EQRO DMC-ODS Survey July 2016 for CBHDA governing Board Saumitra SenGupta, PHD Rama K Khalsa, PhD

Overview of Survey & Goals Obtain Updated Information on DMC Processes/Prep from Phase I and II Timing of Plan Submission and Structure (Individual or DMC group) Understanding Level of Integration with MH or Public Health and key leaders coordinating DMC-ODS Work in each County Understand County ASAM Preferences and Technical Assistance Needs Survey available software systems in use for County and Contract Providers Preferences for Separate or Side by Side EQRO Reviews with MH Plans Performance Outcome Measures Recommended or In Place Obtain Recommendations for Process of EQRO success with DMC-ODS

20 Counties Responded Counties with Plans Submitted: Monterey, Santa Cruz, San Francisco, Santa Clara, San Mateo, Los Angeles, Riverside, Marin, Napa, Contra Costa, Counties with Plans Pending: Alameda – late July, San Diego – late September, Orange – October, San Bernardino-July, Santa Barbara-uncertain, Sonoma-July, San Joaquin – July, Solano-uncertain, San Luis Obispo- July

DMC-ODS Structure & Level of Integration with Mental Health & Public Health 18 Individual County Plans & 2 Undecided about regional DMC-ODS MH Integrated Departments: 14 integrated, 4 separate, 2 undeclared Integrated Quality Improvement Teams: 13 integrated, 7 separate Integrated MIS/IT Teams: 10 integrated, 7 separate, 2 undeclared Have Electronic Medical Records System?: 15 yes (Avatar, Cerner, ECHO/Sharecare, CoCentrix/profiler, moving to Epic (2), Bestnotes, Tower, WITS, Salesforce), 5 no Contractor MIS Systems: 16 yes partial, 4 no (Cerner/Anastasi, Netsmart/Avatar, MethaSoft, Askesis, Sigmund, WITS, Aegis, MedMark Treatment, Healthy Connections, Accucare, Seneca

EQRO Review Baseline Year Processes Familiar with EQRO Process and Participated in Review: 15 yes, 2 no, 3 undeclared Separate EQRO Visit for DMC-ODS or Side by Side Review with MH – 11 Same time (Side by side) Reviews (Santa Cruz, San Mateo, San Francisco, San Bernardino, Orange, Monterey, Marin, Riverside, Alameda, Contra Costa, Sonoma, San Joaquin) 5 Separate Reviews -Santa Clara, LA, Napa, San Luis Obispo, Solano 2 Not Sure – Santa Barbara, San Diego

Additional Performance Measures besides CalOMS in use now by Counties % of clients who receive services in preference language % of clients available for exit interviews % of clients using Vivetrol or Suboxine % of clients with 2 or more encounters in first 30 days % of clients in recovery (sober) at time of discharge Population based measures specific to age, race, ethnicity Initiation and Engagement reports for all providers of direct services (use claim data) Reminder: 7 federally mandated EQRO Performance Measures & 5 additional measures with State approval first year Mandated Performance Measures: Access/ Timeliness, Penetration Rate, Total Unduplicated Beneficiaries Served, Cost per beneficiary, Cultural Needs Met in Service Delivery System, Coordination with other MediCal physical health services, acute care/detox follow to treatment

Additional Performance Measures in use by Counties (continued) Days from request (phone or in person) to first visit (could be assessment/evaluations) Days from request to first treatment visit Days from assessment to first treatment visit ASAM levels tracked on Avatar Many specific contractor measures linked to level of care Clinical Performance Measures linked to practice standards Family reunification EQRO State Desired Elements: *Coordination/Collaboration with non-DMC Services *Effectiveness – Evident Based Practices two or more, length of stay in total SUD program services measured by sequential treatment episodes, engagement as measured by numbers/intensity of visits, transfers between levels of care based on client clinical needs, symptom reduction and improved life functioning.

SUD Client Satisfaction/Experience of Care Surveys 9 Counties do them at least annually 8 Counties do not do Surveys, 1 County undeclared 5 survey samples provided which will be in full EQRO report of survey Many counties report contractors doing their own surveys of patient care Many counties used some combination of MHSIP SUD questions and customer service questions on hours, transportation, provider and admin staff courtesy and helpfulness, etc.

Other Types of TA Needed: 1. Help explaining EQRO to our contracting partners 2. Descriptive list of identical requirements between SUD and MH EQRO; what other requirements SUD EQRO would need to measure 3. Any and all help you can lend will be appreciated

County Recommendations for EQRO Process Identify and share early key PM indicators and how they will be measured Get County SUD clinical Input on measures and indicators Standard Terms & Conditions not specific, need more clarification in operational terms It would be helpful to have one standardized short client satisfaction tool and process Wait one year from plan approval to do first review If Joint Review with MH add additional day(s) not more simultaneous sessions SUD systems need focused individual attention and support, not easy to do with MH at same time ASAM is unique to SUD and deserves extra system focus and support Onsite training early and often to reduce problems especially with PIPs Development and support focus for all first year reviews, get baseline data, educate

DMC-ODS EQRO Next Steps Create Clinical Committee to provide input on review measures/indications Twice per month meetings starting July 22 to react to draft measures/indicators Go to Meeting Forum to Allow Discussion –email Rama Khalsa to participate Will share grid of national sets of SUD performance measures (HEDIS, AHRQ, National Quality Board, ASAM, County Performance Measures) Do EQRO Training August 23-26 DHCS SUD Conference Orange County Hyatt Schedule on site reviews in response to individual county requests Schedule Northern and Southern CA PIP trainings using SUD examples and new tools (Oct 12, 13, 14, 2016 – locations to be announced with webinar capacity) Individualized DMC TA support for draft PIP ideas and concepts Continue intensive coordination with CBHDA, SAPT, CIBHS, DHCS

Behavioral Health Concepts, 590 Christie Ave, Suite 502, Emeryville, CA. 94608, 855-385-3776 CalEQRO- DMC Staff Resources– Saumitra SenGupta, PhD Exec Director, Saumitra.sengupta@bhceqro.com, 855-385-3776, ext109 Rama K Khalsa, PhD, Director Drug MediCal EQRO, rama.khalsa@bhceqro.com, 855-385-3776, ext136 Leslie Tremaine, Special SUD Consultant, leslie.Tremaine@bhceqro.com, 855-385-3776, ext137 Bill Ullom, Chief Information Systems Reviewer, bill.ullom@bhceqro.com, 855-385-3776, 104 Amy McCurry Schwartz, Special Consultant PIPs, amy.mccurry@bhceqro.com, 855-385-3776, 103