Session # D3a Productivity, quality, and beyond in integrated behavioral health care: Identifying, measuring, and developing a system of tracking and evaluating key performance indicators. Victoria Frehe-Torres, PhD, Director of Behavioral Health Courtney Whitt, PhD, Licensed Psychologist Monica Villa, Report Analyst Healthcare Network of Southwest Florida CFHA 19 th Annual Conference October 19-21, 2017 Houston, Texas
Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
Conference Resources Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=resources_2017 Slides and handouts are also available on the mobile app.
Learning Objectives At the conclusion of this session, the participant will be able to: Understand the importance of establishing productivity and quality and performance indicators in integrated behavioral health care. Gain knowledge on how to define productivity and performance in integrated behavioral health care. Gain knowledge on how to implement key performance indicators (KPIs) as part of an ongoing evaluation and monitoring program.
Bibliography / References 1. Avis, E. (2016, May). Incorporating Quality Metrics Into Behavioral Health Care. Retrieved August 1, 2017, from https://www.hfma.org/content.aspx?id=47994 2. Goldman, M.L., Spaeth-Rublee, B., Nowels, A.D., Ramanug, P.P., & Pincus, H.A. (2016, April). Quality measures at the interface of behavioral health and primary care. Current Psychiatry Reports, 18. doi: https://doi.org/10.1007/s11920-016-0671-8 3. Hogg, W., & Dyke, E. (2011). Improving measurement of primary care system performance. Canadian Family Physician, 57, 758-760. 4. Kilbourne, A. M., Keyser, D., & Pincus, H. A. (2010, September). Challenges and opportunities in measuring the quality of mental health care. Canadian Journal of Psychiatry, 55, 549-557. 5. Manson, L., Bauman, D., Beachy, B., Ogbeide, S., & Baker, M. (2015, October). What s with all the numbers?: Quality indicators within integrated behavioral health programs. Concurrent Education Session presented at the Collaborative Family Healthcare Association 17 th Annual Conference, Portland, OR. 6. Pincus, H.A., Scholle, S.H., Spaeth-Rublee, B., Hepner, K.A., & Brown, J. (2016, June). Quality Measures for Mental Health and Substance Use: Gaps, Opportunities, and Challenges. Health Affairs, 35, 1000-1008.
[cont.] Bibliography / References 7. Purington, K., & Yalowich, R. (2017, January). Measuring physical and behavioral health integration: A look at state approaches in the context of value-based purchasing. Washington, DC: National Academy for State Health Policy. 8. Rozner, S. (2013, December). Developing and using key performance indicators: A toolkit for health sector managers. Bethesda, MD: Health Finance and Governance Project, Abt Associates, Inc. 9. Stiefel, M., & Nolan, K.A. (2012). A guide to measuring the triple aim: Population health, experience of care, and per capita cost. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement. http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx 10. Sunderji, N., Ion, A., Ghavam-Rassoul, A., & Abate, A. (2017, May). Evaluating the implementation of integrated mental health care: A systematic review to guide the development of quality measure. Psychiatric Services. doi: 10.1176/appi.ps.201600464.
About Us: Healthcare Network (HCN) FQHC providing medical, behavioral health and dental care Our Mission. To provide the highest level of health care to all residents of Southwest Florida, whether insured, uninsured or underinsured, regardless of age, gender, race, national origin or financial status. Our Patients. Serve about 50,000 patients in SWFL, 28,000 of whom are children. Provide services to over 60% of children in Collier County. Physicians deliver over 50% of newborns.
About Us: Dept. of Behavioral Health Program in its 4 th year Team of 8 psychologists, as well as affiliated clinical psychology postdoctoral fellowship training program Provide BH services to all* HCN clinics in Naples & Immokalee, FL 6 Pediatric clinics 5 Family Medicine/Adult clinics, including 1 Specialty and 1 Geriatric 3 Women s Health clinics On call for consultations with 4 Dental clinics Financial goals and success to date
Background The mental health services sector [has lagged] behind in the development and implementation of performance measures and strategies for implementing them as tools to improve quality and outcomes. (Kilbourne, Keyser, & Pincus, 2010). With greater organizational and financial integration, establishing a system of and standards for performance and its measurement becomes increasingly essential With medical BH/MH parity (i.e., demands, expectations, procedures, etc.) Allocation of resources Justification for sustainability, service line growth/expansion Healthcare team culture, organizational structure/leadership Changing expectations, models of healthcare payment (i.e., fee-for-service vs. value-based)
[cont.] Background Quality is never an accident. It is always the result of intelligent effort. (John Ruskin) Performance measurement (Rozner, 2013, p. 1) Providing feedback to inform and improve service delivery Promoting accountability by demonstrating to key stakeholders the results... achiev[ed]. Key Performance Indicators (KPIs) are measures that a sector or organization uses to define success and track progress in meeting its strategic goals (Rozner, 2013, p. 3) Samples of Types/Domains Donabedian Model: Structure, Process, Outcomes Cost-effectiveness IOM s Experience of Care: Safety, Effectiveness, Patient Centeredness, Timeliness, Equity, Efficiency National Behavioral Health Quality Framework (NBHQF): Evidence-based Practices, Patient- Centered Care, Coordinated Care, Healthy Living for Communities, Reduction in Adverse Events, Affordable/Accessible Care
[cont.] Background KPIs as vital signs, represent the health of a department/system Establish baseline information Support establishment of targets/benchmarks Identify trends; track and monitor continuous improvement Provide critical information, allow for detection of problems Provide feedback Support accountability
Getting Started Started with the basics # of visits: total, peds vs. adults # of unique patients seen Types of visits: # of initial intakes, # of follow-ups Diagnosis: Top 10 Patient demographics Later additions: # of warm hand offs, # of cancellations
Evolving/Expanding Growing department, changing needs Overall performance Quality Establish/Identify Measure/KPI Domain Population Data Source Numerator, Denominator Evidence Level Mirrored existing models for internal medical services: KPI Dashboard, Clinical Performance Report (CPR) Report Card
At a Glance: Individual Provider Level Department Level
At a Glance: 3 Month Trend
At a Glance: 3 Month Trend
Beyond Tracking Patient Count Data tells a story Allows use of trends to identify opportunities for improvement Individual level: Self-monitoring/reflection and personal accountability, relative to self, other BH providers Clinic/System level: Introduction, utilization of BH; Coverage needs Qualitative data for employee evaluations/reviews Speaks to financial health of department Language and data facilitates communication to Operations Leadership Committee/Clinical Leadership Committee about integration, needs, requests
Initial Hiccups & Challenges What I want vs. What I got Translating need to EHR, analyst language EHR: Is it possible? Wait What do I want? Pairing down: See next slide Setting benchmarks Establishing norms What does this even mean? Valid measure? Meaningfulness? Utility? Understandability
Additional Resources Center for Quality Assessment in Mental Health http://www.cqaimh.org/searchmeasures.asp Institute for Healthcare Improvement (IHI) http://www.ihi.org/resources/pages/default.aspx National Quality Forum https://www.qualityforum.org/measuring_performance/measuring_performance. aspx National Quality Measures Clearinghouse https://www.qualitymeasures.ahrq.gov/search?q=access SAMHSA National Behavioral Health Quality Framework http://www.samhsa.gov/data/national-behavioral-health-quality-framework
Thank You! Discussion. Questions?!