PRELIMINARY DRAFT

Behavioral Health Transformation

September 26, 2014

PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE

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Agenda

▪ Metrics– Process Metrics Thresholds– Outcome Metrics Tied to Payment

▪ Crisis Services

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Proposed Behavioral Health Home Quality Metrics

1 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-13-001.pdf

Considerations for Quality Metrics Design

▪ Required Centers for Medicare and Medicaid

(CMS) Core Health Home Measures1

▪ Behavioral Health Population Needs

▪ Phased Approach

– 2 years for tracking purposes only

▪ Metric Types

– Process

– Outcome

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Process Metrics

Metric/activity Details

Has integrated care plan Portal must reflect yes/no

Crisis intervention plan in place Portal must reflect yes/no

BH Inpatient (IP) flag in portal for those requiring IP care

Portal must reflect BH IP occurrences from claims data

Number of client check-ins Portal must reflect check-ins; frequency of check-ins required will vary based on intensity of report required

Follow-up with BH client post-IP encounter

Portal must reflect provider has followed up with client (face to face or by telephone) within 3 days of discharge1

Involved with BH IP discharge planning

Portal must reflect documented provider contact with hospital discharge planner prior to discharge and notification of discharge to BH provider, PCMH, and/or PCP

Proposed Behavioral Health Home Process Metrics

1 Applies to existing health home clients only

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Must be met (plus any 1 additional process metric)

For PMPM eligibility, BHH must meet the first three and one more of the remaining three process metric thresholds

▪ % of clients with an integrated care plan

▪ % of clients with crisis intervention plan in place

▪ % of clients with whom HH is involved with BH IP discharge planning

▪ % of clients who received appropriate number of client check-ins

▪ % of clients with BH IP flag in portal for those requiring IP care

▪ % of clients who received a follow-up from BHH within 3 days post-IP encounter

Year 3

70%

90%

50%

70%

50%

50%

Year 4

80%

90%

65%

80%

65%

65%

Process metric/activity Year 5

90%

90%

75%

90%

75%

75%

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Outcome Metrics

Metric/activity Details

Child and adult acute IP # child and adult acute IP admissions for any cause

Child and adult acute IP w/readmit within 30 days

# child and adult acute IP admissions for any cause followed by acute readmission for any cause within 30 days1

Follow-Up after hospitalization for mental illness

% clients who were hospitalized for mental health disorders that visited mental health practitioner within 7 days of IP discharge

% clients who were hospitalized for mental health disorders that visited mental health practitioner within 30 days of IP discharge

BH acute IP readmit rates Rate of BH-related readmission within 30 days discharge from acute IP facility

AOD (alcohol or other drug) treatment

% adolescents and adults with new episode of AOD dependence who received initiation or engagement of AOD treatment

Depression % patients 12 yrs+ screened for clinical depression using a standardized tool and follow-up documented

Blood pressure management2 % of clients (18 – 85) who had a diagnosis of hypertension and whose blood pressure was adequately controlled (≤140/90) during the measurement year

BMI assessment4 % of clients (18 – 74) who had an outpatient visit and whose BMI was documented during the measurement year or the year prior to the measurement year

Bold – CMS requiredProposed Behavioral Health Home Outcome Metrics1

1 Applies to existing health home clients only 2 Alignment on clear expectations and accountability for BHH for follow-up plan, collaboration with PCMH and/or PCP, and regular review of blood pressure will be outlined and reviewed with CMS 3 Language aligned with pharmacy requirements 4 Alignment on clear expectations and accountability for BHH for follow-up plan, collaboration with PCMH and/or PCP, and regular review of BMI will be outlined and reviewed with CMS

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Outcome Metrics

Metric/activity Details

Treatment adherence # of outpatient encounters versus # of visits in treatment plan

Hearing and vision screen % youth (under 16) with documented scheduled hearing and vision screen and follow-up plan documented for those with identified need; shows evidence of collaboration with PCMH and/or PCP

Labs review % children (under 18) on antipsychotic agents who have had metabolic lab tests for fasting lipids and glucose documented and reviewed by a physician or licensed APN1

Acute BH IP utilization Rate of utilization of acute BH IP care for BH related services per fixed time frame (acute IP admits PMPY)

BH Emergency Department (ED) visits

Rate of BH ED visits per fixed time frame (ED visits PMPY)

Medication adherence2 % clients with medication possession ratio3 > 80% for antipsychotics, mood stabilizers, and anti-depressants

Utilization of residential services (days PMPY)

Rate of utilization of residential care for care related services per fixed time frame (residential days PMPY)

Utilization of PCMH % individuals who have received at least one documented healthcare visit with their PCMH (or physician or other healthcare provider if individual does not have PCMH) that included a review of the medical plan4

1 As defined by DMS pharmacy requirements 2 There are 3 separate medication adherences metrics for Schizophrenia (antipsychotics); Bipolar Disorder (antipsychotics or mood stabilizers) and Depression (anti-depressants) 3 Sum of days’ supply for fills in period / number of days in period 4 Metric will be based on an annual basis.

Proposed Behavioral Health Home Outcome Metrics

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Beginning in Year 3, four outcome metrics will be tied to the at-risk portion of the PMPM.

Outcome Metrics4

Metric/activity Details Threshold

Follow-Up after hospitalization for mental illness

% of clients who were hospitalized for mental health disorders that visited mental health practitioners within 7 days of discharge

The metric will be set after analysis of data tracked from the first two years.

BH acute IP readmit rates

Rate of BH-related IP readmission within 30 days discharge from acute IP facility

The metric will be set after analysis of data tracked from the first two years.

Utilization of residential services (days PMPY)

Rate of Utilization of residential care for care related services per fixed time frame (residential days PMPY) 2

The metric will be set after analysis of data tracked from the first two years.

Utilization of PCMH % of individuals who have received at least one documented healthcare visit with their PCMH (or physician or other healthcare provider if individual does not have PCMH) that included a review of the medical plan, if applicable.3

The metric will be set after analysis of data tracked from the first two years. 

1 The outcome metrics will be weighted evenly for risk portion. 2 The “Utilization of Residential Services” to be measured for Children and Youth only and that a third metric “Therapeutic Community” be added for adults only 3 The “Utilization of PCMH” to be measured for adults only due to the high rate of co-occurring medical condition in adult population. 4 Metrics listed on this slide are a subset of overall metrics being tracked from Year 1.

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Base PMPM At risk portion

No portion of PMPM at-risk in first two years to allow providers to become familiar with reporting and metrics and develop sustainable infrastructure

Increasing portion of PMPM placed at-risk over next three years as providers understand metric baselines and adopt practices to achieve high outcomes

BHH Proposed Quality Metrics

%

Current perspective on PMPM Phased Payment

Year 1 Year 2 Year 3 Year 4 Year 5

100 10090

8070

0 010

20 30

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Crisis Services

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Crisis Services

A Request for Proposals will be released for

a Single Statewide Crisis

Entity will be responsible for:

Coordination of Mobile

Crisis Response and Stabilization

Monitoring Mobile Crisis

Response and Stabilization

Training providers on

how to handle behavioral

health crises

Contracting with Regional Mobile Crisis

Response Entities

Collecting and Reporting Key

Indicators

Supporting a centralized access call

center.

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Online

▪ More information on the Payment Improvement Initiative can be found at www.paymentinitiative.org