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Emerging Models of Value Based Payment: Opportunities for Behavioral Health Providers

Tami L. Mark, PhD, MBASenior Director, Behavioral Health Financing and Quality Measurement

Agenda

Big Picture – What are the Fed’s Trying to do?

Federal Initiatives – What’s New?

How Can Behavioral Health Field Benefit?

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Economic and Markets 101

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Increase in Health Insurance of Individuals with SUD

4Source: Author Analysis National Survey of Drug Use and Health

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SOLUTION:MORE INFORMATIONMORE PRICE SENSITIVITY

U.S. Lists Death Rates for Medicare Hospital Patients, NY Times, 1989

In an effort to help patients and their families make informed choices on where to be hospitalized, the Government today published its fourth annual report on death rates for Medicare patients at nearly 6,000 hospitals, including 196 where deaths exceeded Federal predictions.

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Nursing Home Compare

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48 NQF-Endorsed Behavioral Health Quality Measures

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1879 Adherence to Antipsychotic Medications for Individuals with Schizophrenia1880 Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder0104e Adult Major Depressive Disorder (MDD): Suicide Risk Assessment2599 Alcohol Screening and Follow-up for People with Serious Mental Illness0105 Antidepressant Medication Management (AMM)2601 Body Mass Index Screening and Follow-Up for People with Serious Mental Illness1933 Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)1365e Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment3175 Continuity of Pharmacotherapy for Opioid Use Disorder2602 Controlling High Blood Pressure for People with Serious Mental Illness0711 Depression Remission at Six Months0710e Depression Remission at Twelve Months1884 Depression Response at Six Months- Progress Towards Remission1885 Depression Response at Twelve Months- Progress Towards Remission0712e Depression Utilization of the PHQ-9 Tool2606 Diabetes Care for People with Serious Mental Illness: Blood Pressure Control (<140/90 mm Hg)2609 Diabetes Care for People with Serious Mental Illness: Eye Exam2608 Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Control (<8.0%)2607 Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)2603 Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Testing2604 Diabetes Care for People with Serious Mental Illness: Medical Attention for Nephropathy1934 Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)1932 Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)0008 Experience of Care and Health Outcomes (ECHO) Survey (behavioral health, managed care versions)2605 Follow-Up After Emergency Department Visit for Mental Illness or Alcohol and Other Drug Abuse or Dependence0576 Follow-Up After Hospitalization for Mental Illness (FUH)1922 HBIPS-1 Admission Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths Completed0640 HBIPS-2 Hours of physical restraint use0641 HBIPS-3 Hours of seclusion use0560 HBIPS-5 Patients discharged on multiple antipsychotic medications with appropriate justification0004 Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment0027 Medical Assistance With Smoking and Tobacco Use Cessation3205 Medication Continuation Following Inpatient Psychiatric Discharge2800 Metabolic Monitoring for Children and Adolescents on Antipsychotics2806 Pediatric Psychosis: Screening for Drugs of Abuse in the Emergency Department0418e Preventive Care and Screening: Screening for Depression and Follow-Up Plan0028e Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention2152 Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling1661 SUB-1 Alcohol Use Screening1663 SUB-2 Alcohol Use Brief Intervention Provided or Offered and SUB-2a Alcohol Use Brief Intervention1664 SUB-3 Alcohol & Other Drug Use Disorder Treatment Provided or Offered at Discharge and SUB-3a Alcohol & Other Drug Use Disorder Treatment at Discharge1654 TOB - 2 Tobacco Use Treatment Provided or Offered and the subset measure TOB-2a Tobacco Use Treatment1651 TOB-1 Tobacco Use Screening1656 TOB-3 Tobacco Use Treatment Provided or Offered at Discharge and the subset measure TOB-3a Tobacco Use Treatment at Discharge2803 Tobacco Use and Help with Quitting Among Adolescents2600 Tobacco Use Screening and Follow-up for People with Serious Mental Illness or Alcohol or Other Drug Dependence2801 Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

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What is new with VBP

2018 Emphasis for CMS’s Quality Initiatives

Meaningful Measures Patients over Paper Work Interoperability – putting data in hands of

patients

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Quality Payment Program

The Merit-based Incentive Payment System (MIPS)

Advanced Alternative Payment Models (aAPMs)– Comprehensive ESRD Care (CEC) - Two-Sided Risk– Comprehensive Primary Care Plus (CPC+)– Next Generation ACO Model– Shared Savings Program - Track 2, 3– Oncology Care Model (OCM) - Two-Sided Risk– Comprehensive Care for Joint Replacement Payment Model

Quality Payment Program Emphasis

Improve Beneficiary Outcomes Reduce Burden on Clinicians Increase Adoption of Advanced APM Improve data and information sharing

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Opportunities for the Behavioral Health Field

Suicide Rates are Rising

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Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999–2014. NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics. 2016

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1. Meaningful Measures

Measurement Based Care

18 Source: University of Washington, AIMS Center, Tracking Clinical outcomes, 2013

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Source: Kaiser Permanente Care Management Group. Highlight of a Leading Practice: Group Health Cooperative: Integrating Patient Reported Outcomes Across the Continuum of Depression Care, 2015

20Source: Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51)

Vermont Example: Population Outcome Reports

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Initiation of Alcohol and Other Drug Treatment

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Engagement in Alcohol and Other Drug Treatment

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Measurement Based Care

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2. Reduce Burden on Clinician

Increase Value of State and Federal Data Collection to Clinicians

Treatment Episode Data Set

Data collected from 1.7 million admissions to specialty substance abuse facilities annually

Data collected at least at admission and discharge Data includes numerous relevant outcome measures:

– Substance use– Employment– Housing– Continuity of Care

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Connecticut Example: Continuous Performance Improvement System Built on TEDS Data

27 Source: Connecticut Department of Mental Health and Addiction Services

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3. Put Data in the Hands of Patients

Measurement Based Care, Report Cards

Put Measurement Based Care in the Hands of Patients

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• Mobile technology linked to measurement based care could keep patients engaged after they leave “acute care” settings and formal treatment”

Nursing Home Compare

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No “Compare” for Behavioral Health Providers

SAMHSA BH Treatment Locator Partial Solution

SAMHSA Behavior Health Treatment Locator is Not User Friendly

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4. Increase Adoption Advanced APMs

Leverage Per Capita Payment to Expand Services

Medicaid APM Initiatives, by Type

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Source: Sources: KFF 50-state Medicaid Budget Survey for FY16 and FY17; CMS list of approved Medicaid Health Home SPAs (May 2017); CHCS Medicaid ACO Fact Sheet (June 2017) as compiled in Deloitte. Health Policy Brief, Alternative Payment Models in Medicaid.

APMs Models for Behavioral Health

Behavioral Health HomesCertified Community Behavioral

Health CentersBundled Payments

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5. Improve Data and Information Sharing

Admission Discharge Transfer Alerts

Follow-Up Within 7 Days After Mental Health Hospitalization, HEDIS

Source: NCQA, State of Health Care Quality, 2017

Geographic Variation in Percentage of Adults Hospitalized for Treatment of Mental Illness Receiving a Follow-Up Visit Within 7 Days of Discharge, FFY 2016

Source: CMS, Medicaid Core Measures

Admission, Discharge, Transfer (ADT) Alerts

40 Source: https://www.healthit.gov/sites/default/files/onc-beacon-lg1-adt-alerts-for-toc-and-care-coord.pdf

Rhode Island Quality Institute: Current Care Real-time admission and discharge alerts

41 Source: Rhode Island Quality Institute, http://riqi.org/matriarch/CODACTestimonial.html

We are not ‘out of the loop’ like we had been previously: we don’t have to rely on the hospitals calling us or the patients self-reporting when they have an admission. Center for Treatment and Recovery

Summary

Adopt Measurement-Based Care: Focus on outcomes in context of clinical care

Use Data Already Being Collected: Reduces burden of data collection on providers by making data meaningful

Put Measurement-Based Care in the Hands of Patients: Leverage mobile apps so that patients are interoperability hub for outcome measures

Implement Alternative Payment Models: To expand wrap around services and improve care coordination

Share Data Through Health Information Exchanges: To develop hospital alerts and make information easily actionable by providers.

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Thoughts and Further Discussion Welcome!!

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Contact Information:Tami L. Mark, PhDTmark@RTI.org(301) 416 - 4212