1. Benchmarks: Overview: Planning: Results: Payment Structure: Measures:
Oklahoma Department of Mental Health and Substance Abuse Services Pay for Performance - Enhanced Tier Payment System (ETPS)
Overview:
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) designed a performance outcomes payment plan, the Enhanced Tier Payment System (ETPS), with an overarching goal to proactively increase the recovery of Oklahomans from mental illness and substance abuse. Two primary objectives are 1) improve outcomes and, 2) creatively pay for outcomes with no additional state funds.
Benchmarks:
Benchmarks were established for the first five measures based on data from a previous six-month time period and knowledge of best practices. The sixth measure is determined through “secret shopper” phone calls made to the facilities. Funding is allocated based on number of clients served and agency performance on each measure. Facilities may earn zero dollars, 50% of their allotment, 100% of their allotment, or more than 100% of their allotment depending on where each lands in relation to the benchmark.
Planning: 
ODMHSAS developed six measures that guide positive outcomes for consumer recovery. In addition, the ETPS was approved by the Center for Medicare and Medicaid Services (CMS) which then allowed Oklahoma to receive federally-matched funds for the project. For every state dollar contributed to the outcome measures, the federal government contributes $1.93, a match rate of 65.9%. With federally matched funds, we are able to turn roughly $2,000,000 into $6,000,000 and return that to communities to provide data-driven, research-based recovery outcomes to improve the lives of Oklahomans.
Results:
From the start of the new payment system in January 2009, all measures have shown improvement. The greatest improvement has been shown in the outpatient crisis follow-up measure, improving from 34% of the consumers being followed up in December 2008 to a 54% follow-up rate in February While only five facilities met or exceeded the benchmark for this measure in December 2008, 12 facilities had reached the benchmark in February Reduction in drug use has shown the least improvement, however, consumers showing a reduction in drug use has increased by six percent in the following two months and 12 of the 15 facilities have now met or exceeded the benchmark for this measure.
Report Example
Payment Structure:
Below is the payment structure for February ‘Amount Available’ is based on the percent of clients a facility serves. If Agency A serves 10% of the state’s mental health population, their ‘Amount Available’ would be 10% of $1.5 Million or $150,000. If a facility’s scores are above the benchmark on all scores, they would earn 100% of their funds. If any of their scores were below the benchmarks, there would be money ‘left on the table.’ Facilities scoring one standard deviation above the benchmark, would earn bonus money.
Measures:
Outpatient Crisis Service Follow-up within 8 Days
Inpatient/Crisis Unit Follow-up within 7 Days
Reduction in Drug Use
Engagement in Treatment
Medication Visit within 14 Days of Admission
Access to Treatment
The ETPS is improving data fidelity and existing resources are focused on research-based outcomes from treatment partners.
For more information, please contact Wendy Larsen at or Mark A. Reynolds at