1. Outcomes in Integrated Care Aileen Wehren April 2012

2. Types of Outcomes Process Outcomes Health Outcomes Financial Outcomes Satisfaction Outcomes

3. Why Measure Outcomes? Monitor/improve health care quality Provide information about what works and what does not Establish your value as a provider Provide incentives to providers Establish accountability

4. Process Outcomes Providers are most familiar with these The most frequent starting place Examples in medical, dental, behavioral health?

5. Health Outcomes Selection of Measures Can you collect the information? Can you use the information (is it retrievable for care)? Is the information useful for care, for communication, strategically (internal and external)? Does the measure fit the population? Should you look at risk factors, illness (diagnosis), medication, age? What is the cost?

6. Selection of Common Measures for Behavioral Health For depression: PHQ9 For addictions risk: Audit, CAGE, CRAFFT For Anxiety: GAD Functional Health & Well-Being: Short Form 12 or 36 For Tobacco: Surgeon General Questions, Fagerstrom For Lifestyle/Diet: Glasgow 2005 Do you screen (collect data) on everyone? How often do you screen? Can you get paid? Operational impact?

7. Selection of Medical Outcomes Measures Weight Body Mass Index (BMI) Blood Pressure Hemoglobin A1c Triglycerides Cholesterol Look at Health Effectiveness Data and Information Set (HEDIS), National Quality Forum (NQF) lists

8. Selection of Dental Outcomes Measures Gingivitis Periodontal disease

9. Outcomes Measures - Financial Per member per month cost pre and post Changes in cost based on length of time in integrated care, presence/complexity of the chronic health conditions Look at primary care, inpatient (psychiatric and medical), outpatient, ER, pharmacy at a minimum – expected and actual cost trajectories

10. Outcomes Measures: Satisfaction Many options

11. Other Considerations When do you build in? Is anyone asking now? Do you want to be ahead of the curve? Any questions?

12. Resources www.integration.samhsa.gov www.pcppc.net Patient Centered Primary Care Collaborative www.pcppc.net http://www.behavioralhealthintegration.co m http://www.behavioralhealthintegration.co m National Quality Forum (NQF)