National Behavioral Health Quality Framework: Improving Health Outcomes

August 16, 2011

Peter Delany, PhD, LCSWDirector, Center for Behavioral Health Statistics and QualityRichard Frank, PhD, Special Advisor

Presentation to the SAMHSA Advisory Councils

The Need for Improvement3

2001 IOM Report highlighted the need to make real changes to the structure of the health care system to address quality, cost, and the application of health information technology to improve administrative and clinical processes.

National Quality Strategy: Three Aims

Better Care

Healthy People/ Healthy Commu-

nities

Affordable Care

Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

Improve population health through proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.

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Reduce the cost of quality health care for individuals, families, employers, and government.

National Quality Strategy Priorities

• To help achieve its aims, the strategy also establishes six priorities, to help focus efforts by public and private partners.

Making care safer by reducing harm caused in the delivery of care.

Promoting effective communication and coordination of care

Ensuring that each person and family are engaged as partners in their care.

Promoting the most effective prevention and treatment practices for the leading causes of

mortality, starting with cardiovascular disease.

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Working with communities to promote wide use of best practices to enable healthy living

Making quality care more affordable by developing and spreading new health care

delivery models.

National Behavioral Health Quality Strategy Priorities

• To help achieve its aims, the strategy also establishes six priorities, to help focus efforts by public and private partners.

Promote the most effective prevention, treatment and recovery practices for BH

disorders

Encourage effective coordination within BH care systems and between the BH care system and

primary care and social service systems

Assure that Behavioral Health care is consumer and family-centered

Assist communities in the utilization of best practices to support health living

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Make Behavioral Health care safer by reducing harm caused in the delivery of services

Foster affordable, quality BH care for individuals, families, employers, and governments by

developing and advancing new delivery models

National Behavioral Health Quality Framework

Priority 1: Promote the most effective prevention, treatment and recovery practices for BH disorders

Goal: Prevent and reduce the harm caused by mental illness and addictions Opportunities for success:

Reduce suicides, underage and problem drinking, binge drinking, illicit drug use, tobacco use Improve functioning and increase the number of individuals achieving goals of recovery including health,

home, purpose, and community

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Percentage of clients receiving services who

report: improved functioning; improved

living conditions; improved social

supports

Practitioner Program System Percentage of youth 12-20 reporting use of alcohol in

the past 30 days

Number of

practitioners using SBIRT as measured by

CMS codes

Number of programs

demonstrating sustainable models for improving the quality of service

Use of recovery measures in community report cards on outcomes

National Behavioral Health Quality Framework

Priority # 2 Assure Behavioral Healthcare is consumer and family-centered

Goal: Structuring services in ways that meet individual and family needs and making patients centrally involved in decision-making about their care. Includes enhancing capacity to capture and act on patient-reported information, including preferences, desired outcomes, and experiences with behavioral health care Opportunities for success:

Integrate behavioral health consumer feedback on preferences and experiences of care into all care settings

Increase use of electronic health records (EHRs) that capture the voice of the behavioral health consumer

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Number of States adopting shared decision-making

paradigms

Practitioner Program System Percentage of individuals

reporting that receive information that helps them make informed

decisions about treatment options

Adherence to standard

care practice for consumer preferences

in service planning

Percentage of facilities with

functioning EHRs that build in

consumer choice

Number of

communities that provide report

cards on behavioral health

care programs

National Behavioral Health Quality Framework

Priority 3: Encourage effective coordination within BH care, and between BH care and other health care and social support services Goal: Create a less fragmented and more coordinated behavioral health care system, and improve coordination of this system with other health care and social support systems Opportunities for success:

Reduce preventable behavioral health hospital admissions and readmissions Prevent and manage chronic illness and disability among behavioral health consumers Ensure secure information exchange to promote efficient behavioral health care delivery

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Percentage of grantees that provide screening

and/or assessments that are coordinated among

or shared across agencies

Practitioner Program System Percentage of individuals with severe mental illness

who report they can identify their accountable

provider

Number of providers

practicing in local care networks

Percentage of visits where primary care

and other practitioners are

aware each other’s contact with patient

Percentage of

individuals with readmitted within 30-, 60-, and 90-

days for the same condition, as measured by

diagnostic codes

National Behavioral Health Quality Framework

Priority 4: Assist communities to utilize best practices to enable healthy living

Goals: Support every U.S. community as it pursues local behavioral health priorities and support individuals in achieving recovery Opportunities for success:

Increase the provision of preventive behavioral health services for children and adults Increase the adoption of evidence-based behavioral health interventions to improve public health

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Percentage of service population receiving

evidence based practices

Practitioner Program System Percentage of adults with

a behavioral health disorder who report they

improvement in their quality of life

Clinical training

supporting application of best practices in the context of consumer choice and outcomes

monitoring

Percentage of adults

screened for depression and/or risky alcohol use and receiving a

documented follow-up plan/SBIRT

Number of State

and local governments using

monetary and alternative

incentive programs to support the use of evidence-based services monitored

through EHRs

National Behavioral Health Quality Framework

Priority 5: Make BH care safer by reducing harm caused in the delivery of care

Goal: Eliminate preventable and/or adverse behavioral health care induced consequences Opportunities for success:

Reduce adverse medication events Eliminate abuse and neglect in psychiatric facilities

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Percentage of complaints of alleged abuse, neglect, and

rights violations substantiated and not

withdrawn by the client that resulted in positive

change as a result of PAIMI involvement

Practitioner Program System Number of individuals

with a behavioral health disorder reporting an

emergency department visit for an adverse medication event

Number of clinicians

using EHR’s to manage patient records

Percentage of

patients maintaining positive

diabetic symptom management during

treatment in specialty factility

Percentage of communities

implementing a prescription drug

monitoring program

National Behavioral Health Quality Framework

Priority 6: Foster affordable high quality BH care for individuals, families, employers and governments by developing and advancing new delivery models Goal: Reduce behavioral health costs while improving service quality and efficiency for individuals, families, employers and government Opportunities for success:

Increase health insurance coverage Improve access to behavioral health care Reduce financial barriers to care

Illustrative Measures

SAMHSA Managed

Structural Level

Population Level

Number of admissions to substance abuse treatment programs

receiving public funding

Practitioner Program System Percentage of individuals who report that financing and/or cost is a barrier to accessing ad/or receiving behavioral health services

Percentage of allied

health care practitioners providing

SBIRT services for primary care practitioners

Enrollment success

rate among new treatment admissions

Percentage of

individuals receiving recovery support services

Stakeholders13

Stakeholders14

National Behavioral Health Quality Framework Priorities, Goals and Illustrative Measures

• Designed to begin a dialogue with stakeholders to create specific quantitative goals and measures

• SAMHSA and HHS will promote effective measurement while minimizing the burden of data collection by:• aligning measures across programs• coordinating measurement with the private sector; and • developing a plan to integrate reporting on quality

measures with the reporting requirements for meaningful use of electronic health records

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Initial thoughts on Acton Steps

• Policy Instruments and Tools – Measurement process– Technical assistance Programs– Contract specifications– Terms and provisions on grants– Assessment and dissemination of best practices– Organizational design (SAMHSA’s role in health

homes)– Payment systems (collaborations with CMS, State

programs)

Next Steps

• Public comments on SAMHSA’s National Behavioral Health Quality Framework can be submitted through Thursday September 1st

– Send comments by email to SAMHSA at SAMHSAinfo@samhsa.hhs.gov

– Put “Quality” in email subject line