Transcript Slide 1

Oklahoma Department of Mental Health and Substance Abuse Services
Pay for Performance - Enhanced Tier Payment System (ETPS)
Benchmarks:
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.
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.
Measures:
1. Outpatient Crisis Service Follow-up within 8 Days
2. Inpatient/Crisis Unit Follow-up within 7 Days
3. Reduction in Drug Use
4. Engagement in Treatment
5. Medication Visit within 14 Days of Admission
6. Access to Treatment
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.
Number of Facilities Meeting or Exceeding
the Benchmark
Outpatient Crisis Follow-up in 8 Days
Inpatient Follow-up in 7 Days
Reduction in Drug Use
Engagement in Treatment in 45 Days
Medication Visit in 14 Days
0
3
4
5
Jan-09
6
7
8
9
10
11
12
13
14
15
Feb-09
Results:
Report Example
Below is the payment structure for February 2009. ‘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.
Amount Available
91,838.00
55,525.62
82,573.37
84,376.55
71,567.73
73,184.38
217,003.81
120,129.33
44,519.98
99,921.24
51,173.11
126,409.38
145,436.08
88,293.82
148,047.59
1,500,000.00
2
Dec-08
Payment Structure:
FEB 2009 TOTAL
Associated Centers for Therapy
Bill Willis CMHC
Carl Albert CMHC
Central Oklahoma CMHC
CREOKS Mental Health Services
Edwin Fair CMHC
Family & Children's Services
Grand Lake MHC
Green Country BHS
Hope Community Services
Jim Taliaferro CMHC
MHSACSO
North Care Center
NW Center for Behavioral Health
Red Rock BHS
Total
1
Amount Earned
91,838.00
55,525.62
61,930.03
63,282.42
47,711.82
54,888.29
217,003.81
110,118.55
44,519.98
91,594.47
17,057.70
84,272.92
145,436.08
66,220.36
148,047.59
1,299,447.65
Left on table
20,643.34
21,094.14
23,855.91
18,296.10
10,010.78
8,326.77
34,115.40
42,136.46
22,073.45
200,552.35
Bonus Earned
27,105.77
5,575.38
12,451.21
3,393.48
6,388.19
2,661.89
45,512.82
20,084.23
6,089.59
14,051.86
4,597.81
42,925.12
4,330.15
5,384.84
200,552.35
Total Earned
118,943.78
61,101.00
74,381.24
66,675.90
54,100.01
57,550.17
262,516.64
130,202.79
50,609.57
105,646.33
17,057.70
88,870.73
188,361.20
70,550.51
153,432.43
1,500,000.00
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 followup measure, improving from 34% of the consumers being
followed up in December 2008 to a 54% follow-up rate in
February 2009. While only five facilities met or exceeded the
benchmark for this measure in December 2008, 12 facilities
had reached the benchmark in February 2009. 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.
Change in Outcome Measures
Outpatient Crisis Follow-up in 8 Days
Inpatient Follow-up in 7 Days
Drug Reduction
Engagement in Treatment in 45 Days
Medication Visit in 14 Days
0%
10%
20%
Dec-08
30%
40%
Jan-09
50%
60%
70%
80%
Feb-09
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 [email protected] or Mark A. Reynolds at [email protected]
90%
100%