2014 Pay-for-Performance ReviewTo

Executive Directors 1

Topics

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• 2014 Pay-for-Performance (P4P)

• 2014 Results on 2013-14 services

• Comparisons to previous years

• Positive Trends

• Ongoing challenges

• Looking ahead to 2015

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2014 P4P Process

• Behavioral Health Rehabilitation Services (BHRS) – Wraparound

• BHRS School-based Therapeutic Services (STS)

• Community Integrated Recovery Centers (CIRC)

• Extended Acute Care (EAC) • Host Homes• Inpatient Psychiatric,

Adult(AIP)• Inpatient Psychiatric, Child

(CIP)• Intensive Drug & Alcohol

Outpatient (IOP)

• Journey of Hope• Outpatient, Drug &Alcohol

(DAOP)• Outpatient, Mental Health

(MHOP)• Residential Treatment

Facilities for Children (RTF)• Residential Treatment

Facilities for Adults (RTFA)• Residential Rehabilitation• Residential Non-Hospital

Inpatient Treatment (RINT)• Targeted Case Management

(TCM)

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2014 Levels of Care

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Major Activities in 2014

• Spring webinars to review proposed measurements & thresholds

• Fall webinars to review data & new/revised measurements

• Meetings with individual providers at their request

• Piloted addition of participation in a behavioral health screening

event for outpatient providers

• Incorporation of participation in the STS Outcomes Monitoring

Project into scoring

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Status as of February 2015

• Awards totaling over $5 million to providers

• More than 250 reports, in new streamlined format, have been e-mailed to providers

Streamlined Provider Summary

• Eliminated redundancy of information from NIAC and Quality Management reports

• Cover Sheet with relevant information

• Operational Definitions Master Document

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2014 Results

2014 Results

Level of Care

Number of Providers Scored in 2014*

Number of Providers with a Total Score > 70%

Percentage of Providers with a Total Score > 70%

Providers Receiving P4P in 2013

Total Funds in 2014

BHRS 71 6 8% 44 out of 81 (54%) 844,960$ CIRC 11 1 9% 11 out of 13 (85%) 92,140$ Host Homes 2 0 0% 2 out of 4 (50%) -$ IOP 31 3 10% 21 out of 46 (46%) 203,164$ Inpatient 25 5 20% 15 out of 26 (58%) 1,622,909$ Journey of Hope 4 1 25% 1 out of 4 (25%) 128,819$ Outpatient D&A 70 16 23% 43 out of 66 (65%) 500,707$ Outpatient MH 134 22 16% 28 out of 108 (26%) 510,545$ Residential Rehabilitation 44 10 23% 27 out of 51 (53%) 609,439$ RTF 13 4 31% 8 out of 19 (42%) 634,360$ RTFA 3 1 33% 2 out of 5 (40%) 136,301$ TCM 22 2 9% 15 out of 35 (43%) 187,910$ Grand Total 430 71 17% 47% 5,471,172$ *Excludes providers that did not have a sufficient total denominator to be scored, were out of network, or otherwise ineligible to receive an award

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• Total amount of awards by Reporting Year:– $5.4 million in 2014

– $9.5 million in 2013

– $16 million in 2012

– $13.4 million in 2011

– $3.2 million in 2010

2014 Award compared to Past Years

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Positive TrendsAchieving Quality Through P4P

Residential Rehabilitation: Continuity of Care

2011 2012 20130.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

58.75%

64.03%

72.54%

Residential Rehabilitation - Women with Chil-dren Providers: Continuity of Care: 30-Day Fol-

low-up Rate

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Child Mental Health Outpatient: Early Engagement

ASD Non-ASD0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

20.51%

37.22%

27.59%

48.06%

42.2%

51.2%

Early Engagement: Percent Having at Least 4 Claims Within 60 days of Episode Start

201120122013

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TCM: Service Delivery and Continuity of Care

2010-2011 2011-2012 2012-2013 2013-20140.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

38.20%

46.80%

72.20%

91.31%

TCM - Adult ICM: Service Delivery and Continuity of Care: Percent

Having TCM Contact Within 2 Days of Inpatient Admission

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Ongoing Challenges

• Redundancy of measures

• Allegations and convictions of fraud, waste and abuse for past awards

• Recognizing consistency in achievement over multiple years

• Consistently underperforming providers

Ongoing Challenges

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2015 and Beyond

Looking Ahead…

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Looking Ahead: 2015 and Beyond• Ongoing evolution of measurements

• Behavioral health screening event participation–Scoring and fairness in application

• Client/Family Satisfaction Survey–Outcomes data directly from service

recipients and families

Questions or Comments?

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Thank You!

Suet Lim, PhD

Performance Evaluation, Analytics and Research

Community Behavioral Health

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