Behavioral Health Transformation September 26, 2014. PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE. Agenda. Metrics Process Metrics Thresholds Outcome Metrics Tied to Payment Crisis Services. Proposed Behavioral Health Home Quality Metrics. Considerations for Quality Metrics Design
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Behavioral Health Transformation • September 26, 2014 PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE
Agenda • Metrics • Process Metrics Thresholds • Outcome Metrics Tied to Payment • Crisis Services
Proposed Behavioral Health Home Quality Metrics • 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 1 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-13-001.pdf
Proposed Behavioral Health Home Process Metrics 1Applies to existing health home clients only
For PMPM eligibility, BHH must meet the first three and one more of the remaining three process metric thresholds PRELIMINARY • Must be met (plus any 1 additional process metric) Process metric/activity Year 3 Year 4 Year 5 • % of clients with an integrated care plan • 70% • 80% • 90% • % of clients with crisis intervention plan in place • 90% • 90% • 90% • % of clients with whom HH is involved with BH IP discharge planning • 50% • 65% • 75% • % of clients who received appropriate number of client check-ins • 70% • 80% • 90% • % of clients with BH IP flag in portal for those requiring IP care • 50% • 65% • 75% • % of clients who received a follow-up from BHH within 3 days post-IP encounter • 50% • 65% • 75%
Bold– CMS required Proposed 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
Proposed Behavioral Health Home Outcome Metrics 1As 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.
Beginning in Year 3, four outcome metrics will be tied to the at-risk portion of the PMPM. 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 onlydue 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.
BHH Proposed Quality Metrics Current perspective on PMPM Phased Payment % Base PMPM 0 0 At risk portion 10 20 30 100 100 90 80 70 Year 1 Year 2 Year 3 Year 4 Year 5 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
Online • More information on the Payment Improvement Initiative can be found at www.paymentinitiative.org