1. Pennsylvania Office of Mental Health & Substance Abuse Services
ONE-MHSIP & MUG
Joint Fall Meeting
November 6, 2003

2. OMHSAS
Every person with serious mental illness and/or addictive disease, and every child and adolescent who abuses substances and/or has a serious emotional disturbance will have the opportunity for growth, recovery and inclusion in their community, have access to services and supports of their choice, and enjoy a quality of live that includes family and friends
9/22/2018

3. Five Year Vision: Draft Guiding Principles
The Mental Health and Substance Abuse Service system will provide quality services that will:
Facilitate recovery for adults and resiliency for children
Be responsive to individuals’ unique needs throughout their lives.
Focus on prevention and early intervention
Ensure individual human rights and eliminate discrimination.
Be provided by partnering with consumers and family members to design, implement, and monitor the system as it strives for excellence.
Be provided in a comprehensive array by unifying programs and funding
Be provided to recognize the cultural diversity of the persons being served.
9/22/2018

4. OMHSAS Program Office within Department of Public Welfare
Scope of Responsibility includes Mental Health, Drug & Alcohol*, & Behavioral Health Medicaid Managed Care Program; approximately $2B budget
Maintain IS capability within OMHSAS
Compatible with Department & Commonwealth IS systems
20 year history of systems development and data infrastructure
Data Uses
Internal Management Reports
Financial Monitoring
Program Accountability
Public Information
Access Measures
Quality Measures: OUTCOMES
* Drug & Alcohol Program Responsibility , Base Funding & Federal Block Grant provided through the Department of Health
9/22/2018

5. Pennsylvania at a Glance
County Based Programs ( 67 Counties)
46 County MH/MR programs
49 Single County Authorities ( D&A)
2 Major Urban Centers
Behavioral Health HealthChoices Program
Mandatory Managed Care Program
County Right of First Opportunity
25 Counties representing approximately 70% of the MA population
Our Future: Unified Systems
Integrated Program Areas
Integrated Funding Strategies
Integrated Data Systems
9/22/2018

6. Pennsylvania
Tentative schedule
9/22/2018

7. Pennsylvania at a Glance
Of the total funds appropriated for behavioral health services for FY 2003/04, 77% are administered by counties and 23% are administered within the state hospitals.
9/22/2018

8. Pennsylvania at a Glance
Caseload Statistics
Persons served across all mental health funding streams (SMH, County, MA FFS, HC): 210,000
Persons served in the State Mental Hospitals: 7,278
Persons served in County Grant system: 202,460
Adults served: 134,196
Children served: 68,264
Persons served in MA FFS: 109,722
Persons served in HealthChoices: 152,240
Adults served in HC: 90,809
Children served in HC: 61,431
Unduplicated persons served across all substance abuse funding streams (BHSI, Act 152, HC): 60,339
Persons served with BHSI funds: 42,694
Persons served with Act 152 funds: 5,793
Persons served in HealthChoices: 30,165
9/22/2018

9. IS Highlights: Recent Accomplishments
Consumer Satisfaction Survey
Five Southeast Counties; over 20% return rate; mh consumers, persons in recovery, families; high percentage of satisfaction; adults more satisfied than families of children in the program
Greene County Survey : survey all eligibles as indicator of ability to access behavioral health services (waiver requirement)
HealthChoices Early Warning Reports
Quarterly reports, real time data that focus on access and quality indicators; includes authorization data; complaints and grievances; special attention to access for minority populations; quality indicators include readmission rates; involuntary psychiatric admissions and homelessness. Findings reviewed by county programs and corrective action noted in subsequent report. Have been able to identify and resolve issues including untimely claims payments, data and systems problems; and identify specific access concerns that have been resolved more timely due to report.
9/22/2018

10. IS Highlights: Recent Accomplishments
HealthChoices Annual Report
Annual report of the HealthChoices Program, includes demographic information, penetration rates, financial overview and program highlights, Report highlights increased penetration in each year of healthchoices program; primary diagnosis for mh adults in schizophrenia( women is major depression); for d&a adults is opiod addiction; children is ADD, ADHD for mh; cannibis dependence for d&a
OMHSAS Annual Report
OMHSAS at a glance; program and fiscal data across major program areas including state hospitals, CHIPPS (Community Hospital Integration Project Program), HealthChloices, Drug & Alcohol Services
Block Grant Report Cards
Issued first series of Report Cards. Nine performance Indicators were developed in 2000; they include 1) overall utilization rates for SMI adults, Number of homeless SMI adults served by PATH grant, number of CHIPPS beds; rate of MH community inpatient days for SED children; Percentage of readmission to community inpatient within 90 days for SED children; Overall utilzation rates for SED children; Rate of HC behavioral health children with SED having co-occuring disorders; Rate of SED children living in rural areas; percentage of new block grant funds allocated to serve children with SED
9/22/2018

11. 9/22/2018

12. HealthChoices: Updates
In CY 2002, 927,294 Medicaid recipients covered in three zones; 175,000 served through the Behavioral Health Program (IN CY 2001, 136,000 persons were served through the BH Program)
Three Zones
Southeast (SE), Southwest (SW), Lehigh/Capital (L/C)
25 Counties including both rural and urban
Variety of Models; County operated; ASO; Full Risk Subcontracts; Direct State/BH-MCO Contract
Pennsylvania Penetration rates for overall utilization in both mental health & drug and alcohol meet or exceed national HEDIS benchmark
SE: ranged from 13.7% to 17.1% in CY 2002 ( increased from range of 13.2 to 16.5% in CY 2001)
SW ranged from 13% to 17.8% in CY 2002 ( increased from 11.6 to 15.6% in CY2001)
L/C ranged from 8% to 15.4% in CY 2002
9/22/2018

13. IS Highlights: On the Horizon
County MH Plan Guidelines
Comprehensive Data Set Provided to Counties to support planning efforts
Unduplicated counts across different payor sources including county base funding, Fee For Service, State Hospital, HealthChoices
Target Populations Prioritized; includes service utilization and average cost
Provides vehicle to identify funding priorities for county and Commonwealth
Incorporates performance expectations; planning goals- area planning goals
9/22/2018

14. IS Highlights: On the Horizon
Service Area Planning Goals: Incorporated in local county plan; track annually
Within five years no person will be hospitalized in a state hospital beyond two years.
Within five years no person will be involuntarily committed to a community hospital more than twice in one year.
Within five years, the incarceration of the target population will be reduced
9/22/2018

15. IS Highlights: On the Horizon: Performance Based Measures
All HealthChoices Counties
Percentage of expected annual prevalence rate receiving treatment in HC for adults with SMI
No co-occurring SA diagnosis, ages 18-64
Co-occurring SA diagnosis, ages 18-64
Percentage of expected annual prevalence rate receiving treatment in HC for:
Any MH service by significant minority population and by age group (under 21, 21-64)
Any SA service by significant minority population and by age group (under 21, 21-64)
9/22/2018

16. Performance Indicators Cont’
Discharges from psychiatric inpatient not readmitted within 30 days post discharge, under age 21, ages ,65+
Percentage of HC eligible children with:
– No placement in JCAHO or non-JCAHO residential treatment
– No placement in JCAHO or non-JCAHO residential treatment with
cumulative length of stay exceeding 120 days.
Percentage of individuals discharged from RTF with follow-up service(s) within 7 days post-discharge
9/22/2018

17. Performance Indicators Cont’
Percentage of individuals discharged from psychiatric inpatient with follow-up service(s) within 7 days post-discharge, under age 21 and ages 21-64, 65+
Percentage of individuals discharged from D&A residential rehab with follow-up service(s) within 7 days post-discharge, under age 21 and ages 21-64, 65+
9/22/2018

18. Performance Indicators Cont’
Quality of Life Indicators
Change in SMI Independence of Living (IOL)
Change in SMI Vocational/ Employment/ Educational Status (VES)
Change in SED Independence of Living (IOL)
Change in SED Vocational/Employment/ Educational Status (VES)
9/22/2018

19. Stakeholder Feedback Consumer/Family Questions
Access (getting into services)
In the last 12 months, did you or your child have problems getting the help you needed?
 Process (what happens during services)
Were you or your child given the opportunity to make decisions as much as you wanted in your treatment?
Outcome (results of service)
What affect has the treatment you or your child got had on the quality of your life?
9/22/2018

20. Baseline Tables Performance Indicator Benchmarks
CY 2001
CY 2002
“Gold Standard”
National Norm
Southeast Region Average
Southwest Region Average
Lehigh/Capital Average
Rural Counties Average
Suburban Counties Average
Urban Counties Average
9/22/2018

21. Baseline Tables Example HealthChoices Baseline Performance
Rural Counties
CY 2001
CY 2002
SW Counties
Armstrong
Fayette
Greene
Indiana
Lawrence
L/C Counties
Adams
Lebanon
Perry
9/22/2018

22. IS Highlights: On the Horizon: People Stat
Department initiative to annually access program success; based on COMSTAT models to provide accountability for government; OMHSAS measures:
To increase access for Administrative Case Management Services, to reduce reliance on more restrictive, costly services.
To develop pilot study measures to be used in determining whether D&A treatment is meeting health outcome and social function for individuals.
To ensure that the 33 long stay individuals moving to the community from the SMH have treatment and supports in place in the community to facilitate their continued recovery.
To ensure that individuals served in the HC Behavioral Health program have improved health outcomes as demonstrated by performance measurement of specific indicators.
To maintain or enhance the quality of care and services delivered in the SMH while requiring greater fiscal accountability through overtime reduction.
9/22/2018

23. Performance Based Contracting Visit our WebSite
Where to next?
Integrated data sets with other services systems including drug & alcohol, children& youth, mental retardation, education, corrections
Clinical Outcomes
Performance Based Contracting
Visit our WebSite
9/22/2018