Transcript CBH Provider Profile Report and Pay for Performance

Measuring to improve quality
June 29, 2011
1
This presentation will:
 Provide an overview of the provider profile and pay-
for-performance (P4P) process
 Invite discussion on proposed measures and the P4P
process for BHRS
 Outline next steps after today
2
What is a Provider Profile
 Data-oriented report to measure change at the System and
the Provider level
 Intended to profile a Provider in our network on their
performance on key quality measures
 Include contextual data on who (e.g. demographic
information) and how (e.g. length of stay) were served by
said Provider
 Iterative process: may include new measures each year
and or higher targets
3
What makes good performance
measures?
 Central to our Shared Mission
 Important & Meaningful
 Feasible to Capture
 Accurate and Representative
 Leads to Improved Performance
4
What is Pay-for-Performance
 A payment model rewards providers for meeting
certain performance measures for quality and
efficiency
 Providers under this arrangement are usually rewarded
for meeting pre-established targets for delivery of
healthcare services
5
How is Philadelphia affected by P4P?
 HealthChoices Contract with State
 PA Department of Public Welfare pay-forperformance
 So far, focused on inpatient psychiatric
hospitalization
 Received pay for 2008 performance
 2009 performance probably will not as our
Inpatient Outcomes did not keep up with other
Counties
6
Purpose of Pay for Performance
 Focus attention on desired quality processes &
outcomes
 Shared Focus
 What are the things DBH can do to improve and what
are things Providers can do?
 Develop Shared Clarity about the direction we want to
go
7
Timeline (abbreviated) of development of
provider profile
• 2007 – Series of meetings with providers to introduce
•
•
•
•
concept & start discussion
2008 – Preliminary data tabulations; internal sharing
of results
2009 – Baseline reports on Inpatient Psychiatric
Services (April) and Children’s Residential Treatment
(Dec)
2010 - 2nd series on IP & RTF; baseline report on D & A
Residential Rehabilitation Services
2011 – Repeat others and Baseline for:
•
BHRS, TCM, CIRC, Host Homes
8
Who gets a report?
 In-network providers
 Providers serving at least 20 youths
 Individualized reports
 Need to discuss dose within the year before expected
improvement
 Providers with fewer than 20 discharges
 All CBH providers combined report or
 Letter of Intent for Continuous Quality Improvement?

Similar to the OTIP process? Or Expanded Chart Reviews?
9
Types of Information in the Profiles
• Quantitative Outcomes
– Inpatient/CRC Visits/RTF rates, Follow-up rates, AMA rates,
etc.
• Contextual
– Length of Stay
– Cost Summaries
– Avg Units per Child per Level of Care
• Contractual Oversight
– Compliance and Credentialing
• Qualitative Measures (being piloted)
– Agency and Individual Service Reviews (chart audits)
10
All reports have:
•
Measures that compare to national and/or state standards or
to local norms
•
Thresholds for assessing good, adequate and poor
performance (green, yellow and red) based on national
and/or state standards or local norms
•
Comparison to overall CBH statistics
•
Blinded comparisons to other providers
•
Multi-year trends for selected (not all) measures
11
How to use the reports
 Provide you with comparison benchmarks
 System as a whole and other providers
 Raise questions about care, expectations, and generate
research about differences
 Generate discussion about system wide challenges
 Help to determine P4P measures
 Facilitate providers sharing information about
practices with each other after receiving reports
 Inform the credentialing process
12
Purpose of Pay for Performance
 Focus attention on desired quality processes &
outcomes
 Shared Focus
 What are the things DBH can do to improve and
what are things Providers can do?
 Develop Shared Clarity about the direction we want
to go?
13
P4P Methodology
 Criteria for being in P4P Pool each Year
◦ In Network Providers
◦ Adequate sample size for measuring said provider
◦ Top 2/3 of Aggregated Scores

Unless all are meeting national standards then possibly
consider all as qualifying
 Scores/weights for each Measure used in P4P
◦ Weighting for specific measure and to population
served – details available from CQI
14
2011 performance pay will be
based on 2010 FY data for BHRS
• Measures from profiles used in all levels of care
P4P
•
•
•
Continuity of Care
Readmission or alternately Not Readmission
Compliance
• Measures used in some levels of care (not all)
•
•
AMA
Quality of Care Concerns
• Measures not used include Complaints
15
Sample of what CEO’s Received regarding
D&A Residential Rehab P4P Scores
16
Performance Dollars are:
Proportional to Volume Served
Proportional to Weighted Scores
17
2010 Performance Pay
 Based on their weights/scores (which are based on
how well they did in certain measures from the
profiles), and how much services they had provided in
2009
 some providers received performance pay
 some providers did not receive performance pay
18
Profiles reported on 5 domains
 System Transformation
 Access and Service Utilization
 Quality of Care
 Customer Service
 Contract Status
19
1. System Transformation
 Suggestions for measure includes:
 Peer Culture Development
 Family Involvement
 Recovery/Resilience Training
20
2. Access and Utilization
 What are we counting
 Those served
 Units per Child per Level of care
 Length of Stay
 Are membera having timely access?
 Do we have enough system capacity?
 Under and over utilization?
21
Utilization measures
22
3. Quality of Care
 Measures in the section of CBH Provider Profiles that
focus on:
 Safety
 Clinical effectiveness
 Consumer-centered
23
Measures in Quality of Care
• How do we know that our members received quality
care?
– Members are doing better
• How measured?
– Not returning to same or higher level of care –
recidivism
– Engagement in continuity of care – follow-up care in a
lower level of care
– Provider closed to admissions
24
Quality of Care (cont’d)
 Few DIRECT measures of quality of care
 We need to assess for indicators of quality care:
◦ Documentation of specific desirable (operationally
defined) activities or events in client records (e.g. family
meetings)
◦ Lack of undesirable events in client records or data sets
(e.g. serious incidents, AMAs, restraints)
◦ Individual assessment tools (e.g. recovery tools,
community participation scales).
25
Comparison of Providers to CBH System as a whole
26
Comparison to other providers – Adult Inpatient
recidivism
27
One example measure of
Significant Incident
28
Types of severe incidents
29
4. Customer Service
 Complaints
 “an issue, dispute, or objection presented by or on behalf
of a member regarding a participating health care
provider, or the coverage, operations or management
policies of a managed care plan”
30
Complaints: what we report
• First-level complaints
– Number of complaints per provider
– Type of complaint
•
E.g., consumer rights, treatment concerns
– Rate per 1000 authorized units of service
• Blinded comparison across providers
– How rate per 1000 authorizations compare to other
providers in same level of care
31
5. Contract Status
 Rate Increase History
 Provider Volume
 Compliance Status and Audit Rate
 Credentialing History
 Refusal to Admit (proposed)
 Failure to Notify CBH of Closure (proposed)
32
Measurements to be reported by
the categories
 Population/diagnostic cohorts
 ASD, ID or other
 Specific Level of Care Groupings
 STS
 CARE
 School-based Wrap-around
 Non-school based Wrap-around
 Group TSS
 Mobile Therapy
 Family Services
33
Breakout Group 1: Clinical Review of Agency
Infrastructure and Chart Reviews
• A break-out group to review and discuss
• Proposed Self Audits and Cross-Validation
• What to do for small volume providers?
• Letter of Intent: Plan for Quality Improvement
Processes regarding Practice Guidelines and measures
that are included in the reports.
•
•
Similar to OTIP along with quantitative measures..weigh
quantitative measures less for these
Additional chart reviews
34
Breakout Group 2: Access and
Delivery of Service
 Average number of days between auth and date of first
claim for new auths that year
 Paid to Auth Ratios to demonstrate delivery of service
 By 6-digit level of care
 Staffing Ratio based upon census submission
 Length of time between date of completion of
evaluation and date of submission to CBH
 Avg Number of Units per youth per level of care
35
Breakout Group 3: Transitioning from BHRS to
high intensity services or failure to transition
 % of (non ASD, non ID) youth receiving greater than 3
years of BHRS
 % of (non ASD, non ID) youth >= 14 receiving BHRS
 % of Children admitted to Inpatient, and CRC
respectively
 Control for minimum dose: or two measures those with
higher auth/paid ratio’s and those with lower auth/paid
ratio
 Or Control by length of time with provider
36
Breakout Group 3: Successful Completion,
Transition to Family or Lower Levels of Care,
positive Outcome
 % Transitioned to Family Level of Care
 Family Based Services
 Family Focused Behavioral Health
 PHICAPS
 FFT
 Others?
 % Transitioned to any Outpatient Treatment
 % Listed as Successful Completion on Discharge
Summaries
 % of Children with Improvement in School Attendance
37
Breakout Group 4: (3 topics) Support of
Evidenced Informed Evaluations, Interpretation of
Quality, and Compliance
 % Completion and Data Submission of ASEBA at
Baseline and Follow-up
 % Submission of Census
 % Submission of Discharge Summaries
 Rate of Quality of Care Concerns
 Error Rates on Compliance
38
Report Back by Groups
39
Next Steps
 Summary to the Website
 Data and profile development
 Distribution of Reports
 Recommendations for Pay for Performance
 Pay for Performance Weights and Outcomes
 Pay Increase before 01/01/2012 for those deemed as
receiving P4P
40