Enigma - TeamCare Software for Mental Health Referrals Depends
A complete care team solution bringing together the Patient, Practice, PHO and Health Providers, enabling them to deliver services seamlessly to the patient, within budget, with minimal manual back office processing
Who is TeamCare intended for?
Originally created for the healthcare market but flexible enough to be used in other industries, TeamCare was designed to facilitate communication and collaboration between groups of people responsible for sharing the care of individuals.
TeamCare is intended for organisations that are responsible for making services available for clients to be referred to; for funding these services; for controlling, monitoring and tracking the progress of these services and for analysing the outcomes resulting from the delivery of these services.
To be more specific, TeamCare would typically be used by DHBs or PHOs to make it easy for patients to be referred from their registered practice to one or more Service Providers for services that they may need, and for those delivering the services to receive the appropriate remuneration, under the financial control and management of the DHB/PHO.
How can TeamCare help?
TeamCare streamlines the referral process between the Referrer and Service Provider by introducing efficiencies in workflow:
- Directly links the Referrer to the Provider
- Enables Practices to receive payment for initial triage services where applicable
- Provides immediate real-time status information, with reporting on key data
- Refers patients to the most appropriate, and available, Provider
- Eliminates most manual processing normally associated with referrals
- Provides certainty of payment for Providers for services before they are delivered
- Provides certainty to the DHB/PHO over expenditure
- Fully flexible budget configurations allows budgets to be allocated by Practice; by Service; by Locality
- Reduces overspend, allows Referrer to decide for whom to prioritise funding
- Eliminates “lost” referrals
- Automatic generation of Buyer Created Tax Invoices negates the need for manual reconciliation
- Capable of integrating with other 3rd party referral systems
TeamCare – the Platform
TeamCare as a platform delivers access to, and oversight of collections of programmes of care, which include sets of services within them. The packages of care are linked to managed budgets, and the types of services available within them can be:
- Simple, fee for service types of services
- More complex, enrolled services with multiple sessions / types of services
TeamCare is a platform, based upon the ‘PREDICT v2.5’ suite, with built-in work-flow engines, definable forms, service definitions, cohorts of patients and service providers.
The platform is flexible in terms of the types of usage and services which can be delivered through it therefore it is simpler to describe what it can do in terms of the types of service bundles which it can manage. It is capable of delivering different types of access to services, in a number of different main styles:
- Referral / direct service request
- Referrals in from a primary care team where the requestor can directly obtain access to a service provider’s service on behalf of their patient
- Referral in to a centrally coordinated service
- Enrolment by the Coordinators
- Coordinators enrol directly as a ‘self-referral’, something which has not originated from the normal primary care referral channels
- Triaged services / Stepped Care
- Primary care deliver services initially as part of a multi-tiered approach which could potentially involve others in a wider care team as required later on within the patient’s enrolment
- Combinations of all of the above
The platform can build upon an inward referral (aka enrolment), and can be assigned to a set of coordination services in parallel with direct referrals to allied health service providers (this system was previously known as PCRMS). Extensions now allow a ‘Stepped Care’ approach for service delivery where a degree of initial management and triage is provided before external services are then called upon.
All of these activities can attract service payments as required. Services are accounted for and payments are made through the extensive in-built ‘service definitions’ and their associated charging schemes.
Accounting is performed using Buyer Created Tax Invoices (BCTIs) which can be used to directly pay the contracted service providers. Monthly payment schedules are exportable into external accounting formats which enable you to directly use your own local account and ledger codes.
TeamCare is a web-based system, no software needs to be installed to use this in a standalone environment. For Practices, for integration with Medtech or MyPractice Patient Management Systems, a form would need to be installed within the PMS to launch the service with patient pre-population of data.
TeamCare can be used by Service Providers, PHO and DHB users from anywhere that there is an internet connection.
TeamCare – streamlining the mental health referral process
Enigma’s TeamCare solution has been used for a number of years to facilitate the process of referring people in primary care with concerns around their mental health, to Counsellors, Psychologists and others who provide associated services, to help them with their concerns. The instance of TeamCare used for mental health referrals depends on the type of service needed; Enigma has customised its TeamCare platform to create a number of mental health solutions that are used on a daily basis – customised at the front end dependent on the requirements of the customer and the user.
How is TeamCare actually being used?
The systems described below are real examples of how TeamCare is being used on a daily basis.
PCRMS – Primary Care Referral Management System
PCRMS is Enigma’s core mental health referral solution whereby patients are referred directly from the practice to PHO-funded services such as brief interventions, counselling etc. This can be done using eReferrals or by enrolling patients directly into the programme from within practice. The PHO and the Providers access the cloud-based system to triage, allocate packages of care, assign, monitor and record session details for the patients with all invoicing occurring automatically as each session is recorded. PCRMS uses the full suite of functionality available within TeamCare, detailed on the TeamCare page.
Enigma is proud that TeamCare is the platform chosen by Counties Manukau Health to support their Wellness Support primary mental health model of care. Wellness Support was recently awarded the NZ Primary Healthcare Award for Best Mental Health Programme. The model is used directly by GPs and Nurses in-practice to enable them to record mental health consultations for their patients and as in the case of PCRMS, all funding and reporting flows automatically in real-time.
For more information on Counties Manukau Health’s Wellness Support model of care click here.
Since mid-2019 TeamCare has been used by Health Improvement Practitioners (HIP) and Health Coaches, both in-practice and externally, to deliver services for their clients, initially as part of a pilot programme* which includes progress reporting to the Ministry of Health. Based on feedback received from the HIPs and Health Coaches the system was adapted to further meet their needs. This system has been updated to ensure fully automated reporting of data to the Ministry of Health for the Integrated Primary Mental Health & Addictions (IPMHA) programme and is in the process of being deployed further afield.
TeamCare Wellness provides the full TeamCare functionality as described on the TeamCare page of this website, adapted to reflect the unique requirements of the Ministry’s Integrated Primary Mental Health & Addictions (IPMHA) programme. It enables HIPs and Health Coaches to record details on all consults they deliver to their clients – including if their client does not attend – giving them full oversight of all services delivered for a client under a referral. A data extract to mirror the Ministry’s reporting requirements (Version 0.7) can be generated automatically by simply clicking a button. This can be uploaded to the Ministry using the DHB’s own Ministry reporting process.
TeamCare Wellness also allows people to be referred to healthcare providers based outside of the practice such as Community Support workers. This process works in exactly the same way as referring people for counselling or psychological services, either via the PHO or directly to the appropriate Provider Organisation, where the receiving Provider can update the record based on the activity that they are about to take or have already taken.
Follow every aspect of your patient’s journey in one central hub – from what funded services are available to them, to their history and current progress within their programme, their care is at your fingertips.
Within a GP Practice, depending on the services being offered by the PHO/DHB, the list of services available to the practice is displayed on the Services Launchpad. As its name suggests, this is the starting point for selecting services for the patient.
The Services Launchpad is also used as a gatekeeper for service funding. On a per service basis, the Launchpad can be configured to show either a $ value available, the number of packages of care available or simply that funding is available. A self-funded option is always available.
Supplementary business rules can also be implemented within this Launchpad eg funding is only available for certain age groups, DHBs, ethnicities etc, so the GP would be able to access services only where their patient meets the eligibility criteria.
The Launchpad enables the GP to enrol their patient into the chosen service and from this point, they are able to see the services that are subsequently added to the patient’s package of care; who is the assigned Provider; whether the Provider has accepted the patient; whether the Provider has seen the patient and any notes added by the Provider into the record – all updated in real-time.
Reduce the overheads of staying organised – customise your own Packages of Care and manage which providers can deliver them with TeamCare’s powerful and flexible Referral Management engine.
Some services may be provided within the practice but others will require referring to either a Coordination Service or directly to a Service Provider. TeamCare allows you as the customer, to configure which services are available; configure ‘standard’ ie most commonly requested packages of care; which Providers can provide which services; whether the Practice can refer directly to the Provider and even advise when the Provider is not available for a period of time.
The patient is enrolled directly into TeamCare and from this point the patient progresses through the pathway; their record is updated in real-time; the status and progress can be monitored by all parties responsible for their care and actions not completed within customer predetermined periods are flagged as delinquent.
Coordination / Creating a Package of Care
While ‘standard’ packages of care would be suitable for most patients, there will always be a need for custom or adhoc package of care to be provided for a patient – TeamCare caters for both. TeamCare allows Service Coordinators to create bespoke packages for patients and assign each of the services to Service Providers independently.
For example, a diabetic patient may have mental health issues. A package of care could be created for the patient comprising a psychology service and perhaps a dietary service. The psychologist would work with the patient and simultaneously (over the same few weeks), the dietician would work with the patient:
- The Psychologist would have visibility on the dietary service
- The Dietician would have visibility of the psychology service
- The PHO would have visibility on both services (minus the Provider notes)
- The Practice would have visibility on both services
Stay on top of your budgets with real time tracking and reporting of your funding and current spend. Streamline your workflow by allowing providers to receive payments without having to submit any additional claims.
For each service, session and even down to the Provider level, the cost of service can be configured by the customer. This means that if the DHB or PHO specifies that a Provider can be funded to provide 5 sessions (2 at $75 and 3 at $50), the Provider can claim for a maximum of $300 for that service. TeamCare also allows for some Providers to receive different rates for service provision by applying an override against the Provider’s account.
TeamCare includes the automatic generation of IRD approved Buyer Created Tax Invoices (BCTI).
Each time a Provider records in TeamCare that they have seen a patient, a transaction is logged against that Provider’s organisation. On 1st of the following month, a BCTI is automatically generated which is used by the PHO to pay the Provider for their services. Summary reports are also available.
As well as improving workflow, TeamCare has indepth real-time reporting available, aggregated or expanded dependent on the user running the report. Some of the reports that come as standard with TeamCare are:
- Open and Closed Services Reports
- Closed Service Data Extract
- Closed Service Provision Data Extract
- Unassigned Services
- Delinquent Returns Contractual Report
- Budget Report
Revolutionary web-based gateway allowing PHNs / PHOs to control and demand-manage delivery of their funded services through their networks of Providers.
- Control access to PHO funding for services
- Manage available PHO / Practice service budgets, reduce overspending
- Simplify claiming by providing Buyer Created Tax Invoices (BCTIs)
- Give your Providers certainty of payment for their service delivery before they deliver their services
- Capture and report upon clinical information relating to delivered services
- Allow the Providers to prioritise their patient funding
- Provide a view of all such programmes to the wider team of associated providers.
A dynamic and interactive view to help your Providers deliver funded services to Patients, with certainty of payment.
Benefits of the TeamCare Launchpad
To the Providers
- A green light provides guaranteed payment, no more unexpected rejected claims
- Funding automatically flows after providing services, no claiming is required (BCTIs)
- Shift focus from claiming to delivering care
- Clarity over service funding simplifies treatment decisions
- Budget insight shows how much remains for each service. You choose how to allocate / prioritise your remaining funding
- Simple Launch pad for all services. Colours and icons show what you can access
- Brief clinical support forms, designed to capture relevant clinical information for the delivery of services to your patients
To the PHO / PHN
- Control access / funding eligibility on:
- Patient, provider eligibility, clinical prerequisites, patient enrolment, high needs, other demographic factors
- Budget availability
- Manage available budgets:
- Across the whole PHO, by clinic, by provider, by patient
- Simplify accounting and payments using Buyer Created Tax Invoices (BCTIs)
- Capture data required for PHO programmes using clinical delivery forms
- Aggregate reports provided from
- clinical datasets
- Recycle unused budgets
- No unmanaged exposure to future claims, no time lags relating to claiming
IPMHAS – Integrated Primary Mental Health & Addictions Service
The IPMHAS Programme is a Ministry of Health initiative to expand New Zealanders’ access to, and choice of, primary mental health and addiction services. The programme introduces the roles of Health Improvement Practitioners (HIPs) and Health Coaches into general practice to deliver key mental health services, supporting the GPs and nurses. It also enables community services to be delivered outside of general practice, such as the Awhi Ora service across the metro Auckland region.
With any new programme, to understand whether the programme is making a difference, reporting is necessary and the IPMHAS programme is no different. To facilitate recording of data and reporting for the PHOs and DHBs, Enigma has adapted its TeamCare solution for exactly this purpose, branded TeamCare Wellness.
Why use TeamCare Wellness for the IPMHAS Programme?
- Generation of the Ministry-specified IPMHAS data extract, aggregated for all HIP and Health Coach activity in the DHB, in one simple action
- Custom data-capture forms specifically for HIPs and Health Coaches to ensure that mandatory data for Ministry of Health reporting is captured consistently
- No double-data-entry into the PMS as session notes write back to the PMS automatically on submission of the form
- Integrated calculators for The Duke and the Strengths & Difficulties Questionnaire (SDQ) – covered by the appropriate licences
- User, PHO and DHB KPI reporting as standard
- Ability to introduce patients electronically to community support services outside of the practice with secure automated data updates back to the practice (standard Healthlink messaging charges apply)
- Custom integrated introduction forms, specifically created based on the needs of the receiving community support service
- Access to services on a practice-by-practice basis
- Integrated with all mainstream Patient Management Systems (PMS) – Medtech32, Evolution, MyPractice, Indici (PMS licensing charges may be applied by the PMS vendors)
Terminology and data structures
There is a complex data model behind all of this; it allows us to describe what is available and to whom, under what packages of care and with what budget, how much will it be subsidised, who delivers the services, are they available directly or just as a coordinated package of care etc.
The data model is very hierarchical and linked; within it specific terminology is used. Here is a little bit of information on the various terminology and structures that exist within TeamCare:
A Programme is typically the clinic area that the services relate to, for example Primary Mental Health, Diabetes Care Services, Mobility Services etc.
Once enrolled into a Programme, the patient would be allocated some relevant services, for example Counselling, Dietary Service, Physiotherapy.
Each service comprises of a number of sessions eg for Counselling, there may be 5 sessions available. They could all be counselling sessions but one could be an initial triage session and the funded amount may differ from other counselling sessions.
Package of Care
A Package of Care would be a combination of all services allocated to the patient under the Programme. Again taking the example of Primary Mental Health: Under the Primary Mental Health Programme, the patient may be allocated a Package of Care comprising a Counselling Service with 5 counselling sessions, a Psychology Service comprising 2 psychology sessions and a Brief Intervention Service, comprising a single brief intervention session.
Each Programme, eg Primary Mental Health, Diabetes Care Services, Mobility Services, would typically have its own budget for services. TeamCare has an extremely flexible budgeting model which allows for a number of varying budget configurations; here are some examples:
- Each practice has a number of packages of care available
- Each practice has a specified amount of funding available
- Each practice has differing amounts of funding per service eg for Diabetes Mental Health, there would be different budgets for Mental Health Credentialled Nurses; eTherapy; Flexifund etc
- Practices share a single budget across a Locality
For each service that is included in the Package of Care, TeamCare allows it to be assigned to the appropriate Provider. This can be directly from the Practice or from the Coordination Service, depending on the service and how the customer would like it to be handled.
Each Service Provider is responsible for performing initial triage and accepting or returning the service request back to the Coordination Service.
At any time, the PHO and the Practice can see whether the service request has been seen and accepted by the Provider, whether the patient has been seen and if any notes have been added by the Provider at the time of delivering the service (Provider notes are restricted from the Coordination Service).
Service requests have a number of states depending on what part of the workflow the patient has reached, making it easy to see at a glance which Provider is looking after the patient:
- Assigned – request is sitting with the Provider waiting to be opened
- Received – request has been opened but no decision yet indicated by the Provider
- Accepted – request has been accepted by the Provider and first appointment has been booked
- Returned – request has been returned to the Coordination Service and is waiting for further instruction by the Coordination Services
- Rejected – request was not appropriate
- Closed – request has been actioned
Each time a Service Provider sees their patient they would record this in TeamCare. This will create a financial transaction which is included in an automatically generated IRD approved Buyer Created Tax Invoice, created at the end of the month.
PHOs pay the Providers based on the Buyer Created Tax Invoice – no manual reconciliation is required.
A number of types of hierarchies exist within TeamCare:
- Service Coordination and Delivery
- National / Regional / PHO / Coordination Service / Service Provider Organisation / Individual Service Providers
- Referrers (Who can refer / enrol into Programmes)
- Clinic / PHO
- Service Provider Organisation / Business Units (GST#s) / Individual Service Providers
A number of standard user roles exist within TeamCare:
- Oversight Role for Primary Customer contact / Manager of contract
- Administrative role / Programme Manager
- Setup and configuration of programmes, services, service providers and users
- Financial Administrator
- Assign and manage budgets to programmes / split by requestor
- Access to BCTI and accounting exports
- Coordination Service user
- Receive and manage enrolments; initial triage; create package of care for patients; assign to service providers; monitor and manage returns / delinquent requests; reject inappropriate referrals
- Service Provider Admin user
- Receive general service requests targeted towards organisation; reassign requests from one of their providers to another
- Service Provider
- Review and accept referrals; return inappropriate or non-contactable referrals to Coordinator; book and deliver services to patients; record service delivery