Massachusetts Behavioral HealthPartnership / ValueOptions

Implementing a Clinical Outcomes Management Protocol in a

Medicaid Behavioral Health

Provider Network

MBHP: A ValueOptions General Partnership

• Contracting with Commonwealth of Massachusetts: MassHealth (Medicaid) and Dept of Mental Health

• Contract began: July 1, 1996• 230 employees in four sites (including three

regional offices)• Provider Network:

– Over 250 organizations (400+ sites)– Over 1000 individual practitioners

Overview of MBHP: Member Services

• 320,000 Medicaid enrollees• About 100,000 utilizers, annually• Process 3.2 million claims, annually• Emergency services for all populations• Services for all levels of care:

– Outpatient– Diversionary– Acute Care

Key Definitions

• Outcome– Clinical change during the course of treatment as

measured by a standardized assessment tool

• Outcomes measurement– Administering the same assessment tool at

different points during treatment to measure the rate of clinical change over time

• Outcome management– Using outcomes data to evaluate, inform and

improve clinical practices

Why Measure Outcomes?

• Clients have a right to a comprehensive intake assessment, with periodic re-assessments.

• Treatment is improved when clinicians receive objective feedback on the clinical progress of their clients.

• The centralized collection of outcomes data across a provider network allows for the identification and promotion of best practices.

• Reports of network-wide achievements in outcomes allow the EOHHS administration and the legislature to hold MBHP and its providers accountable.

Goals the MBHPOutcomes Management Initiative

• Care Management– Improve intake assessments and treatment planning through

use of a structure outcomes instrument.

• Practice Management– Identify, promote and support best practices among MBHP

network providers.

• Accountability Management– Improve accountability for publicly-funded behavioral health

services.

MBHP’s Outcomes Policy(Core Principles)

• All network providers for all levels of care are required to:1. Select a standardized assessment instrument from the list of

MBHP-approved instruments;

2. Begin administering the selected instrument for all new intakes of PCC Plan MassHealth Members;

3. Incorporate the findings of the assessment into the Members’ treatment plans, with feedback to Members about the assessment results; and

4. Incorporate the aggregated findings of the outcomes assessments into the provider’s quality management program.

Scope of the Outcomes Policy

• All providers in the MBHP network– 250 provider agencies (with over 400 sites) and 1000

individual practitioners

• All levels of care: inpatient, outpatient, diversionary– With the exception of a few exempt services, such as

medication management, psychological testing, and case consultation

• All Member ages– Children, adolescents, adults up to age 65

• All Members are assessed– Sampling is not allowed

Implementing the Outcomes Policy

• Providers can select from 20 MBHP-supported outcomes instruments.

• Providers may apply for approval to use standardized assessment tools with good psychometric properties that are not supported by MBHP.

• The Brief Psychiatric Rating Scale will be included in the pre-certification and discharge protocol for all 24-hour acute admissions and discharges.

MBHP Policy on Use of Outcomes Data

• MBHP will use outcomes data as a means of offering technical assistance to providers in areas where improved outcomes is a desired goal.

• MBHP will not use outcomes data to manage Member benefits.

• MBHP will not use outcomes data as a sole indicator for taking disciplinary action against a provider.

• MBHP will continue, as it has, to conduct quality audits on provider practices and will require corrective actions when service quality does not meet provider performance specifications.

Turning the Outcomes Initiative into aBest Practices Initiative

The Central Role of

Behavioral Health Laboratories’ (BHL)

Treatment Outcome Package (TOP)

Selecting BHL’s TOP as theMBHP Preferred Outcomes Instrument

• BHL’s TOP is an excellently designed outcomes measurement and clinical information system.

• Providers using TOP would be in immediate compliance with the MBHP outcomes policy.

• With its centralized outcomes data collection, MBHP’s access to TOP data allows achievement of the three project goals: improving care management, practice management, and accountability management.

Clinically rich dataStrengthsSeparation AnxietyEatingSexual IssuesSleepADHDConductAssertivenessDepressionPsychosisAccidentsSuicideViolence

Sensitivity to change>90%No floors or ceilings

Fair comparisonsExtensive risk- adjustment

ImmediateSTAT lab tests

Largest dataset

Data analysis included

Exceptional supportToll free

ToolsetsChildAdolescentAdult

Leading academicsSee Advisory Panel

Extensive validationMA MedicaidN>250,000

What is Unique About TOP?

MBHP’s Subsidy Arrangement for TOP

• MBHP is paying all fees associated with the use of TOP (except for mailing and fax charges).

• Providers register with BHL and use TOP at virtually no cost to them.

• In return for the subsidy, providers agree that MBHP will collect their outcomes data from BHL.

Current Status of Implementationas of March, 2004

• The MBHP provider network has about 250 agencies and 1000 individual practitioners.

• 75% of the agencies and 40% of the individual practitioners (or 50% of all providers) have declared their choice of instrument.

• Over 470 (70%) of the declared providers have chosen to use TOP.

• When fully operational, TOP outcomes data will be collected on more than 60,000 Members.

• Client Empowerment• Clinical Decision Support• Clinician and Agency Accountability• Clinician and Agency Quality Improvement• National, State, and Agency Benchmarking• Legislative Reports for Performance Accountability

The Power of BHL Data and Reports

TOP 4.0 Child Outcomes Report(lower values = improvement)

TOP 4.0 Client Report of Stress Indicators

TOP 4.0 Client Report of Risk Indicators

Using BHL Benchmarked Reports toIdentify Best Practice Providers

• BHL generates benchmarked reports that can be used at the agency-level or network-level for quality improvement.

• These benchmarked reports show provider performance in achieving good outcomes relative to other providers.

• MBHP will use the benchmarked reports to identify best practice providers and to promote their successful methods.

BHL’s Benchmarked Reports for Provider- orNetwork-Level Child Practice Management

Best Practice

Needs

Improvement

Developments in Process

• Combining TOP outcomes data with MBHP claims data to assess the relationship of clinical outcomes to service utilization and cost.

• Improving and expanding provider profiling reports for quality improvement and performance management.

• Generating accountability reports for the Commonwealth that will be a national model for performance management.

MBHP Contact

Wayne Stelk, Ph.D., VP, Quality Management

Massachusetts Behavioral Health Partnership

150 Federal Street, 3rd Floor

Boston, MA 02110

617-790-5612

wayne.stelk@valueoptions.com

www.masspartnership.com