1. PRELIMINARY DRAFT Behavioral Health Transformation September 26, 2014 PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE

2. 2 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Agenda ▪ Metrics – Process Metrics Thresholds – Outcome Metrics Tied to Payment ▪ Crisis Services

3. 3 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Proposed Behavioral Health Home Quality Metrics 1 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-13-001.pdf Considerations for Quality Metrics Design ▪ Required Centers for Medicare and Medicaid (CMS) Core Health Home Measures 1 ▪ Behavioral Health Population Needs ▪ Phased Approach – 2 years for tracking purposes only ▪ Metric Types – Process – Outcome

4. 4 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Process Metrics Metric/activityDetails  Has integrated care plan  Portal must reflect yes/no  Crisis intervention plan in place  Portal must reflect yes/no  BH Inpatient (IP) flag in portal for those requiring IP care  Portal must reflect BH IP occurrences from claims data  Number of client check-ins  Portal must reflect check-ins; frequency of check-ins required will vary based on intensity of report required  Follow-up with BH client post-IP encounter  Portal must reflect provider has followed up with client (face to face or by telephone) within 3 days of discharge 1  Involved with BH IP discharge planning  Portal must reflect documented provider contact with hospital discharge planner prior to discharge and notification of discharge to BH provider, PCMH, and/or PCP Proposed Behavioral Health Home Process Metrics 1 Applies to existing health home clients only

5. 5 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Must be met (plus any 1 additional process metric) For PMPM eligibility, BHH must meet the first three and one more of the remaining three process metric thresholds ▪ % of clients with an integrated care plan ▪ % of clients with crisis intervention plan in place ▪ % of clients with whom HH is involved with BH IP discharge planning ▪ % of clients who received appropriate number of client check-ins ▪ % of clients with BH IP flag in portal for those requiring IP care ▪ % of clients who received a follow-up from BHH within 3 days post-IP encounter Year 3 70% 90% 50% 70% 50% Year 4 80% 90% 65% 80% 65% Process metric/activity Year 5 90% 75% 90% 75% PRELIMINARY

6. 6 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Outcome Metrics Metric/activityDetails  Child and adult acute IP  # child and adult acute IP admissions for any cause  Child and adult acute IP w/readmit within 30 days  # child and adult acute IP admissions for any cause followed by acute readmission for any cause within 30 days 1  Follow-Up after hospitalization for mental illness  % clients who were hospitalized for mental health disorders that visited mental health practitioner within 7 days of IP discharge  % clients who were hospitalized for mental health disorders that visited mental health practitioner within 30 days of IP discharge  BH acute IP readmit rates  Rate of BH-related readmission within 30 days discharge from acute IP facility  AOD (alcohol or other drug) treatment  % adolescents and adults with new episode of AOD dependence who received initiation or engagement of AOD treatment  Depression  % patients 12 yrs+ screened for clinical depression using a standardized tool and follow-up documented  Blood pressure management 2  % of clients (18 – 85) who had a diagnosis of hypertension and whose blood pressure was adequately controlled (≤140/90) during the measurement year  BMI assessment 4  % of clients (18 – 74) who had an outpatient visit and whose BMI was documented during the measurement year or the year prior to the measurement year Bold – CMS required Proposed Behavioral Health Home Outcome Metrics 1 1 Applies to existing health home clients only 2 Alignment on clear expectations and accountability for BHH for follow-up plan, collaboration with PCMH and/or PCP, and regular review of blood pressure will be outlined and reviewed with CMS 3 Language aligned with pharmacy requirements 4 Alignment on clear expectations and accountability for BHH for follow-up plan, collaboration with PCMH and/or PCP, and regular review of BMI will be outlined and reviewed with CMS

7. 7 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Outcome Metrics Metric/activityDetails  Treatment adherence  # of outpatient encounters versus # of visits in treatment plan  Hearing and vision screen  % youth (under 16) with documented scheduled hearing and vision screen and follow-up plan documented for those with identified need; shows evidence of collaboration with PCMH and/or PCP  Labs review  % children (under 18) on antipsychotic agents who have had metabolic lab tests for fasting lipids and glucose documented and reviewed by a physician or licensed APN 1  Acute BH IP utilization  Rate of utilization of acute BH IP care for BH related services per fixed time frame (acute IP admits PMPY)  BH Emergency Department (ED) visits  Rate of BH ED visits per fixed time frame (ED visits PMPY)  Medication adherence 2  % clients with medication possession ratio 3 > 80% for antipsychotics, mood stabilizers, and anti- depressants  Utilization of residential services (days PMPY)  Rate of utilization of residential care for care related services per fixed time frame (residential days PMPY)  Utilization of PCMH  % individuals who have received at least one documented healthcare visit with their PCMH (or physician or other healthcare provider if individual does not have PCMH) that included a review of the medical plan 4 1 As defined by DMS pharmacy requirements 2 There are 3 separate medication adherences metrics for Schizophrenia (antipsychotics); Bipolar Disorder (antipsychotics or mood stabilizers) and Depression (anti-depressants) 3 Sum of days’ supply for fills in period / number of days in period 4 Metric will be based on an annual basis. Proposed Behavioral Health Home Outcome Metrics

8. 8 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Beginning in Year 3, four outcome metrics will be tied to the at-risk portion of the PMPM. Outcome Metrics 4 Metric/activityDetailsThreshold  Follow-Up after hospitalization for mental illness % of clients who were hospitalized for mental health disorders that visited mental health practitioners within 7 days of discharge The metric will be set after analysis of data tracked from the first two years.  BH acute IP readmit rates Rate of BH-related IP readmission within 30 days discharge from acute IP facility The metric will be set after analysis of data tracked from the first two years.  Utilization of residential services (days PMPY) Rate of Utilization of residential care for care related services per fixed time frame (residential days PMPY) 2 The metric will be set after analysis of data tracked from the first two years.  Utilization of PCMH% of individuals who have received at least one documented healthcare visit with their PCMH (or physician or other healthcare provider if individual does not have PCMH) that included a review of the medical plan, if applicable. 3 The metric will be set after analysis of data tracked from the first two years. 1 The outcome metrics will be weighted evenly for risk portion. 2 The “Utilization of Residential Services” to be measured for Children and Youth only and that a third metric “Therapeutic Community” be added for adults only 3 The “Utilization of PCMH” to be measured for adults only due to the high rate of co-occurring medical condition in adult population. 4 Metrics listed on this slide are a subset of overall metrics being tracked from Year 1.

9. 9 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Base PMPMAt risk portion No portion of PMPM at-risk in first two years to allow providers to become familiar with reporting and metrics and develop sustainable infrastructure Increasing portion of PMPM placed at-risk over next three years as providers understand metric baselines and adopt practices to achieve high outcomes BHH Proposed Quality Metrics % Current perspective on PMPM Phased Payment Year 1Year 2Year 3Year 4Year 5 100 90 80 70 00 10 20 30

10. 10 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Crisis Services

11. 11 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Crisis Services A Request for Proposals will be released for a Single Statewide Crisis Entity will be responsible for: Coordination of Mobile Crisis Response and Stabilization Monitoring Mobile Crisis Response and Stabilization Training providers on how to handle behavioral health crises Contracting with Regional Mobile Crisis Response Entities Collecting and Reporting Key Indicators Supporting a centralized access call center.

12. 12 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Online ▪ More information on the Payment Improvement Initiative can be found at www.paymentinitiative.org www.paymentinitiative.org