MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES BH-TEDS What Are We Learning? P u t t i n g p e o p l e f i r s t, w i t h t h e g o a l o f h e l p i n g a l l M i c h i g a n d e r s l e a d h e a l t h i e r a n d m o r e p r o d u c t i v e l i v e s, n o m a t t e r t h e i r s t a g e i n l i f e.
BH-TEDS From Many Perspectives SUD Data & Finance Administrator PIHP MH Reimbursement Officer I/DD Provider Reimbursement Officer Advocate O/P Biller Married to a Clinician
Working together for Improved Outcomes BH-TEDS: A measurement Tool
Today s Agenda BH-TEDS A Brief What & Why Record submission percentages Record completeness Problems and Solutions What are the outcome fields showing? How do we compare across the state? Nationally? MI BH-TEDS Data Trends Kudos and red flags Questions welcomed throughout the presentation.
BH-TEDS allows us to measures the magnitude and direction of change over time Co-occurring MH & SUD Education
BH-TEDS FY17 Records by Transaction Type as of 12/01/2017 Frequency Percent Cumulative Percent A 63,996 19.8% 19.82% M 83,663 25.9% 45.72% U 78,130 24.2% 69.92% D 47,292 14.6% 84.56% E 49,854 15.4% 100.00% Total 322,935 100.0% Frequency Percent Cumulative Percent Admission 147,659 45.7% 45.72% Update 78,130 24.2% 69.92% Discharge 97,146 30.1% 100.00% Total 322,935 100.0% Frequency Percent Cumulative Percent MH (M, U, E) 211,647 65.5% 65.54% SUD (A, D) 111,288 34.5% 100.00% Total 322,935 100.0%
FY17 BH-TEDS Calculated Completeness Rates by PIHP at 12/01/17 Target = 95% Completeness Mental Health FY17 Count Unique Client ID Substance Use Disorder FY17 Count Unique Client ID Region Name Submitter ID All BH- TEDS Encounters Missing BH-TEDS FY17 % Complete* All BH- TEDS Encounters Missing BH-TEDS FY17 % Complete* CMH Partnership of SE MI 00XT 11,848 11,373 2,569 77.41% 3,728 3,071 509 83.43% Detroit-Wayne MH Authority 00XH 54,667 67,663 24,007 64.52% 18,117 11,688 7 99.94% Lakeshore Regional Entity 00ZI 25,938 21,083 2,463 88.32% 8,585 5,927 916 84.55% Macomb 00GX 13,440 12,884 1,607 87.53% 7,880 5,036 20 99.60% Mid-State Health Network 0107 52,606 42,709 2,553 94.02% 12,100 10,949 3,412 68.84% NorthCare Network 0101 8,961 6,964 207 97.03% 2,707 1,685 20 98.81% Northern MI Regional Entity 0108 16,540 14,948 3,300 77.92% 6,843 4,941 476 90.37% Oakland 0058 18,365 19,014 2,799 85.28% 6,318 2,897 259 91.06% Region 10 0109 21,604 16,072 18 99.89% 8,858 6,245 254 95.93% Southwest MI Behavioral Health 0102 25,151 21,347 4,308 79.82% 9,558 6,451 843 86.93% 249,120 234,057 43,831 81.27% 84,694 58,890 6,716 88.60% *Percent of Unique Client IDs with a non-h002-only encounter in FY17 who also have a FY17 BH-TEDS Record (M, U, E, A, D)
FY16 vs. FY17 Mental Health Completion Rates by PIHP 100.00% 90.00% 95% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% FY16 % Complete FY17 % Complete*
FY16 vs. FY17 SUD Completion Rates by PIHP 100.00% 90.00% 95% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% SUD BH-TEDS Completeness SUD BH-TEDS Completeness
Challenges Meeting Completion Targets
How do we address/accommodate for these challenges????? 1. Addition of Full-BH-TEDS Record Exception response on the MH side. Caution - NOT a get-out-of BH-TEDS Jail free card. Never a default answer State must meet stringent response criteria set by SAMHSA Not Collected FY17
Addressing these challenges (cont.) 2. Delay final completion/submission of records. Records are not due for a month. Currently not measuring timeliness except for year-end. Careful of double-edged sword. Have a mechanism to go back and complete what is needed. 3. Reduce the number of records being submitted. Only required at admission start, annually, and end of episode Think EPISODES not SERVICES Crisis at 9 a.m. resolved at 11 a.m. & returns at 3??? Leave the 9 a.m. admission opened. If service continues leave BH-TEDS alone until annual review. If service doesn t continue discharge will look like the admit.
Addressing these challenges (cont.) 4. When you simply can t be positive of an answer, let the best answer you can give/ascertain under the circumstances be good enough.
Where Are Referrals Coming From? Referral Source CJ Referrals 9.8% 3.1% 1.2% 5.6% 7.9% 10.2% 4.2% 0.1% 2.1% 10.9% 3.9% 52.8% 17.8% 63.8% 6.5% Individual AOD Care Provider Other Health Care School EAP Other Community CJ Federal State Court Probation or Parole Diversionary Program DUI or DWI Municipal Court Other Legal Entity Prison Other
Do Individuals Served Have a PSA? Michigan - PSA 42.5% 57.5% None Not None
Service Settings 2.0% 0.3% 10.4% 9.9% 0.2% 6.4% 3.5% 2.6% 43.7% 20.9% 0.1% 0.1% Residential Detox Short Residential Long Residential IOP Outpatient Ambulatory Detox State Psych Hospital Community Based Residential Tx Center Other psychiatric inpatient Justice System MH Assessment Only
Demographic Comparisons (FY16 Data Most Current SAMHSA Summary Data Available)
Demographic Comparisons (FY16 Data Most Current SAMHSA Summary Data Available)
Demographic Comparisons (FY16 Data Most Current SAMHSA Summary Data Available)
Outcome Comparisons (FY16 Data Most Current SAMHSA Summary Data Available)
Outcome Comparisons (FY16 Data Most Current SAMHSA Summary Data Available) Dependent setting not otherwise defined
Outcome Comparisons (FY16 Data Most Current SAMHSA Summary Data Available)
FY17 Outcomes as of 12/07/17 70.00% Employment Status 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Employed Full-Time Employed Part-Time Unemployed Not in the Labor Force Admission Update Discharge
FY17 Outcomes as of 12/07/17 90.00% Living Arrangement 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Homeless Dependent Independent Residential Care Private Residence or Foster Home Crisis Residential Institutional Setting Jail Admission Update Discharge
FY17 Outcomes as of 12/07/17 60.00% PSA Frequency of Use 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% No Use 1-3 Days in PastMonth 1-2 Days in Past Week 3-6 Days in past Week Daily Admission Update Discharge
FY17 Outcomes as of 12/07/17 Corrections Related Status 100.00% 90.00% 91.29% 80.00% 70.00% 73.25% 71.75% 60.00% 50.00% 40.00% 30.00% 20.00% 21.47% 23.58% 10.00% 4.28% 5.28% 4.43% 4.67% 0.00% No Status w/corrections Status w/corrections Not Collected Admission Update Discharge
I/DD Designation Guidelines: Yes = documented severe, chronic condition meeting the Michigan Mental Health Code Definition of Developmental Disability. No = evaluated for I/DD and the documentation does not support a severe, chronic condition meeting the Michigan Mental Health Code Definition of Developmental Disability. Not evaluated = not been evaluated to determine if s/he meets Michigan Mental Health Code Definition of Developmental Disability.
MI/SED Designation Yes = individual has an MI DSM Diagnosis exclusive of I/DD or SUD OR individual has a Serious Emotional Disturbance. Yes is utilized for the entire mild to severe spectrum. This designation does NOT have to be made as a result of the PIHP s or provider s evaluation; however, must be provided by a licensed clinician operating within his/her scope of practice (i.e. psychiatrist, LMSW, Physician Assistant, Primary Care Physician, etc.).
Detailed SMI/SED
BH-TEDS Observations - Kudos Improvement in meeting 95% submission requirement. Differing responses for MH & SUD being correctly reported 99.9% of the time. Legal Status at State Hospital Field is Delivering as Intended Greatly improved demographics for 904 report
BH-TEDS Observations Red Flags Volume of Not Collected Responses increasing Not SMI/SED Detail Confusion Multiple M, U, & Es on the same day Hours Worked Reporting Problems Earnings Per Hour Reporting Hours worked in last 2 weeks 0 55,049 1-10 1,352 11-20 2,218 21-30 1,860 31-40 3,455 41-50 793 51-60 1,010 61-69 293 70-80 3,232 81-90 106 91-100 305 101-110 40 111-120 72 >120 39 N/A 45,480 Not Collected 15,418 130,722 Earnings Per Hour 0.00 55,221 0.01-5.00 903 5.01-8.89 2,277 8.90 744 8.91-10.00 5,251 10.01-15.00 3,688 15.01-20.00 738 20.01-25.00 162 25.01-30.00 70 30.01-40.00 93 40.01-50.00 29 50.01-60.00 18 >60.00 19 N/A 45,482 Not Collected 16,027 130,722
FY18 BH-TEDS Changes Currently in Mainstream Special Education 6 - N/A added for individuals not school age (3-17 or 0-26 for those qualifying for Special Education. Not Collected MH BH-TEDS Full Record Exception added to many fields.not a get out of BH-TEDS Jail Free Card Clarification of self-employed vs. Micro-enterprise Earning at least minimum wage? Integrated environment? Integrated SUD and MH Treatment added to Update/End record. You no longer have to D/C and re-admit if this status changes.
FY18 BH-TEDS Changes Integrated SUD and MH Treatment added to Update/End record. You no longer have to D/C and re-admit if this status changes. Cannot have: 2 As on the same day 2 Ms on th same day 2 Us on the same day 2 Ds on the same day 2 Es on the same day An M and U on the same day A U and E on the same day
New Military-related fields ****This is different than the veteran question. Individuals may answer these fields who don t qualify as veterans.*** Most Recent Military Era: WWII, Korea, Vietnam, Desert Storm, Post 9/11, Peace-time Branch Served In: Army, Army National Guard, Navy, Air Force, Air National Guard, Marines, Coast Guard Family Military Service: Immediate family = spouse, mother, father, spouse, child, sibling, half-sibling Client/family enrolled in/connected to VA/veteran resources/other support & service organizations
BH-TEDS Contact Information Carol Hyso, MDHHS Contract Analyst, BH-TEDS Coordinator HysoC@Michigan.gov 586-260-7282 Phil Chvojka, MDHHS Specialist, BH-TEDS SA Coordinator ChvojkaP@Michigan.gov 517-335-0173 www.michigan.gov/mdhhs - in the Reporting Requirements Section