The Readmissions Quality Collaborative

Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013

Overview

Background and Scope of the Problem

The Readmissions Quality Collaborative Participants and Activities Strategies to Reduce Readmissions

Resources PSYCKES indicators PSYCKES public website and training webinars

Behavioral Health Inpatient Readmissions:

Background and Scope of the Problem

Reducing Hospital Readmissions: A National Quality Focus

Hospital readmissions are common and costly 19.6% of Medicare beneficiaries discharged were re-hospitalized within 30

days; cost to Medicare of unplanned readmissions estimated at $17.4 billion (Jencks, 2009)

Medicaid enrollees aged 21-64 had 10.7% 30-day readmission rate (HCUP Statistical Brief #89, 2010)

National/multi-state initiatives to address preventable readmissions include Partnership for Patients Community-Based Care Transitions Program:

national initiative to reduce unnecessary hospital readmissions by 20% Project BOOST (Society of Hospital Medicine): 60 sites in 26 states IHI STAAR (State Action to Reduce Avoidable Readmissions) Initiative: 4-

state collaborative in 148 hospitals

While most attention nationally is on medical readmissions, behavioral health readmissions are an important component of the overall picture.

30-Day Readmission by Major Diagnostic Category at Initial Hospital Stay for Medicaid

Recipients Age 21-64, 2007

Among 15 states, behavioral health discharges ranked among the top 5 diagnostic categories for 30-day readmissions.

AHRQ Health Care Utilization Project Statistical Brief #89, 2010

30-day Behavioral Health Readmission Rates in the NYS Medicaid BH

Population, April 2011- April 2012

New York State Office of Mental Health, 2012

Characteristics of NYS Medicaid BH Recipients with 30-day BH Readmissions

NYS Office of Mental Health, 2012

The Readmissions Quality Collaborative

The Readmissions Quality Collaborative

Goal: Reduce readmission rates among adults discharged from behavioral health inpatient services

Projected time frame: June 2012-December 2013

Sponsors: GNYHA, HANYS, OMH/PSYCKES

Steering Committee of peer institutions decides: Focus of project (i.e., readmissions) Strategies and activities Reporting requirements

Participating Hospitals and Service Types

47 Participating Hospitals Statewide NYC (23), LI (9), Hudson River (6), Central (5),

Western (3)

50 Inpatient Services 44 Psychiatry, 6 Detox / Rehab

16 Outpatient Services 12 Mental Health, 2 Chemical Dependency, 2 Dual

Diagnosis

3 Psychiatric Emergency Departments / CPEPs

Key Activities of the Collaborative

Conferences

Monthly Learning Collaborative Calls Interactive, report on progress

Strategies calls: Training on specific strategies

Data reporting Monthly self-report Quarterly Medicaid data

Site Visits (selected hospitals)

Strategies to Reduce Behavioral Health

Readmissions

Core Project Activities Case finding: Implement admission protocol to identify

clients at risk of readmission, using Screening Tool and/or PSYCKES data.

Identify and address risk factors: Assess for risk factors and implement policy that identified risks for readmission are addressed explicitly on treatment plan and discharge plan.

Optimize discharge process: Implement a protocol or checklist to ensure best practices in discharge planning, including procedures for bridging time between discharge and first outpatient session. Coordinate discharge planning efforts with the BHO.

Priority Targets for Intervention

Improve medication practices

Improve engagement in outpatient care

Improve delivery of integrated treatment for co-occurring psychiatric and substance use disorders

Intervention: Improving Medication Practices

Intervention: Improving Engagement in Outpatient Care

Intervention: Improving Delivery of Integrated Treatment for

Co-Occurring MH and SUD

■ Using the evidence-based Integrated Dual Diagnosis Treatment (IDDT) model

■ **On-line training available via OMH “Focus on Integrated Treatment” Modules.**

Inpatient Strategies: Services Delivered

Self report data:

Enhanced Discharge Processes

Among 50 participating inpatient services

Outpatient Strategies: Interventions/Services Initiated Self report data:

Examples from Participating Hospitals

At several hospitals, if a potential readmission comes to ED, the inpatient treatment team who knows the client is called to ED for consultation.

Hospitals are attending more carefully to barriers such as insurance, e.g., checking which LAIs the client’s insurance will cover before initiating a regimen.

At Woodhull Hospital, clients at high risk of readmission receive two individual sessions focused on preventing readmission.

Examples from Participating Hospitals, cont’d

Several hospitals, including LIJ and Maimonides, are implementing “plan for discharge” workbooks and worksheets.

Lutheran Hospital “Warm Hands” initiative to improve transitions from inpatient detox to outpatient chemical dependency, e.g., before 1st appointment, clinician makes provides motivational interviewing on reminder call.

Next Steps

Midyear conference

Analysis of Medicaid and other data to review trends over time

Identify which strategies are most effective and result in best return on investment

Site visits to identify best practices and provide technical assistance

Resources: The PSYCKES Application

and Public Website

Brief Introduction to PSYCKES A HIPAA-compliant, web-based application that

provides access to Medicaid claims data for clinical decision-making and quality improvement Includes fee for service and managed Medicaid, but

not Medicare or private insurance

Includes data on NYS Medicaid behavioral health population

Up to 5 years of data across treatment settings

Quality measures calculated at state, region, county, and provider level

PSYCKES Quality Measures Acute Care Utilization

High Utilization (Inpatient/ER)

Behavioral Health Readmission

Preventable Hospitalization

Physical Health Outpatient Medical

Visits Lab monitoring

Psychotropic Medications Adherence Cardiometabolic Risk High Dose Polypharmacy

Psychotropic Prescribing for Youth Too much, too many,

too young

Access to Client-Level Data

PSYCKES QI Overview

Indicator sets associated with readmission risk

QI Indicators within the Set

All behavioral health vs. hospital-specific

Quality Indicators Link to List of Flagged Clients

Clinical Summary Integrated view of all services Service Summary Tables by Category

Medications Outpatient Inpatient/ER And more …

Drill down to view linked claims/encounters Can be exported to Excel/PDF

Clinical Summary: Graphs

Rapid identification of service utilization patterns

Inpatient and ER Services Service type (ER or Inpt, BH or Medical), hospital name, date of admission/discharge, LOS, last diagnosis, procedures, “See all Data” > links to each invoice/claim

PSYCKES Home Page www.psyckes.org

Public website, PYSCKES access not needed Click on “Hospital Collaborative”

PSYCKES Website: Readmissions Collaborative Page

Tools on PSYCKES Website: Readmission Risk Assessment

Tools on PSYCKES Website: Slides from “Strategies” Calls

For Further Information PSYCKES website

www.psyckes.org

PSYCKES Help (PSYCKES support) 9:00AM – 5:00PM, Monday – Friday PSYCKES-help@omh.ny.gov

OMH Help Desk (PSYCKES access, SMS support) 7:00AM – 8:00PM, 7 days 800-HELP-NYS (800-435-7697) Helpdesk@omh.ny.gov

Question and Answer