.
  3 = Controls/has direct access to all levels of addiction, mental health, and primary care.
CATEGORY: YOUR ORGANIZATION
Board of Directors 0 = Board is uninformed about parity and health care reform.
  1 = Board is informed about opportunities presented by parity and health care reform.
  2 = Board is informed and supports staff efforts to take advantage of opportunities presented by parity/reform opportunities.
  3 = Board assures all activities take advantage of opportunities presented by parity/reform in finance, operations, human resources, treatment quality, or programming
Workforce 0 = Has < 20% licensed clinicians.
  1 = Has > 20% licensed clinicians. Patients have access to medical personnel.
  2 = Has > 33% licensed clinicians and  > 10% staff are medical personnel.
  3 = Has > 50% licensed clinicians and  > 15% staff can prescribe medications.
Patient Record 0 = Uses only paper records.
  1 = Uses electronic records.
  2 = Uses pre-formatted electronic records which integrates into data management and billing systems.
  3 = Uses pre-formatted electronic records which integrates into data management and billing systems. Shares clinical information and patient registries electronically with other health care partners.
Holistic Care 0 = Provides only substance abuse treatment. Does not refer to other services.
  1 = Provides only substance abuse treatment, and refers patients to primary care and support services.
  2 = Provides substance abuse treatment, assesses patients’ physical and psychosocial health, and has formal agreements to refer patients to other services.
  3 = Provides substance abuse treatment, assesses patients’ physical and psychosocial health, and can transfer patients and records to other health/support organizations.
Outcomes Measurement 0 = Collects data on dates and types of service.
  1 = Collects data on dates, types of service, admissions and length of stay. Uses data for process improvement.
  2 = Collects data on dates, types of service, admissions, length of stay and patient functioning during treatment. Uses data for process improvement.
  3 = Collects data on dates, types of service, admissions, length of stay, patient functioning during treatment, and outcomes measures. Uses data for process improvement.
Quality Management 0 = Documents quality indicators. Does not have quality management staff.
  1 = Documents quality indicators. A staff person monitors requirements for licensing, payer contracts and accreditation.
  2 = Documents quality indicators. Monitors requirements for licensing, payer contracts and accreditation. Has a quality management officer and conducts regular quality reviews.
  3 = Documents quality indicators. Monitors requirements for licensing, payer contracts and accreditation. Has a quality management officer. Conducts regular quality reviews, and has a culture of continuous improvement and high level of accreditation.
Patient Health Technology 0 = Does not collect data to use in treatment.
  1 = Patients complete assessments using electronic media.
  2 = Patients complete assessments, and have access to records and clinician communication using electronic media.
  3 = Patients complete assessments, have access to records and clinician communication, and interactive support/ direction using electronic media.
Administrative Information Technology (IT) 0 = Has paper and/or electronic systems that do not interact.
  1 = IT system collects and manages utilization and financial information for billing and accounting.
  2 = IT system collects and manages utilization and financial information for billing and accounting, and links directly to billing system.
  3 = IT system collects and manages utilization and financial information. Data system is integrated for management, billing, human resources, and clinical data.
Finance 0 = Revenue mostly from grants. Does not bill third-party payers.
  1 = Up to 10% revenue comes from third-party payers. All services have unit costs.
  2 = Up to 30% revenue comes from third-party payers. All services have unit costs, and organization has cash reserves up to 90 days.
  3 = Up to 50% revenue from third-party payers. All services have unit costs, and organization has cash reserves up to 90 days.
  1. The survey tool used a rating scale from “Needs to Begin” (score = 0) to “Advanced” (score = 3), with a progression of organizational competencies (indicators of reform readiness) as possible answers for each Condition question. Table 1 summarizes the scores and progression of organizational competencies for each Condition.