DMC-ODS & EQRO Next Steps For PMS & Clinical Tools SAPT 6 28 17 Rama Khalsa, PhD Director DMC-ODS EQRO Behavioral Health Concepts, Inc.

Potential DMC-ODS Performance Measures Background *Performance Measures (PMs) linked to access, timeliness and outcomes are a core component of the external quality review; *With CBHDA and SAPT leadership, a DMC-ODS EQRO Clinical Committee was formed with County, State DHCS and UCLA Staff and Dr MeeLee; *Since May 2016 the Committee has been reviewing research, data linked to sustained recovery, and other best practices and outcomes. With consultation and support from many we have drafted list of PMs to consider *Core areas for measures include the DMC-ODS Waiver Standard Terms and Conditions, Metrics linked to timely access to care, positive outcomes, initiation, engagement, retention, and recovery supports Behavioral Health Concepts, Inc.

What Organizations use metrics to enhance care? Looking for National Standards that Improve process & outcomes for SUD… NCQA –National Committee for Quality Assurance– HEDIS www.ncqa.org/hedis-quality-measurement/ IBHP – Integrated Behavioral Health Project- www.ibhpartners.org/ National Quality Forum- www.qualityforum.org/ AHRQ –www.ahrq.gov SAMHSA Substance Abuse & MH Services Administration www.samhsa.gov including NSDUH www.nsduh.org Washington Circle Measures www.washingtoncircle.org/ Kaiser – www.KP.org UCLA – SUD research division – www.uclaisap.org/ Veterans Health Administration- www.VA.gov/health/ Washington Business Group on Health- www.businessgrouphealth.org/ American Society of Addiction Medicine www.ASAM.org Centers for Medicare & Medicaid (CMS) www.cms.gov Behavioral Health Concepts, Inc.

What data sources are used by EQRO/BHC to measure SUD performance measures?? Eligibility Data from baseline years and each year of the waiver (MMEF file) Claims Data from billing for baseline and each year of the waiver CalOMS Data from baseline years and each year of waiver Provider File Data from baselines years and each year of waiver ASAM DATA on level of care recommended to match client needs Also, consumer family focus groups, county reports and data, stakeholder focus groups, PIPS, Health Plans MOUs, client experience of care surveys UCLA. Behavioral Health Concepts, Inc.

What types of PMs are used in SUD quality of care metrics?? Screening/Identification/Outreach – such as SBIRT protocols Timely Access Initiation and Engagement in care Retention in care ASAM Fidelity in terms of placement in the treatment continuum including individualized care plans with client buy-in Coordination of Care (along the ASAM continuum and with MH, PH and others) Outcome and Recovery Measures Behavioral Health Concepts, Inc.

Six Mandated Measures which BHC will measure: 1 Six Mandated Measures which BHC will measure: 1. Total Beneficiaries Served by DMC-ODS with demographic breakdown by baseline and all years of Waiver. 2. Total and average costs per year per beneficiaries with demographic breakdown for all years of Waiver. 3. Penetration rate of care into the Medi-Cal Population of eligibies. What percentage of members is accessing care? Comparisons by region, size, and statewide. 4. Cultural Competence of services and access to services for all ethnic groups and special needs using CLAS standards and evaluation through client focus groups in multiple languages. 5. Timeliness and Access to Care from request to first face to face ASAM assessment/appointment to first treatment appointment . 6. Coordination with Physical and Mental Health Care through shared programs, MOUs, and policy as well as special focus groups and specific questions on the Client Experience of Care Survey from UCLA. 1.

Additional Performance Measures for consideration now or in the future years- Number of ASAM assessments in each year of waiver. Initiation & Engagement Visits Per Washington Circle Therapeutic Alliance measures via client/family focus groups and “Experience of Care Survey” Percentage of clients accessing ASAM recommended Level of Care per year Average Total LOS in SUD system of care (linked to best sustained recovery in research)but not easy to do in current system. Average days from first face to face visit to first NTP visit for opioid disorders Improving services for High Cost Beneficiaries Timely Access to MAT from request to initial face to face visit or first prescription/dose MAT penetration rates for clients with alcohol and opioid disorders within DMC-ODS Percentage of clients with 90 days of retention in SUD system of care (best practice for engagement per Dr MeeLee) Behavioral Health Concepts, Inc.

Additional PMs for SUD Outcomes for the future: *Outcomes from CalOMs specific to clients in case management services (still defining metric for frequency per year) *Outcomes from CalOMS specific to clients in recovery services (still defining metric per year) *Key outcomes for PMs arrests, jobs, housing, and use of drugs in last 30 days via CalOMS or other outcome tools used by County. Behavioral Health Concepts, Inc.

Next Steps for Clinical Committee & DHCS & UCLA……… *Work with DHCS to select initial 12 measures and after doing sample data analysis from Riverside and San Mateo to be sure our great ideas work!!! * Finalize Clinical toolkit for EQRO reviews with Clinical Committee Input *Test all Protocols in 3 Mock Reviews and refine if they are not helpful. *Provide Stakeholder Trainings on process and final tools (no surprises!!!) *Provide advance PIP TA to help insure success for DMC-ODS Counties * Do Webinars with counties on how to use the data to improve systems and do analysis of EQRO data PMs for local needs Behavioral Health Concepts, Inc.