Behavioral Health Clinic Quality Measures(BHCQMs) I-Eval: Time to Initial Evaluation Next Steps

Purpose and Benefits Able to more quickly engage individuals into services Provide better care and support of individuals Enroll individuals in services as they are ready, increases chance that they will be more engaged in services as they go.

I-EVAL What Outcome is being measured? This measure has 2 parts and requires 2 separate calculations: The percentage of new persons with an initial evaluation provided within 10 business days of first contact Stratified by age (12-17 and 18 and older) and Payer status (Medicaid, Medicare, Low Income, Uninsured) The mean number of days until initial evaluation for new individuals

What needs to be collected? Tracked? Business days (M-F excluding state and federal holidays regardless of operation) Initial Evaluation (routine, not crisis) New Individual (not seen within the last 6 months) Provided (received, service must be received or completed not just scheduled) Provider Entity (The system being measured not individual providers) Age (12-17 and 18 and older) Medicaid/Low Income/Uninsured Status There are not specific definitions of “first contact” or “initial evaluation” First contact can be telephonic, and is persons “requesting or being referred for BH services” Think initial screening and determination of acuity (crisis) Can be a walk in appointment or crisis service Does not include phone calls that are informational gathering in nature (hours of operation, etc.) This initial screening is FOLLOWED by the initial evaluation and person/family centered diagnostic treatment plan per CCBHC criteria.

Initial evaluation Preliminary diagnosis Source of referral Reason for seeking care Identification of immediate clinical needs relating to diagnosis List of current medications and substances Assessment of risk to self or others Assessment of need for medical care Determination of veteran status

Specification #1: Percentage of New individuals with an initial evaluation provided within 10 business days of first contact Denominator: Number of individuals in eligible population Individuals Identified as contacting provider seeking services during measurement year Stratified by age (12-17 and 18 and older as of the end of measurement year) Measurement year excludes last 30 days of measurement year and INCLUDES the 6 months preceding the measurement year. Numerator: Number of individuals in the eligible population who received an initial evaluation within 10 business days of the first contact during measurement year Measurement year is measurement year. Denominator: excluding the last 30 days of measurement year and including the

100 individuals contact the clinic in the first 11 months of the MY 50 were not seen at the clinic in the 6 months preceding MY Of those, 20 had Medicaid, 15 were uninsured, 15 had other payer source. Steps in Calculation Medicaid Uninsured Other Total 1. Number of individuals who contact clinic in first 11 months of MY 50 25 100 2. Number of those NOT seen in 60 months prior to MY 20 15 Denominator Stratified by Payer status

Numerator calculation: Medicaid: 19/20= .95 or 95% Uninsured: 10/15= .667 or 67% Other payer source: 7/15= .47 or 47% Total: 36/50 or .72 or 72% Repeat steps to stratify by age Steps in Calculation Medicaid Uninsured Other Total Denominator Stratified by Payer status 20 15 25 50 Individuals seen within 10 business days of first contact 19 10 7 36 Numerator stratified by payer status

Specification #2: Mean number of days until initial evaluation for new individuals If 10 individuals are seen during the first 11 months of MY year and not seen in prior 6 months with counts by payer status shown below: Denominator: The number of eligible individuals Number of individuals Medicaid Uninsured Other Total 4 3 10

Numerator: Total number of business days between first contact and initial evaluation (stratified by payer): Individual Medicaid Medicare Neither Total A 10 B 15 C 8 D 31* E 20 F 13 G 3 H 4 I J Total Numerator 64 36 38 138 *First contact at the end of the 11th Month and not seen again for initial evaluation

Indicates first contact at the end of the 11th month of MY and not seen for initial evaluation Measuring the Mean (average) days until initial evaluation for new individuals by payer status: Medicaid: 64/4 = 16 days Uninsured: 36/3 = 12 days Other: 38/3= 12.7 days Total: 138/10 = 13.8 days Repeat steps to stratify by age

Next Steps Updates to the Texas Council intranet site DEW presentation at the Texas Council annual conference Got Data! Now What? Survey Centers to determine needs Conference calls Future webinars