Measuring Outputs, Preparing for Outcomes

Alex Attinson, Juliette Palmer,Boris Vilgorin and Ashley Fuss

About the McSilver Institute

The McSilver Institute for Poverty Policy and Research at New York University Silver School of Social Work is committed to creating new knowledge about the root causes of poverty, developing evidence-based interventions to address its consequences, and rapidly translating research findings into action.

CTAC and MCTAC

The Community Technical Assistance Center of New York (CTAC) and the Managed Care Technical Assistance Center of New York (MCTAC) are training, consultation, and educational resource centers serving all behavioral health agencies in New York State. We help agencies strengthen their clinical and business infrastructure through training opportunities focused on implementing evidence-based practices and addressing the challenges associated with the recent changes in regulations, financing and overall healthcare reforms.

Review of the Project

Project Components

Goal: To help behavioral health providers improve quality of care while lowering healthcare costs.

1) Creating a comprehensive assessment database for practitioners and organization decision makers to identify clinical outcome and process measures – OTO

2) Developing a set of standardized reports to integrate within organizations’ electronic health records (EHRs)

3) Disseminating project tools through presentations and training opportunities

Creating Standardized Reports

Performance Improvement Network

● Pilot project

● 7 NYS agencies who operate over 65 programs

● 4 large Electronic Health Record (EHR) vendors: Netsmart, Foothold, Accumedic, IMA

● Activities included: focus groups, web-based meetings, and face-to-face sessions

● PIN outcome: design a set of standardized reports available through agencies’ EHR system using existing agency data

In Depth Process

● Provider Driven – Focus Groups, with vendor guidance

● Starting with information already in the EHR (mostly billing data)

○ Allows standardization

○ Lets agencies use the information they already have rather than collecting new information

● Standardization of: Diagnostic Categories, Service Type, Payer Mix

Focus Groups and Lessons Learned

● What do we already track? What is required and necessary?

● What do we need to track and why? Requires thinking in advance how data may best inform what we need to know

● How should we track our progress? Implement standard performance-monitoring protocol

● What changes do we need to make? Be willing to adjust measurements intermittently – feedback loop

Focus Group Takeaways

“We do not want to produce reports where people don’t use the information contained within them, especially when people put effort and time into the production of such reports.”

Report Features

● Payer Mix & Service Delivery

● Each report is available at the agency, program type, and individual program level

● Each report can be drilled down by diagnostic category and service type

● Standardized set of definitions

● Free of charge and available in perpetuity to ALL current and future NYS clients

Reports

Reports will allow organizations to quickly and accurately

● Get a sense of who they’re serving

● The types of services they are delivering

● The types of services individuals with specific diagnoses are receiving

● Breakdown of clients by Insurance Type

● Key features: standardization of definitions and terms across organizations and vendors

Sample Payer Mix Report

Standardized Definitions

● Self-pay: Individuals with no insurance or with insurance, but out of network

● Medicare fee-for-service: Individuals with only Medicare● Medicare and Medicaid: Individuals with Medicare and Medicaid ● Medicaid fee-for-service: Individuals with only Medicaid● Commercial Insurance: Individuals with non-managed insurance/PPO● Commercial Managed Care: Individuals with commercial insurance that is

managed● Medicaid Managed Care: Individuals with Managed Medicaid + FIDA● Total managed care and insurance: Includes commercial insurance,

Managed Medicaid, Managed Medicare, and Commercial Managed Care● Third Party Payer: Grants and other payers

Sample Service Delivery & Diagnostic Report

● Follows the structure of the DSM V, please consult for more thorough definitions

● The service-type options correspond with the program type

Implementing ReportsWho, What, When, Where, How

Implementing Reports

● Executive/senior team, quality compliance team, program directors, finance team and staff should see and understand reports

● Ideally, reports should be produced and reviewed monthly

Using the data to make informed decisions

To succeed in new health care environment, all levels of staff must use the best available data to make informed-decisions

● Clinical staff will collect, monitor, and review clinical data to make treatment decisions

○ For example, seeing which diagnosis corresponds to what type of treatment in order to determine if the appropriate service is being provided

● Program directors will use payer mix data, clinical, claims and payment data for each service and program to understand profitability

● Leadership will use data to make decisions about staffing, and contracting and negotiating leverage

Back to the FutureVBP and the importance of outcomes

Useful in a VBP environment

● Building upon these reports, providers will be better positioned to succeed in the Value Based Payment environment.

● VBP contracts require providers to have the tools to monitor performance in real time and course correct based on that data so that their outcomes can meet the expectations of the contracts

Business Intelligence

It will be important to incorporate data from a number of sources to begin understand what are the services and their costs that contribute to positive outcomes. The data will include:

● Client demographic data that includes behavioral and physical health conditions

● Service data at the client, program, and episode of care level

● Financial data cost per service, cost per episode of care, base revenue, and performance revenue

● Outcome data for clinical outcomes, social outcomes, and system utilization outcomes

Resources● Outcomes Database: http://outcomes.ctacny.org/● Where Are the Reports? Within your EHR. ● OMH Online Access to Statistical Data: https://www.omh.ny.gov/omhweb/statistics/● Client or Program Specific Data you may have access to:

○ Psychiatric Clinical Knowledge Enhancement System (PSYCKES)○ Children & Adult Information Reporting System (CAIRS)○ Integrated Program Monitoring and Evaluation System (IPMES)

● Quality Strategy for the NYS Medicaid Managed Care Program: https://www.health.ny.gov/health_care/managed_care/docs/quality_strategy.pdf

● 2016 Quality Assurance Reporting Requirements: https://www.health.ny.gov/health_care/managed_care/qarrfull/qarr_2016/docs/qarr_specifications_manual.pdf

● Plan Specific Reports of NYS Medicaid Managed Care Plans:● https://www.health.ny.gov/statistics/health_care/managed_care/plans/reports/● For more resources and training information go to ctacny.org

Questions & Discussion

Output to OutcomesAn Assessment Resource for Providers

Database Search Functionality

Database Browse Functionality

How Providers can use the OTO Database

● Providers can search and identify assessment tools to be used within their agency

● Assessment tools range from daily living skills, to behavioral health, social, and employment

● Many of the assessment tools within the database allow providers to measure and track progress

QPP and MIPS

2015 Edition of AWARDS

● Merit-based Incentive Payment System (MIPS) is an implementation of the Medicare Quality Payment System (QPP)

● Based on eCQMs

○ 15 for the Group Reporting Option (GPRO)

○ 6 for individual providers

● 2017 → +/- 5% payment modification, +/- %9 by 2022

● 15-20 Behavioral Healthcare focused eCQMs

● Focus on encounters, intense medical workflow, value sets

Questions?