Monitoring Behavioral Health Care Mark Madrilejo Application Engineer at network180

network180 Serve population by connecting consumers to services MI: depression, bipolar disorder, schizophrenia I/DD (DD): intellectual/developmental disorder, autism SUD (SA): substance use disorder CF: children and families

Organizational Context network180 – Community Mental Health Service Provider (CMHSP) Kent County Mostly Medicaid or Healthy Michigan Plan Lakeshore Regional Partners Prepaid Inpatient Health Plan (PIHP) Kent, Allegan, Ottawa, Muskegon, Oceana, Mason, Lake Michigan Department of Health and Human Services (MDHHS) Contract requirements for reporting

MMBPIS and BH-TEDS Michigan’s Mission-Based Performance Indicator System Access (six indicators, reported by CMHSP/PIHP) Efficiency (one, calculated by state) Outcomes (six; two reported, four calculated) Quarterly report for both CMHSPs and PIHPs Behavioral Health Treatment Episode Data Set An extension of SUD-only TEDS

MMBPIS Indicator 1 (Access) “The percentage of persons during the quarter receiving a pre- admission screening for psychiatric inpatient care for whom the disposition was completed within three hours (by two sub- populations: Children and Adults). Standard = 95%” “Rationale for use”: “People who are experiencing symptoms serious enough to warrant evaluation for inpatient care are potentially at risk of danger to themselves or others. Thus, time is of the essence. … This indicator is a standard measure of access to care.”

MMBPIS Full List Pre-admission screening (3 hours) > 95% First request (14 days) > 95% First service (14 days) > 95% Follow-up (7 days) > 95% Denials % Second opinions % *Admin costs Employment: *Competitive employment %, *Minimum wage % Inpatient Recidivism (readmission within 30 days) < 15% Recipient Rights complaints Residence: *DD-A in private residence %, *Serious MI-A in private residence %

MMBPIS Codebook Definitions and Instructions Disposition, start time, stop time Selection Methodology Access-Timeliness/First Service excludes inpatient screening Exception Methodology No-shows and reschedules do not count toward 14-day window Documentation Requirements State external quality reviews Dates/times, reasons for exclusion, supporting clinical documentation Performance Improvement Plan and follow-up

TEDS Federal data set for SUD population and programs Capture/recapture data collection at admission and discharge Large-scale lack of change is a red flag Patient constants: DOB, gender, race, ethnicity Variables “30-day” use of primary substance Employment status Living arrangement “30-day” number of arrests Attendance at self-help groups

TEDS Data Issues Automatic fill-in of data during discharge Defeats capture/recapture Codebook misunderstanding Discharge reason is “death” … followed by re-admission

BH-TEDS Michigan data set extends TEDS to add MI and I/DD populations New for FY2016 Process changes; IT system changes; staff training Much more data for future analysis Fuzzier definition of “discharge” for non-SUD SUD 45 days w/o service; 90 days for non-SUD; clinical judgment call Update Record in addition to A/D records Annual update for long-term I/DD or MI treatment with no discharge