Texas Council Endorsed Measurement Strategy

Transcription

1 Texas Council Endorsed Measurement Strategy During 2013, the Data Work Group of the Texas Council of Community Centers met to identify a set of clinical quality measures that can be used across the entire behavioral health sector. What began with a wide-scale process to review scores of measures, resulted in concise list of measures adopted by the Texas Council members. As stated in the Data Work Group Charter, the goal of the Measurement Task Force was to endorse 5-7 clinical quality measures for Texas Council members that are aligned with: DSRIP requirements and MU measures; Needs of DSRIP partner agencies; Based on national research and/or a national dataset; Clinically relevant to Texas Council members; and Operationally feasible for Texas Council members. In order to achieve these ends, the Measurement Task Force started with a list of more than 100 measures related to outpatient behavioral health. These were gleaned from various sources including quality measures associated with Federal Programs like Accountable Care Organizations (ACO), Meaningful Use (MU) Stage 2, and CMS s Health Care Innovations Awards (HCIA). Additionally, the group looked at measures as identified by third-party quality organizations like the National Quality Forum (NQF), the National Council for Quality Assurance through their Healthcare Effectiveness Data and Information Set (HEDIS) measures, and the Center for Quality Assessment and Improvement in Mental Health (CQAIMH). Finally, the group also reviewed measures included in the State of Texas 1115 Demonstration Waiver for its Delivery System Reform Incentive Payment (DSRIP) program. Through multiple discussions, The Data Work Group identified key objectives for a measurement approach, and charged a Measurement Task Force (MTF) broad responsibilities for evaluating different measures. At a high level, the measures must be both clinically relevant and operationally feasible; however, the MTF was given leeway to interpret this. Although no single measure was expected to embody all of the objectives, collectively the endorsed measures and must represent the approach as described by the Data Work Group. To this end, the Data Work Group requested measures that: Can be readily produced with information and systems as they currently exist; Employ, where possible, outcome (not merely process) measures; Effectively convey to other care providers the value of behavioral health services in terms that are germane to other care providers; Communicate to the entire state how behavioral health providers would like to encourage system-wide development. The initial list contained more than 100 measures. The MTF then engaged in a series of efforts to winnow down the list. After multiple meetings and discussions, the MTF reached an initial Page 1 of 13

2 Clinical Relevance Lower Higher consensus to limit subsequent discussion to just 30 measures broadly aligned with the Data Work Group approach. Using these 30 measures, the MTF scored each measure with two separate scores on a 1-10 scale one axis concerns clinical relevance, the other operational feasibility. For both scales, 1 was lowest and 10 the highest. These measures were then plotted on a chart as a way to drive additional discussion among the MTF and the Data Work Group. Diabetes Monitoring for People With Diabetes and Schizophrenia Adherence to An psycho c Medica ons for Individuals With Schizophrenia 9.5 Follow-up a er Hospitaliza on for Mental Illness Bipolar Disorder (BD and Major Depression (MD): Appraisal for alcohol or substance use Diabetes screening for people with Assessment of Major Depressive schizophrenia or bipolar disorder who Symptoms are prescribed an psycho c Ini a on of Depression Treatment 8.5 medica ons (SSD) Housing Assessment for Individuals with Schizophrenia Assignment of Primary Care Physician to Individuals with Schizophrenia 8 An depressant Medica on Management BBD and MD: Assessment 9.5 for Manic or 10 hypomanic behaviors Cardiovascular health monitoring for people with cardiovascular disease and schizophrenia (SMC) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia Voca onal Rehabilita on for Schizophrenia Annual Physical Exam for Persons with Mental Illness Scored BH Clinical Measures 10 Decrease in mental health admissions and readmissions to criminal jus ce se ngs such as jails or prisons Depression Remission at 12 months 7.5 Care Planning for Dual Diagnosis Behavioral Health /Substance Abuse 30 9 day readmission rate Assessment for Medical Problems of Psychiatric Pa ents Assessment for Substance Abuse Problems of Psychiatric Pa ents Assessment of Risk to Self/Others Independent Living Skills Assessment for Individuals with Schizophrenia Diabetes monitoring for people with diabetes and schizophrenia Follow-Up Care for Children Prescribed ADHD Medica on Assessment for Psychosocial Issues of Psychiatric Pa ents Screening for clinical depression and f/ u plan Depression Screening By 18 years of age Lower 6 Higher Feasibility Finally, from this list of 30 measures, the MTF settled on just 12, with the intention of bringing them back to the entire Data Work Group for discussion and, eventually, endorsement. From among these 12 measures, the Data Work Group took an approach of looking for a combination of measures to reflect the over-all orientation of the Texas Council. As a result, some measures are more clinical in focus; some are process measures; some are aspirational in that they require data not currently available to Council members. Collectively, however, they demonstrate the commitment of Council Members to using health information to drive quality improvements. The Work Group believes that individuals served by community centers deserve the highest caliber of care for the totality of their health conditions regardless of whether the benefit is accrued to behavioral health providers. These measures are intended to communicate the value of behavioral health services to all stakeholders in the continuum of care. On January 17, 2014 the Texas Council Executive Directors Consortium reviewed and approved an Endorsed Measurement Strategy an approach to clinical quality measures that reflects a balanced approach to quality. This strategy identifies a core set of quality measures that all Texas Council of Community Centers Page 2 of 13

3 community centers must tract, and provides one of two options to reflect local implementation of assessment tools. The strategy further identifies two measures that require additional refinement before they can be effectively implemented either because the measure lacked clarity, or because data was not currently available to make the measure most valuable. Finally, for centers desirous of a stretch goal, the strategy approved also recommends but does not require two additional measures. Required Measures: NQF #105: Antidepressant Medication Management; and NQF #1932: Diabetes Screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications (SSD); and NQF #0576: Follow-up after Hospitalization for Mental Illness; and NQF #1879: Adherence to Antipsychotic Medications for Individuals With Schizophrenia. Either/or o Improvement as demonstrated through CANS/ANSA scores; or o Improvement as demonstrated through DLA20/GAF score. Development Measures Proportion of crisis episodes that result in an admission to a state hospitals and DSHSfunded community hospitals within 30-days of the first day of the crisis episode o Needs a more precise definition of a crisis episode Behavioral Health Re-admission Rate: o Needs better information from the State with regard to discharge data from all hospitals. High Value Menu Measures NQF #1934: Diabetes monitoring for people with DM and Schizophrenia Decrease in mental health admissions and readmissions to criminal just settings Details for these measures are included in subsequent pages. Texas Council of Community Centers Page 3 of 13

4 Required Measures: NQF #105: Antidepressant Medication Management HEDIS/DSRIP/MU Stage 2 Strong measure, but difficulty will be in obtaining the fill rate especially for non-insured consumers. Definition: Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported. a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months). Description: Numerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114- day period following the Index Prescription Start Date Numerator 2: Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231- day period following the Index Prescription Start Date Included Population(s) Patients 18 years of age and older with a diagnosis of major depression in the 180 days (6 months) prior to the measurement period or the first 180 days (6 months) of the measurement period, who were treated with antidepressant medication, and with a visit during the measurement period. Excluded Population(s) Individuals are excluded from the denominator if they have diabetes (during the measurement year or the year prior to the measurement year). Local Modification: 1. Only report on fill /pick-up rates for patients for whom you have pick-up/fill information. NQF #1932: Diabetes screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications (SSD) Definition: The percentage of individuals years of age with schizophrenia or bipolar disorder, who were dispensed any antipsychotic medication and had a diabetes screening during the measurement year. Texas Council of Community Centers Page 4 of 13

5 Description: One or more glucose or HbA1c tests performed during the measurement year. Included Population(s) Adults ages 18 to 64 years of age as of December 31 of the measurement year with a schizophrenia or bipolar disorder diagnosis and who were prescribed any antipsychotic medication. Excluded Population(s) Have Diabetes Texas Council of Community Centers Page 5 of 13

6 NQF #0576 Follow-up after Hospitalization for Mental Illness DSRIP/HEDIS Full compliance will requires that behavioral health agencies receive notification of hospital discharges, perhaps through an HIE or some other means. Currently, agencies are only notified of state psychiatric hospital discharges. Definition: This measure assesses the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported. 1. The percentage of members who received follow-up within 30 days of discharge 2. The percentage of members who received follow-up within 7 days of discharge. Description 1. An outpatient visit, intensive outpatient encounter or partial hospitalization with a mental health practitioner within 30 days after discharge. Include outpatient visits, intensive outpatient encounters or partial hospitalizations that occur on the date of discharge. 2. An outpatient visit, intensive outpatient encounter or partial hospitalization with a mental health practitioner within 7 days after discharge. Include outpatient visits, intensive outpatient encounters or partial hospitalizations that occur on the date of discharge. Included Population: Members 6 years and older as of the date of discharge who were discharged alive from an acute inpatient setting (including acute care psychiatric facilities) with a principal mental health diagnosis on or between January 1 and December 1 of the measurement year. The denominator for this measure is based on discharges, not members. Include all discharges for members who have more than one discharge on or between January 1 and December 1 of the measurement year. Mental health readmission or direct transfer: If the discharge is followed by readmission or direct transfer to an acute facility for a mental health principal diagnosis (within the 30-day follow-up period), count only the readmission discharge or the discharge from the facility to which the member was transferred. Although rehospitalization might not be for a selected mental health disorder, it is probably for a related condition. Texas Council of Community Centers Page 6 of 13

7 Excluded Population(s) Exclude both the initial discharge and the readmission/direct transfer discharge if the readmission/direct transfer discharge occurs after December 1 of the measurement year. Exclude discharges followed by readmission or direct transfer to a nonacute facility for a mental health principal diagnosis within the 30-day follow-up period. These discharges are excluded from the measure because readmission or transfer may prevent an outpatient follow-up visit from taking place. Refer to Table FUH-B for codes to identify nonacute care. Non-mental health readmission or direct transfer: Exclude discharges in which the patient was transferred directly or readmitted within 30 days after discharge to an acute or nonacute facility for a non-mental health principal diagnosis. This includes an ICD-9-CM Diagnosis code or DRG code other than those in Tables MPT-A and MPT-B. These discharges are excluded from the measure because rehospitalization or transfer may prevent an outpatient follow-up visit from taking place. Local Modification: Operationalize members to mean individuals who are already known to the LMHA who are discharged from DSHS Beds or where the LMHA receives a referral. Strong runway possibilities to communicate care coordination with other care providers and/or the state. Texas Council of Community Centers Page 7 of 13

8 NQF #1879: Adherence to Antipsychotic Medications for Individuals With Schizophrenia HEDIS Definition The measure calculates the percentage of individuals 18 years of age or greater as of the beginning of the measurement period with schizophrenia or schizoaffective disorder who are prescribed an antipsychotic medication, with adherence to the antipsychotic medication [defined as a Proportion of Days Covered (PDC)] of at least 0.8 during the measurement period (12 consecutive months). Description: Individuals with schizophrenia or schizoaffective disorder who filled at least two prescriptions for any antipsychotic medication and have a Proportion of Days Covered (PDC) for antipsychotic medications of at least 0.8. Included Population: Individuals at least 18 years of age as of the beginning of the measurement period with schizophrenia or schizoaffective disorder with at least two claims for any antipsychotic medication during the measurement period (12 consecutive months). Excluded Population(s): Individuals with any diagnosis of dementia during the measurement period. Local Modification: 1. Only report on fill /pick-up rates for patients for whom you have pick-up/fill information. Texas Council of Community Centers Page 8 of 13

9 Care Improvement: CANS/ANSA or DLA20/GAF Score Improvement Child and Adolescent Needs and Strengths/Adult Needs and Strengths Assessment (ANSA) Intention is to build towards use of the CANS/ANSA as a tool to assess efficacy of on-going treatment. Initially must establish a benchmark completion rate for Texas/Texas Council Members. Numerator: Adult: Patients 18 and older who had any improvement in their ANSA score between two ANSA assessments more than 3 months apart in the last 12 months. Children: Patients older than 6 and younger than 18 who had any improvement in their CANS score between two CANS assessments more than 3 months apart in the last 12 months. Denominator: Adults: All patients 18 and older with two ANSA assessments more than 3 months apart in the last 12 months. Children: Patients older than 6 and younger than 18 with with two CANS assessments more than 3 months apart in the last 12 months. Exclusions: Local Implementation Mathematical adjustment for % of population Daily Living Activities 20/Global Assessment of Functioning (GAF) Score Like the CANS/ANSA, the intention is to build the use of the DLA 20/GAF score into standard practice so agencies can report on changes (reductions) to the GAF scores over time. Initially, however, this measure will look at the percentage of patients treated in the last 12 months with a GAF score present. The DLA20 is validated for frequent use (monthly) and is relatively inexpensive. Also like the CANS/ANSA completion rate, a benchmark or target rate will need to be established. Numerator: # of Patients 18 and older who had any improvement in their GAF score at least 3 months apart in the last 12 months. Denominator: All patients 18 and older with at least one visit in the last 12 months. Texas Council of Community Centers Page 9 of 13

10 High Value Menu NQF #1934: Diabetes monitoring for people with DM and Schizophrenia Definition: The percentage of individuals years of age with schizophrenia and diabetes who had both and LDL-C test and an HbA1c test during the measurement year." Description: One or more HbA1c tests and one or more LDL-C tests performed during the measurement year. Included Population(s): Adults age 18 years and older as of December 31 of the measurement year with a schizophrenia and diabetes diagnosis. Excluded Population(s) Members with a diagnosis of polycystic ovaries (Table CDC-O) who did not have a face-to-face encounter, in any setting, with a diagnosis of diabetes (CDC-B) during the measurement year or the year prior to the measurement year. Diagnosis may occur at any time in the member s history, but must have occurred by December 31 of the measurement year. Members with gestational or steroid-induced diabetes (CDC-O) who did not have a face-to-face encounter, in any setting, with a diagnosis of diabetes (CDC-B) during the measurement year or the year prior to the measurement year. Diagnosis may occur during the measurement year or the year prior to the measurement year, but must have occurred by December 31 of the measurement year. Local Comments: High value menu (i.e. optional) set twinned with NQF #1932. Consider future modification to have diagnosis population consistent with NQF #1932 (i.e. include BPD) Texas Council of Community Centers Page 10 of 13

11 Decrease in mental health admissions and readmissions to criminal justice settings such as jails or prisons This measure will require closer electronic coordination between the criminal justice system and the behavioral health sector. Such coordination is in its early stages, and will require additional development to be fully realized. Will need to define admission to a criminal justice setting. Likely will be a challenge to implement since the measure, as described in the planning document, is focused on decreasing incarceration rates among individuals with a history in a specific agency who were discharged in a baseline year. Description: Decrease in mental health admissions and readmissions to criminal justice settings such as jails or prisons. Goal: Reduce the number of individuals receiving project interventions who had an admission/readmission to criminal justice setting by 15% below baseline rate. Author/Source Submitted by: MHMR Authority of Brazos Valley This project is expected is expected to prevent admissions/readmissions into the criminal justice system of individuals with primary mental health issues, and help to reduce the criminalization of mental illness. Local Comments: TLETS system is currently the only way of obtaining information on people with psychiatric issues being discharged from criminal justice settings. Poor data. Of those LMHA patients with criminal justice history in the last 12 months, what percent return to prison/jail in the next 12 months. Texas Council of Community Centers Page 11 of 13

12 Development Measures Crisis Episodes: The proportion of crisis episodes that result in admission to a State hospital or DSHS-funded community hospital within 30 days of the first crisis episode Denominator: The number of Crisis Episodes that result in an admission to State hospitals and DSHS funded community hospitals within 30 days of the first day of the Crisis Episodes. Numerator: The number of Crisis Episodes. Local Approach: Look at something with a higher level of validity on how to define an episode. Communicate to state where we want to get with this measure it should ultimately be expanded so that it is not limited to state-funded psychiatric hospitals and/or DSHS-funded beds. Exclude: Substance abuse crisis treatment Texas Council of Community Centers Page 12 of 13

13 Behavioral Health Readmission Rate: Description: Behavioral Health 30-day Readmission Rate Denominator: Adults discharged who are readmitted to a public mental health bed with a principal diagnosis of a behavioral health condition within 30 days. Numerator: Adults discharged from any hospital with a principal diagnosis of a behavioral health condition. Comments: This is a critical measure for hospitals and other healthcare providers, yet LMHAs currently lack adequate connectivity to achieve this. Texas Council of Community Centers Page 13 of 13