2014 pay-for-performance review to executive directors 1
TRANSCRIPT
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
• 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 $5 million to providers
• More than 250 reports, in new streamlined format, have been e-mailed to providers
Streamlined Provider Summary
• Eliminated redundancy of information from NIAC and Quality Management reports
• Cover Sheet with relevant information
• Operational Definitions Master Document
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2014 Results
Level of Care
Number of Providers Scored in 2014*
Number of Providers with a Total Score > 70%
Percentage of Providers with a Total Score > 70%
Providers Receiving P4P in 2013
Total Funds in 2014
BHRS 71 6 8% 44 out of 81 (54%) 844,960$ 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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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
• 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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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