Netsmart Technologies, a vendor of electronic health records systems serving behavioral health, substance abuse, cognitive developmental disability providers, and health and human services agencies, has acquired its third EHR vendor in four years.

The move continues an initiative to consolidate the market and pick up new technologies and expertise to aid clients in moving toward accountable care, says Kevin Scalia, executive vice president of corporate development.

The company in late 2011 purchased Sequest Technologies which marketed an EHR and practice management system and had staff and clinicians with deep expertise in substance abuse. Rather than having to recruit such talent, Netsmart brought them onboard, Scalia says. Next came the 2013 buy of Defran Systems, which supported behavioral and medical treatment, as well as modules to aid reporting required by child welfare and foster care programs.

Now, Netsmart has bought Lavender & Wayatt Systems, whose EHR includes top-line financial applications such as general ledger, payroll and expense management that will be integrated into the other three EHRs, including Netsmart’s flagship CareRecord EHR that also supports health information exchange, care management and analytics platforms.

Netsmart has integrated with Epic and Cerner systems to support clients wanting to exchange information with other provider organizations in the region. Right now, the information exchange is via Continuity of Care Records.

Also See: ONC Releases Final Nationwide Interoperability Roadmap

Behavioral health providers increasing are developing “health homes,” the behavioral equivalent of medical homes, but data exchange remains in the early stages, Scalia says. But with capitation quickly coming to the behavioral side of healthcare, there is significant awareness among at least the larger organizations that they quickly need to adopt data exchange, population health and analytics, he notes.

The state of Kansas, for instance, in mid-2014 launched a health home program for more than 400,000 Medicaid recipients with serious mental illnesses and made Netsmart’s care management software available to health homes to support care coordination, track quality measure and outcomes, manage authorizations and claims, and exchange data.

Netsmart currently links to about 1,300 laboratories and about 15 state or regional HIEs. But one metric illustrates how quickly integration is coming to behavioral health: Netsmart has a total of about 25,000 distinct connections now, compared with a couple hundred two years ago.

Changes in federal law would significantly aid in accelerating information exchange, Scalia contends. In the 1970s, heroin users were afraid to get treatment because their addiction might be exposed, so a section of law called 42 CFR put a layer of privacy around treatment and gave behavioral health patients a low level of control over who can see their records. Now, behavioral health providers are trying to get the law updated in the age of HIE to enable a patient to give consent for their information to be sent to other doctors treating the patient. Right now, the law “makes it very difficult to share data electronically,” he adds.

Smaller behavioral organizations remain far behind in information exchange, particularly because they are very price-sensitive in an arena where reimbursement rates have been steady for two decades. Significant HIE adoption likely won’t happen absent a mandate, Scalia says.

While larger behavioral providers are interested in information exchange, sizable activity is still a ways off, says Monica Oss, president of OPEN MINDS, a research and management consulting services firm serving the behavioral industry. “I would say the interoperability piece is pretty poor.”

Finding those exchanging information remains more the exception than the rule, but Oss also sees high awareness in interoperability and a desire to get on board. “Leading organizations in the field are taking big steps and investing a lot of money to achieve capability.”

A major reason for the change of heart about interoperability is that Medicaid agencies and commercial insurers are pushing behavioral health providers into capitated payment models and health homes to support coordinated care of patients with complex conditions, Oss says. And, the larger organizations know they have to move to accountable care and all of its components, including substantial HIE.

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