BEHAVIORAL HEALTH OUTCOMES ANALYSIS

Name

Agency, if applicable

Position or role relative to

Outcomes Implementation

Past clinical experience if

applicable

Familiarize participants with a method for

utilizing outcomes in a clinical setting.

Participants will explore GAF for consumer

improvement changes and identifying consumer

demographics and services.

Participants will discuss variables, trends, and

evaluate relationships represented in data.

Participants will look for potential changes in

clinical care.

What or, how is your organization calling or

defining outcomes? (List as part of a brain storming)

Is anyone including or measuring cost of

efforts and connecting these to outcomes?

Accountable

Efficient

Appropriate

Accessible

Acceptable

In Being:

Behavioral Health Outcomes

Community Based

Healthcare Outcomes

Diagnosis Related Groups DRGs

Severity of Illness: Extent of physiological decomposition or organ system loss of function

Risk of Mortality: Likelihood of dying

Prognosis: Probable outcomes of the illness including improvement or deterioration in the severity of the illness

Treatment Difficulty: Management of the illness and procedures

Need for Intervention: What would happen if you do not intervene

Resource intensity: Number and type of resource(s) required

Client Extreme Dysfunction

Client Independent Function

Levels of Functioning

1 2 3 4 5 6 7 8 9 10

Danger to self/others

Personal self care

Activities of daily living

Independent Functioning

Community living skills

1 2 3 4 5 6 7 8 9 10

Service Environment

Acute Hospital Jail/Prison

24Hr Residential

Partial Care Day Support

Outpatient Aftercare

System Independent

OUTCOMES INDIVIDUAL STATEWIDE ADULT STATEWIDE CHILD

With a drug/alcohol use history are now

abstaining

30.3% 37.8%

Are Not Homeless 96.5% 99.8%

Are Employed 19.4% .2%

Attend School 13.5% 86.1%

No recent criminal justice system involvement 92.5% 96.2%

Self-help groups Coming Coming

Clinical & Programmatic

Staff billable time calculation and

production options

Staff time tracking

Cost analysis components

Clinical and cost outcome

communications tools

Outcomes systems start with the ability to capture

how staff utilize their production potential

Example:Potential Annual Hours 2080

Annual Leave/PTO 160

Personal/Holidays/Sick 144

Total potential production hours 1776

Expected production at 56% 1000

Expected production at 67% 1200

Expected production at 75% 1332

DATE: STAFF: PROGRAM: Activity Time Total

DIRECT SERVICE (1-10)

1. Comp Assessment x 2.0 2

2. Individual

3. Group

4. Case Management

5. Family

6. Peer

7. Case Staff

8. Other

REPORT & DOCUMENTATION (11-20)

11. Case Notes

12. Closure

13. Incident Report

14. Other

STAFF DEVELOPMENT (21-30)

21. Conference

22. Workshop external

23. Workshop internal

24. Staff Supervision

25. Other

ADMINISTRATIVE (31)

31. Meetings

Salary

Fringe Benefits

Billable Services-Productivity

Production –Value of Service

Non-billable Activities

Overhead and Administrative Expenses

Show and No Show Rates

Scheduling – Double Booking, Walk-In

• Staff Confidentiality

• Training for Clinical Supervision

• Training for Program and Clinical Improvement

1 2 3 4 5 6 7 8 9 10

1 M

2 A

3 I

4 T

5 E

6 N

7 A

8 N

9 C

10 E

ENTRY

EXIT

1 2 3 4 5 6 7 8 9 10

1

2

3 1 1 1

4 2 3 3

5 1 4 29 68 18 3 1

6 2 18 59 50 13

7 1 4 9 6 1

8 1

9

10

ENTRY

EXIT

GAF Score 1-30 Client is a candidate for

inpatient care

GAF Score 31-69 Client is a candidate for

outpatient care – either PCP,

IOP or traditional outpatient

counseling

GAF Score 70 or Clients in this range do not

typically meet the criteria for

medically necessary services

because they are functioning

to well to be a candidate for

therapy

Adapted From : Packard M. A. (2009). Midwest Behavioral Health Network. New Avenues, South Bend, Indiana.

N=31

N=97

N=124

N=42

0

30

60

90

120

150

Worse No Change Slightly Better Significantly Better

Average Length of Stay

N=31

N=97

N=124

N=42

0

5

10

15

20

25

30

Worse No Change Slightly Better Significantly Better

Average Days of Service

N=31

N=97

N=124

N=42

0

300

600

900

1200

1500

Worse No Change Slight Better Significantly Better

Average Cost Per Case

13%

30%

17%3%

14%

23%

Female Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

Meds

N = 166

12%

39%

13%5%

13%

18%

Male Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

Meds

N = 134

12%

37%

18%2%

14%

17%

18-29 Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 60

12%

35%

15%4%

13%

21%

30-55 Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

Meds

16%

23%

17%6%

13%

25%

56+ Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

Meds

14%

31%

14%3%

17%

21%

Hispanic Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 67

15%

28%

18%

12%

12%

15%

BlackIndiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 28

12%

36%

15%

3%13%

21%

White Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 196

24%

11%

14%

4%

16%

31%

Other Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 5

4%

68%

8%

2% 13%

5%

American Indian Indiv Srvcs

Group

Case Management

Wrap Srvcs

Assessment

MedsN = 4

69.8%

30.2%

Gender

Female

Male

N = 43

26%

65%

9%

Age

18-29

30-55

56+

N = 43

75%

7%

16%

0% 2%

Ethnicity

White

Black

Hispanic

American Indian

OtherN = 43

10%

30%

15%

2%

14%

29%

Service Mix

Indiv Srvcs

Group

Case Management

Recovery / Wrap Srvcs

N = 43

55.2%

44.8%

Gender

Female

Male

N = 125

21%

65%

14%

Age

18-29

30-55

56+

N = 125

70%

7%

19%

2% 2%Ethnicity White

Black

Hispanic

American Indian

Other

N = 125

13%

35%

16%4%

12%

20%

Service Mix

Indiv Srvcs

Group

Case Management

Recovery / Wrap Srvcs

Assessment

MedsN = 125

55.2%

44.8%

Gender

Female

Male

N = 125

21%

65%

14%

Age

18-29

30-55

56+

N = 125

70%

7%

19%

2% 2% Ethnicity

White

Black

Hispanic

American Indian

Other

N = 125

13%

35%

16%4%

12%

20%

Service MixIndiv Srvcs

Group

Case Management

Recovery / Wrap Srvcs

Assessment

MedsN = 125

50.0%50.0%

Gender

Female

Male

N = 32

25%

69%

6%

Age

18-29

30-55

56+

N = 32

59%14%

22%

0%

6%

Ethnicity

White

Black

Hispanic

American Indian

OtherN = 32

16%

19%

21%9%

13%

22%

Service Mix

Indiv Srvcs

Group

Case Management

Recovery / Wrap Srvcs

Assessment

MedsN = 32

SELECTED BIBLIOGRAPHY

Averill. R.F., Goldfield, N., Hughes, J.S., Bonazelli, J., McCullough, E. C., et.al. (2003) All patient refined diagnosis related groups (APR-DRGs) Version 20.0: Methodology Overview. 3M Health Information Systems. Wallingford, CT

Bradley, R. Cardenas, E. Ginsburg, D. H. Rosenthal. R. & Velez, F. (2010) Producing Disease-Based Price Indexes: Using a Total-Expenditure Scope and Adjusting for Utilizations under a Treatment Concept for Measuring Health Care Costs Slows Down the Rate of Growth of Medical Prices; the Downside Is That Most of the Saving Is Seen in Insurance Benefit Payments and Not in Out-of-Pocket Payments or Lower Insurance Premiums for Consumers. Monthly Labor Review. (133). Pp 20+. U.S. Bureau of Labor Statistics;

Chi, F. W. & Weisner, C. (2008) Nine year psychiatric trajectory and substance use outcomes: An application of group based modeling approach. Evaluation Review (32), 1 pp 39-59 Sage Publication, Thousand Oaks, CA.

Division of Behavioral Health, ADHS. (2010) Presentation of the Outcomes Framework: AZ Council of Human Service Providers. ADHS. Phoenix Az.

Ettner, S.L., Huang, D., Evans, E., Rose, D. A., Hardy, H., Jourabchi, M., & Hser, Y. (2005) Benefit- Cost in California treatment outcomes project. Does substance abuse treatment pay for itself. Health Research and Educational Trust. (10) 1111. Pp. 1-22.

Holder, H.D. (198) Cost benefits of substance abuse treatment: An overview of results from alcohol and drug abuse. The Journal of Mental Health Policy and Economics.(10, 23. Pp23-29.

Ketcham, J.D. Baker, L.C. & Mac Isaac, D. (2007) Physician practice size and variations in treatment and outcomes: Evidence from Medicare Patients with AMI. Health Affairs. (26), 1. Pp 195-205

Lutterman., T. Ganju, V. Schacht, L, Shaw, R. Monihan, K. et.al. (2003) Sixteen State Study on Mental Health Performance Measures. DHHS Publication No. (SMA) 03-3835. Rockville, MD.)

Moos. R.H. Finney, J.W. Federman, E.B. & Suchinsky, R. (2002) Specialty mental health care improves patient’s outcomes: Findings from a nationwide program to monitor the quality of care for patients with substance use disorders. Journal of Studies on Alcohol (61), 5. Pp 704 Gale Group. Florence, KY.

Newman, F.L. Burwell, B.A. & Underhill, W.R. (1978) Program analysis using the Client Oriented Cost Outcome System. Journal of Evaluation and Program Planning, (1), pp. 13-30 (1978). Pergamon Press. Printed in U.S.A.

Sorensen, J.E. (1997) Client outcomes and cost in frontier mental health organizations: Letter to the field no. 13. Frontier Mental Health Resources Network. Denver, CO.