Clinical Committee for DMC-ODS EQRO – September 16 Mtg 11-1pm - Go to Meeting or physical location – Health Improvement Partnership SCC – Scotts Valley, CA.

Clinical Committee DMC-ODS EQRO 11am-1pm Go To Meeting Info https://global.gotomeeting.com/join/618422597 Or dial in phone 1-408-650-3123, code 618-422-597 Physical Location with Lunch – Health Improvement Partnership - SCC 1600 Green Hills Road, Suite 101, Scotts Valley, CA 95066

National Performance Measures Overview – Quality Metrics SUD Key Organizations SUD Measures Surveyed – AHRQ: Agency for Healthcare Research Quality National Quality Forum HEDIS –NCQA National Committee on Quality Assurance ncqa.org ASAM – American Society of Addiction Medicine

Other Data Sources for possible SUD PMs Counties provided recommendations in EQRO survey and on site visits Healthy People 2020 SUD quality goals www.healthpeople.gov/2020/topic/substance-abuse National Household Survey (SAMHSA) www.nsduhweb.rti.org

Types of Performance Measures- SUD Screening for Substance Use & Need for Education and Treatment Initiation in Treatment Engagement in Treatment including MAT by level and type and length of stay Outcomes/Improvements in functioning & level of drug use at end of treatment and follow-up Client Satisfaction with care, process, outcomes

SUD Screening Measures Since most of the screening happens in primary care and other settings that initiate SUD referral, screening measures were not analyzed in depth. Screening is a frequently added or required measure in prevention, Primary Care and for Medicaid Health Plans. SBIRT is most common evidence based tool but there are many others and many that target youth or other groups with risk factors

EQRO SUD Statewide Performance Measures - Current Data Constraints EQRO must use available data sets for statewide comparison –MediCal SUD claims, CalOMS, and MediCal Provider file information, MediCal eligibility files statewide Other measures may be very desirable in terms of linkage to recovery/ SUD wellness but may not be an option at this time for EQRO Counties can do their own enhanced PMs because of having more local data sets such as phone logs/requests for treatment tracking, medical records, special reports, etc.

Initiation of SUD Treatment Percentage of patients or members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient service or partial hospitalization within 14 days of the diagnosis visit. References: Percentage of patients who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient service or partial hospitalization within 14 days of the diagnosis. (AHRQ)1 Percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or partial hospitalization within 14 days of the diagnosis. (AHRQ)1 The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of diagnosis. (ASAM)2   Members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an alcohol or drug-use related outpatient visit, an intensive outpatient encounter or partial hospitalization with a BH practitioner within 30 days and 7 days after discharge. The percentage of discharges for patients 18 years of age and older who had a visit to the emergency department with a primary diagnosis of mental health or alcohol or other drug dependence during the measurement year, AND who had a follow-up visit with any provider with a corresponding primary diagnosis of mental health or alcohol or other drug dependence within 7 and 30 days of discharge. (NQF)3 Members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner within 30 days and 7 days after discharge. (HEDIS)4 Discharged patients who screened positive for unhealthy alcohol use or who received a diagnosis of alcohol or drug disorder during their inpatient stay, who are contacted within 30 days after hospital discharge and follow-up information regarding their alcohol or drug use status post discharge is collected. (ASAM)2 Adolescents and adult members with a new episode of alcohol or other drug dependence who initiate treatment within 14 days of the diagnosis and members who initiated treatment and who had two or more additional services within 30 days of the initiation visit. Adolescents and adult members with a new episode of alcohol or other drug dependence who initiate treatment within 14 days of the diagnosis visit and members who initiated treatment and who had two or more additional services within 30 days of the initiation visit. (HEDIS)4

Engagement SUD Metrics-1 Percentage of patients or members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of initiation visit. References: Percentage of patients who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit. (AHRQ)1 Percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit. (AHRQ)1 The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of initiation visit. (ASAM)2   Percentage of patients aged 18 years and older with a diagnosis of current alcohol dependence or opioid addiction that were counseled regarding psychosocial AND pharmacologic treatment options for alcohol dependence within the 12 month reporting period. Percentage of patients aged 18 years and older with a diagnosis of current opioid addiction who were counseled regarding psychosocial AND pharmacologic treatment options for opioid addiction within the 12 month reporting period. (AHRQ)1 Percentage of patients aged 18 years and older with a diagnosis of current alcohol dependence that were counseled regarding psychosocial AND pharmacologic treatment options for alcohol dependence within the 12 month reporting period. (ASAM)2 Percentage of patients aged 18 years and older with a diagnosis of current opioid addiction that were counseled regarding psychosocial AND pharmacologic treatment options for opioid addiction within the 12 month reporting period. (ASAM)2

Engagement SUD Metrics - 2 Summary of the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED. References: Summary of the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED. (AHRQ)1 Summary of the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED. (ASAM)2 Medicine Assisted Treatment Number of individuals with at least one prescription for appropriate pharmacotherapy for alcohol or opioid dependence at any time during the measurement year compared to (or divided by) the Number of individuals with any encounter associated with diagnosis of alcohol dependence (primary or other) at any time during the measurement year. Number of individuals who initiate pharmacotherapy within 30 days following index visit with relevant diagnosis of alcohol or opioid dependence compared to (or divided by) the total number of individuals with index visit associated with relevant SUD diagnosis (e.g., alcohol dependence or opioid dependence ) after 60 day period with no SUD claims. Initiation of pharmacotherapy within 30 days of index visit (new episodes of alcohol dependence or opioid dependence, measured separately). (ASAM)2 Numerator: Number of individuals who initiate pharmacotherapy within 30 days following index visit with relevant diagnosis of alcohol dependence Denominator: Number of individuals with index visit associated with relevant diagnosis (e.g., alcohol dependence or opioid dependence) after 60 day period with no SUD claims.  

Engagement SUD Metrics - 3 Percentage of inpatient /residential and outpatient detox episodes that have 7 day follow-up visits of any SUD treatment after discharge/transfer   References: Percentage of inpatient detox episodes that have 7 day follow-up (ASAM)2 Percentage of outpatient detox episodes that have 7 day follow-up (ASAM)2 Patients who are identified with alcohol or drug use disorder who receive or refuse at discharge a prescription for FDA-approved medications for alcohol or drug use disorder, OR who receive or refuse a referral for addictions treatment . Patients who are identified with alcohol or drug use disorder who receive or refuse at discharge a prescription for FDA-approved medications for alcohol or drug use disorder, OR who receive or refuse a referral for addictions treatment. (ASAM)2 Percentage of total patients with 3 visits within 30 days of initiation visit - Total program patients who have identified SUD diagnosis who get 3 or more visits within 30 days of initiation visit (ASAM) and diagnosis.

Outcomes/Follow-up Recovery & Relapse - SUD Metrics Key Indicator per ASAM research – rapid engagement/treatment on demand/at appropriate level of care; Length of Stay in treatment and sustained recovery supports = linked to recovery consistently per ASAM – chronic disease model best framework; Measures of drug use at end of each treatment level of care/episode – via bio tests, counselor assessment, self report (similar to CalOMS) Functioning Indicators at end of treatment episodes or regular intervals – arrests, housing, parenting & reunification, school, employment, acute care episodes, etc. (similar to CalOMS but follow-up after treatment at 6 months, annual for several years depending on study) MAT linked treatment showed consistently better outcomes for chronic alcoholism and opioid use (see Dr Tsai summary on MAT for references and Dr. Goplerud summary)

SUD Client Satisfaction Outcomes 1 Percentage of adult patients who reported how often they get treatment quickly. (AHRQ)1 Percentage of adult patients who reported how often their clinicians communicated well. (AHRQ)1 Percentage of adult patients who reported how much of a problem they had getting treatment and information from their health plan or managed behavior health organization. (AHRQ)1 Percentage of adult patients who rated how much improvement they perceived in themselves. (AHRQ)1 Percentage of adult patients who reported whether they were provided information about treatment options. (AHRQ)1 Adult patients' overall rating of the counseling or treatment they received. (AHRQ)1 Percentage of adult patients who reported whether they were told about medication side effects. (AHRQ)1 Percentage of adult patients who reported whether someone talked to them about including family or friends in their counseling or treatment. (AHRQ)1 Percentage of adult patients who reported whether they were given enough information to manage their condition. (AHRQ)1 Percentage of adult patients who reported whether they felt they could refuse a specific type of medicine or treatment. (AHRQ)1 Percentage of adult patients who reported whether anyone shared information regarding their counseling or treatment that should have been kept private. (AHRQ)1

SUD Client Satisfaction Outcomes 2 Percentage of adult patients who reported whether the care they received was responsive to their cultural needs. (AHRQ)1 Percentage of adult patients who reported how much they were helped by the counseling or treatment they received. (AHRQ)1 Percentage of adult patients who reported whether they were told about other ways to receive treatment after their benefits were used up. (AHRQ)1

ASAM Quality & Fidelity as DMC System of Care Percentage of patients with 2 or more levels of care in past year with SUD diagnosis Percentage of clients with 2 or more levels of care in past year with different providers Percentage of clients served at appropriate ASAM level of care based on ASAM assessment Percentage of clients evaluated with ASAM tools for transitions in care as reflected in medical records

Key References for Background Agency for Healthcare Research and Quality. National Quality Measures Clearinghouse: https://www.qualitymeasures.ahrq.gov/matrix.aspx. Accessed: July 13, 2016 American Society of Addiction Medicine, Inc. Performance Measures for the Addiction Specialist Physician. Adapted by the ASAM Board of Directors. November 19, 2014. See web site for comprehensive ASAM outcomes and tools. National Quality Forum. Behavioral Health Endorsement Maintenance 2014: Phase 3, Final Report. May 19,2015 NCQA- HEDIS Behavioral Health Resource Guide. 2016.

Recommendations & Principles for PMs for DMC-ODS??? Group At least one PM for each type of metric: initiation/access; treatment engagement/intensity; outcomes/functioning; evidence based linkage to recovery/follow-up measures; satisfaction (UCLA?) At least two child/adolescent measures? At least one linked to effectiveness of new Medicaid services? At least one linked to MAT? At least one linked to culturally appropriate care? Other suggestions on principles - group

Highly Recommended SUD PMS – Ideas from each participant of best options will be compiled 1 2 3 4 5 6 7 8 9 etc

Next Clinical Meeting is Sept 30 11-1pm – PMs to reviewed with DHCS in October as draft concepts. Same log in and same location Thanks for your help Send additional ideas to rama.khalsa@bhceqro.com