Ensuring Quality Outcomes in Behavioral Health
Care with the Integration of Healthcare
NASMHPD Annual Meeting
Washington, DC July 29, 2014
Tim Knettler, MBA, CAE
Executive Director/CEO
National Association of State Mental Health Program
Directors Research Institute, Inc. (NRI)
Table of Contents
• NRI’s New Initiatives
• 2013 State Profiles
• 2014 Case Studies of Early Innovator States
o Health/Behavioral Health Integration
• Assessing two Outcomes for Consumers Served by
State Mental Health Agencies:
(1) Improving Competitive Adult Employment &
(2) Reducing Homelessness
• Psychiatric Hospital Reporting Performance
Requirements – The New Landscape
3
New NRI Initiatives
Strategic Planning and New Initiatives
NRI Vision, Mission, Values
• Vision: No person's life will be limited by mental illness
or addiction.
• Mission: NRI products and services support and enable
actions that improve mental health and wellness.
• Values: NRI pursues its mission according to the
following core values:
o Lack of bias
o Life enhancing value
o Insight
4
New NRI Initiatives
NRI is working with its Board and States to develop new
initiatives to meet State needs
1. Pilot/Develop an Integrated Medicaid Claims and State
Behavioral Health Agency Data System
2. Customized State Reports to help SBHAs with budgeting,
planning, operations and policy
3. Help SBHAs respond to critical incidents and legal actions
by accessing the latest state and national data customized
to state needs
4. Assessing the Premature Mortality of SBHA Clients
5. Psychiatric Hospital Analytics/Consultations to comply
with new requirements and Improve Outcomes
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2013 State Profiles: Funding and
Characteristics of SMHAs and
SSAs
• New SAMHSA publication that focuses on
how SMHAs and SSAs are organized,
financed and major policy initiatives
o Jointly produced by NRI, NASADAD,
and Truven Health Analytics
• Focus on SMHA and SSA activities to
integrate health-BH care and impact of
ACA implementation
• Report will be available on the SAMHSA
website in August, 2014
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2014 State MH Profiles:
Case Studies of Early
Innovator States
•
1.
2.
3.
Activities in 3 major policy areas—
Health-Behavioral Health Integration
Implementing Evidence-Based Practices
Changing SBHA Business Practices (including EHRs)
o How Parity and ACA impact SBHA activities?
o Effects on State General Funds and MH Block
grants?
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Health-Behavioral Health
Integration: Early Results
Factors that Impact Health-BH Integration:
• Medicaid Support: Support for health integration
initiatives from State Medicaid Agencies was a key to
successful integration across the early innovator states.
• State Leadership: Identifying a common cause, issue,
report, or topic to rally state leadership around a focus
on behavioral health was seen as vital.
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Health-Behavioral Health
Integration: Early Results (continued)
Factors that Impact Health-BH Integration:
• Long Term Planning: a long-term planning effort to
comprehend the complexities of integration of system
changes (can easily take from 1.5 to 3 years).
• 42 CFR Part 2: limits the sharing of patient
information on substance use clients restricts state’s
ability to share substance use treatment data with
primary care providers and HIEs.
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Focus on Two SAMHSA
MH National Outcome
Measures (NOMS)
• Improving Competitive Employment
• Reducing Homelessness
Uses information from:
• the Annual CMHS/SAMHSA Uniform Reporting
System (which collects information on 7.2 million
persons served by SMHAs each year)
• MH-Client Level Data: de-identified client level data
from SMHAs
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Competitive Employment of
Adults in the SMHA System:
2013
Employed
17%
Not In Labor
Force
53%
Unemployed
30%
26.8% of all SMHA Adult Consumers had an unknown employment status in 2013, an improvement from 30% in 2003
Source: 2013 SAMHSA Uniform Reporting System (URS)
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Percent of SMHA Mental Health
Consumers Competitively Employed:
2003 to 2013
25%
20%
15%
23.0%
21.0%
21.0%
22.0%
21.0%
21.0%
19.0%
16.9%
20.0%
18.1%
17.0%
10%
5%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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Adult Employment:
Diagnostic Group
2012, Employed At Start of Reporting Period , Ages 18-64
Employed
25.0%
20.0%
19.7%
16.1%
15.6%
15.2%
15.0%
10.9%
10.9%
10.0%
8.1%
5.0%
0.0%
Anxiety Disorders
Personality
Disorders
Bipolar Disorders
ADHD
Delusional and
Other Psychoses
Intellectual
Disability
Schizophrenia
Employed
Total N=1,344,579 (59.8%); missing=902,982 (40.2%)
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Employment Change During
2012 from T1 to T2
90%
80%
(For Clients Ages 18-64 who were
Employed at T1)
76.6%
70%
60%
50%
40%
30%
20%
11.2%
12.2%
10%
0%
Maintained Employment from T1 Moved from Employed at T1 to
to T2
Unemployed at T2
N=701,581
2014 NASMHPD Commissioners Meeting: July 29, 2014
Moved from Employed at T1 to
Not In Labor Force at T2
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Living Situation of Adult
Consumers: 2012
Foster Home, 0.7%
Residential Care, 4.9%
Crisis Residence, 1.4%
Residential Treatment
Center, 0.1%
Institutional Setting,
3.9%
Private Residence,
78.7%
Jail (Correctional
Facility), 2.3%
Homeless (Shelter),
4.0%
Other, 4.1%
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Homelessness Rate:
Age & Gender
2012, At Start of Reporting Period
10%
Male
9%
Female
8%
Homelessness Rate at Each Age
7%
6%
5%
4%
3%
2%
1%
0%
5
10
15
20
25
30
35
40
45
50
Client Age
55
60
65
70
75
80
85+
Male: N=1,070,796 (68.0%); missing=503,423 (32.0%) Female: N=1,143,532 (69.0%); missing=512,679 (31.0%)
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Homelessness Rates:
Major Diagnostic Groups
2012, At Start of Reporting Period, Ages 18+
Percent of Each Diagnostic Group That Were Homeless
10%
9%
8.8%
Male
Female
8%
6.7%
7%
6%
6.6%
5.4%
5.3%
5.2%
5%
4.5%
4%
3.3%
3.2%
2.7%
3%
3.2%
3.1%
2.6%
2.4%
1.8%
2%
2.1%
1%
0%
Delusional
and Other
Psychoses
Bipolar
Disorders
Depressive
Disorders
Personality Schizophrenia
Disorders
Total N=1,508,607 (63.6%); missing=864,935 (36.4%)
Anxiety
Disorders
ADHD
Intellectual
Disability
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Percent of Persons Homeless At T1
Living Situation at T2
60%
Living Situation at T2 (End of Year or
Discharge) for SMHA Adult (age 18+)
Consumers who were Homeless at T1
(Admission/Start of Year)
51.9%
50%
40%
33.8%
30%
20%
10%
4.6%
7.4%
2.3%
0%
Homeless at T2
Total N=1,054,951
Homelike setting at T2 Residential Care at T2 Institution/Jail/Prison
at T2
Other Residential
Status at T2
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Living Situation at T2 (End of Year or
Discharge) for SMHA Adult (age 18+)
Consumers who were Living in a Homelike
Setting at T1 (Admission/Start of Year)
Percent of Persons Living in a Homelike
Setting At T1 Living In Situation at T2
100%
93.3%
90%
80%
70%
60%
50%
40%
30%
20%
10%
1.0%
1.1%
Homeless at T2
Homelike setting at Residential Care at T2 Institution/Jail/Prison
T2
at T2
0%
Total N=1,054,951
.8%
3.8%
Other Residential
Status at T2
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Psychiatric Hospital Reporting
Performance Requirements –
The New Landscape
CMS Requirements IPFQR
• IPFQR program: Inpatient Psychiatric Facility Quality
Reporting program
o Free-standing psychiatric hospitals and psychiatric
units (IPF) (approximately 1800)
o Measures apply to the Medicare certified units
reimbursed under the IPF Prospective Payment
System (PPS)
o Independent of accreditation
o Failure to report quality measure results in a 2
percentage point reduction in the hospital’s
annual payment update determination
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Requirement – FFY2014
- Completed
• Oct 2012 – Mar 2013 data on HBIPS 2 -7
o HBIPS: Hospital Based Inpatient Psychiatric Services core
measure set.
o Measure steward: The Joint Commission
• 100% of NRI facilities met the requirement
• 62 facilities lost 2 percentage points in their Annual Payment
Update for not meeting the requirements (none of the NRI
facilities lost revenue)
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Current & Proposed CMS
Reporting Requirements
Reporting Requirements
16
14
12
10
Aggregate Count
8
Attestation
6
Quality Measures
4
2
0
2015
2016
2017
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Requirements – Current
and Future
• FFY2015
o April 2013 – Dec 2013 data on HBIPS 2-7
• FFY2016
o Calendar 2015 data on HBIPS 2-7; SUB-1: Alcohol Use
Screen.
o FUH: Follow-up after hospitalization. (Note: this
measures will be calculated by CMS based on Claims
data)
o Attestation: Is facility conducting a “Patient Experience
of Care” survey
o Possible New Attestation: What level of Electronic
Health Record (EHR) the facility is using during
transitions of care
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Requirements – Current
and Future
• FFY2017
o Continuation of all previous measures
o Proposed new measures:
‒ TOB1 – Tobacco Use Screen; TOB2 – Tobacco Use
Treatment provided or offered, TOB2A – Tobacco Use
Treatment provided
‒ IMM-2: Influenza Immunization for patients
‒ Influenza vaccination among health care personnel
‒ Aggregate Population and Sample Counts, by
Medicare/Not Medicare, Age Group, Diagnostic group
• Also undergoing testing/development
o Screenings within 1 day of admission
o All cause, any location readmission rate
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The Joint Commission
Requirements
• Complete reporting
o Underreporting patient-level records will be questioned
and must be corrected
o The Joint Commission has had patient-level data for HBIPS
since the beginning (2008)
o The Joint Commission data integrity process mirrors the
CMS process, although CMS only receives aggregate data
for IPF at this time
• Accountability rate
o Summary calculation across the HBIPS measure must be at
least 85%
o Failure to meet performance levels will result in a ‘Request
for Improvement Action Plan’ during the triennial review
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Assisting your hospitals
with compliance
• Know the rules, prepare to respond to proposed rulemaking
• Ensure hospital commitment to meeting the performance
expectation
• Encourage moving beyond the minimum expectation to
use the data/information to improve care and
coordination with other providers
• NRI – BHPMS resources include numerous reports to
assist with quality initiatives and personal technical
assistance
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Contact
Tim Knettler, MBA, CAE
Executive Director/CEO
www.nri-inc.org
3141 Fairview Park Dr., Suite 650
Falls Church, Virginia 22042-4539
Phone: (703) 738-8161
TKnettler@nri-inc.org
Lucille Schacht, PhD
Senior Director of Performance
and Quality Improvement
Phone: (703) 738-8163
lschacht@nri-inc.org
Ted Lutterman
Senior Director of Government
and Commercial Research
Phone: (703) 638-8164
tlutterman@nri-inc.org
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