November Data Jam. Mastering PSYCKES: Maximizing Multiple Data Sources to Operationalize a Population Health Approach

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1 November Data Jam Mastering PSYCKES: Maximizing Multiple Data Sources to Operationalize a Population Health Approach Anni Kramer, LMSW & Erica Van De Wal-Ward, MA New York Office of Mental Health

2 Anni Kramer, LMSW PSYCKES Implementation Director New York State Office of Mental Health Erica Van De Wal-Ward PSYCKES Medical Informatics Project Director New York State Office of Mental Health Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health

3 CMS Change Package: Primary and Secondary Drivers Patient and Family- Centered Care Design Continuous, Data- Driven Quality Improvement Sustainable Business Operations 1.1 Patient & family engagement 1.2 Team-based relationships 1.3 Population management 1.4 Practice as a community partner 1.5 Coordinated care delivery 1.6 Organized, evidence-based care 1.7 Enhanced access 2.1 Engaged and committed leadership 2.2 QI strategy supporting a culture of quality and safety 2.3 Transparent measurement and monitoring 2.4 Optimal use of HIT 3.1 Strategic use of practice revenue 3.2 Staff vitality and joy in work 3.3 Capability to analyze and document value 3.4 Efficiency of operation

4 Review & Update: CTN Data Dashboards Dashboard data are derived from Medicaid claims data Provides easy access to aggregate, practice-level data on 13 clinical quality measures Shows your most recent PAT scores and progress through CMS Phases of Transformation Financial and utilization data from the Medicaid Data Warehouse will be added to the dashboards soon! See: October 2016 Data Jam

5 # Indicator 1 All-cause 30-day readmission rate following MH inpatient discharge CTN Clinical Quality Measures National Standard NYS 2 30-day MH re-admission NYS 3 Follow-Up After Hospitalization for Mental Illness, 7 Days NQF 0576 PQRS 391 HEDIS FUH- A Numerator Number of all-cause hospital readmissions after MH inpatient discharge in measurement period Number MH readmissions in measurement period The number of MH discharges who had a MH outpatient visit, intensive outpatient encounter, or partial hospitalization with a mental health practitioner within 7 days of discharge Denominator (all years) Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period Target 25% 25% 50% 4 Follow-Up After Hospitalization for Mental Illness, 30 Days NQF 0576 PQRS 391 HEDIS FUH- B The number of MH discharges who had an MH outpatient visit, intensive outpatient encounter, or partial hospitalization within 30 days of discharge Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period 50% 5 Adherence to antipsychotic medications (PDC) for people with schizophrenia (%) NQF 1879 PQRS 383 HEDIS 2016 Number of people with schizophrenia or schizoaffective disorder with adherence to antipsychotic medication [defined as a Proportion of Days Covered (PDC)] of at least 0.8 during the measurement year. Total number of people with schizophrenia or schizoaffective disorder with 2+ claims for any antipsychotic medication during measurement year 80%

6 # Indicator Adherence to mood stabilizers for people with bipolar I disorder (%) Use of Antipsychotic Drug Clozapine for Schizophrenia Use of antipsychotic long acting injectable (LAIs) for schizophrenia Use of multiple concurrent antipsychotics Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (%) National Standard NQF 1880 (NYS OMH) (NYS OMH) HEDIS v2016 NQF 1932 Numerator Number of people with Bipolar I Disorder that received a mood stabilizer that had a Proportion of Days Covered (PDC) for mood stabilizer medications (including AP) 0.8 during the measurement year. Number of people with schizophrenia with 1 or more clozapine claims in measurement year Number of people with schizophrenia who are exposed to LAIs (1 or more prescriptions in measurement year) The number of people on antipsychotic medication and who received two or more concurrent antipsychotic medication prescriptions for > 90 days during measurement year. Number of people with schizophrenia and bipolar who were dispensed an antipsychotic medication and had a diabetes screening during the measurement year Denominator (all years) Total number of people with Bipolar I Disorder who fill 2+ prescriptions for a mood stabilizer in measurement year Total number of people with schizophrenia during measurement year Total number of people with schizophrenia during measurement year Total number of people ages years who were on antipsychotic medication > 90 days in the measurement year Total number of people with schizophrenia or bipolar disorder who were dispensed an antipsychotic medication in the measurement year Target 80% 25% 25% 25% 80%

7 # Indicator 11 LDL screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (%) National Standard NQF 1927 Numerator Number of people with schizophrenia and bipolar who were dispensed an antipsychotic medication and had an LDL- C test during measurement year Denominator (all years) Total number of people with schizophrenia or bipolar disorder with 1+ antipsychotic in the measurement year Target 80% day initiation and engagement of alcohol and other drug (AOD) dependence treatment (14 days) NQF 004 MU 137v4 PQRS 305 Number of people with a new AOD episode in first 10.5 months of the measurement year and received AOD treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the index episode start date Total number of people diagnosed with a new AOD episode (alcohol or other drug dependency) during the first 10.5 months of the measurement year 25% day initiation and engagement of AOD dependence treatment NQF 004 MU 137v4 PQRS 305 Number of people diagnosed with a new AOD episode during the first 10.5 months of the measurement year and received AOD treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 30 days of the index episode start date Total number of people diagnosed with a new AOD episode during the first 10.5 months of the measurement year 25%

8 CTN Dashboard Key Points Data are aggregated from Medicaid claims; dual eligible patients are not represented in the data Each quarter, a full 12 months of data are uploaded to the dashboard Data are mature - the October 2017 data upload reflects data from January- December 2016 If the denominator of eligible clients is less than 10, you will not see any data in the dashboard Dashboard data can help you track population-level trends and identify where to focus your QI efforts

9 Using PSYCKES with your CTN Data Dashboard PSYCKES provides one way to drill down from the aggregate data you see on your CTN data dashboard There is not a 1:1 relationship between the CTN dashboard measures and the measures in PSYCKES Nonetheless, PSYCKES can help you: Analyze CTN dashboard numbers Identify clients in your current population where you can intervene to improve those numbers Make individual clinical decisions Understand your general client population for quality improvement and risk stratification Explore your client utilization and provider network for VBP

10 PSYCKES Data: Who & What Who is Viewable? Over 7 million NYS Medicaid enrollees (currently or previously enrolled) Fee for service, Managed Care encounters, Medicaid data only for dual eligible Medicaid/Medicare The Behavioral Health population: a paid claim with either a psychiatric or substance use service, diagnosis or medication What is Available? 1. Medicaid data: All paid services; time lag varies from weeks to months depending on how quickly providers bill and Managed Care plans submit to DOH 2. Non-Medicaid data: real time (0-7 day lag) State Psychiatric Center EMR data ACT & AOT provider and contact information Health Home enrollment and Care Management provider information Managed Care Plan & HARP Status NIMRS suicide attempts

11 PSYCKES Navigation: Screens PSYCKES is organized in the following 8 tabs: My QI Report Statewide Reports Provider Search Recipient Search Registrar Menu Usage Reports Utilization Reports User Settings Not all providers will have access to all tabs

12 Example 1: Intervene with current clients You identify a CTN dashboard measure that you want to improve Use PSYCKES Quality Indicators in My QI Reports to find current clients that are flagged for that same quality concern Drill down to individual clients and export list Provide client names to applicable staff to support intervention When a client has a quality flag, you can also access that individual s PSYCKES clinical summary for additional clinical history and decision support Review PSYCKES data over time to see if that flag has dropped and numbers improve

13 Quality Indicator QI Flag Definitions 10 Indicator Sets: BH QARR- DOH Performance Tracking Measures BH QARR Improvement Measures General Medical Health HARP Enrolled Not Health Home Enrolled High Utilization Inpatient/ER Polypharmacy Preventable Hospitalization Readmission Post-Discharge from any Hospital Readmission Post-Discharge from this Hospital Treatment Engagement Each indicator set is made up of several measures

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15 Example 2: Analysis of CTN data You identify a CTN dashboard measure that you want to explore further: The numbers don t match your internal program data or your experience Over time, your %s improve and you want to understand why so you can do that more Over time, your %s get worse and you want to understand why so you can do that less Use PSYCKES My QI Report and Recipient Search to (approximately) find the individual clients in that cohort Depends on measure: PSYCKES has people with a quality concern; some CTN measures are for those without the quality concern Cohorts may not match perfectly (time frame or specifications different) Export and review client list/charts Identify some hypotheses about what systems/client care could have impacted those numbers (root cause analysis) Develop QI project and PDSA!

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17 Other PSYCKES Uses Clinical Summaries for individual clinical decision-support Utilization Reports to Support VBP Preparation Recipient Search to identify high need cohorts/cohorts of interest And more for future Data Jams!

18 Clinical Summary: Levels of Access

19 Clinical Summary: How to Consent 1. Consent clients (at intake) using PSYCKES consent form: At and go to About PSYCKES page 2. Go to Recipient Search screen 3. Search for client using unique identifier 4. Click Change PHI Access Level 5. Select level of access 6. Confirm client identity 7. Submit

20 How to Consent: Find Client in Recipient Search

21 How to Consent: Search for Client w/ Unique Identifier Main Street Agency Medicaid ID or Social Security # (SSN), or First Name (at least 2 characters) and Last Name (full) and DOB

22 How to Consent: Change PHI Access Level

23 How to Consent: Select Level of Access

24 How to Consent: Confirm Client Identity & Submit

25 Review Clinical Summary

26 Three Utilization Reports to Support VBP 1. Payer Mix Which Managed Care Plans and product lines are my clients enrolled in? Which plans and product lines should I focus on? 2. Provider Network Which other providers do I share clients with, for what service types? For example, my mental health clinic clients use which SUD services, medical ERs, or outpatient medical services? Who should I partner with? 3. Service Settings and Volume What services are my clients consuming from me, and from other providers? How many encounters per year, by service type (at my agency, at other providers, and in total)

27 Report 1: Medicaid Managed Care Plan & Product Line

28 Report 2: Provider Network

29 Report 3: Service Settings & Volume

30 Recipient Search to Identify High Need Cohorts Use Recipient Search to generate list of clients meeting specified criteria Characteristics Filters: Health and Recovery Plan (HARP) Status Managed Care (MC) Plan Assisted Outpatient Treatment (AOT) Status Alerts & Incidents: Suicide Attempts, Suicidal Ideation, Self-Harm Service Setting Categories: Health Home Enrolled (Source: DOH) Inpatient & Emergency Room (ER) ACT MH Specialty Search by Quality Flag or add to any Search

31 Recipient Search Characteristic Filters

32 Example: Look at Alerts & Incidents

33 Recipient Search Service Setting Options

34 Example: Look at Inpatient and ER

35 Recipient Search: Add a Quality Flag to Any Search

36 Example: Look at 2+ Inpatient/ER - BH

37 Helpful Resources October 2016 Data Jam Data dashboard user guide (attached as a handout) Cheat sheet --Data upload schedule / timeframes covered Cheat sheet Measure list and targets PSYCKES Helpdesk Support: PSYCKES-Help@omh.ny.gov Monday to Friday, 9 am 5 pm PSYCKES Trainings: Recorded webinars: Live trainings:

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40 Thank you! The project described was supported by Funding Opportunity Number CMS-1L from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.