june 16, 2011 michael reiter, pharmd executive director

June 16, 2011Michael Reiter, PharmD Executive Director

Saumitra SenGupta, PhD Sandra Sinz, LCSW, CPHQInformation Systems Director Operations Director

Overview of APS California External Quality Review Organizationwith a Special Focus on Older Adults

California Mental Health Planning Council

Older Adult Committee

© 2011 APS Healthcare, Inc. 2

Data: Hui Zhang, PhD

Production: Esperanza Calderon


Our Approach

EQROReviews

Quality and Performance Improvement

Wellness,Recovery,

andResilience

Key Informant Interviews

Technical Assistance and

Training

CulturalCompetence

Consumer and Family MemberFocus Groups

PerformanceImprovement

Projects

Data AnalysisInformation Systems

CapabilitiesAssessment

PerformanceMeasurement

FinalReport

CAEQRO Activities

August 2008


Site Review Process

Highlights

Consistent core phases– Pre-site planning

– Site visit

– Post-site analysis

Customized to MHP– Seven years’ data

– Input from many individuals

– Year-to-year follow up

Annual update and revision of review materials

We Heard From… 1,047 people (FY05)

1,612 people (FY06)

2,666 people (FY07)– 663 Consumers and

family members


family members


family members


family members


Key Components Tables

1. Quality

2. Access

3. Timeliness

4. Outcomes

Components



A current strategic plan/initiatives drives the service delivery system

Quality management and performance improvement are organizational priorities

Data is used to inform management and guide decisions

Investment in information technology infrastructure is a priority

Integrity of Medi-Cal claim process, including determination of beneficiary eligibility and timely claims submission

Effective communication from MHP administration

Stakeholder input and involvement in system planning and implementation

Consumers and family members are employed in key roles throughout the system

1. Quality Components



Service accessibility and availability are reflective of cultural competence principles and practices

Manages and adapts its capacity to meet service needs

Penetration Rates are used to monitor and improve access

Integration and/or collaboration with community based services

2. Access Components



Tracks and trends access data from initial contact to first appointment.

Tracks and trends access data from initial contact to first psychiatric appointment.

Tracks and trends access data for timely appointments for urgent conditions.

Has a mechanism to assure timely access (within 7 days) to follow up appointments after hospitalization.

Tracks and trends No Shows and implements quality improvement activities to improve overall timeliness to services.

3. Timeliness Components



Consumer run and or consumer driven programs

Measures clinical and/or functional outcomes of consumers served

Has one active and ongoing (clinical) PIP

Clinical PIP shows post-intervention results

Has one active and ongoing (non-clinical) PIP

Non-Clinical PIP shows post-intervention results

Utilizes information from DMH/POQI Satisfaction Surveys

Utilizes information from Consumer Satisfaction Surveys

4. Outcomes Components


Consumer/Family Member Process

How do the EQRO reviews compare to other reviews of County Mental Health Plans?

What parts of the review do the C/FM consultants typically participate in? – Pre- and post-site, on-site

– Key components

– Focus groups

Highlights in conducting CFM focus groups (both the positives and the challenges).


Promising Practices

County Webinar Presentations

Monterey– Using data for quality management and client centered care:

Monterey experience post-EMR implementation

– Presented on November 15, 2010

Trinity– Process Mapping and Workflow Analysis: What, Why, How

– Presented on December 16, 2010

Marin– Providing Behavioral Health & Primary Care Services under

One Roof: The Marin County Mental Health Experience

– Presented on February 10, 2011


Access

Medi-Cal Eligibles & Beneficiaries Served Calendar Year 2005-2009

Calendar Year

Statewide CANOLA

Total Medi-Cal Eligibles

Total Beneficiaries

ServedTotal Medi-Cal

Eligibles

Total Beneficiaries

Served

CY05 6,810,962 430,877 4,353,453 302,116

CY06 6,783,625 426,158 4,380,931 297,839

CY07 6,837,351 430,406 4,470,483 300,005

CY08 6,983,132 445,651 4,630,972 310,086

CY09 7,381,253 441,682 4,954,687 302,406

Key Findings — Eligibles v. Beneficiaries Served


Quality: Performance Improvement Projects

What is a Performance Improvement Project (PIP)?– In general terms, a PIP is “a systematic process for improving

the quality of care and service designed, conducted and reported in a methodologically sound manner.”

– To elaborate, the Protocol defines a PIP as “a set of related activities designed to achieve measurable improvement in processes and outcomes of care. Improvements are achieved through interventions that target health care providers, practitioners, plans, and/or beneficiaries.” (Human Services Research Institute, 2004)

PIPs are generally more functional if the MHP receives support than creating it in isolation. – Examples: SCERP I, SCERP II, CalMEND

Challenges– Rapid cycle measurements have been problematic; CalMEND

can be of assistance


Quality: Performance Improvement Projects

PIP Descriptive Category by MHP Size

Descriptive Category Fiscal Year

MHP Size

Total PercentSmall-Rural Small Medium Large

Use of acute or inpatient Services

06-07 3 4 1 19

10%

07-08 10

8 2 4 24

28%

08-09 11

13 8 4 36

40%

09-10 3 6 4 6 19

23%

Improved diagnosis or treatment processes

06-07 9 8 7 9 33

38%

07-08 1 6 5 11

23

27%

08-09 2 3 4 12

21

23%

09-10 5 4 9 7 25

31%

Other PIP categories include:– Business process improvement– Co-occurring disorders– Physical health care– Psychiatrist/medication appointment

– Retention– Wellness, recovery and resilience– Other


Outcomes

High Cost Beneficiaries

Statewide Medi-Cal Eligibles & Beneficiaries Served

Approved Claims Summary CY05-09CY05 CY06 CY07 CY08 CY09

Total Medi-Cal Eligibles 6,810,962 6,783,625 6,837,351 6,983,132 7,381,253

Total Beneficiaries Served 430,877 427,232 430,406 445,651 441,682

Total Approved Claims (in Billions) $1.68 $1.85 $1.93 $2.09 $2.11

% of Approved Claims by Top 4% of Beneficiaries Served 36% 37% 37% 38% 37%


Timeliness

We ask counties for data on timeliness of first

appointment, first psychiatric appointment, access

to urgent care, post-hospitalization services, and

No Shows


Information Systems

0 5 10 15 20 25 30 35 40

Assessments

Document Imaging

Electronic Signature Consumer

Electronic Signature Provider

Laboratory Results

Outcomes

Prescriptions

Progress Notes

Treatment Plans

Number of MHPs

NA* Not Present Partial Present

*NA includes those MHPs for which this information was not collected or not available

Figure 3-1. Electronic Health Record Functionality


Information Systems

New Information System Status

FY05-06 FY06-07 FY07-08 FY08-09 FY09-10

# % # % # % # % # %

No plans for new information system

9 16% 5 9% 4 7% 7 12% 14 25%

Considering new information system

8 14% 4 7% 6 11% 5 9% 4 7%

Actively searching for new information system

11 20% 17 30% 14 25% 11 20% 12 21%

New information systems selected, not implemented

19 34% 7 13% 3 5% 4 7% 3 5%

Implementation in progress

9 16% 17 30% 22 39% 25 45% 17 30%

New system in place

0 0% 6 11% 7 13% 4 7% 6 11%

TOTAL 56 100% 56 100% 56 100% 56 100% 56 100%

# = Number of MHPs


CAEQRO Website - Homepage

www.caeqro.com Register online, if you have not done so already


CAEQRO Website – Register


CAEQRO Website – Log-on Page


CAEQRO Website – Finding Data

Reports and Presentations Tab


CAEQRO Website – Finding Data

Data Analysis Tab


Penetration Rates by Age Groups

Statewide Penetration Rates by Age Groups CY07-09

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%

CY07 CY08 CY09

Statewide 0-5 6-17 18-59 60+


Number of Beneficiaries by Age Groups

Statewide Beneficiaries Served by Age Groups CY07-09

050,000

100,000150,000200,000250,000300,000350,000400,000450,000500,000

CY07 CY08 CY09

Statewide 0-5 6-17 18-59 60+


Approved Claims by Age Groups

Statewide Approved Claims per Beneficiaries Served by Age Groups CY07-09

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500$5,000

CY07 CY08 CY09

Statewide 0-5 6-17 18-59 60+


Penetration Rates by Race/Ethnicity

Statewide Penetration Rate by Race/Ethnicity CY07-09

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

CY07 CY08 CY09

White Hispanic African-AmericanAsian/Pacific Islander Native American Other


Number of Beneficiaries by Race/Ethnicity

Statewide Beneficiaries Served by Race/Ethnicity CY07-09

020,00040,00060,00080,000

100,000120,000140,000160,000180,000

CY07 CY08 CY09



Approved Claims by Race/Ethnicity

Statewide Approved Claims Per Beneficiary Served by Race/Ethnicity CY07-09

$3,000

$3,500

$4,000

$4,500

$5,000

$5,500

$6,000

CY07 CY08 CY09



Number of Beneficiaries by Gender

Statewide Beneficiaries Served by Gender CY07-09

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

0-5 6-17 18-59 60+

CY07 Female CY07 Male CY08 Female

CY08 Male CY09 Female CY09 Male


Approved Claims by Gender

Statewide Approved Claims Per Beneficiary Served by Gender CY07-09

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

0-5 6-17 18-59 60+

CY07 Female CY07 Male CY08 Female

CY08 Male CY09 Female CY09 Male


Older Adult Beneficiaries by Gender

Older Adult Beneficiaries Served by Gender CY07-09

0

5,000

10,000

15,000

20,000

25,000

30,000

CY07 CY08 CY09

Female Male


Older Adult Approved Claims by Gender

Older Adult Approved Claims Per Beneficiary Served by Gender CY07-09

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

CY07 CY08 CY09

Female Male


Older Adult Beneficiaries by Age and Gender

Older Adult Beneficiaries Served by Age and Gender CY07-09

02,0004,0006,0008,000

10,00012,00014,00016,00018,00020,000

55-59 60-64 65-69 70-74 75-79 80-84 85+

CY07 Female CY08 Female CY09 Female

CY07 Male CY08 Male CY09 Male


Older Adult Approved Claims by Age and Gender

Older Adult Approved Claims Per Beneficiary Served by Age and Gender

CY07-09

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

55-59 60-64 65-69 70-74 75-79 80-84 85+

CY07 Female CY08 Female CY09 Female

CY07 Male CY08 Male CY09 Male


Older Adult Beneficiaries by Race/Ethnicity

Older Adult Beneficiaries Served by Race/Ethnicity CY07-09

0

5,000

10,000

15,000

20,000

CY07 CY08 CY09



Older Adult Approved Claims by Race/Ethnicity

Older Adult Approved Claims Per Beneficiary Served by Race/Ethnicity CY07-09

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

CY07 CY08 CY09



Older Adult Beneficiaries by Age and Ethnicity

Older Adult Beneficiaries Served by Age and Ethnicity CY09

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

CY09 55-59 CY09 60-64 CY09 65-69 CY09 70-74 CY09 75-79 CY09 80-84 CY09 85+

White Hispanic African-American Asian/Pacific Islander Native American Other


Older Adult Approved Claims by Age and Ethnicity

Older Adult Approved Claims Per Beneficiary Served by Age and Ethnicity CY09

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

CY09 55-59 CY09 60-64 CY09 65-69 CY09 70-74 CY09 75-79 CY09 80-84 CY09 85+

White Hispanic African-American Asian/Pacific Islander Native American Other


Number of Beneficiaries by Service Categories

Statewide Beneficiaries Served by Service Activity CY07-09

050,000

100,000150,000200,000250,000300,000350,000400,000

TBS Day Treatment

23 Hours Services

24 Hours Services

Linkage/Brokerage

MedicationSupport

Outpatient Services

CY07 CY08 CY09


Approved Claims by Service Categories

Statewide Approved Claims Per Beneficiary Served by Service Activity CY07-09

$0$2,000$4,000$6,000$8,000

$10,000$12,000$14,000$16,000$18,000

Linkage/Brokerage

MedicationSupport

23 Hours Services

Outpatient Services

24 Hours Services

Day Treatment

TBS

CY07 CY08 CY09


Number of Beneficiaries by Age Groups and Service Categories

Older Adult Beneficiaries Served by Age and Service Activity CY09

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

0-5 6-17 18-59 60+

24 Hours Services 23 Hours Services Day Treatment Linkage/BrokerageOutpatient Services TBS Medication Support


Approved Claims by Age Groups and Service Categories

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

$16,000.00

0-5 6-17 18-59 60+

Approved Claims Per Beneficiary Served by Age and Service Activity CY09

24 Hours Services 23 Hours Services Day Treatment Linkage/BrokerageOutpatient Services TBS Medication Support


Older Adult Beneficiaries by Age and Service Categories

Older Adult Beneficiaries Served by Age and Service Activity CY09

0

5,000

10,000

15,000

20,000

25,000

55-59 60-64 65-69 70-74 75-79 80-84 85+

24 Hours Services 23 Hours Services Day TreatmentLinkage/Brokerage Outpatient Services Medication Support


Older Adult Approved Claims by Age and Service Categories

Older Adult Approved Claims Per Beneficiary Served by Age and Service Activity CY09

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

55-59 60-64 65-69 70-74 75-79 80-84 85+

24 Hours Services 23 Hours Services Day TreatmentLinkage/Brokerage Outpatient Services Medication Support


Number of Older Adult Beneficiaries by MHP Size

Older Adult Beneficiaries Served by MHP Size CY07-09

0

5,000

10,000

15,000

20,000

CY07 CY08 CY09

Large Medium Small Small-Rural Very Large


Older Adult Approved Claims by MHP Size

Older Adult Approved Claims Per Beneficiary Served by MHP Size CY07-09

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

CY07 CY08 CY09

Large Medium Small Small-Rural Very Large


Number of Older Adult Beneficiaries by Region

Older Adult All Beneficiaries Served by Region CY07-09

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

CY07 CY08 CY09

Bay Area Central Los Angeles Southern Superior


Older Adult Approved Claims by Region


Older Adult Service Retention

7.696.085.516.18

39.65

34.88

7.935.925.426.54

41.8

32.4

10.24

7.265.946.22

36.71

33.63

10.52

8.136.445.36

35.54

34.02

13.69

8.026.185.8

34.64

31.67

14.75

8.636.215.4

33.72

31.29

18.5

10.14

10.01

6.46

26.74

28.14

0%

20%

40%

60%

80%

100%

55-59 60-64 65-69 70-74 75-79 80-84 85+

1 service 2 services 3 services 4 services 5-15 services > 15 services

Retention Rates - Ages 55-85+ CY09

Questions?

Comments?

june 16, 2011 michael reiter, pharmd executive director

Documents

total approved claims

cy09 data

total beneficiaries

total medical eligibles

unreleased annual report

review tables

number of reviews walter

additional question