Transcript Power Point Presentation - Erie, Niagara and Orleans Counties

WRBHO BEST Meeting &
Quarter Three Performance Report Presentation
Erie, Niagara and Orleans Counties
December 17, 2012
WRBHO BEST Meeting Agenda
I. Introductions and Key Findings
II. Q3 Performance Report
•
Regional Overview of all domains
III. Health Homes and the role of the WRBHO
IV. Q3 Sub-Regional Performance Review
•
•
Review of key metrics tied to the “Effective Linkages” domain for the sub-region
Discuss the information to determine what it means to those in attendance (Are there opportunities for
improvement?)
V. Effective practices presentations
•
•
•
Assistance in attending MH appointments: ECMC, Michael Zuber, Vice President of Behavioral Health
Critical Time Intervention: Tara Karoleski , Coordinator, Adult Single Point of Access & Accountability, Erie County
Intro to Consumer Centered Family Consultation and opportunity for technical assistance
VI. Identify areas of focus for improving sub-region BH system of care
VII. Next Steps
2
Presenters
• Adele Gorges, Executive Director, NYCCP
• Anne Wilder, President, CCSI
• John Lee, WRBHO Program Director, Beacon
• Christine Mangione, WRBHO Manager of
Clinical Operations, Beacon
3
INTRODUCTION & KEY FINDINGS
4
Introduction
Q3 Performance Report Organization:
– Domains
– Metrics within each domain (Data Sources: BHO data collection and OMH
BHO Portal)
5
The 5 Performance Metric Domains
Performance Domain 1: Coordination with the BHO
Performance Domain 2: Person-Centered Care Coordination
during the Inpatient Stay
Performance Domain 3: Linkages to After Care Services
Performance Domain 4: Continuity of Care
Performance Domain 5: Engagement in Care
6
Highlights of WRBHO Findings
Observed changes that support transformation:
•
Improved provider performance within the WRBHO’s 19 county region
– 6 out of 8 metrics within the Performance Domain: Linkage to After Care Services, reflect
improvement: Q2 to Q3.
– A number of OMH BHO Portal metrics reflect performance in WNY that exceeds the
Statewide rates: outpatient visits, readmission rates.
•
County MH Directors convening meetings to engage providers about the changes that need to
take place to prepare for BH Managed Care.
•
Facility COO expressing appreciation that the State is monitoring data to assess the ability of
providers to work as a system of care.
•
MH inpatient providers expressing interest in learning how to be more effective in linking
patients with PH providers.
•
Facility discharge planners requesting help from the WRBHO in securing housing for a patient,
recognizing impact on avoidance of readmissions.
•
Providers devoting a full day to listen to feedback from those with a inpatient psychiatric
experience (The WRBHO forums)
7
REGIONAL & PROVIDER
PROFILE PERFORMANCE
REPORTS
8
Performance Domain 1 – Coordination with the RBHO
Domain includes measures helpful in ensuring complete and timely
data report and review practices
Metrics:
• The number of Notices of Admission submitted by providers is
consistent with established targets
• Notices of Admission are received within 24 hours of admission
• Initial Reviews are completed within 72 hours of admission
9
Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(a):
The number of Notices of Admission (NOAs) received is consistent with established targets
Data Source:
Data on NOAs provided through the eServices Portal / data gathered by WRBHO staff via telephone. Data on 2011
fee-for-service admissions provided by the NYS Office of Mental Health
Metric Calculation:
Total Admissions Noticed for Period / Total FFS Medicaid Admission Reported for Period
# of Admissions
Noticed to
WRBHO: Q1
816
# of Admissions
Noticed to
WRBHO: Q2
828
# of Admissions
Noticed to
WRBHO: Q3
849
Total # of
Admissions
Noticed through
Q3
2493
Mental Health Youth
192
164
157
513
Mental Health Total
1008
992
1006
Substance Use Detox Adult
128
72
Substance Use Inpatient
Rehab Adult
383
Substance Use Total
TOTAL
Inpatient Admission Type
Mental Health Adult
Total Admissions
through Quarter 3
2011*
% of Target
(2011)
3006
4268
70.40%
64
264
987
26.70%
264
267
914
2443
37.40%
511
336
331
1178
3430
34.30%
1519
1328
1337
4184
7698
54.35%
10
Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(b):
Notices of Admission are Received within 24 Hours of Admission
Data Source:
Data gathered via phone by WRBHO clinician or e-portal entry
Metric Calculation:
# of NOAs received within 24 hours of admission/Total admissions noticed in reporting period
Inpatient Admission Type
NOAs within 24 NOAs within 24
Total admissions hours for current hours/admissions Provider range for
for current quarter
quarter
for current quarter current quarter
NOAs within 24
hours for previous
quarter
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
849
829
97%
78 - 100%
95%
2%
Mental Health Youth
157
156
99%
93 - 100%
98%
1%
Substance Use Detox Adult
64
58
90%
81 - 100%
98%
-8%
Substance Use Inpatient
Rehab Adult
267
253
94%
87 - 100%
89%
5%
Total
1337
1296
96%
78 - 100%
94%
2%
11
Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(c):
Initial Reviews are Completed within 72 Hours of Admission
Data Source:
Gathered via phone by WRBHO clinician
Metric Calculation:
Initial Reviews within 72 Hours of admission/Total admissions in reporting period
Inpatient Admission Type
Total Admissions:
Current Quarter
# of Initial
Initial Reviews
Reviews w/in 72 w/in 72 hours /
hours: Current Total Admissions:
Quarter
Current Quarter
Provider Range:
Current quarter
Initial Reviews w/in
72 hours / Total
Admissions:
Previous Quarter
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
849
805
94%
52 - 100%
83%
11%
Mental Health Youth
157
146
92%
77 - 100%
85%
7%
Substance Use Detox Adult
64
55
85%
53 - 96%
94%
-9%
Substance Use Inpatient
Rehab Adult
267
209
78%
38 - 100%
67%
11%
Total
1337
1215
90%
38 - 100%
80%
10%
12
Performance Domain 2 – Person-Centered Care Coordination During the Stay
Domain includes metrics that describes the extent to which
effective, person-centered care coordination practices during the
inpatient stay are evident.
• Particular interest in efforts to ensure that the individual’s
needs have been identified so that an effective discharge plan
can be developed.
• Additional metrics will be added under this domain over time.
Metric:
• Treatment history is shared with the inpatient provider during
the Initial Review
13
Performance Domain 2 – Person-Centered Care Coordination During the Stay
Performance Metric 2(a):
Treatment History is Shared with the Inpatient Provider during the Initial Review
Data Source:
Data recorded in FlexCare by WRBHO Clinician
Metric Calculation:
Discharges w/Treatment History Shared/Total Discharges in Reporting Period
Inpatient
Admission Type
# of Discharges % of Discharges
% of Discharges
w/Treatment
w/Treatment
w/Treatment
Variance:
Current vs.
Total Discharges: History Shared: History Shared: Provider Range: History Shared:
Current Quarter Current Quarter Current Quarter Current Quarter Previous Quarter Previous Quarter
Regional YearTo-Date
Mental Health
Adult
842
720
85%
55 - 100%
80%
5%
83%
Mental Health
Youth
152
136
89%
70 - 100%
80%
9%
86%
Substance Use
Detox Adult
66
54
81%
80 - 100%
84%
-3%
82%
Substance Use
Inpatient Rehab
Adult
267
242
90%
81 - 100%
74%
16%
85%
Total
1327
1152
86%
55 - 100%
79%
7%
84%
14
Performance Domain 3 – Linkages to After-Care Services
Domain includes metrics that measures the extent to which steps were taken during
the inpatient stay to establish linkages to needed outpatient services.
Metrics:
•
•
•
•
•
•
•
•
The current or prior mental health outpatient provider was contacted during stay
An appointment for mental health outpatient treatment was scheduled as part of
the discharge plan
The case summary was sent to the outpatient mental health or substance use
disorder (SUD) outpatient Provider
A physical health appointment scheduled post-discharge if a physical health care
need was identified during the stay
A SPOA application was submitted for case management, housing and other
services
For youth with multi-system needs, the discharge plan includes referrals /linkages
for the provision of basic needs
For youth with multi-system needs, the discharge plan documents post discharge
educational needs
There is improvement in housing status for individuals who are homeless at
admission
15
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summaries
Higher performing providers
• Fall in the top 25% for the performance metric
• 8 or more discharges during the quarter
• Data collection process for Q3 was viewed as an accurate reflection of the providers’
work by the WRBHO Utilization Review Clinician.
16
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(a):
The current or prior mental health outpatient provider was contacted during stay
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in
Reporting Period
Inpatient Admission Type
# Where
% Where
Outpatient
Outpatient
Provider was
Provider was
Contacted During Contacted During
Total Discharges:
the Stay:
the Stay: Current
Current Quarter
Current Quarter
Quarter
Provider Range:
Current Quarter
Where Outpatient
Provider was
Contacted During
the Stay: Previous
Quarter
Variance
Mental Health Adult
842
662
78%
49 - 100%
64%
14%
Mental Health Youth
152
140
92%
71 - 100%
84%
8%
Total
994
802
81%
49 - 100%
68%
13%
17
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(a):
The current or prior mental health outpatient provider was contacted during stay
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in
Reporting Period
Inpatient Admission Type
Provider Average
Provider range
Higher Performing Providers
Adult Mental Health
Youth Mental Health
78%
92%
49 - 100%
71 - 100%
D
L
P
18
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(a):
The current or prior mental health outpatient provider was contacted during stay
Best Practices:
• Gathers collateral information from outpatient provider and is linked closely
with other outpatient agencies.
• Attempts to keep MH clients within their system of care, which appears to
help with continuity of care.
• Is protocol that the Discharge Planner notifies outpatient provider of
individuals admitted (once identified) and shares appropriate collateral
information.
• Has a “no wrong door” philosophy and offers co-existing treatment with
mental and physical health providers in close proximity of each other.
Encourages effective communication.
19
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(a):
The current or prior mental health outpatient provider was contacted during stay
Barriers:
• Gaps in communication between UR clinicians and discharge
planners.
• The practice is not built in to standard facility procedures.
• The treatment team does not reach out to current or active
providers to collaborate and work together towards the
recovery of patients.
20
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(a):
The current or prior mental health outpatient provider was contacted during stay
WRBHO Actions:
• Clarified meaning of the indicator during one-on-one provider meetings
through issuing a new review template and holding provider calls.
• WRBHO System of Care Transition Coordinator’s role redefined to include
contacting outpatient providers when an active client has been admitted and
encouraging follow-up. This outreach continues to encourage contact
between inpatient and outpatient providers.
• Focused on the importance of the transition to outpatient treatment during
the February and June BEST Meetings.
• Effective linkage to after care services was the theme during the September
27 BEST Meeting.
21
Performance Domain 3 – Linkages to After-Care Services
VIGNETTE:
Linking with Past Supports to Avoid Future Readmissions
On August 31, 2012 a 51 year-old man was mental hygiene arrested after he was found lying in the road
with suicidal ideation. His diagnoses included: Psychosis Not Otherwise Specified and Paranoid
Schizophrenia. The individual was observed as grandiose, paranoid, delusional and unkempt. The
treatment history indicated that the individual had been discharged from the facility just three days
earlier. It was also noted that the he had an apartment, but little to no supports. In addition, the
individual had no current outpatient providers.
Through use of PSYCKES the WRBHO Utilization Review Clinician (URC) learned that the individual had a
history with the ACT team through the local psychiatric center. It also appeared likely that he was not
taking his current medications. Due to his limited supports, the WRBHO URC recommended that the
inpatient provider explore reestablishing the linkage with the ACT team. The provider accepted this
recommendation. The individual was discharged home to his apartment and the ACT Team followed up
within a very few days of the discharge. By reviewing the treatment history in PSYCKES, the WRBHO URC
was able to identify a past support and encourage a linkage that will assist the beneficiary in living
successfully and securely in his own apartment.
22
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(b):
An appointment for mental health outpatient treatment was scheduled as part of the
discharge plan
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges
in Reporting Period
Inpatient Admission Type
An Appointment
for MH
An Appointment
Treatment was for MH Treatment
Part of the
was Part of the
Discharge Plan:
Total Mental Health Discharge Plan:
Discharges: Current Current Quarter Current Quarter
(%)
Quarter
(#)
Provider Range:
Current Quarter
An Appointment for
MH Treatment was
Part of the
Discharge Plan:
Previous Quarter
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
842
641
76%
0 - 100%
81%
-5%
Mental Health Youth
152
108
71%
0 - 100%
70%
1%
Total
994
749
75%
0 - 100%
79%
-4%
23
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(b):
An appointment for mental health outpatient treatment was made as part of the discharge
plan
Best Practices:
• Strong ties to the system’s array of outpatient services facilitate effective
communication and efficient scheduling.
• Follow a person-centered, thorough and comprehensive discharge planning process.
• Connecting with outpatient treatment is a standard practice for those individuals not
transferring to another facility for inpatient rehabilitation (SUD).
• Standard operating practice to ensure linkage with a community- based provider prior
to discharge.
• Intake coordinator assigned to client and follows him or her from inpatient to
discharge.
• Outreach is performed if the aftercare appointment is missed.
24
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(b):
An appointment for mental health outpatient treatment was made as part of the discharge
plan
Barriers:
• In instances where the individuals do not have an outpatient
provider at the time of admission, this process is more difficult
to accomplish during the inpatient stay.
• Lack of outpatient capacity is a barrier in some areas.
25
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(b):
An appointment for mental health outpatient treatment was scheduled as part of the
discharge plan
WRBHO Actions:
• During September 27 BEST Meeting, providers shown to be successful
in scheduling outpatient appointments spoke about their practices.
• December BEST meeting will focus on sharing practices in place at
providers having success with individuals leaving inpatient care with a
outpatient mental health appointment scheduled.
• WRBHO staff will follow-up directly with providers with lower
performance in this area to further define barriers and identify solutions.
26
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (c):
The case summary was sent to the outpatient mental health or substance use disorder
(SUD) outpatient Provider
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period
Inpatient Admission Type
Total Discharges:
Current Quarter
Case Summary
Case Summary
was Sent to the was Sent to the
Outpatient
Outpatient
Provider: Current Provider: Current
Quarter (#)
Quarter (%)
Provider Range:
Current Quarter
Case Summary was
Sent to the
Outpatient
Provider: Previous
Quarter (%)
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
842
555
65%
0 - 100%
65%
0%
Mental Health Youth
152
92
60%
40 - 100%
52%
8%
Substance Use Detox Adult
66
28
42%
22 - 61%
44%
-2%
Substance Use Inpatient
Rehab Adult
267
116
43%
9 - 83%
35%
8%
Total
1327
791
59%
0 - 100%
56%
3%
27
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3 (c):
The case summary was sent to the outpatient mental health or substance use disorder
(SUD) outpatient Provider
Best Practices:
• Standardized practice has been implemented to submit the
discharge summary so the outpatient provider is aware of the
discharge diagnosis, GAF, and medications/instructions.
• It is a standard operating practice that when a patient signs a
release, case summaries are sent to the outpatient provider. If
patient initially declines, staff will discuss with the patient the
need to send the summary for good continuity of care.
• Provider has effective linkages to outpatient programs in their
organization’s system of care.
28
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3 (c):
The case summary was sent to the outpatient mental health or substance use disorder
(SUD) outpatient Provider
WRBHO Actions:
• Confusion existed as to what constituted a “case summary.”
WRBHO clarified definition: Discharge instructions which
include dates of admission, discharge diagnosis, and
medication list.
• Definition shared with providers and the WRBHO UR
Clinicians are using this definition in their reviews.
• We anticipate that we will continue to see improvement on
this important dimension.
29
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (d):
A physical health appointment scheduled post-discharge if a physical health care need was
identified during the stay
Data Source:
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to
the WRBHO
Metric Calculation:
Discharges w/physical health appointment scheduled with an outpatient provider/discharges w/physical health need
identified during inpatient stay for reporting period
Inpatient Admission Type
Total Discharges
w/Physical Health
Needs Identified:
Current Quarter
# w/Physical
% w/ Physical
Health
Health
Appointment
Appointment
Scheduled w/
Scheduled w/
Outpatient
Outpatient
Provider for
Provider for those
those w/ Needs
w/ Needs
Identified:
Identified: Current
Current Quarter
Quarter
Provider Range:
Current Quarter
% w/ Physical
Health
Appointment
Scheduled w/
Outpatient Provider
for those w/ Needs
Identified: Prior
Quarter
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
279
110
39%
0 - 100%
21%
18%
Mental Health Youth
12
6
50%
0 - 100%
25%
25%
Substance Use Detox Adult
25
5
35%
0 - 100%
8%
27%
Substance Use Inpatient
Rehab Adult
49
27
55%
0 - 100%
14%
41%
Total
365
148
40%
0 - 100%
19%
21%
30
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3 (d):
A physical health appointment scheduled post-discharge if a physical health care need was
identified during the stay
Best Practices:
• Facility goal is to ensure that all patients are well connected to
all areas of health care - both mental and physical.
• Provider has a protocol requiring the case manager to link the
patient with a Primary Care provider if the patient is admitted
without one. The provider has developed relationships with two
PCP practices to help expedite creating this very important link.
• Provider strives to connect clients to previous primary care
providers, if none have been established, they refer clients to
the county system. The County provides a list of accepting
physicians.
31
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3 (d):
A physical health appointment scheduled post-discharge if a physical health care need was
identified during the stay
Barriers:
• The responsibility is placed on the individual to follow up with their primary
care physician after discharge.
• Some facilities have procedures that focus on SUD and mental health
outpatient appointments only (not physical health).
• Many individuals admitted do not have a primary care provider and
inpatient staff says that it is too hard to link the individuals with a PCP during
the inpatient stay.
32
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3 (d):
A physical health appointment scheduled post-discharge if a physical health care need was
identified during the stay
WRBHO Actions:
• Developed a template for inpatient providers that details the rationale and
offers a definition of this (and other) metric(s). Template reviewed with
inpatient providers via webinar.
• WRBHO Utilization Review Clinicians engaged in a thorough review of all
questions contained in the review cycle to be better prepared to extract
more accurate information from the providers during these reviews.
• WRBHO will continue to work to identify effective practices for integrating
physical health engagement into the behavioral health admissions through
surveying providers for effective practices and sharing strategies via BEST
Meetings and other provider forums.
33
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(e):
A SPOA Application was Submitted During the Inpatient Stay
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool Faxed to the
WRBHO
Metric Calculation:
# of SPOA Applications Submitted/# of Discharges in Reporting Period
Total Discharges:
Current Quarter
# of Discharges
w/SPOA
Application
Submitted:
Current Quarter
% of Discharges
w/SPOA
Application
Submitted:
Current Quarter
Provider range for
current quarter
% of Discharges
w/SPOA
Application
Submitted:
Previous Quarter
Variance:
Current vs.
Previous
Quarter
Mental Health Adult
842
104
12%
0 - 66%
9%
3%
Mental Health Youth
152
30
19%
0 - 100%
19%
0%
Substance Use Detox Adult
66
1
4%
0 - 33%
2%
2%
Substance Use Inpatient
Rehab Adult
267
5
1%
0 - 9%
1%
0%
Total
1327
140
10%
0 - 100%
8%
2%
Inpatient Admission Type
34
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(e):
A SPOA Application was Submitted during the Inpatient Stay
Best Practices:
• Overall, SPOA referrals are made for 12% of adults discharged from inpatient
care and 19% of youth. However, the range varies considerably, with several
providers reporting much higher referral rates. Based on interactions with
providers, we have identified a few practices that appear to be proving
successful:
• SPOA “consultant” from the county is placed on each unit to help
identify and assist discharge planners with application process.
• Provider uses a team approach in working with the patient. That is, the
discharge planner, the social worker/therapist and the MD/NPP all meet
together with the patient to assist in determining needs for a successful
transition.
35
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(e):
A SPOA Application was Submitted during the Inpatient Stay
Barriers:
• Lack of SPOA services (care management) to support the needs of those with SU
diagnosis.
• SPOA review processes occur on a monthly basis only in some counties.
• Inpatient facilities will start process if needed but rely on outpatient services to finish
the referral.
WRBHO Actions:
• The WRBHO has begun to work with county directors to assess the interest in
developing greater consistency in SPOA processes.
• WRBHO UR Clinicians have been oriented to county specific SPOA processes so that
they are in a better position to support the providers’ needs in each county.
• WRBHO UR Clinicians have been encouraged to support specific SPOA requests by
helping with the application or even attending SPOA meetings to represent the needs
of the individual and the provider.
36
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(f):
For youth with multi-systems needs, the discharge plan includes referrals / linkages for
basic needs
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges with Indication that Basic Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for
Reporting period
Inpatient Admission Type
Mental Health Youth
# of Youth
% of Youth
w/Indication that
# of Youth w/Multi- w/Indication
Systems Needs
that Basic Needs Basic Needs were
Addressed:
Identified: Current were Addressed:
Quarter
Current Quarter Current Quarter
95
94
98%
Provider Range:
Current Quarter
% of Youth
w/Indication that
Basic Needs were
Addressed:
Previous Quarter
Variance:
Current vs.
Previous
Quarter
87 - 100%
98%
0%
37
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(f):
For youth with multi-systems needs, the discharge plan includes referrals / linkages for
basic needs
Best Practices:
• Discharge planning is comprehensive and involved all outside agencies.
• Weekly team meetings are held for the interdisciplinary team and UR team.
• On-site team member meetings.
• Provider gathers collateral information from outpatient providers and is very
knowledgeable about resources that are available in the community.
38
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (g):
For youth with multi-systems needs, the discharge plan documents post-discharge
educational needs
Data Source:
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the
WRBHO
Metric Calculation:
# of Discharges with Indication that Educational Needs Were Addressed/# of Discharges w/Multi-System Needs
Identified for Reporting period
Inpatient Admission Type
Mental Health Youth
# of Youth
w/Indication
% of Youth
# of Youth w/Multi- that Educational w/Indication that
Systems Needs
Needs were
Educational Needs
were Addressed:
Identified: Current
Addressed:
Quarter
Current Quarter Current Quarter
95
84
88%
Provider Range:
Current Quarter
% of Youth
w/Indication that
Educational Needs
were Addressed:
Previous Quarter
Variance:
Current vs.
Previous
Quarter
0 - 100%
93%
-5%
39
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3 (g):
For youth with multi-systems needs, the discharge plan documents post-discharge
educational needs
Best Practices:
Supporting the multi-system needs of children requires very comprehensive
planning, involving a number of outside agencies in regular interdisciplinary
team meetings. Higher performing providers have made school programming
mandatory for children and youth.
40
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(f)
and (g):
For youth with multi-systems needs, the discharge plan includes referrals / linkages for
basic and educational needs
WRBHO Actions:
• WRBHO staff will review these measures with providers following the
release of the Q3 data to ensure that data collection and reporting
accurately reflect current practice.
• A Clinical Grand Rounds scheduled for 2013 will focus on children’s services
and will be presented by the WRBHO Child Psychiatrist, Mario Testani. Dr.
Testani will spend a portion of his presentation discussing the importance of
addressing educational needs.
41
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(h):
Improvement in housing status for individuals who are homeless at admission
Data Source:
Gathered by WRBHO clinician during review
Metric Calculation:
# of Discharges w/Improved Housing Status/# of Discharges that were Homeless at Admission for Reporting Period
Inpatient Admission Type
Improvement in Improvement in
Housing Status Housing Status for
for Individuals
Individuals
Homeless at
Homeless at
Total # Homeless at
Admission:
Admission:
Admission: Current Current Quarter Current Quarter
Quarter
(#)
(%)
Provider Range:
Current Quarter
Improvement in
Housing Status for
Individuals
Homeless at
Admission:
Previous Quarter
(%)
Variance
Mental Health Adult
63
20
31%
0 - 100%
20%
11%
Mental Health Youth
No Data
No Data
No Data
No Data
100%
No Data
Substance Use Detox Adult
7
1
33%
0 - 50%
No Data
No Data
Substance Use Inpatient
Rehab Adult
24
16
66%
0 - 100%
68%
-2%
Total
94
37
39%
20 - 100%
30%
9%
42
Performance Domain 3 – Linkages to After-Care Services
Performance Metric 3(h):
Improvement in housing status for individuals who are homeless at admission
WRBHO Actions:
• As access to stable housing is critical to achieving recovery this measure
has been an area of focus in our review and discussion of both system and
provider performance.
• WRBHO UR clinicians have been asked to encourage providers to work
diligently to address this need for cases we review.
• WRBHO staff has also worked with county SPOAs to support an expedited
review for inpatients, especially those in need of housing.
• Providers have been encouraged to begin the housing planning process for
individuals admitted as homeless as soon as they are admitted.
43
Performance Domain 4 – Continuity of Care
Domain includes metrics that look at the extent to which individuals are
connected to outpatient mental health services following discharge from
inpatient – as well the timeliness of that connection.
• Utilize data collected by WRBHO and data available through BHO Portal.
Metrics:
• The percentage of scheduled Mental Health clinic outpatient appointments
attended (WRBHO collected)
• The percentage of Mental Health Discharges followed by an outpatient visit
for Mental Health treatment within 7 days (BHO Portal)
• The percentage of SUD Detox discharges with lower level SUD services with
14 days (BHO Portal)
• The percentage of SUD rehabilitation discharges with lower level SUD
services within 14 days (BHO Portal)
44
Performance Domain 4 – Continuity of Care
Performance Metric 4(a):
Percentage of scheduled Mental Health clinic outpatient appointments attended
Data Source:
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to
the WRBHO
Metric Calculation:
# of Outpatient Licensed Mental Health Clinic Appointments Attended Post-Discharge / # of Outpatient Mental Health
Appointments Attended / Total # of Outpatient Mental Health Appointments Scheduled
Inpatient
Admission Type
# of Outpatient # of Outpatient
Mental Health
Mental Health
Appointments
Appointments
Scheduled:
Attended:
Current Quarter Current Quarter
% of Outpatient
% of Outpatient
Mental Health
Mental Health
Appointments
Appointments
Variance:
Attended:
Attended:
Current vs.
Provider Range:
Current Quarter Current Quarter Previous Quarter Previous Quarter
Regional YearTo-Date
Mental Health
Adult
286
232
81%
52-100%
79%
2%
80%
Mental Health
Youth
37
30
81%
0 - 100%
85%
-4%
84%
Total
320
262
81%
52 - 100%
80%
1%
80%
45
Performance Domain 4 – Continuity of Care
Performance Metric 4(a):
Percentage of scheduled Mental Health clinic outpatient appointments attended
WRBHO Actions:
• WRBHO clinicians gather these data through follow-up w/identified the
outpatient mental health providers.
•
WRBHO follow-up takes place for up to 60-days post discharge (or until there can
be confirmation of either attendance or a “no show.”)
• Complements data available from the BHO Portal by providing a more timely
way for staff to monitor the rate at which individuals are attending their
outpatient mental health appointments.
• WRBHO focus will be on identifying barriers to after care attendance and
strategies providers are finding effective in increasing attendance.
46
Performance Domain 4 – Continuity of Care
Performance Metric 4 (b): Percentage of MH Discharges Followed by an Outpatient Visit for MH Treatment within 7 Days
Data Source:
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals receive outpatient mental health treatment within 7 days of discharge
from a mental health inpatient hospitalization.
Inpatient
Admission Type
Western Region:
Q1 2012
Variance:
Current vs.
Western Region:
Q4 2011
Previous Quarter
Statewide: Q1
2012
Variance:
Western Region
vs. Statewide
Mental Health
Adult
44.8%
45.9%
1%
34.7%
10.1%
Mental Health
Youth
44.3%
48.1%
-4%
38.6%
5.6%
47
Performance Domain 4 – Continuity of Care
Performance Metric 4 (c):
Percentage of SUD Discharges Followed by a Lower Level SUD Service within 14 Days
Data Source:
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals receive a lower level, less intensive, substance use disorder service within 14 days
following a discharge from an inpatient substance use treatment.
Inpatient
Admission Type
Western Region:
Q1 2012
Variance:
Current vs.
Western Region:
Q4 2011
Previous Quarter
Statewide: Q1
2012
Variance:
Western Region
vs. Statewide
Substance Use
Detox Adult
58.1%
50.5%
7.5%
33.1%
25%
Substance Use
Inpatient Rehab
Adult
47.7%
47.7%
0%
39.5%
8.2
48
Performance Domain 5 – Engagement in Care
Metrics
• % of Mental Health discharges followed by 2 or more MH
outpatient visits within 30 days (BHO Portal)
• % of SUD Detox or Rehabilitation services followed by 2 or
more SUD services within 14 days of discharge (BHO Portal)
49
Performance Domain 5 – Engagement in Care
Performance Metric 5(a):
Percentage of MH Discharges Followed by Two or More MH Outpatient Visits within 30 Days
Data Source:
NYS OMH BHO Portal
Metric Definition:
Received two or more outpatient mental health visits within thirty days of discharge.
Inpatient
Admission Type
Western Region:
Q1 2012
Variance:
Current vs.
Western Region:
Q4 2011
Previous Quarter
Statewide: Q1
2012
Variance:
Western Region
vs. Statewide
Mental Health
Adult
42.6%
40.9%
1.7%
31.9%
10.7%
Mental Health
Youth
48.9%
49.6%
-.7%
43.3%
5.6%
50
Performance Domain 5 – Engagement in Care
Performance Metric 5 (b):
Percentage of SUD Detox or Rehabilitation Discharges Followed by Two or More Lower Level SUD Services within 14
Days of Discharge
Data Source:
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals discharged from inpatient detoxification or chemical dependence inpatient
rehabilitation engage in 2 or more lower level substance use disorder treatment services within fourteen days of
discharge.
Inpatient
Admission Type
Substance Use
Adult
Western Region:
Q1 2012
32.2%
Variance:
Current vs.
Western Region:
Q4 2011
Previous Quarter
32.5%
-.3%
Statewide: Q1
2012
Variance:
Western Region
vs. Statewide
21.4%
10.8%
51
HEALTH HOMES
Brief Overview
Adele Gorges
52
WRBHO ROLE IN HEALTH HOMES
Chris Mangione
53
Role of the WRBHO in Supporting Health Homes
• Notify inpatient providers when an admitted individual being reviewed
by the WRBHO is enrolled in a Health Home or eligible for Health
Home outreach
• Ensure the provider has contact information for the Health Home care
coordinator.
• Contact Health Home care coordinators to review and assist with
post-discharge follow-up as needed.
• Share past treatment history as found in PSYCKES and FlexCare
• Alert Health Home when Health Home member is admitted.
• Support community referrals to Health Homes
54
WRBHO
Q3 SUB-REGIONAL
PERFORMANCE REVIEW:
Linkages to Aftercare
Services
55
Sub-Regional View - Discharges
County of Residence - Current
Quarter
Sub-Regional vs. Regional
Erie
Niagara
Orleans
SubRegional
Current
Qtr
Mental Health Adult
266
100
6
372
842
44%
Mental Health Youth
31
3
2
36
152
24%
Substance Use Detox
24
3
1
28
66
42%
Substance Use Inpatient Rehab
Adult
73
17
4
94
267
35%
TOTALS
394
123
13
530
1327
40%
Inpatient Admission Type
Regional
Current
Qtr
SubRegional
vs.
Regional
56
Sub-Regional View
Performance Metric 3 (a):
Data Source:
Metric Calculation:
The Current or Prior Mental Health Outpatient Provider was Contacted During the Stay
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool
faxed to the WRBHO
# of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of
Discharges in Reporting Period
By County of Residence - Current Quarter
Inpatient Admission Type
Sub-Regional vs. Regional
Erie
Niagara
Orleans
Sub-Regional
Current Qtr
Regional
Current Qtr
Sub-Regional vs.
Regional
Mental Health Adult
85%
55%
100%
77%
78%
1%
Mental Health Youth
80%
100%
100%
83%
92%
-9%
TOTALS
84%
56%
100%
78%
80%
-2%
57
Sub-Regional View
Performance Metric 3 (b):
Data Source:
Metric Calculation:
An appointment for mental health outpatient treatment was made as part of the discharge plan
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool
faxed to the WRBHO
# of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health
Discharges in Reporting Period
By County of Residence - Current Quarter
Inpatient Admission Type
Sub-Regional vs. Regional
Erie
Niagara
Orleans
Sub-Regional
Current Qtr
Regional
Current Qtr
Sub-Regional vs.
Regional
Mental Health Adult
81%
76%
83%
80%
76%
4%
Mental Health Youth
74%
100%
100%
78%
53%
22%
TOTALS
80%
77%
87%
80%
72%
8%
58
Sub-Regional View
Performance Metric 3 (c):
Data Source:
Metric Calculation:
The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient
Provider
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool
faxed to the WRBHO
# of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period
By County of Residence - Current Quarter
Inpatient Admission Type
Sub-Regional vs. Regional
Erie
Niagara
Orleans
Sub-Regional
Current Qtr
Regional
Current Qtr
Sub-Regional vs.
Regional
Mental Health Adult
71%
67%
33%
69%
65%
4%
Mental Health Youth
67%
100%
100%
72%
60%
12%
Substance Use Detox
29%
50%
100%
34%
43%
-11%
Substance Use Inpatient
Rehab
58%
21%
100%
53%
43%
10%
TOTALS
66%
61%
69%
65%
59%
6%
59
Sub-Regional View
Performance Metric 3 (d):
Data Source:
Metric Calculation:
A physical health appointment scheduled post-discharge if a physical health care need was identified
during the stay
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review
tool FAX'd to the WRBHO
Discharges w/physical health appointment scheduled with an outpatient provider/Discharges w/physical
health need identified during inpatient stay for reporting period
By County of Residence - Current Quarter
Inpatient Admission Type
Sub-Regional vs. Regional
Erie
Niagara
Orleans
Sub-Regional
Current Qtr
Regional
Current Qtr
Sub-Regional vs.
Regional
Mental Health Adult
11%
61%
0%
49%
39%
10%
Mental Health Youth
0%
0%
0%
0%
50%
-50%
Substance Use Detox
0%
0%
0%
0%
42%
-42%
Substance Use Inpatient
Rehab
20%
0%
100%
40%
55%
-15%
TOTALS
11%
50%
31%
21%
41%
-20%
60
Sub-Regional Analysis Summary
• Initial sub-regional reports show performance within each sub-region
by county of residence.
• While the number of cases within some counties is small, Q3 data do show
some variation in performance within the sub-region when compared to the
region as a whole.
• These reports will be followed with a report by county of fiscal responsibility
that provides a view of provider-specific performance, which we believe will
be helpful in better understanding patterns of care and identifying
opportunities to strengthen effective linkages to after care services.
61
WRBHO EFFECTIVE PRACTICES
PRESENTATIONS
• Assistance in attending MH appointments: Michael Zuber,
Vice President of Behavioral Health, ECMC
Critical Time Intervention: Tara Karoleski , Coordinator, Adult
Single Point of Access & Accountability, Erie County
• Consumer Centered Family Consultation - Family Institute for
Education, Practice and Research, U of R Medical Center
62
Assistance in attending MH appointments
Michael Zuber, Vice President of Behavioral Health,
ECMC
63
Critical Time Intervention
Tara Karoleski , Coordinator, Adult Single Point of Access
& Accountability, Erie County
64
The Family Institute for Education,
Practice and Research (at URMC) & CCFC
• Has been funded by the NYS Office of Mental Health for
over 10 years; has worked with over 200 agencies in a
variety of settings
• Provides training and implementation support for agencies
that are adopting evidence based family-involving
approaches for people with severe mental illness
• Offers training and consultation related to evidence based
practices as well as organizational changes related to the
successful implementation of those practices
• One core offering is Consumer Centered Family
Consultation (can also be called person centered family
consultation)
• See 2012 article for additional detail and background
65
Consumer Centered Family Consultation
• Consumer Centered Family Consultation (CCFC) is a brief, education-based
engagement and consultation service that is typically completed in one to
three sessions
• It promotes collaboration among adult consumers of mental health
services, members of their family or social network, and service providers
to support each consumer’s recovery
• The focus of CCFC is the person/consumer with a behavioral health issue
(the focus is not the family or family therapy)
• There are specific shared decision-making tools embedded in the process
of engaging people and their natural supports
• CCFC provides an opportunity to help prevent avoidable hospitalizations
and to help facilitate linkage with outpatient services by involving people’s
natural supports in meaningful ways
66
Consumer Centered Family Consultation
• WRBHO CCFC Webinar: January 11 at 11:00 am
• Contact at the Family Institute:
– Anne Smith, Executive Director
– 585-279-7903
– [email protected]
67
SUB-REGIONAL AREAS OF
FOCUS
68
Sub-Regional Areas of Focus
• Top 4 reasons for admission for Individuals with Complex Needs
•
Lack of engagement with outpatient provider
•
Non-adherence to medication
•
Drug & Alcohol Use
•
Increased symptomology w/o Precipitant Noted
• Improve access to housing at discharge
• Address any gaps in the SPOA process and help county prepare for
Health Homes
• Support the introduction of Consumer Centered Family Consultation
across the sub-region
• Add more…
69
WRBHO Report Summary
WRBHO PLANS
70
WRBHO Plans
• Post Q3 WRBHO Performance Report on NYCCP Website
• Distribute provider-specific reports
• Distribute county of origin reports to County Directors
• Survey to identify areas of focus for each region / begin to plan
for Learning Collaborative
• Consumer Centered Family Consultation Webinar scheduled
for January 11, 2013
• Support Health Homes in our region
• Begin Grand Rounds Webinars
71
Q and A
72