August 9, 2018 Jose J. Arbelaez Director of Epidemiology RecoveryStat – Summer 2018 Overview of Public Behavioral Health System (PBHS) Baltimore City - FY2017 August 9, 2018 Jose J. Arbelaez Director of Epidemiology

RecoveryStat Process and goals Provider-driven development process Generation of indicators to paint the picture of a high quality behavioral health system Action-oriented discussion Goals Increasing access, quality, effectiveness and efficiency of the public behavioral health system Increasing the capacity of the network to use data to drive decision making Being nimble and responsive to the needs of Baltimore City consumers

ASO/Beacon Health Data What it can tell us What it cannot tell us Mental Health claims SUD claims Reimbursed costs Dates of service and flow of consumers across providers, time and behavioral health system silos Gaps in service time Capacity but might be overextending or not necessarily fully realized Privately-funded services Need or demand that exceeds what is reimbursed The Black Box of claims data Integrated Behavioral Health Report Complete Residential providers (until January 2019) Providers serving Baltimore City residents ≠ providers IN Baltimore City Number of IDs may ≠ number of providers/consumers Billing and CPT code complexities

Your role – Bringing the data to life Do these data resonate with you? Important piece of the puzzle missing? Helping us contextualize – historical, service or consumer side, etc. Change is the keyword Tracking change is vital Consider how you might use these data Advocacy Decision support Solution finding Forecasting What analyses would be helpful for future meetings? What data needs should we anticipate? Can be macro or micro Changes in consumer needs

Baltimore City – Behavioral health Epidemiological Profile

Baltimore – A City Of neighborhoods Demographics Total Population: 614,664 (2016 ACS estimate) Age: Youth (21.2%) and Adults (78.8%) Median: 34.7 years. Gender: Female (52.9%); Male (47.1%) Race: African Americans (64%); White (29%); Other (7%) Socio-Economic Income: Median Household ($44,262) Poverty Rate: 21.8% Unemployment Rate: 6.3% Health Indicators (Rates) Life Expectancy: 73.4 years Mortality: 1,089 deaths per 100,000 people (2016) Infant Mortality: 8.8 deaths per 1,000 live births Mixed pattern with Chronic Diseases, Trauma, Homicides, and Infectious Diseases (HIV/AIDS) Overdose Deaths

Overdose death rates Baltimore City (BC) and Maryland (MD) 2007-2017

Heroin-related death rates Baltimore City (BC) and Maryland (MD) 2007-2017

Fentanyl-related death rates Baltimore City (BC) and Maryland (MD) 2007-2017

Baltimore City – Behavioral health prevalence rates (General Population)

ANY Mental Illness – Baltimore city *Any Mental Illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder, which met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Serious Mental Illness – Baltimore city Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012–2014

Substance use (past Month) – Baltimore city Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012–2014.

Substance use disorders – Baltimore city *Substance Use Disorder (either Alcohol and/or Illicit Drugs) includes the concepts of Dependence or Abuse. Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Baltimore City – Behavioral health prevalence rates (Youth population)

MH proxy indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

MH proxy indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

SUD indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

SUD indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

SUD indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

SUD indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

SUD indicators – Baltimore city Source: CDC Youth Risk Behavior Surveillance System (YRBSS), 2015

Baltimore City - Utilization Data from the public behavioral health system (PBHS)

people served during FY2017 (MH, SUD and BOTH) Data Source: ASO Claims FY2017 Total Unduplicated: 74,930 people served MH = 59,559 Overlap = 16,850 SUD = 32,221

MH – people served FY15-17

SuD – people served FY15-17

MH - Expenditures FY15-17

SuD - Expenditures FY15-17

MH – residents – people served (%) FY15-17

SuD – residents – people served (%) FY16 -17

MH – average cost per consumer FY15-17

SuD – average cost per consumer FY16 -17

MH – average cost per consumer by Age groups FY17

SuD – average cost per consumer by Age groups FY17

MH – Adults vs. youth FY15-17

SuD – Adults vs. youth FY16 -17

MH – expenditures by service lines FY17

SuD – expenditures by service lines FY17

MH – Baltimore city - expenditures by service lines FY17

SuD – Baltimore city - expenditures by service lines FY17

MH – statewide - expenditures by service lines FY17

SuD – statewide - expenditures by service lines FY17

MH – Medicaid penetration rates FY15-17

Discussion Next Steps

Contact us Jose J. Arbelaez Jose.Arbelaez@BHSBaltimore.org 100 S. Charles Street, Tower II, 8th Floor, Baltimore, MD, 21201 Phone: 410-637-1900 Website: www.BHSBaltimore.org Facebook: www.facebook.com/BHSBaltimore Twitter: @BHSBaltimore Envisioning a city where people live and thrive in communities that promote and support behavioral health