Problem Gambling Treatment Providers

Monthly Call/WebinarQuality Improvement

ReportOverview and

Performance Based Contracting

Greta Coe, Problem Gambling Services Manager

Thomas L. Moore, PhD, Herbert & Louis LLC

April 1, 2015

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AgendaTime Topic3:00pm-3:10pm Introductions/County Roll Call

 3:10pm-3:15pm AMH Update/Announcements

PG System Improvement 5 year Plan UpdateMay PGS All Provider Webinar

3:15pm-3:45pm Presentation Statewide Quality Improvement Report Outcomes Performance Based Payments and Metrics for next Fiscal Year

3:45pm-4:00pm Discussion TopicsPGS Treatment Provider Discussion-Updates from the fieldFuture agenda items: MH clinicians not knowing how to refer and screenTreating gambling addiction and co-occurring disordersIdeas for increasing enrollments

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AMH Updates

1. Community forums completed and next steps

2. May 14 All Provider Webinar3. QIRs4. Budget Notices5. NARA Problem Gambling

Treatment Specialist Position

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Overview

1. Purpose of the Quality Improvement Reports (QIR)

2. Data Collection Protocol

3. Report Contents

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Purpose

Purpose of the Quality Improvement Report (QIR) is to provide a data-driven platform for system-wide, regional, and local agency managers to track performance to contractual and non-contractual goals with the goal of improving system efficiencies and outcomes.

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ProtocolA. Monthly worksheets of the performance

items are distributed to key agency and regional personnel for review and tracking.

B. Local agencies are expected to provide the opportunity for active clients to participate in an anonymous satisfaction survey at least once during each six-month period.

C. Reports are prepared semiannually (July – December and January – June), reviewed by PGS with Herbert & Louis LLC staff, then distributed to local agency directors, with comments.

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Protocol

D. Program strengths and success are normally addressed in the comments that accompany the reports as well as suggestions for possible technical assistance in areas that are consistently below expected benchmarks.

E. In rare situations, PGS may delineate corrective action – this will not come as a surprise.

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Criteria   AboveAverage

Average BelowAverage

         Contractually Required Performance Criteria

         Access/Wait   ◙    Retention   ◙    Completion   ◙    Satisfaction   ◙    Reporting       ◙         

Informational Performance Criteria         Penetration       ◙Length of Stay       ◙Client Authorization       ◙Enrollment Survey Reporting       ◙

Performance SummaryStatewide

July 1, 2014 – December 31, 2014(N=478)

Past Period◙

Current Period

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Contractually Required Performance Criteria

Table 1. Access Wait Time(Percent Less Than 5 Days)

n = 461Average wait times are calculated by determining the number of business days from the initial contact to the first available appointment opportunity. Contractually, providers are required to provide face-to-face access for 90% of all clients within five business days.

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The retention criteria is defined as a minimum of 40% of gambling clients that enter into treatment and remain for a minimum of 10 contact sessions.

Table 2. Retention Rate (In Percent)

n = 417

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Table 3. Successful Completion Rate (Gamblers)

(In Percent)n = 306

Successful program completion is defined as the gambling client having completed a minimum of 75% of the short-term treatment goals, completion of a continued wellness plan (relapse prevention plan) for post treatment, and lack of engagement in problem gambling behaviors for a least 30 days prior to discharge. This criteria has been established as a minimum of 30% successful discharge using the adjusted discharge rate. 

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Table 4. Consumer Satisfaction(In Percent)

n = 184

The client satisfaction criterion is based on gambling clients’ indicated willingness at discharge to recommend the program to others with similar problems. The score is calculated by summing the responses of always and often to this question on the discharge survey. This minimum cutoff is 85% positive rate.

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Contractual stipulations require that: (a) Client intake data (enrollment forms) is submitted within 14 days of the first face to face contact. (b) Discharge data (discharge forms) is submitted within 90 days of last contact. (c) Encounter data is required to be submitted within 30 days following the end of the billing month. The “reporting” criteria indicator is calculated by averaging the percent of submitted data for each set of data and arriving at an overall percent of data submitted within the required time periods.

Table 5. Data Reporting Cycles Enrollment, Termination, and

Encounter Data Reporting Cycles

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Non-benchmarked Performance Indicator Trends

The average number of gambler and family client enrollments is calculated by taking the total number of enrollments and dividing by the number of months in the reporting window. There is no minimum standard for this element.

Table 6. Average Number of Enrollments per Month

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The average number of encounters per gambling client is provided for information. This is based on cases that were closed during the period. This information may understate actual services hours provided if clients discharged during the period had been enrolled prior to the reporting of encounter data. There is no minimum standard for action for this element although 30% less than the statewide average will require written comments discussing potential causative factors and steps that might improve the number of encounters per client.

Table 7. Average Number of Encounters (Gamblers)

n =

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Table 8. Average Number of Open Cases per Month

The average number of open cases per month during the period is provided for information. There is no minimum standard for this element.

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Table 9. Percent of Cases Open Over 12 Months With no Waiver

n = 115The percent of cases that have been open more than 12 months without a waiver is provided for information. As claims will be automatically denied for clients open more than 12 months without a waiver, the expectation is that there will be no such cases.

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The estimated penetration is provided for informational purposes. It is a target of the number of gamblers that would be expected to enroll in your agency’s program during the report period. This number is calculated by multiplying the estimated population 18 years and older by the current estimated prevalence rate (2.7%) of problem and pathological gamblers in the state based on the most recent population study and finally multiplied by 3.0% as a target of the number of individuals that will seek treatment during the period. These estimates are conservative and somewhat coarse. There may be regional variations in the prevalence of the disorder or in the willingness of individuals to seek treatment. Nonetheless, this should serve as a gauge of the outreach efforts for your catchment area. The numbers provided in Chart 11 are for the six month period. Although there is no contractual minimum penetration rate, situations where gambler enrollments are 30% or more lower than the expected rate will require written discussion regarding what steps might be taken to increase enrollments.

Table 11. Estimated Penetration

Gamblers Only(For Six-Month Period)

  

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This data element is provided for information purposes only as there is no contractual minimum rate. This rate is based on the number of gambling clients who volunteer to participate in the system-wide evaluation follow-up activities. Clients may opt out of the follow-up as it is voluntary and care must be exercised by agency staff to ensure that accurate information is provided to the client regarding participation. Based on similar follow-up studies, no fewer than 80% of clients would normally be expected to volunteer. Rates less than this comprise quality improvement efforts. In situations where the authorization rate is 50% or less a written explanation will be required.

Table 12. Client Authorization for Follow-up Rate

n = 478

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Table 13. Combined Enrollment Survey Reporting Rate

n = 416

This data element tracks the combine rate of gambler and family enrollment surveys submitted during the period. Data that was previously required to be collected on the record abstracting form was transferred to the client self report survey. This data is essential to monitoring system performance. The expected reporting rate is 95%. This is not a contractual requirement.

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Agencies that submit client satisfaction surveys will also receive a detail report of how their clients responded to the “most helpful,” “least helpful,” and suggestions for improvement open-ended questions.

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Top Five Performing Agencies

Jefferson BestCare (75)Addictions Recovery Center (60)

Yamhill County (60)Emergence (50)

Josephine Options for Southern Oregon (50)

Maximum points possible:80 with a 10 point bonus for exceeding enrollments

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Prepared ByThomas L. Moore, PhDHerbert & Louis, LLCPO Box 304Wilsonville, OR 97070-0304(503) 685-6100admin@herblou.com  

LLC

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2015-16 Performance Based Contracting MetricsMoving to a Performance Based

Contracting Model starting July 1, 2015Contractors (direct and Counties) will be

eligible for a 5% performance payment each year if metric are met.

There will be five metrics and each represents 1 percent.

Data will be reviewed in mid-March 2016 for the reporting period of July 1, 2015 through December 31, 2015.

Performance payments must be used for problem gambling.

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Performance Based Contracting Metrics1. 95% completion of enrollment surveys2. 50% penetration rate reach for

counties3. 90% of clients seen within 5 business

days (access/wait time)4. 90% of reporting submitted within

contractual requirement timeframe (3 data points- enrollment, discharge and encounter data)

5. 50% or greater of yearly allocation spent on gambling treatment services

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Future Agenda Items

MH clinicians not knowing how to refer and screen

Treating gambling addiction and co-occurring disorders

Ideas for increasing enrollments

Next meeting is May 6, 2015 at 3:00 pm.

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Questions

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