ATTACHMENTS. Attachment A: Review Agenda. Attachment B: Review Participants. Attachment C: Approved Claims Source Data CAEQRO 44

Transcription

1 AlamedaCountyMHPCAEQROReport ATTACHMENTS AttachmentA:ReviewAgenda AttachmentB:ReviewParticipants AttachmentC:ApprovedClaimsSourceData AttachmentD:DataProvidedtotheMHP AttachmentE:CAEQROPIPValidationTools AttachmentF:MHPPIPSummariesSubmitted FiscalYear CAEQRO 44

2 AlamedaCountyMHPCAEQROReport FiscalYear A. Attachment ReviewAgenda CAEQRO 45

3 AlamedaCountyMHPCAEQROReport Time Wednesday September 25, 2013 Day 1 Activities unless noted all sessions held at 2000 Embarcadero Cove, Oakland 9:00-12:00 Performance Management Access, Timeliness, Outcomes, and Quality FiscalYear :00-10:30 Introduction of participants Overview of review intent Significant MHP changes in past year Last Year s CAEQRO Recommendations 10:40-12:00 CAEQRO approved claims data Performance improvement measurements utilized to assess access, timeliness, outcomes, and quality Examples of MHP reports used for to manage performance and decisions Participants Those in authority to identify relevant issues, conduct performance improvement activities, and implement solutions including but not limited to: MHP Director, senior management team, and other managers/senior staff in: Fiscal, program, IS, medical, QI, research patients rights advocate Involved consumer and family member representatives 12:00-1:00 APS Staff Working Lunch 1:00-2:30 Clinical Program Managers Group Interview 8-10 program managers representing various programs and sites Core system; programs that see the most clients Pool of Consumer Champions Leadership Team and Consumer Empowerment Team Interview IS Manager/Key IS Staff Group Interview Review and discuss ISCA FY13-14 CAEQRO information technology recommendations New EHR Planning 2:45-4:15 Disparities in Service Access, Retention, Quality, or Outcomes Group Interview: Fiscal/Billing Finance and SD/MD Claims Processing Review of MHP data or CAEQRO approved claims data to examine penetration rates and utilization patterns by age, ethnicity, or gender Review of Cultural Competency strategies to improve access/engagement and improve health equity Review of activities to address overall capacity Evidence based or best practices for diverse or high risk populations Short Doyle Phase 2 Claims Process Medicare/Medi-Cal claim submissions for contract providers Void and Replace Claim transactions New policies and procedures since last review CAEQRO 46

4 AlamedaCountyMHPCAEQROReport FiscalYear Time Thursday September 26, 2013 Day 2 Activities See individual cells for times (9:00-10:00) Katie A. Implementation Include staff involved in the implementation and monitoring of Katie A. and at least one Child Welfare Partner Discussions of implementation readiness, strategies, and activities 8:30-9:00 Travel (9:00-10:30) Parent Partner/Family Member Employee Group Interview 6-8 MHP or contract employees who are employed as Parent Partners (9:00-10:30) Contract Provider Group Interview Group interview with clinical and business administrators from # 8-10 identified contract providers See individual cells for times (10:15-11:45) MHP and Contract Provider Clinical Line Staff Group Interview 8-10 (80% contractors) clinical line staff (all peers) representing various programs and geographical areas (10:30-12:00) Consumer Employee Group Interview 6-8 MHP or contract employees who are consumers, such as Peer Advocates, Peer Support Specialist, or Consumer Liaisons. (1:30 3:00) Consumer/Family Member Focus Group with Parents/Guardians of Foster Care Children from Alameda Family Services (AFS) 8-10 participants as specified in the notification letter The Gathering Place 401 Roland Way, Oakland See individual cells for times 2:30-3:00 Travel 3:00-3:30 Travel (3:00-4:30) PATH Performance Improvement Project (3:30-5:00) Consumer/ Family Member Focus Group Berkeley Mental Health Discussion includes topic and study question selection, baseline data, barrier analysis, intervention selection, methodology, results, and plans Participants should be those involved in the development and implementation of including, but not necessarily limited to: PIP committee. MHP Director and other senior managers. Eastmont Mall 7200 Bancroft Ave, Oakland 8-10 participants as specified in the notification letter Auditorium 2640 Martin Luther King Jr. Derby in Berkley CAEQRO 47

5 AlamedaCountyMHPCAEQROReport FiscalYear Time See Individual cells for times 11:30-12:00 Friday September 27, 2013 Day 3 Activities (10:00-11:30) Outcomes/Timeliness MHP examples of data used to measure timeliness, functional outcomes and satisfaction MHP s readiness for the upcoming EPSDT Performance Outcomes System as will be implemented by DHCS. Timely access for non-english speakers Contractor Outcomes 9:30-10:00 Travel (10:00-11:30) Consumer/ Family Member Focus Group at La Clinica de la Raza 8-10 Latino participants as specified in the notification letter Casa Del Sol 1423 Fruitvale Ave. Oakland 11:30-12:00 Travel Back to Admin 12:00-1:30 APS Working Lunch and Staff Meeting 1:30 2:30 Final Questions Session MHP Director, QI Director, BHCS Executive Team, EQRO Coordinator and APS staff only Clarification discussion on any outstanding review elements MHP opportunity to provide additional evidence of performance CAEQRO Next steps after the review CAEQRO 48

6 AlamedaCountyMHPCAEQROReport FiscalYear B. Attachment ReviewParticipants CAEQRO 49

7 AlamedaCountyMHPCAEQROReport FiscalYear CAEQROREVIEWERS DawnKaiser,LCSW,LeadReviewer JerryMarks,SeniorInformationAnalyst,InformationSystemsReviewer WalterShwe,Consumer/FamilyMemberConsultant SaumitraSenGupta,Ph.D.,DirectorofInformationSystems AdditionalCAEQROstaffmemberswereinvolvedinthereviewprocess,assessments,and recommendations.theyprovidedsignificantcontributionstotheoverallreviewby participatinginboththepresiteandthepostsitemeetingsand,ultimately,inthe recommendationswithinthisreport. SITESOFMHPREVIEW CAEQROstaffvisitedthelocationsofthefollowingcountyoperatedandcontractproviders: Countyprovidersites AlamedaCountyAdministrativeOffice 2000EmbarcaderoCove Oakland,CA94606 Contractproviderorganizations BerkeleyMentalHealthClinic 2640MartinLutherKingJr.Way Berkeley,CA94720 CasaDelSol 1423FruitvaleAve. Oakland,CA94605 EastmontMall 7200BancroftAve. Oakland94605 TheGatheringPlace 401RolandWay Oakland,CA94605 CAEQRO 50

8 AlamedaCountyMHPCAEQROReport FiscalYear CAEQRO 51 PARTICIPANTSREPRESENTINGTHEMHP AaronChapman,InterimDirector AdrianneDeSantis,ConsumerRelationsProgramAssistant AllisonMassey,FamilyPartner AndreaJudkins,FinancialServicesSpecialist AndreaChristian,ClinicalSupervisor AnnieKim,ProgramDirector,FamilyEducationResourceCenter AnthonyAlcott,CaseManager BarbaraSaler,Director,ACCESS BettyeFoster,LeadFamilyAdvocate,FERC BeverlyBergman,FamilyCaregiverAdvocateSpecialist,MentalHealthAssociation BrendaBracy,PeerSpecialist, CamillePeterson,InformationSystemsApplicationSpecialist CarolynNovosel,ChildrensSystemofCareDirector CeciliaSerrano,FinancialServicesOfficer ChaleenWhiteLeach,ProgramCoordinator ChangJiang,FamilyPartner CharlesRaynor,ClinicalPharmacist ChrisShaw,ManagementAnalyst ColetteWinlock,ExecutiveDirector,HHREC DianaCunningham,ManagementSupportServicesAdministrator DriWang,ClinicalPharmacist EllenMuir,EPSDTCoordinator EmmittHutson,ProgramCoordinator EstherChow,ProjectDirector FaithFuller,EvaluationConsultant, FawnDowns,ProgramSupervisor,TIP FionaBranagh,NetworkOfficeDirector FrancescaTenenbaum,Director,PatientsRightsAdvocates,MentalHealthAssociation FreddieSmith,ProjectDirector,PATH FrederickTatum,AssistantUnitManager GabrielaCastain,BertProgramCoordinator,ChildrensHospitalOakland GigiCrowder,EthnicServicesManager/CulturalCompetencyCoordinator GildaMansour,ProviderNetworkManager GimoneBryant,CaseManager GiridharReddy,StaffPsychiatrist GloriaRiley,FamilyPartner GuyQristgoard,VicePresident,Administration HelenaLiber,PublicPolicyandEducationCommunityMember,POCC HenningSchulz,ProgramSpecialistAssociation HerbertSingleton,BehavioralHealthClinical IvanBecerra,CommunicationsCoordinator JackieMortensen,Director,ProviderRelations

9 AlamedaCountyMHPCAEQROReport FiscalYear CAEQRO 52 JackiePoque,IPSTrainer JaleahWinn,MentalHealthSpecialist, JamesComfort,ProgramManager,Kidango JamieAlmanza,ExecutiveDirector JanetBiblin,DecisionSupportManager JesseTamplen,Administrator,ChildrensHospitalOakland JiaBroussard,PeerSpecialist,BonitaHouse JohannaSalvador,NurseCareCoordinator JohnEngstrom,DecisionSupportSupervisor JoleneCox,MentalHealthSpecialist JonathanJohnson,Administrator JonicePerry,HeadofClinicalServices,CAPEMentalHealth KaeciBeshears,ProgramCoordinator,WestOaklandHealth KaitlinBruner,ManagementAnalyst KarlyWiley,Administrator,Stars KatherineMcCarthy,CareCoordinator KatrinaKillian,ExecutiveDirector KhateraAslami,ConsumerRelationsManager KotomiIto,AssociateDirector KyreeKlimist,QualityAssuranceAdministrator LauraSanders,PersonnelOfficer, LauriePearman,DivisionDirector,SenecaCenter LedaFrediani,FinancialServicesDirector LeilaniHall,FrontDeskLead,LifeLongMedicalCare LillianSchaechner,OlderAdultServicesDirector LisaMoore,Manager,ProviderRelations LisaRock,PublicPolicyandEducationCommunityMember,POCC LouiseMonsour,PacificCenter LuisArenas,FamilyPartner MarcDiamond,CaseManager MarciaHeadley,FamilyPartner MargaretWalkover,WellnessRecovery&ResiliencyDirector MarkRahnian,FamilyAdvocate MarkRobinson,Physician,LifeLongMedicalCare MaryHogden,ProgramSpecialist, MaryannDonofrio,Director,CrisisResponse MeredithCadwallader,LeadClinician MichaelLisman,AdultCommunitySupportCentersDirector MichaelKing,PeerCounselor,BayAreaCommunityServices MichaelDiehl,CommunityOrganizer,BuildingOpportunitiesforSelfSufficiency MichaelAlexander,CareCoordinator,Seneca MicheleMoncrief,MentalHealthSpecialist MichelleBurns,TAYServicesDirector

10 AlamedaCountyMHPCAEQROReport FiscalYear CAEQRO 53 MichelleFiorenzo,RecoveryCoach,RecoveryInnovationsChoices MichelleLove,AssistantAgencyDirector, NatalieCourson,InformationSystemsManager NathanHobbs,ProgramSpecialist, NeishaBecton,ExecutiveDirector,PathwaytoWellness PaulTakayanagi,TrainingOfficer PauletteFranklin,MentalHealthSpecialist, PedroFelix,LeadClinician,LaFamilia PeterAlevizos,AdultServicesofCareDirector RebekahDriessen,MentalHealthClinician,CAPEMentalHealth RichardPanell,VicePresident,Operations,Telecare RickDeyette,VocationalServicesDirector RobertRatner,HousingServicesOffice RosaWarder,FamilyRelationsManager RosaQuinonez,Member,PoolofConsumerChampions(POCC) RuebenDloatch,WellnessMentor,BayAreaCommunityServices SallyZinman,Member,PoolofConsumerChampions(POCC) SamNelson,FamilyPartner SandyStier,Director,InformationSystems SanjidaMazid,WorkforceEducationandTrainingManager, SarahMohr,CaseManager,BuildingOpportunitiesforSelfSufficiency SatwinderMahabir,ClinicalSupervisor/Coordinator SeanJara,QualityImprovementCoordinator SennaHams,CrisisClinician SherylDiedrick,InformationSystemsAnalyst SonaBasra,SupervisingFinancialServicesSpecialist StaceyKrtz,ExecutiveDirector,WestCoastChildrensClinic StacyThayer,NurseManager StephanieGerdes,ProgramSupervisor,Seneca SusanDrager,ProgramDirector,WestCoastChildrensClinic TangieYoung,Manager,WillowRockCSU TomTrabin,AdultSystemofCareAssociateDirector ToniTullys,DeputyDirector TracyHazel,PreventionServices VickieMcClany,AdministrativeSpecialist VilaYoung,PsychiatricSocialWorker VincenrneMuzell,Intern WendiVargas,SupervisingPS

11 AlamedaCountyMHPCAEQROReport C. FiscalYear Attachment ApprovedClaimsSourceData CAEQRO 54

12 AlamedaCountyMHPCAEQROReport FiscalYear CAEQRO 55 Source:DatainFigures5through15andAttachmentDarederivedfromthreestatewidesourcefiles: o ShortDoyle/MediCalapprovedanddeniedclaims(SD/MC)fromtheDepartmentofHealthCareServices(DHCS) o InpatientConsolidationapprovedclaims(IPC)fromDHCS o MonthlyMEDSExtractFiles(MMEF)fromDHCS SelectionCriteria: o MediCalbeneficiariesforwhomtheMHPisthe CountyofFiscalResponsibility areincluded,even whenthebeneficiarywasservedbyanothermhp o MediCalbeneficiarieswithaidcodeseligibleforSD/MCprogramfundingareincluded ProcessDate:ThedateDHCSprocessesfilesforCAEQRO.Thefilesincludeclaimsfortheserviceperiod indicated,calendaryear(cy)orfiscalyear(fy),processedthroughtheprecedingmonth.forexample,the CY2008filewithaDHCSprocessdateofApril28,2009includesclaimswithservicedatesbetweenJanuary 1andDecember31,2008processedbyDHCSthroughMarch2009. o CY2012includesSD/MCandIPCapprovedclaimswithprocessdateJune2013 o CY2011includesSD/MCandIPCapprovedclaimswithprocessdateDecember2012 o CY2010includesSD/MCandIPCapprovedclaimswithprocessdateJune2012 o CY2009includesSD/MCandIPCapprovedclaimswithprocessdateFebruary2011 o CY2008includesSD/MCandIPCapprovedclaimswithprocessdateDecember2009 o CY2007includesSD/MCandIPCapprovedclaimswithprocessdateApril2009 o CY2006includesSD/MCandIPCapprovedclaimswithprocessdateOctober2007 o CY2005includesSD/MCandIPCapprovedclaimswithprocessdateJuly2006 o FY1112includesSD/MCandIPCapprovedclaimswithprocessdateDecember2012 o FY1011includesSD/MCandIPCapprovedclaimswithprocessdateNovember2011 o FY0910includesSD/MCandIPCapprovedclaimswithprocessdateFebruary2011 o FY0809includesSD/MCandIPCapprovedclaimswithprocessdateDecember2009 o FY0708includesSD/MCandIPCapprovedclaimswithprocessdateApril2009 o FY0607includesSD/MCandIPCapprovedclaimswithprocessdateMay2008 o FY0506includesSD/MCandIPCapprovedclaimswithprocessdateOctober2007 o FY0405includesSD/MCandIPCapprovedclaimswithprocessdateApril2006 o FY0304includesSD/MCandIPCapprovedclaimswithprocessdateOctober2005 o FY0203includesSD/MCandIPCapprovedclaimsasoffinalreconciliation o FY1112denialsincludeSD/MCclaims(notIPCclaims)withprocessdateDecember2012 o FY1011denialsincludeSD/MCclaims(notIPCclaims)withprocessdateJune2012 o FY0809denialsincludeSD/MCclaims(notIPCclaims)processedbetweenJuly1,2008andJune30,2009 (withoutregardtoservicedate)withprocessdatenovember2009.samemethodologyisusedforprioryears. o MostrecentMMEFincludesMediCaleligibilityforApril(CY)orOctober(FY)and15priormonths DataDefinitions:Selectedelementsdisplayedinmanyfigureswithinthisreportaredefinedbelow. o Penetrationrate ThenumberofMediCalbeneficiariesservedperyeardividedbytheaverage numberofmedicaleligiblespermonth.thedenominatoristhemonthlyaverageofmedical eligiblesovera12monthperiod. o Approvedclaimsperbeneficiaryservedperyear Theannualdollaramountofapprovedclaims dividedbytheunduplicatednumberofmedicalbeneficiariesservedperyear MHPSize:CategoriesarebaseduponDHCSdefinitionsbycountypopulation. o SmallRuralMHPs=Alpine,Amador,Calaveras,Colusa,DelNorte,Glenn,Inyo,Lassen,Mariposa, Modoc,Mono,Plumas,Siskiyou,Trinity o SmallMHPs=ElDorado,Humboldt,Imperial,Kings,Lake,Madera,Mendocino,Napa,Nevada,San Benito,Shasta,Sutter/Yuba,Tehama,Tuolumne o MediumMHPs=Butte,Marin,Merced,Monterey,Placer/Sierra,SanJoaquin,SanLuisObispo,San Mateo,SantaBarbara,SantaCruz,Solano,Sonoma,Stanislaus,Tulare,Yolo o LargeMHPs=Alameda,ContraCosta,Fresno,Kern,Orange,Riverside,Sacramento,SanBernardino, SanDiego,SanFrancisco,SantaClara,Ventura o LosAngeles statisticsareexcludedfromsizecomparisons,butareincludedinstatewidedata.

13 AlamedaCountyMHPCAEQROReport FiscalYear D. Attachment MediCalApprovedClaimsWorksheets andadditionaltables CAEQRO 56

14 AlamedaCountyMHPCAEQROReport FiscalYear Medi-Cal Approved Claims Data for ALAMEDA County MHP Calendar Year 12 Date Prepared: 09/09/2013, Version 1.0 Prepared by: Saumitra SenGupta, APS Healthcare / CAEQRO Data Sources: DHCS Approved Claims and MMEF Data - Notes (1) and (2) Data Process Dates: 06/11/2013, 03/04/2013, and 03/27/ Note (3) ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year TOTAL 268,392 22,531 $143,287, % $6, % $4, % $5,061 AGE GROUP ,160 1,381 $10,115, % $7, % $4, % $4, ,192 7,781 $66,500, % $8, % $5, % $6, ,950 11,360 $59,273, % $5, % $4, % $4, ,092 2,009 $7,398, % $3, % $3, % $3,467 GENDER Female 153,231 11,835 $62,500, % $5, % $4, % $4,550 Male 115,161 10,696 $80,786, % $7, % $5, % $5,582 RACE/ETHNICITY White 29,473 4,382 $27,428, % $6, % $4, % $4,956 Hispanic 87,937 4,698 $27,670, % $5, % $4, % $5,017 African-American 66,738 8,805 $61,483, % $6, % $5, % $5,459 Asian/Pacific Islander 57,299 4,230 $22,294, % $5, % $4, % $4,250 CAEQRO 57

15 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Native American $942, % $8, % $5, % $5,604 Other 26, $3,468, % $11, % $7, % $8,865 ELIGIBILITY CATEGORIES Disabled 49,738 10,857 $71,052, % $6, % $4, % $5,038 Foster Care 2,201 1,215 $14,540, % $11, % $8, % $8,426 Other Child 102,941 7,342 $45,801, % $6, % $4, % $4,918 Family Adult 55,276 3,267 $8,162, % $2, % $2, % $2,586 Other Adult 58, $3,730, % $4, % $3, % $3,486 SERVICE CATEGORIES Inpatient Services 268,392 1,391 $14,495, % $10, % $7, % $7,665 Residential Services 268, $1,665, % $7, % $7, % $7,812 Crisis Stabilization 268,392 3,333 $9,583, % $2, % $2, % $1,913 Day Treatment 268, $13,380, % $14, % $11, % $12,122 Case Management 268,392 7,692 $6,510, % $ % $1, % $891 Mental Health Serv. 268,392 17,250 $82,095, % $4, % $2, % $3,467 Medication Support 268,392 9,811 $9,299, % $ % $1, % $1,306 Crisis Intervention 268,392 1,670 $1,253, % $ % $ % $1,045 TBS 268, $5,003, % $13, % $10, % $11,983 Footnotes: 1 - Includes approved claims data on DHCS eligible beneficiaries who were served by other MHPs, based on Medi-Cal recipient's "County of Fiscal Responsibility" 2 - Includes Short-Doyle/Medi-Cal (SD/MC) and Inpatient Consolidation (IPC) approved claims for those whose aid codes were eligible for SD/MC program funding 3 - The most recent data processing dates for SD/MC and IPC approved claims and MEDS Monthly Extract File (MMEF) respectively by DHCS for the reported calendar year 4 - County total number of yearly unduplicated Medi-Cal eligibles is 327,009 CAEQRO 58

16 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA County MHP Medi-Cal Services Retention Rates CY12 Number of Services Approved per Beneficiary Served # of beneficiaries ALAMEDA STATEWIDE % Cumulative % % Cumulative % Minimum % Maximum % 1 service 2, services 1, services 1, services 1, services 5, > 15 services 10, Prepared by APS Healthcare / CAEQRO Source: Short-Doyle/Medi-Cal approved claims as of 06/11/2013; Inpatient Consolidation approved claims as of 03/04/2013 Note: Number of services is counted by days for any 24 hours and day services, and by visits or encounters for any outpatient services CAEQRO 59

17 AlamedaCountyMHPCAEQROReport FiscalYear Medi-Cal Approved Claims Data for ALAMEDA County MHP Calendar Year CY12 Foster Care Date Prepared: 09/09/2013, Version 1.0 Prepared by: Saumitra SenGupta, APS Healthcare / CAEQRO Data Sources: DHCS Approved Claims and MMEF Data - Notes (1) and (2) Data Process Dates: 06/11/2013, 03/04/2013, and 03/27/ Note (3) ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year TOTAL 2,201 1,215 $14,540, % $11, % $8, % $8,426 AGE GROUP $1,875, % $8, % $4, % $3, , $12,665, % $12, % $9, % $9,480 GENDER Female 1, $6,564, % $11, % $7, % $8,188 Male 1, $7,976, % $12, % $8, % $8,643 RACE/ETHNICITY White $2,372, % $12, % $7, % $8,659 Hispanic $2,431, % $10, % $7, % $7,548 African-American 1, $8,208, % $12, % $9, % $9,666 Asian/Pacific Islander $1,281, % $12, % $9, % $8,306 CAEQRO 60

18 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Native American $77, % $7, % $8, % $7,632 Other $169, % $12, % $9, % $9,089 SERVICE CATEGORIES Inpatient Services 2, $320, % $10, % $6, % $7,484 Residential Services 2,201 1 $9, % $9, % $6, % $9,294 Crisis Stabilization 2, $62, % $1, % $1, % $1,547 Day Treatment 2, $1,716, % $14, % $13, % $13,509 Case Management 2, $499, % $1, % $1, % $1,128 Mental Health Serv. 2,201 1,153 $10,551, % $9, % $5, % $5,890 Medication Support 2, $281, % $1, % $1, % $1,710 Crisis Intervention 2, $40, % $ % $1, % $1,587 TBS 2, $1,059, % $12, % $10, % $11,250 Footnotes: 1 - Includes approved claims data on DHCS eligible beneficiaries who were served by other MHPs, based on Medi-Cal recipient's "County of Fiscal Responsibility" 2 - Includes Short-Doyle/Medi-Cal (SD/MC) and Inpatient Consolidation (IPC) approved claims for those whose aid codes were eligible for SD/MC program funding 3 - The most recent data processing dates for SD/MC and IPC approved claims and MEDS Monthly Extract File (MMEF) respectively by DHCS for the reported calendar year 4 - County total number of yearly unduplicated Medi-Cal eligibles is 2,938 CAEQRO 61

19 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA County MHP Medi-Cal Services Retention Rates CY12 Foster Care Number of Services Approved per Beneficiary Served # of beneficiaries ALAMEDA STATEWIDE % Cumulative % % Cumulative % Minimum % Maximum % 1 service services services services services > 15 services Prepared by APS Healthcare / CAEQRO Source: Short-Doyle/Medi-Cal approved claims as of 06/11/2013; Inpatient Consolidation approved claims as of 03/04/2013 Note: Number of services is counted by days for any 24 hours and day services, and by visits or encounters for any outpatient services CAEQRO 62

20 AlamedaCountyMHPCAEQROReport FiscalYear Medi-Cal Approved Claims Data for ALAMEDA County MHP Calendar Year 12 Transition Age Youth (Age 16-25) Date Prepared: 09/09/2013, Version 1.0 Prepared by: Saumitra SenGupta, APS Healthcare / CAEQRO Data Sources: DHCS Approved Claims and MMEF Data - Notes (1) and (2) Data Process Dates: 06/11/2013, 03/04/2013, and 03/27/ Note (3) ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year TOTAL 36,695 3,837 $32,306, % $8, % $5, % $6,282 AGE GROUP ,349 1,490 $14,697, % $9, % $6, % $7, ,947 1,678 $13,049, % $7, % $5, % $5, , $4,559, % $6, % $4, % $4,960 GENDER Female 21,725 2,010 $15,748, % $7, % $5, % $6,019 Male 14,971 1,827 $16,558, % $9, % $5, % $6,541 RACE/ETHNICITY White 3, $3,913, % $7, % $5, % $6,152 Hispanic 12, $6,442, % $7, % $5, % $5,957 African-American 11,324 1,860 $16,060, % $8, % $6, % $6,729 Asian/Pacific Islander 6, $4,670, % $7, % $5, % $5,901 CAEQRO 63

21 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA LARGE STATEWIDE Average Number of Eligibles per Month (4) Number of Beneficiaries Served per Year Approved Claims Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Penetration Rate Approved Claims per Beneficiary Served per Year Native American $377, % $18, % $7, % $7,019 Other 2, $842, % $15, % $11, % $11,801 ELIGIBILITY CATEGORIES Disabled 4,514 1,159 $12,485, % $10, % $6, % $6,965 Foster Care $4,937, % $10, % $9, % $9,598 Other Child 9,279 1,101 $7,688, % $6, % $4, % $5,637 Family Adult 16,898 1,113 $4,939, % $4, % $3, % $3,773 Other Adult 5, $2,256, % $6, % $4, % $4,550 SERVICE CATEGORIES Inpatient Services 36, $3,747, % $11, % $7, % $6,850 Residential Services 36, $591, % $10, % $6, % $8,145 Crisis Stabilization 36, $1,572, % $2, % $1, % $1,619 Day Treatment 36, $4,272, % $14, % $12, % $13,256 Case Management 36,695 1,435 $1,481, % $1, % $1, % $992 Mental Health Serv. 36,695 3,264 $17,684, % $5, % $3, % $4,248 Medication Support 36,695 1,237 $1,342, % $1, % $1, % $1,336 Crisis Intervention 36, $263, % $ % $ % $1,090 TBS 36, $1,350, % $12, % $10, % $10,269 Footnotes: 1 - Includes approved claims data on DHCS eligible beneficiaries who were served by other MHPs, based on Medi-Cal recipient's "County of Fiscal Responsibility" 2 - Includes Short-Doyle/Medi-Cal (SD/MC) and Inpatient Consolidation (IPC) approved claims for those whose aid codes were eligible for SD/MC program funding 3 - The most recent data processing dates for SD/MC and IPC approved claims and MEDS Monthly Extract File (MMEF) respectively by DHCS for the reported calendar year 4 - County total number of yearly unduplicated Medi-Cal eligibles is 51,080 CAEQRO 64

22 AlamedaCountyMHPCAEQROReport FiscalYear ALAMEDA County MHP Medi-Cal Services Retention Rates CY12 Transition Age Youth (Age 16-25) Number of Services Approved per Beneficiary Served # of beneficiaries ALAMEDA STATEWIDE % Cumulative % % Cumulative % Minimum % Maximum % 1 service services services services services > 15 services 1, Prepared by APS Healthcare / CAEQRO Source: Short-Doyle/Medi-Cal approved claims as of 06/11/2013; Inpatient Consolidation approved claims as of 03/04/2013 Note: Number of services is counted by days for any 24 hours and day services, and by visits or encounters for any outpatient services CAEQRO 65

23 AlamedaCountyMHPCAEQROReport FiscalYear SD/MCCLAIMSPROCESSINGSUMMARY ThefollowingtableprovidesasummaryoftheMHPsSD/MCclaimsprocessedforservicesclaimedduringFY1112.Thedata presentsclaimsprocessedbythestateasofoctober2012andmaynotyetincludealloriginalorreplacementclaimtransactionsfor FY1112.Tomeettimelyprocessingrules,MHPshave12monthsfromtheservicemonthtosubmitoriginalclaimtransactionsand 15monthsfromtheservicemonthtosubmitreplacementclaimtransactions. FigureD1.MonthlySummaryofSD/MCClaims FY1112 ClaimsProcessedasofOctober2012 Service Month GrossDollars BilledbyMHP Denied Dollars Denial Rate Number Denied Claims Claims Adjudicated Claim Adjustments Approved Dollars Percent Approved Number Approved Claims Replaced Claim Dollars Number Replaced Claims JUL11 $13,869,378 $430, % 1,678 $13,438,732 $2,919,206 $10,519, % 52,953 $4, AUG11 $14,871,198 $879, % 3,886 $13,991,439 $3,068,831 $10,922, % 55,743 $120, SEP11 $15,756,349 $861, % 3,867 $14,895,075 $3,012,093 $11,882, % 64,684 $40, OCT11 $16,711,268 $1,037, % 4,277 $15,673,299 $2,958,519 $12,714, % 68,256 $0 0 NOV11 $15,428,536 $985, % 4,690 $14,442,560 $2,735,204 $11,707, % 63,928 $0 0 DEC11 $14,205,901 $766, % 3,634 $13,439,733 $2,651,477 $10,788, % 57,315 $0 0 JAN12 $16,351,543 $917, % 4,263 $15,434,041 $3,015,918 $12,418, % 67,302 $0 0 FEB12 $15,161,753 $476, % 1,702 $14,685,005 $2,857,879 $11,827, % 63,954 $0 0 MAR12 $17,114,440 $479, % 1,756 $16,634,806 $2,992,633 $13,642, % 74,394 $0 0 APR12 $15,287,808 $370, % 1,232 $14,917,743 $2,665,946 $12,251, % 65,878 $0 0 MAY12 $17,045,275 $419, % 1,340 $16,625,691 $2,929,640 $13,696, % 73,899 $0 0 JUN12 $13,719,852 $229, % 924 $13,490,607 $2,432,633 $11,057, % 55,654 $0 0 FY1112 $185,523,301 $7,854, % 33,249 $177,668,731 $34,239,980 $143,428, % 763,960 $165, Statewide $2,492,997,683 $188,446, % 834,617 $2,304,551,045 $253,898,049 $2,050,652, % 11,950,771 $681,166 2,201 CAEQRO 66

24 AlamedaCountyMHPCAEQROReport FiscalYear DENIEDCLAIMS ThefollowingtablesprovideasummaryofSD/MCdeniedclaimsprocessedduringFY1112.Thedata presentsclaimsprocessedbythestateasofoctober2012andmaynotyetincludealloriginalor replacementclaimtransactionsforfy1112.mhpshave15monthsfromtheservicemonthfor replacementclaimtransactionstocorrectandconvertdeniedclaimstoapprovedclaims. FigureD2.DeniedClaimsbyReason StatewideTop10(FY1112) ClaimsProcessedasofOctober2012 DenialCodeDescription Otherhealthcoveragemustbebilledbeforethe submissionofthisclaim. Medicaremustbebilledpriortothesubmissionofthis inpatientclaim. Denial Code Number Claims Gross Dollars Denied Percent Denied CO22 281,915 $58,676, % CO22N ,326 $21,841, % Beneficiarynoteligible.AidcodeinvalidforDHCS. CO177,CO31 82,019 $17,503, % Lateclaimdenial. CO29 88,153 $15,422, % ServiceFacilityLocationproviderNPIisnoteligibleto providethisservicewithinthesubmittingcounty. Servicelineisaduplicateandarepeatservice proceduremodifierisnotpresent. EmergencyServicesIndicatormustbe Y or PregnancyIndicatormustbe Y forthisaidcode. COB7 44,705 $8,958, % CO18M86 44,857 $7,410, % CO204N30 30,559 $6,264, % Singleserviceexceedsmaximumminutesperday. CO119N20 6,363 $5,751, % OnlySEDservicesarevalidforHealthyFamiliesaid code. CO185 24,147 $5,141, % AidcodeinvalidforDHCS. CO31 22,749 $5,102, % DenialCodeDescription Otherhealthcoveragemustbebilledbeforethe submissionofthisclaim. EmergencyServicesIndicatormustbe Y or PregnancyIndicatormustbe Y forthisaidcode. FigureD3.DeniedClaimsbyReason MHPTop5(FY1112) ClaimsProcessedasofOctober2012 Denial Code Number Claims Gross Dollars Denied Percent Denied CO22 22,962 $4,585, % CO204N30 4,639 $950, % AidcodeinvalidforDHCS. CO $457, % Servicesoverlapaninpatientstay(servicemaybe billedonlyifrenderedondateofadmissionordateof discharge). COA1MA $392, % Lateclaimdenial. CO29 1,603 $277, % CAEQRO 67

25 AlamedaCountyMHPCAEQROReport FiscalYear RETENTIONRATES FigureD5.CY12RetentionRateswithAverageApprovedClaimsperCategory NumberofServices Approvedper BeneficiaryServed MHP Numberof beneficiaries served MHP $perbeneficiary served Statewide $perbeneficiary served 1service 2,112 $475 $334 2services 1,337 $497 $513 3services 1,276 $578 $675 4services 1,039 $705 $ services 5,869 $1,745 $1,669 >15services 10,898 $11,920 $10,572 CAEQRO 68

26 AlamedaCountyMHPCAEQROReport FiscalYear SERVICETYPEBYETHNICITYSTATEWIDE Thefollowingstackedbarchartsshowtheaverageclaimsbyservicemodalityandethnicity.It shouldbenotedthattheseelementsarenotadditive(i.e.,theheightofthebarhasnomeaning), andthemainuseforcomparisonisthedifferentialuseofparticularservicesacrossvarious ethnicities.thebluediamondshowstheaverageapprovedclaimsbyethnicityforallservice modalities.again,thereisnodirectrelationshipbetweentheheightofthebar(claimsper servicemodality)andtheaverageclaimsforthatethnicity. Note:Theleftaxisreferstothecolumns,andtherightreferstothediamonds(overallACBforeachcategory) CAEQRO 69

27 AlamedaCountyMHPCAEQROReport FiscalYear FigureD7.StatewideNumberofBeneficiariesServedCY12Race/EthnicitybyServiceType African American Asian/Pacific Islander Hispanic Native American Other White All 76,426 58, ,110 3,408 10, ,906 InpatientServices 6,391 2,932 10, ,973 12,294 ResidentialServices CrisisStabilization 7,155 3,536 7, ,434 DayTreatment 1, , ,578 CaseManagement 32,719 24,224 66,998 1,564 2,917 61,832 MentalHealthServ. 60,538 46, ,443 2,705 6, ,686 MedicationSupport 40,531 35,184 64,431 1,628 3,762 84,609 CrisisIntervention 8,012 4,658 13, ,761 TBS 1, , ,394 CAEQRO 70

28 AlamedaCountyMHPCAEQROReport FiscalYear SERVICETYPEBYETHNICITYMHP Note:Theleftaxisreferstothecolumns,andtherightreferstothediamonds(overallACBforeachcategory) FigureD9.MHPNumberofBeneficiariesServedCY12Race/EthnicitybyServiceType African American Asian/Pacific Islander Hispanic Native American Other White All 8,805 4,230 4, ,382 InpatientServices ResidentialServices CrisisStabilization 1, DayTreatment CaseManagement 3,018 1,341 1, ,670 MentalHealthServ. 6,680 3,057 4, ,064 MedicationSupport 3,652 2,383 1, ,446 CrisisIntervention TBS CAEQRO 71

29 AlamedaCountyMHPCAEQROReport FiscalYear HIGHCOSTBENEFICIARIES CAEQRO 72

30 AlamedaCountyMHPCAEQROReport FiscalYear EXAMINATIONOFDISPARITIES StatewidedisparitiesremainforHispanicandfemalebeneficiaries: ApprovedclaimsforHispanicbeneficiariesarenowatparitywithWhite beneficiaries.whiletherelativepenetrationratedisparityhasdecreased significantly,duetobothadecreaseinwhitepenetrationrateandanincrease inhispanicpenetrationrate,thereremainsacontinuednotabledisparityin access. Therelativeaccessandtheaverageapprovedclaimsforfemalebeneficiaries arelowerthanformales.thesedisparitieshaveremainedrelativelystable overthelastfiveyears. Foreachvariable(Hispanic/Whiteandfemale/male),tworatiosarecalculatedtodepictrelative accessandrelativeapprovedclaims.thefirstfigurecomparesapprovedclaimsdataand penetrationratesbetweenhispanicandwhitebeneficiaries.thispenetrationrateratiois calculatedbydividingthehispanicpenetrationratebythewhitepenetrationrate,resultingin aratiothatdepictstherelativeaccessforhispanicswhencomparedtowhites.theapproved claimsratioiscalculatedbydividingtheaverageapprovedclaimsforhispanicsbytheaverage approvedclaimsforwhites.similarcalculationsfollowinthesecondfigureforfemaletomale beneficiaries. Forallelements,ratiosdepictthefollowing: 1.0=paritybetweenthetwoelementscompared Lessthan1.0=disparityforHispanicsorfemales Greaterthan1.0=nodisparityforHispanicsorfemales.Aratioofgreater thanoneindicateshigherpenetrationorapprovedclaimsforhispanicswhen comparedtowhitesorforfemaleswhencomparedtomales. CAEQRO 73

31 AlamedaCountyMHPCAEQROReport FiscalYear FigureD12.ExaminationofDisparities HispanicversusWhite CalendarYear NumberofBeneficiariesServed &PenetrationRateperYear Hispanic White #Served PR% #Served PR% ApprovedClaimsper BeneficiaryServed peryear Hispanic White Ratioof Hispanicversus Whitefor PR Ratio Approved Claims Ratio StatewideCY12 167, % 149, % $5,017 $4, MHPCY12 4, % 4, % $5,890 $6, MHPCY11 4, % 4, % $5,789 $6, MHPCY10 4, % 4, % $5,598 $6, MHPCY09 3, % 4, % $5,601 $6, FigureD13.ExaminationofDisparities FemaleversusMale CalendarYear NumberofBeneficiariesServed &PenetrationRateperYear Female Male #Served PR% #Served PR% ApprovedClaimsper BeneficiaryServed peryear Female Male Ratioof Femaleversus Malefor PR Ratio Approved Claims Ratio StatewideCY12 234, % 230, % $4,550 $5, MHPCY12 11, % 10, % $5,281 $7, MHPCY11 12, % 11, % $5,199 $7, MHPCY10 12, % 10, % $5,071 $7, MHPCY09 11, % 10, % $5,027 $7, CAEQRO 74

32 AlamedaCountyMHPCAEQROReport FiscalYear ELIGIBLESVERSUSBENEFICIARIESSERVEDFOSTERCARE CAEQRO 75

33 AlamedaCountyMHPCAEQROReport FiscalYear ELIGIBLESVERSUSBENEFICIARIESSERVEDTRANSITIONAGEYOUTH CAEQRO 76

34 AlamedaCountyMHPCAEQROReport E. Attachment PIPValidationTool FiscalYear CAEQRO 77

35 AlamedaCountyMHPCAEQROReport FiscalYear FY13-14 Review of: Alameda Clinical Non-Clinical PIP Title: Promoting Access to Health (PATH) Date PIP Began: 2011 Date PIP Completed: 2013 PIP Category: Access Timeliness Quality Outcomes Other: Primary Care Descriptive Category: Physical Health Care Target Population: Other: Adults and Older Adults Step Rating Comments/Recommendations 1 Study topic The study topic: Primary Care Integration 1.1 Focuses on an identified problem that reflects high volume, high risk conditions, or underserved populations 1.2 Was selected following data collection and analysis of data that supports the identified problem 1.3 Addresses key aspects of care and services X 1.4 Includes all eligible populations that meet the study criteria, and does not exclude consumers with special needs 1.5 Has the potential to improve consumer mental health outcomes, functional status, satisfaction, or related processes of care designed to improve same Met Partial Totals for Step 1: X X X X Not Met N/A Seriously mentally ill adult consumers of the OASC clinic with potential or current high-risk defined co-morbid medical conditions. All consumers treated at the OASC clinic who meet defined eligibility criteria. Specifically targeted parameters and/or lab values. Study Question Definition The written study question:will co-locating primary care staff/integrating services within a behavioral health care setting that serves adult clients with severe mental illness: (i) increase access primary care services; (ii) increase engagement with primary care services and (iii) improve health care status with respect to the following health conditions: hypertension / high CAEQRO 78

36 AlamedaCountyMHPCAEQROReport FiscalYear Step Rating Comments/Recommendations Met Partial blood pressure; diabetes; obesity and hyperlipidemia / high cholesterol? Not Met N/A 2.1 Identifies the problem targeted for improvement 2.2 Includes the specific population to be addressed 2.3 Includes a general approach to interventions X 2.4 Is answerable/demonstrable X 2.5 Is within the MHP s scope of influence X Totals for Step 2: Clearly Defined Study Indicators The study indicators: 3.1 Are clearly defined, objective, and measurable X 3.2 Are designed to answer the study question X 3.3 Are identified to measure changes designed to improve consumer mental health outcomes, functional status, satisfaction, or related processes of care designed to improve same 3.4 Have accessible data that can be collected for each indicator 3.5 Utilize existing baseline data that demonstrate the current status for each indicator 3.6 Identify relevant benchmarks for each indicator X 3.7 Identify a specific, measurable goal(s) for each indicator X Totals for Step 3: Correctly Identified Study Population The method for identifying the study population: 4.1 Is accurately and completely defined X 4.2 Included a data collection approach that captures all consumers for whom the study X question applies Totals for Step 4: X X X X X Benchmarks are values to be attained and are accepted medical standards. Goals have been provided in clear and consumer-friendly language. CAEQRO 79

37 AlamedaCountyMHPCAEQROReport FiscalYear Step Rating Comments/Recommendations 5 Use of Valid Sampling Techniques The sampling techniques: 5.1 Consider the true or estimated frequency of occurrence in the population Met Partial 5.2 Identify the sample size X 5.3 Specify the confidence interval to be used X 5.4 Specify the acceptable margin of error X 5.5 Ensure a representative and unbiased sample of the eligible population that allows for generalization of the results to the study population Totals for Step 5: Accurate/Complete Data Collection The data techniques: 6.1 Identify the data elements to be collected X 6.2 Specify the sources of data X 6.3 Outline a defined and systematic process that consistently and accurately collects baseline and remeasurement data 6.4 Provides a timeline for the collection of baseline and remeasurement data 6.5 Identify qualified personnel to collect the data X Totals for Step 6: Appropriate Intervention and Improvement Strategies The planned/implemented intervention(s) for improvement: 7.1 Are related to causes/barriers identified through data analyses and QI processes 7.2 Have the potential to be applied system wide to induce significant change 7.3 Are tied to a contingency plan for revision if the original intervention(s) is not successful 7.4 Are standardized and monitored when an intervention is successful X X X X Not Met N/A X No sampling strategy. X More frequent (quarterly) intervals are recommended in order to assess effectiveness of interventions and take prompt actions, as needed. X No contingency plans presented. X PIP not yet at this stage. CAEQRO 80

38 AlamedaCountyMHPCAEQROReport FiscalYear Step Rating Comments/Recommendations Met Partial Totals for Step 7: Analyses of Data and Interpretation of Study Results The data analyses and study results: 8.1 Are conducted according to the data analyses plan in the study design 8.2 Identify factors that may threaten internal or external validity 8.3 Are presented in an accurate, clear, and easily understood fashion 8.4 Identify initial measurement and remeasurement of study indicators 8.5 Identify statistical differences between initial measurement and remeasurement 8.6 Include the interpretation of findings and the extent to which the study was successful Totals for Step 8: Improvement Achieved There is evidence for true improvement based on: 9.1 A consistent baseline and remeasurement methodology 9.2 Documented quantitative improvement in processes or outcomes of care 9.3 Improvement appearing to be the result of the planned interventions(s) 9.4 Statistical evidence for improvement X Totals for Step 9: Sustained Improvement Achieved There is evidence for sustained improvement based on: Repeated measurements over comparable time periods that demonstrate sustained improvement, or that any decline in improvement is not statistically significant Totals for Step 10: X X X X X Not Met N/A X Statistical analysis not presented. X X X X No repeated measurements at this juncture. CAEQRO 81

39 AlamedaCountyMHPCAEQROReport FiscalYear FY Review of: Alameda Clinical Non-Clinical PIP Title: TAY (presented as concept for planned PIP) PIP Category: Access Timeliness Quality Outcomes Other Descriptive Category: Target Population: TAY The MHP did not submit an active Non-Clinical PIP. All elements are rated as not met for purposes of analysis. Step Rating Met Partial 1 Study topic The study topic: 1.1 Focuses on an identified problem that reflects high volume, high risk conditions, or underserved populations 1.2 Was selected following data collection and analysis of data that supports the identified problem X 1.3 Addresses key aspects of care and services X 1.4 Includes all eligible populations that meet the study criteria, and does not exclude consumers with special needs 1.5 Has the potential to improve consumer mental health outcomes, functional status, satisfaction, or related processes of care designed to improve same Totals for Step 1: Study Question Definition The written study question: 2.1 Identifies the problem targeted for improvement X 2.2 Includes the specific population to be addressed X 2.3 Includes a general approach to interventions X 2.4 Is answerable/demonstrable X 2.5 Is within the MHP s scope of influence X Totals for Step 2: Clearly Defined Study Indicators The study indicators: 3.1 Are clearly defined, objective, and measurable X 3.2 Are designed to answer the study question X 3.3 Are identified to measure changes designed to improve consumer mental health outcomes, functional status, satisfaction, or related processes of care designed to improve same X Not Met X X X N/A CAEQRO 82

40 AlamedaCountyMHPCAEQROReport FiscalYear Step Rating Met Partial 3.4 Have accessible data that can be collected for each indicator X 3.5 Utilize existing baseline data that demonstrate the current status for each indicator X 3.6 Identify relevant benchmarks for each indicator X 3.7 Identify a specific, measurable goal(s) for each indicator X Totals for Step 3: Correctly Identified Study Population The method for identifying the study population: 4.1 Is accurately and completely defined X 4.2 Included a data collection approach that captures all consumers for whom the study question applies X Totals for Step 4: Use of Valid Sampling Techniques The sampling techniques: 5.1 Consider the true or estimated frequency of occurrence in the population X 5.2 Identify the sample size X 5.3 Specify the confidence interval to be used X 5.4 Specify the acceptable margin of error X 5.5 Ensure a representative and unbiased sample of the eligible population that allows for generalization of the results to the study population X Totals for Step 5: Accurate/Complete Data Collection The data techniques: 6.1 Identify the data elements to be collected X 6.2 Specify the sources of data X 6.3 Outline a defined and systematic process that consistently and accurately collects baseline and X remeasurement data 6.4 Provides a timeline for the collection of baseline and remeasurement data X 6.5 Identify qualified personnel to collect the data X Totals for Step 6: Appropriate Intervention and Improvement Strategies The planned/implemented intervention(s) for improvement: 7.1 Are related to causes/barriers identified through data analyses and QI processes X 7.2 Have the potential to be applied system wide to induce significant change X 7.3 Are tied to a contingency plan for revision if the original intervention(s) is not successful X Not Met N/A CAEQRO 83

41 AlamedaCountyMHPCAEQROReport FiscalYear Step Rating Met Partial 7.4 Are standardized and monitored when an intervention is successful X Totals for Step 7: Analyses of Data and Interpretation of Study Results The data analyses and study results: 8.1 Are conducted according to the data analyses plan in the study design X 8.2 Identify factors that may threaten internal or external validity X 8.3 Are presented in an accurate, clear, and easily understood fashion X 8.4 Identify initial measurement and remeasurement of study indicators X 8.5 Identify statistical differences between initial measurement and remeasurement X 8.6 Include the interpretation of findings and the extent to which the study was successful X Totals for Step 8: Improvement Achieved There is evidence for true improvement based on: 9.1 A consistent baseline and remeasurement methodology X 9.2 Documented quantitative improvement in processes or outcomes of care X 9.3 Improvement appearing to be the result of the planned interventions(s) X 9.4 Statistical evidence for improvement X Totals for Step 9: Sustained Improvement Achieved There is evidence for sustained improvement based on: Repeated measurements over comparable time periods that demonstrate sustained improvement, or that any decline in improvement is not statistically significant Totals for Step 10: Not Met X N/A CAEQRO 84

42 AlamedaCountyMHPCAEQROReport FiscalYear F. Attachment MHPPIPsSubmitted CAEQRO 85

43 Clinicial PIP Protocol Year 1: Prepared for FY 13/14 EQRO Site Visit, Sept Calliiforniia EQRO 560 J Street, Suite 390 Sacramento, CA Regarding this PIP Document: You are not limited to the space in this document. It will expand, so feel free to use more room than appears to be provided, and include relevant attachments. Emphasize the work completed over the past year, if this is a multi-year PIP. A PIP that has not been active and was developed in a prior year may not receive credit. PIPs generally should not last longer than two years. CAEQRO PIP Protocol Updates for FY12-13 (Protocol Year 1 ) MHP: Alameda County Date PIP Began: October 1, 2011 (start-up year) Title of PIP: Primary and Behavioral Health Care Integration Pilot: Promoting Access to Health (PATH) Project Clinical or Non-Clinical: Clinical NOTE: THIS PROTOCOL ADDRESSES EDITS SUGGESTED DURING THE FY 12/13 EQRO SITE REVIEW THAT THE PIP S CLINICAL INDICATORS BE PRESENTED AS STRENGTH-BASED. WITH THAT IN MIND, THE PIP TEAM REWWORKED PROTOCOL LANGUAGE TO MINIMIZE THE USE OF THE PHRASE NEGATIVE HEALTH CONDITIONS IN FAVOR OF HEALTH CONDITIONS. THE PIP TEAM ALSO DRAFTED A DOCUMENT THAT EXPLAINS, IN EVERYDAY LANGUAGE, AND WITH A STRENGTH-BASED EMPHASIS, THE MEANING OF QUANTITATIVE INDICATORS USED TO DESCRIBE IMPROVEMENT. THE GOAL IS TO SUPPORT CLIENTS ABILITY TO USE THESE INDICATORS AS FEEDBACK AND WORK WITH THE PATH PROGRAM TO BECOME INSPIRED AND ENGAGE IN WELLNESS PRACTICES THAT INPROVE PHYSICAL HEALTH. 1