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Craig Anne Heflinger, Ph.D. Vanderbilt University (Tennessee) Representing the Washington Circle Public Sector Work Grou PowerPoint Presentation
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Obtaining and Working with Data from Multiple Agencies: What You Need to Know Before Attempting This!. Craig Anne Heflinger, Ph.D. Vanderbilt University (Tennessee) Representing the Washington Circle Public Sector Work Group Supported by SAMHSA CSAT & NIDA *. Acknowledgements.

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Craig Anne Heflinger, Ph.D. Vanderbilt University (Tennessee) Representing the Washington Circle Public Sector Work Grou


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slide1

Obtaining and Working with Data from Multiple Agencies:What You Need to Know Before Attempting This!

Craig Anne Heflinger, Ph.D.

Vanderbilt University (Tennessee)

Representing the Washington Circle Public Sector Work Group

Supported by SAMHSA CSAT & NIDA

*

acknowledgements
Acknowledgements
  • Washington Circle Public Sector Group (SAMHSA, CSAT through a supplement to the Brandeis/Harvard NIDA Center on Managed Care and Drug Abuse Treatment (Grant #3 P50 DA010233))
  • Tennessee Adolescent Coordination of Treatment (SAMHSA CFDA # 93-243)
  • NIDA (R21DA17682 )
state success
State “Success”
  • Originally 12 states and other government entities were invited to the public sector work group
  • Only 7/12 were able to actually generate the needed data tables
    • 2 were not able to access the needed data
    • 2 had limited staff resources and were not able to do the needed computer runs
    • 1 had a change in leadership that left a void in interest/skill working with the indicators
  • Of the 7 who “could” do it…..
stories from the states
New York: Office of Alcoholism & Substance Abuse Services

Robert Gallati & Dawne Lambert-Wacey

Massachusetts: Dept. of Public Health, Bureau of Substance Abuse Services

Andrew Hanchett

Oklahoma: Dept. of Mental Health & Substance Abuse Services, Decision Support Services

Steve Davis, Tracy Leeper, Mark Reynolds

North Carolina: Div. of Mental Health, Developmental Disabilities, & Substance Abuse Services, Policy Management Section

Spencer Clark

Connecticut: Dept. of Mental Health & Addiction Services, Quality Improvement

Minakshi Tikoo

Washington: Dept. of Social & Health Services, Div. of Alcohol and Substance Abuse

Kevin Campbell

Tennessee: Governor’s Office of Children’s Care Coordination

Craig Anne Heflinger & Robert Saunders, Vanderbilt University, Evaluation Team

Stories from the States
why did these states agree to participate in the work group
Why Did These States Agree to Participate in the Work Group?
  • National movement to use performance measurement in contracts or for system accountability (HEDIS, NOMS)
  • To hear approaches used in other states
  • To participate in making recommendations, if in the future it may become a mandate
benefits already gained in the states
Benefits Already Gainedin the States
  • Learning about performance measurement and analytic issues
  • Getting conversations going about how the system is working (versus individual providers)
  • Focusing on the quality of the service process instead of just the volume of services
  • Addressing data quality issues so better ready for analysis
  • Starting the conversation with stakeholders about accountability
  • Having a reporting mechanism that makes sense to providers, consumers, government officials
what do you need to start this process
What Do You Need to Start This Process?
  • Data
  • Analysis resources
  • Willing leader
  • “Political Will”
slide8
Data
  • “The timeliness, quality, and specificity of data is HUGE….”
slide9
Data
  • States vary in what is available
    • Uses vary according to what is available
  • Ideal: Integrated or parallel databases
    • Include all payer sources
    • Have individual-specific date and type of service
    • Can examine identification, engagement & continuity
examples
Examples
  • NC
    • See http://www.dhhs.state.nc.us/mhddsas/

statspublications/reports/cspireport_sfy07q1_11-15-06.pdf

  • WA has integrated SA Medicaid and Block Grant
  • OK has integrated MH and SA for all programs funded by State
    • See http://www.odmhsas.org/eda/rpm/okrpmfy2006q2.pdf
slide11
Data
  • Workable: Any database that allows you to track individual clients over time
    • Usually focus on client after in the system
      • Engagement & continuity (after detox, residential)
    • MA and NY have data about all clients in licensed facilities, including all payor sources
    • CT links across multiple databases
analysis resources
Analysis Resources
  • Some states were already working on performance measures and had dedicated analysis resources
  • Some states have used a state infrastructure grant for both IT improvement and analysis resources
  • Must dedicate time to data quality as well as the data access and analytic issues
willing leader political will
Willing Leader & Political Will
  • Having interested leadership in the division with the data is critical
  • Top leadership must “buy in”
    • To have the resources to generate the info
    • To use the info
    • Interest in process as well as outcomes
  • Some states have support of state leaders and are progressing
    • NC, CT, NY and MA have sustained a focus on performance measurement/quality improvement efforts
  • WA and OK have the resources and the info ready, but have recently had turnover in leadership positions
how are states currently using the wc measures
How Are States Currently Using the WC Measures?
  • States are “individualizing” according to needs
  • MA: Bi-monthly reports to state leadership
    • Modality-specific provider meetings to roll out provider-level reports have begun
  • NY: Performance system for county stakeholders includes WC indicators
  • NC: Quarterly reports to Local Management Entity (LME) and legislators
  • OK: Web-based system set up and ready for program access
  • CT: Monthly reports to programs
getting to benchmarks
Getting to Benchmarks

Discussing

Other

Benchmarks

Generating

Anonymous

Program-Specific

Reports for

Discussion

Starting

the

Conversation

Generating

Non-specific

Reports for

Feedback

Sharing

Program-

Level Data

w/ “Average”

Initiating

Contracts

Based on

Performance

overall issues
Overall Issues
  • Should your state consider using similar performance indicators?
    • Look at your current data models and resources available
  • Get in a framework of “quality improvement”
    • Not punitive, work with outliers to improve
  • Data presentation issues: “How to make the data come alive so it isn’t deadly boring?”
    • Providers/Programs
    • Legislators, Commissioners, Regional planners
    • Consumer/Advocacy groups
  • Continuity of care is critical, but it may be what the providers have least control over
  • Advantage of the WC indicators: use existing data
  • Could be paired with NOMS or TEDS for a more comprehensive picture including outcomes
getting started
Getting Started
  • Example of getting the process started from one state without integrated or parallel databases
review of what is needed to produce measures
Review of What is Needed to Produce Measures
  • Access to data from all publicly-funded substance abuse treatment sources
    • Medicaid
    • SAPT Block Grant
    • Others in your state?
  • Individual-level data
    • Can track individual persons over time
  • Services data
    • Individual, date of service, type of service
identifying data sources and documentation
Identifying Data Sources and Documentation
  • Identify federal and state agencies with responsibility for the population of interest.
  • Use known processes to aid detective work:
    • Follow youth through treatment system and note where agencies become involved.
    • Talk with providers to learn their routines.
setting the context
Setting the Context
  • Important issues for using public data sets on adolescent substance abuse treatment:
    • How is the service system structured — and what are the implications for accessing public data sets?
    • Which agencies are responsible for treatment funding, oversight, provision?
    • How is treatment recorded / billed?
    • How are the data sets structured?
slide21

Funding and Administrative Agencies for Adolescent SA Treatment: TN

USDHHS: Substance Abuse Prevention and Treatment Block Grant

USDHHS: Children’s Health Insurance Plan

State Funds to DCS

USDHHS: Medicaid

USDHHS: Title IV-E

Funding

Agencies

Treatment

Types

Tennessee Department of Health

Tennessee Department of Children’s Services

Tennessee Bureau

of TennCare

Bureau of Alcohol & Drug Abuse Services

Tennessee Behavioral Health (BHOs)

Managed Care Orgs (MCOs)

Inpatient Residential

Residential Treatment

Day Treatment (or IOP)

Outpatient

Outpatient

Partial Hospital IOP Case Mgmt

slide22

Data Sets Available About Publicly-Funded Substance Abuse Services in Tennessee

DCS:

Medicaid Carve-Out (FFS File)

TennCare:

Medicaid Managed Care (MCO, BHO Files)

Block Grant:

Access Data Base

Treatment

Encounters

Eligibility File

Treatment

Encounters

Treatment Admissions,

Encounters

data coding
Data Coding
  • What coding systems are used?
    • National standards
      • American Hospital Association revenue codes
      • American Medical Association procedure codes
      • HCFA/CMS HCPCS codes
      • ICD-9-CM
    • SAPT Block Grant TEDS codes
    • State-specific codes
  • How to recode into meaningful categories?
uniform service codes
Uniform Service Codes
  • Reconcile procedure codes between different coding systems.
  • Reconcile units across different reporting systems.
  • Compromise on level of detail obtainable: least common denominator for each measure.
  • Map procedure codes onto new coding scheme.
slide25

TennCare

“VUCAT”

Block Grant

DCS

Inpatient

(MH, SA, MH/SA)

Inpatient Detox

1X0, 1X1, 1X3

1X5, 1X9, 200

203, 656, 987

MH Inpatient

1X8, 1X9

Residential

(MH, SA, MH/SA)

SA Residential

SA Residential

Y0879-Y0882

Y1356, Y1357

912, 913

Intensive OP/

Day Treatment

Intensive OP/

Day Treatment

90804-90815, 90829,

90855, 90876,

90841-90845, H5010

Y1353-Y1354,

G0071-G0088

Y3153,Y0952-Y0955,

914,etc

OP Therapy

(Ind, Grp, Family)

OP Therapy

(Ind, Grp, Family)

90825, 90831

90882, 90885

Z2000-Z2002

Z5000, Z6000

Case Management

next steps
Next Steps
  • NOW you are ready to start analyses combining information from multiple databases and calculating the WC indicators!
  • For more information:
    • C.heflinger@vanderbilt.edu
    • Saunders, R.C., & Heflinger, C.A. (2004). Integrating data from multiple public sources: Opportunities and challenges for evaluators. Evaluation: The International Journal of Theory, Research, and Practice, 10(3), 347-363.