1. California Primary Care, Mental Health, and Substance Use Services Integration Policy Initiative Delivery System Design Workgroup: Outcomes & Measurement Strategies

2. Delivery System Design Work Group Delivery System Design begins with agreeing how implementation of the Continuum might be measured Identify initial measures (process, capacity, and outcome) that might be used statewide, in all settings, for consistent measurement of integrated care

3. Why is Measurement Important? Demonstrating accountability and supporting informed decision-making; Adopting a results-oriented perspective; Aligning a system or organization’s goals and activities with specific, measurable outcomes; and Providing a consistent basis for comparison with benchmarks/best practices and for future planning

4. Bottom Line What gets measured gets done.* * Mauer, Barbara (2008) Measurement of Health Status for People with Serious Mental Illnesses, National Association for State Mental Health Program Directors

5. Choosing the “Vital Few” from the Universe of Measures Explanatory Power for External Sources (State, County MH, PC, AOD, and Other Stakeholders) Data Available to Support Measurement Utility for Internal Purposes (Program Management, Grantee/Contractor Performance, etc. ) Measurable & Meaningful Performance Measures “Vital Few”

6. Measurement Components Capacity & Infrastructure: Authority, resources, time and staff allocated to and used by a program, and the services provided by the organizations Process: Sequence of activities, procedures, and methods that support the achievement of outcomes Outcome: Ultimate focus and desired result of a “intervention.” Outcomes measures can be immediate, intermediate or long-term and are tied to ultimate program goal

7. Levels of Analysis Based on Current Integration Policy Initiative Vision Population health and wellness (i.e., physical, mental, social/emotional, spiritual) Primary care, mental health, and substance use service integration at each level of the health care system

8. Today’s Discussion What is most important to measure at the system and population level? ◦ Capacity ◦ Process ◦ Outcome What are possible strategies (e.g., measurement tools, existing data sources) for collecting these data? Pros, cons, and feasibility of doing this on a Statewide level

9. Capacity: Example Domains Workforce (competency, specialist availability) Service Availability Information Systems (EHR, registries) Financing

10. Process: Example Domains Screening and Assessment Access to Specialty Services (medical, mental health, substance use) Treatment fidelity to evidence-based treatment models Prevention Services Communication and Coordination between health, mental health, and substance use providers Case/Care Management Health Education

11. Outcomes: Example Domains Symptom change (change in standardized assessment tool) Functional change (employment or education participation, justice system involvement, homelessness) Behavior change (SU reduction/abstinence, diet/exercise) Medical outcomes (morbidity/mortality rates, BMI, blood pressure/glucose) Quality of life Patient/consumer satisfaction