Implementation of Performance Improvement Projects

Transcription

1 Implementation of Performance Improvement Projects Mary Marlatt-Dumas, Quality Manager, NMRE, Region 2 Diane L. Bennett, QI Coordinator/Compliance Officer, NorthCare Network, Region 1 Bill Phelps, Quality Improvement & Provider Network Coordinator, Lakeshore Regional Partners, Region 3

2 PIHP PIP presentations Study Topic & Study Question Definitions relevant to PIP Revisions to PIP Origin of Data/Process utilized to extract data Baseline Data Interventions (if applicable) Next Steps

3 Performance Improvement Project May 28, 2015 Improving Outcomes Conference

4 Study Topic: Increasing diabetic screenings for consumers with Serious Mental Illness prescribed an antipsychotic medication by CMH physicians.

5 Study Question: Do targeted interventions increase the percentage of consumers years of age with serious mental illness who were prescribed a second generation antipsychotic medication for six (6) months or more and received an HbA1c or fasting blood sugar test during the measurement year?

6 Study Population Definitions Denominator - Study Population: Medicaid only enrolled adults years old with a serious mental illness prescribed antipsychotic medications by CMH physicians for at least six (6) months during the measurement period. Beneficiary age criteria (if applicable): Adults years old: = Age 18 as of the last day of the measurement year = Age 64 as of the first day of the measurement year

7 Definitions Continued Numerator Number of Individuals (from the denominator) that had a diabetic screening completed during the measurement period.

8 Definitions Consumer (Plan Members): A Medicaid beneficiary who received a Medicaid provided service through an NMRE Member Board at any point in time during the measurement year. Serious Mental Illness for this study is defined as: Major depression (296.xx); schizophrenia (295.xx); bipolar (296.xx); obsessive compulsive disorder (300.3); posttraumatic stress disorder (309.81); borderline personality disorder (301.83); Psychotic Disorders (297.1, 298.9, ). Second Generation Anti-Psychotic Medication includes the following: Abilify (aripiprazole), Clozaril (clozapine), Fanapt (iloperidone), Geodon (ziprasidone), Invega (paliperidone), Latuda (lurasidone), Risperdal (risperidone), Saphris (asenapine), Seroquel (quetiapine), Symbyax (contains both antipsychotic (olanzapine) and antidepressant (fluoxentine)), Zyprexa (olanzapine). The Anti-Psychotic Medication will be prescribed by CMH physicians only. The PIHP will not be looking at antipsychotic medications prescribed by non-community mental health providers.

9 Definitions The Fasting Blood Glucose (FBG) test measures blood sugar levels after a fasting period of eight (8) hours or more, and is most reliable when done in the morning. This test can be used to diagnose pre-diabetes or diabetes. The Hemoglobin A1C (HbA1C) test provides an average blood sugar for the previous two (2) or three (3) months. Unlike the FBG, the A1C does not require a fasting period. Another advantage of A1C is lower variability of test results since A1C levels are less influenced by day to day stress and illness. Targeted Interventions: The targeted interventions have not been defined at this time. Once a baseline has been established then the Quality Improvement structure at each of the five member CMHSPs along with the designated medical and/or data analytics staff will establish targeted interventions in an effort to improve the number of diabetic screenings for those individuals that meet the study criteria.

10 Beneficiary enrollment requirements: Individuals that have Medicaid only Individuals that are dually enrolled in Medicaid/Medicare are excluded from the study. Individuals with Healthy Michigan Plan are included in the study, as Healthy Michigan is a form of Medicaid. Continuous enrollment is not a requirement at this time.

11 Inclusion, exclusion, and diagnosis criteria Inclusions: Individuals with Healthy Michigan Plan (HMP) Any individual that is prescribed an antipsychotic medication for six (6) months or longer Second generation anti-psychotic Medication prescribed by CMH physicians Exclusions: any beneficiary that is dually enrolled in Medicaid/Medicare anyone that has been on medications less than six (6) months.

12 PIP Revision NMRE identified one revision upon the submission and validation to Health Services Advisory Group. The revision included a few anti-psychotic medications that were not second generation anti-psychotic medications listed and these medications were removed from the study prior to the baseline data extraction. HSAG was contacted and the revision will be noted in the baseline submission.

13 Origin of Data Data is pulled through the CareConnect 360 system which is made up of claims data and QI data. Programmed data pull includes claims and encounters from CMH, pharmacy data, PCP, and Medicaid claims data, with the exception of Substance Use Data Utilize National Drug Codes and Diabetic Lab Service Codes to identify if the labs were completed.

14 Baseline data Numerator: 163 Denominator: 239 Results = 68% Medicaid Only enrolled adults years old with a serious mental illness prescribed anti-psychotic medications by CMH physicians for at least six (6) months during the measurement period had a diabetic screening completed during the measurement period.

15 Next Steps Each CMHSP will devise its own interventions and track each intervention for the PIHP. The PIHP will then be able to identify which interventions had the greatest impact and make recommendations to other CMHSPs within the region. One CMH has currently already implemented a Pre/Post Questionnaire that is completed by the consumer Managing Your Diabetes

16 PIP #2 Study Topic Smoking assessment and cessation

17 Tobacco Assessment and Cessation Goal: 1. What percentage of members of NMRE, that receive services through one of the five (5) Member CMH Boards use tobacco. 2. Increase # of individuals that quit smoking. 3. Increase # that reduce tobacco usage.

18 Reason for selecting 1. When discussing NMRE members, the PIHP was unable to identify what percentage of those served smoked or utilized any form of tobacco. 2. Desired overall improvement in consumers health 3. Desired improvement in quality of life 4. Increased longevity for those individuals with a severe mental illness. Decrease the 25 year mortality gap.

19 Implementation Step 1: Determine what each CMHSP is currently assessing and capturing electronically. Complete. Step 2: Develop Tobacco Usage Assessment Complete. Step 3: Add Tobacco Usage Assessment to Electronic Health Record Originally slated for March 2015, a little to ambitious. Step 4: Identifying current Interventions being utilized completion date June 2015, on target. Step 5: Identify curriculums for implementation for identified consumers (FY 2015) Step 6: Implement identified interventions to targeted population (FY 2016)

20 Performance Improvement Project May 28, 2015 Improving Outcomes Conference

21 Study Topic To increase the percentage of adults with a mental illness, who indicate a medical diagnosis of obesity in the self-reported health measures, who receive Medical Nutrition Therapy from a primary health care provider. FY13-14 YTD Health Measures showed 32% of adults (Medicaid SMI) self-reported a medical diagnosis of obesity. It is unknown how many (or if any) of the 32% are receiving primary health services to address obesity/nutrition.

22 Study Question Will targeted interventions increase the percentage of adults, with mental illness and a reported medical diagnosis of obesity, who receive Medical Nutrition Therapy from a primary health care provider?

23 Definitions Denominator Study Population: Total number of Medicaid eligible adults with a mental illness who are enrolled in the Medicaid Health Plan and have a selfreported health condition of medical Diagnosis of Obesity Present (2). Adult 18 y/o on first day of the measurement period. Medicaid Eligible eligible for and receiving PIHP mental health services w/identified scope and coverage codes (D1, F1, F2, G3, K1, P1, T1, T2) at any point in time during measurement period. Enrolled in MHP Mental Illness reported disability designation flag (MI) 1 (Yes) Medical Diagnosis of Obesity Present self-reported Health Condition (Obesity) marked with a 2. Resides in NorthCare Network s 15 county region. No exclusions based on special health care needs.

24 Definitions continued Numerator: Total number of Medicaid eligible adults with a mental illness who are enrolled in the Medicaid Health Plan and have a self-reported health condition of Medical Diagnosis of Obesity Present (2) and have at least one claim for Medical Nutrition Therapy. Medical Nutrition Therapy Codes (97802, 97803, 97804)

25 Origin of Data Electronic Health Record ELMER Health Conditions Denominator extracted based on definition and sent to MHP (UPHP) UPHP matched to their claims data by Medicaid ID List all individuals with one of the identified service codes for Medical Nutrition Therapy

26 Revisions to PIP Revised Numerator Original Study: Increase the percentage of adults with a mental illness who indicate a medical diagnosis of obesity in the selfreported health measure who receive a primary health service(s) to address obesity/nutrition. Study Population was the same. Denominator was the same. Numerator included: Medical Nutrition Therapy procedure codes and/or other services related to nine diagnoses: Overweight and Obesity Obesity, unspecified Morbid Obesity Overweight Obesity hypoventilation syndrome other specified disorder of adrenal glands unspecified endocrine disorder other disorder of pituitary and other syndrome of diencephalohypophyseal orgin unspecified hypothyroidism

27 Revisions to PIP After review of baseline data we learned that: a BMI alone may result in one of the diagnoses originally listed We were not able to comfortably relate all claims returned to one of the identified diagnosis codes Example: Baseline returned a claim for 1710 Anesth Elbow Area Surgery was included in the count because of a secondary diagnosis of Morbid Obesity. One recommendation from HSAG: The health plan only needs to document the codes for the entire study population/denominator in Activity III. The health plan should move codes for the numerator to Activity VI.

28 Baseline Data Baseline data: Denominator of 1189 Numerator of 9.76%

29 Next Steps Preliminary plan: Distribute or refer mental health and primary health providers to the Michigan Quality Improvement Consortium (MQIC) Guideline, which provides recommendations for specific interventions for treatment of overweight and obese conditions in adults. Make referral to nutritional counseling.

30 PIP #2 Study Topic Follow-through in addressing identified safety concerns for children. (Health as well.)

31 PIP #2 Reason for Selecting Annual site reviews conducted by MDHHS for the past two years revealed a disconnect between health and safety issues being identified in the bio-psychosocial assessment (BPS) and appropriate followthrough in treatment planning, service provision and/or coordination of care with other service providers.

32 PIP #2 current status Baseline data showed substantial compliance; however, in changing reviewers, due to staffing issues, the first remeasurement declined. Second reviewer did provide training and oversight to baseline reviewer Higher standard of compliance was established due to required documentation training and reviewer. Current reviewer will continue for to ensure rater reliability.

33 Performance Improvement Project May 28, 2015 Improving Outcomes Conference

34 Lakeshore Regional Partners: PIP #1 Study Topic: Consumers Who Filled at Least One (1) Prescription for a Second-Generation Antipsychotic Medication Who Receive an HbA1c, Lipid Panel or FPG Study Question: Will the targeted interventions the PIHP implements result in an increased number of Medicaid eligible adults who received a Hemoglobin A1c (hba1c), Lipid Panel or Fasting Plasma Glucose (FPG) during the measurement period as reported in the State-provided Data Extract from the MDCH Data Warehouse?

35 Definitions Medicaid Eligible Adults: adults age 18 to 64 with at least one (1) Medicaid Covered Service Second Generation Antipsychotics: Abilify, Clozaril, Geodon, Risperidol/Risperidol Consta, Seroquel, Zypresxa/Zyprexa Zydis Numerator: # of Medicaid Eligible Adults with at least one (1) Medicaid Service who filled at least one (1) prescription for a 2 nd Generation antipsychotic medication during the measurement period according to the State-provided Data Extract from the MDCH Data Warehouse Denominator: The total number of Medicaid Eligible adults age 18 to 64 with at least one (1) Medicaid Service who filled at least one (1) prescription for a 2 nd Generation antipsychotic medication during the measurement period according to the State-provided Data Extract from the MDCH Data Warehouse

36 Revisions to PIP Recommendation from HSAG: Change Study indicator title to The percentage of Medicaid Eligible adults Change measurement periods to: Baseline: 10/1/2013 through 9/30/2014 Remeasurement 1: 10/1/2014 through 9/30/2015 Remeasurement 2: 10/1/2015 through 9/30/2016 Set a percentage change goal, not just achieve a statistically significant increase

37 Baseline Data for the LPR Region # of patients prescribed 2 nd generation antipsychotics (SGAs): 4,595 # of above patients receiving one or more recommended labs: 2,010 % of above patients receiving one or more recommended labs: 43.7%

38 Baseline Data by CMHSP Organization Consumers Consumers Percent Screened with SGARx Screened Allegan % Muskegon % Network180 1,315 3, % Ottawa % West Michigan % Grand Total 2,010 4, %

39 Interventions Educational Memo from LRP QI Coordinator to QI Leads at the CMHSP Educational Memo from LRP Medical Director to CMHSP psychiatrists PowerPoint for psychiatrists Lobby Posters Developing process to drill down the data and get it to the case management level for consumer specific intervention

40 Next Steps Additional Clarification from HSAG Keep on Keeping On

41 Lakeshore Regional Partners: PIP #2 Topic: Using Data Analytics to Improve Consumer Treatment

42 Reason for Selection Individuals with SMI face an increased risk of having chronic medical conditions Adults with SMI die on average 25 years earlier than other Americans Local data: Medicaid individuals receiving care management services are no more likely to have seen their PCP in the past year than individuals not receiving care management

43 Reason for Selection % patients with PCP visit in last 12 mos 46% 45% 47% 42% 52% 49% 49% 50% 38% 42% Allegan Muskegon Network180 Ottawa West Michigan No care management Receives care management

44 Current Status

45 PIHP PIP presentations