behavioral health outcomes analysis - arizona state …...gaf score 1-30 client is a candidate for...
TRANSCRIPT
BEHAVIORAL HEALTH OUTCOMES ANALYSIS
Name
Agency, if applicable
Position or role relative to
Outcomes Implementation
Past clinical experience if
applicable
Familiarize participants with a method for
utilizing outcomes in a clinical setting.
Participants will explore GAF for consumer
improvement changes and identifying consumer
demographics and services.
Participants will discuss variables, trends, and
evaluate relationships represented in data.
Participants will look for potential changes in
clinical care.
What or, how is your organization calling or
defining outcomes? (List as part of a brain storming)
Is anyone including or measuring cost of
efforts and connecting these to outcomes?
Accountable
Efficient
Appropriate
Accessible
Acceptable
In Being:
Behavioral Health Outcomes
Community Based
Healthcare Outcomes
Diagnosis Related Groups DRGs
Severity of Illness: Extent of physiological decomposition or organ system loss of function
Risk of Mortality: Likelihood of dying
Prognosis: Probable outcomes of the illness including improvement or deterioration in the severity of the illness
Treatment Difficulty: Management of the illness and procedures
Need for Intervention: What would happen if you do not intervene
Resource intensity: Number and type of resource(s) required
Client Extreme Dysfunction
Client Independent Function
Levels of Functioning
1 2 3 4 5 6 7 8 9 10
Danger to self/others
Personal self care
Activities of daily living
Independent Functioning
Community living skills
1 2 3 4 5 6 7 8 9 10
Service Environment
Acute Hospital Jail/Prison
24Hr Residential
Partial Care Day Support
Outpatient Aftercare
System Independent
OUTCOMES INDIVIDUAL STATEWIDE ADULT STATEWIDE CHILD
With a drug/alcohol use history are now
abstaining
30.3% 37.8%
Are Not Homeless 96.5% 99.8%
Are Employed 19.4% .2%
Attend School 13.5% 86.1%
No recent criminal justice system involvement 92.5% 96.2%
Self-help groups Coming Coming
Clinical & Programmatic
Staff billable time calculation and
production options
Staff time tracking
Cost analysis components
Clinical and cost outcome
communications tools
Outcomes systems start with the ability to capture
how staff utilize their production potential
Example:Potential Annual Hours 2080
Annual Leave/PTO 160
Personal/Holidays/Sick 144
Total potential production hours 1776
Expected production at 56% 1000
Expected production at 67% 1200
Expected production at 75% 1332
DATE: STAFF: PROGRAM: Activity Time Total
DIRECT SERVICE (1-10)
1. Comp Assessment x 2.0 2
2. Individual
3. Group
4. Case Management
5. Family
6. Peer
7. Case Staff
8. Other
REPORT & DOCUMENTATION (11-20)
11. Case Notes
12. Closure
13. Incident Report
14. Other
STAFF DEVELOPMENT (21-30)
21. Conference
22. Workshop external
23. Workshop internal
24. Staff Supervision
25. Other
ADMINISTRATIVE (31)
31. Meetings
Salary
Fringe Benefits
Billable Services-Productivity
Production –Value of Service
Non-billable Activities
Overhead and Administrative Expenses
Show and No Show Rates
Scheduling – Double Booking, Walk-In
• Staff Confidentiality
• Training for Clinical Supervision
• Training for Program and Clinical Improvement
1 2 3 4 5 6 7 8 9 10
1 M
2 A
3 I
4 T
5 E
6 N
7 A
8 N
9 C
10 E
ENTRY
EXIT
1 2 3 4 5 6 7 8 9 10
1
2
3 1 1 1
4 2 3 3
5 1 4 29 68 18 3 1
6 2 18 59 50 13
7 1 4 9 6 1
8 1
9
10
ENTRY
EXIT
GAF Score 1-30 Client is a candidate for
inpatient care
GAF Score 31-69 Client is a candidate for
outpatient care – either PCP,
IOP or traditional outpatient
counseling
GAF Score 70 or Clients in this range do not
typically meet the criteria for
medically necessary services
because they are functioning
to well to be a candidate for
therapy
Adapted From : Packard M. A. (2009). Midwest Behavioral Health Network. New Avenues, South Bend, Indiana.
N=31
N=97
N=124
N=42
0
30
60
90
120
150
Worse No Change Slightly Better Significantly Better
Average Length of Stay
N=31
N=97
N=124
N=42
0
5
10
15
20
25
30
Worse No Change Slightly Better Significantly Better
Average Days of Service
N=31
N=97
N=124
N=42
0
300
600
900
1200
1500
Worse No Change Slight Better Significantly Better
Average Cost Per Case
13%
30%
17%3%
14%
23%
Female Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
Meds
N = 166
12%
39%
13%5%
13%
18%
Male Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
Meds
N = 134
12%
37%
18%2%
14%
17%
18-29 Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 60
12%
35%
15%4%
13%
21%
30-55 Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
Meds
16%
23%
17%6%
13%
25%
56+ Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
Meds
14%
31%
14%3%
17%
21%
Hispanic Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 67
15%
28%
18%
12%
12%
15%
BlackIndiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 28
12%
36%
15%
3%13%
21%
White Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 196
24%
11%
14%
4%
16%
31%
Other Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 5
4%
68%
8%
2% 13%
5%
American Indian Indiv Srvcs
Group
Case Management
Wrap Srvcs
Assessment
MedsN = 4
69.8%
30.2%
Gender
Female
Male
N = 43
26%
65%
9%
Age
18-29
30-55
56+
N = 43
75%
7%
16%
0% 2%
Ethnicity
White
Black
Hispanic
American Indian
OtherN = 43
10%
30%
15%
2%
14%
29%
Service Mix
Indiv Srvcs
Group
Case Management
Recovery / Wrap Srvcs
N = 43
55.2%
44.8%
Gender
Female
Male
N = 125
21%
65%
14%
Age
18-29
30-55
56+
N = 125
70%
7%
19%
2% 2%Ethnicity White
Black
Hispanic
American Indian
Other
N = 125
13%
35%
16%4%
12%
20%
Service Mix
Indiv Srvcs
Group
Case Management
Recovery / Wrap Srvcs
Assessment
MedsN = 125
55.2%
44.8%
Gender
Female
Male
N = 125
21%
65%
14%
Age
18-29
30-55
56+
N = 125
70%
7%
19%
2% 2% Ethnicity
White
Black
Hispanic
American Indian
Other
N = 125
13%
35%
16%4%
12%
20%
Service MixIndiv Srvcs
Group
Case Management
Recovery / Wrap Srvcs
Assessment
MedsN = 125
50.0%50.0%
Gender
Female
Male
N = 32
25%
69%
6%
Age
18-29
30-55
56+
N = 32
59%14%
22%
0%
6%
Ethnicity
White
Black
Hispanic
American Indian
OtherN = 32
16%
19%
21%9%
13%
22%
Service Mix
Indiv Srvcs
Group
Case Management
Recovery / Wrap Srvcs
Assessment
MedsN = 32
SELECTED BIBLIOGRAPHY
Averill. R.F., Goldfield, N., Hughes, J.S., Bonazelli, J., McCullough, E. C., et.al. (2003) All patient refined diagnosis related groups (APR-DRGs) Version 20.0: Methodology Overview. 3M Health Information Systems. Wallingford, CT
Bradley, R. Cardenas, E. Ginsburg, D. H. Rosenthal. R. & Velez, F. (2010) Producing Disease-Based Price Indexes: Using a Total-Expenditure Scope and Adjusting for Utilizations under a Treatment Concept for Measuring Health Care Costs Slows Down the Rate of Growth of Medical Prices; the Downside Is That Most of the Saving Is Seen in Insurance Benefit Payments and Not in Out-of-Pocket Payments or Lower Insurance Premiums for Consumers. Monthly Labor Review. (133). Pp 20+. U.S. Bureau of Labor Statistics;
Chi, F. W. & Weisner, C. (2008) Nine year psychiatric trajectory and substance use outcomes: An application of group based modeling approach. Evaluation Review (32), 1 pp 39-59 Sage Publication, Thousand Oaks, CA.
Division of Behavioral Health, ADHS. (2010) Presentation of the Outcomes Framework: AZ Council of Human Service Providers. ADHS. Phoenix Az.
Ettner, S.L., Huang, D., Evans, E., Rose, D. A., Hardy, H., Jourabchi, M., & Hser, Y. (2005) Benefit- Cost in California treatment outcomes project. Does substance abuse treatment pay for itself. Health Research and Educational Trust. (10) 1111. Pp. 1-22.
Holder, H.D. (198) Cost benefits of substance abuse treatment: An overview of results from alcohol and drug abuse. The Journal of Mental Health Policy and Economics.(10, 23. Pp23-29.
Ketcham, J.D. Baker, L.C. & Mac Isaac, D. (2007) Physician practice size and variations in treatment and outcomes: Evidence from Medicare Patients with AMI. Health Affairs. (26), 1. Pp 195-205
Lutterman., T. Ganju, V. Schacht, L, Shaw, R. Monihan, K. et.al. (2003) Sixteen State Study on Mental Health Performance Measures. DHHS Publication No. (SMA) 03-3835. Rockville, MD.)
Moos. R.H. Finney, J.W. Federman, E.B. & Suchinsky, R. (2002) Specialty mental health care improves patient’s outcomes: Findings from a nationwide program to monitor the quality of care for patients with substance use disorders. Journal of Studies on Alcohol (61), 5. Pp 704 Gale Group. Florence, KY.
Newman, F.L. Burwell, B.A. & Underhill, W.R. (1978) Program analysis using the Client Oriented Cost Outcome System. Journal of Evaluation and Program Planning, (1), pp. 13-30 (1978). Pergamon Press. Printed in U.S.A.
Sorensen, J.E. (1997) Client outcomes and cost in frontier mental health organizations: Letter to the field no. 13. Frontier Mental Health Resources Network. Denver, CO.