2014 Pay-for-Performance Review
To
Executive Directors
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Topics
• 2014 Pay-for-Performance (P4P)
• 2014 Results on 2013-14 services
• Comparisons to previous years
• Positive Trends
• Ongoing challenges
• Looking ahead to 2015
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2014 P4P Process
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2014 Levels of Care
• Behavioral Health
Rehabilitation Services
(BHRS) – Wraparound
• BHRS School-based
Therapeutic Services (STS)
• Community Integrated
Recovery Centers (CIRC)
• Extended Acute Care (EAC)
• Host Homes
• Inpatient Psychiatric,
Adult(AIP)
• Inpatient Psychiatric, Child
(CIP)
• Intensive Drug & Alcohol
Outpatient (IOP)
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• Journey of Hope
• Outpatient, Drug &Alcohol
(DAOP)
• Outpatient, Mental Health
(MHOP)
• Residential Treatment
Facilities for Children (RTF)
• Residential Treatment
Facilities for Adults (RTFA)
• Residential Rehabilitation
• Residential Non-Hospital
Inpatient Treatment (RINT)
• Targeted Case Management
(TCM)
Major Activities in 2014
• Spring webinars to review proposed measurements & thresholds
• Fall webinars to review data & new/revised measurements
• Meetings with individual providers at their request
• Piloted addition of participation in a behavioral health screening event for
outpatient providers
• Incorporation of participation in the STS Outcomes Monitoring Project into
scoring
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Status as of February 2015
• Awards totaling over $5 million to providers
• More than 250 reports, in new streamlined format,
have been e-mailed to providers
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Streamlined Provider Summary
• Eliminated redundancy of information from NIAC
and Quality Management reports
• Cover Sheet with relevant information
• Operational Definitions Master Document
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2014 Results
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2014 Results
Number of
Providers Number of
Percentage of
Scored in Providers with a Providers with a Providers Receiving Total Funds in
Level of Care
2014*
Total Score > 70% Total Score > 70% P4P in 2013
2014
BHRS
71
6
8%
44 out of 81 (54%) $
844,960
CIRC
11
1
9%
11 out of 13 (85%) $
92,140
Host Homes
2
0
0%
2 out of 4 (50%)
$
IOP
31
3
10%
21 out of 46 (46%) $
203,164
Inpatient
25
5
20%
15 out of 26 (58%) $
1,622,909
Journey of Hope
4
1
25%
1 out of 4 (25%)
$
128,819
Outpatient D&A
70
16
23%
43 out of 66 (65%) $
500,707
Outpatient MH
134
22
16%
28 out of 108 (26%) $
510,545
Residential Rehabilitation
44
10
23%
27 out of 51 (53%) $
609,439
RTF
13
4
31%
8 out of 19 (42%) $
634,360
RTFA
3
1
33%
2 out of 5 (40%)
$
136,301
TCM
22
2
9%
15 out of 35 (43%) $
187,910
Grand Total
430
71
17%
47%
$
5,471,172
*Excludes providers that did not have a sufficient total denominator to be scored, were out of network, or otherwise
ineligible to receive an award
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2014 Award compared to Past Years
• Total amount of awards by Reporting Year:
– $5.4 million in 2014
– $9.5 million in 2013
– $16 million in 2012
– $13.4 million in 2011
– $3.2 million in 2010
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Positive Trends
Achieving Quality Through P4P
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Residential Rehabilitation: Continuity of Care
Residential Rehabilitation - Women with Children Providers:
Continuity of Care: 30-Day Follow-up Rate
80.00%
72.54%
70.00%
60.00%
64.03%
58.75%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2011
2012
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2013
Child Mental Health Outpatient: Early Engagement
Early Engagement: Percent Having at Least 4 Claims
Within 60 days of Episode Start
60.00%
51.2%
48.06%
50.00%
42.2%
40.00%
37.22%
2011
30.00%
27.59%
2012
2013
20.51%
20.00%
10.00%
0.00%
ASD
Non-ASD
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TCM: Service Delivery and Continuity of Care
TCM - Adult ICM: Service Delivery and
Continuity of Care: Percent Having TCM
Contact Within 2 Days of Inpatient Admission
100.00%
91.31%
90.00%
80.00%
72.20%
70.00%
60.00%
46.80%
50.00%
40.00%
38.20%
30.00%
20.00%
10.00%
0.00%
2010-2011
2011-2012
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2012-2013
2013-2014
Ongoing Challenges
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Ongoing Challenges
• Redundancy of measures
• Allegations and convictions of fraud, waste and
abuse for past awards
• Recognizing consistency in achievement over
multiple years
• Consistently underperforming providers
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2015 and Beyond
Looking Ahead…
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Looking Ahead: 2015 and Beyond
• Ongoing evolution of measurements
• Behavioral health screening event
participation
– Scoring and fairness in application
• Client/Family Satisfaction Survey
– Outcomes data directly from service
recipients and families
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Questions or Comments?
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Thank You!
Suet Lim, PhD
Performance Evaluation, Analytics and
Research
Community Behavioral Health
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