Data Driven Decision Making for CCBHCs September 14, 2017 12:30pm 1:30pm ET
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Todays Presenter Pam Pietruszewski Integrated Health Consultant at National Council Practice coach for QI implementation Trainer for measurement-based care: Depression, substance use, preventive svcs
Learning Objectives 1. List the baseline quality reporting measures participants and their states are subject to, as well as any additional staterequired metrics for quality bonus payments. 2. Understand what is meant by data-driven care delivery and how data can inform rapid cycle change at their organization. 3. Recognize the key components and processes of a datadriven approach to care, including registries, clinician benchmarking, and more. 4. See specific, relevant examples of how these tools can be used to drive operational and clinical changes. 5. Develop a plan for implementing or improving use of data for decision making, including establishing regular internal processes for monitoring and evaluating progress on quality metrics, identifying key staff who should be involved, and more.
CCBHC Reported Measures (9 Required) Potential Source of Data EHR, Patient records, Electronic scheduler EHR, Patient records EHR, Encounter data EHR, Encounter data EHR, Patient records EHR, Patient records EHR, Patient records EHR, Patient records EHR, Patient records Measure or Other Reporting Requirement Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) (see Medicaid Child Core Set) Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment (see Medicaid Child Core Set) Adult major depressive disorder (MDD): Suicide risk assessment (use EHR Incentive Program version of measure) Screening for Clinical Depression and Follow-Up Plan (see Medicaid Adult Core Set) Consumer follow-up with standardized measure (PHQ-9) Depression Remission at 12 months NQF Endorsed N/A 0421 0024 0028 2152 1365 0104 0418 0710
State Reported Measures(12 Required) Potential Source of Data Measure or Other Reporting Requirement NQF Endorsed URS Housing Status (Residential Status at Admission or Start of the Reporting N/A Period Compared to Residential Status at Discharge or End of the Reporting Period) Claims data/ encounter data Follow-Up After Emergency Department for Mental Health 2605 Claims data/ encounter data Follow-Up After Emergency Department for Alcohol or Other 2605 Dependence Claims data/ encounter data Plan All-Cause Readmission Rate (PCR-AD) (see Medicaid Adult Core Set) 1768 Claims data/ encounter data Diabetes Screening for People with Schizophrenia or Bipolar Disorder 1932 who Are Using Antipsychotic Medications Claims data/ encounter data Adherence to Antipsychotic Medications for Individuals with N/A Schizophrenia (see Medicaid Adult Core Set) Claims data/ encounter data Follow-Up After Hospitalization for Mental Illness, ages 21+ (adult) (see 0576 Medicaid Adult Core Set) Claims data/ encounter data Follow-Up After Hospitalization for Mental Illness, ages 6 to 21 0576 (child/adolescent) (see Medicaid Child Core Set) Claims data/ encounter data Follow-up care for children prescribed ADHD medication (see Medicaid 0108 Child Core Set) Claims data/ encounter data Antidepressant Medication Management (see Medicaid Adult Core Set) 0105 EHR, Patient records Initiation and engagement of alcohol and other drug dependence 0004 treatment (see Medicaid Adult Core Set) MHSIP Survey Patient experience of care survey; Family experience of care survey N/A
What is the ultimate purpose of collecting & sharing data?
True Goals of Measurement Focuses improvement efforts Facilitates objective evaluation of progress Motivates by providing feedback to the team Eliminates wishful thinking Accelerates improvement
Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Langley GL, Nolan, KM, Nolan, TW, Norman, CL & Provost, LP, 1999
Improvement-Through-Learning Culture Shared assumptions, beliefs, values, and behaviors that support the ability to develop new capabilities to succeed. Doing current things better, doing new things, and/or adapting to external changes.
Enhancing Staff Buy-In Stakeholders need answers to these questions: 1. What evidence is there that this change is for real? 2. Ok, it is for real, then is this good for me? 3. Is this good for my patient/healthcare provider? 4. What do I stop doing? 5. What do I keep doing the same? 6. What do I do differently?
Why Does This Matter To Me Improved Quality of Care Staff Vitality and Joy Financial Sustainability
Population Health Management Improving and maintaining the health of your entire patient population across the full continuum of care - from low risk, healthy individuals to high-risk individuals with one or more chronic conditions, who are therefore much more likely to use the emergency department or have a hospital admission.
Establishing Your Process Assign accountability Who is in our population? What risk factors & chronic conditions will we track? Who is part of the care team for that population? Stratify risk What tool(s) will we use? Who are our low/med/high risk clients? Identify care gaps What are the evidence-based services and treatments for this population? What is the care pathway (systematic approach to workflow, documentation, frequency & duration of services) based on each level of risk?
Risk Stratification Example PHQ-9 Depression Recommended Treatment Score severity 5-9 Mild Watchful waiting, periodic re-screening, education, patient activation 10 14 Moderate Develop tx plan, consider therapy, education, assertive follow-up and evaluation, pharmacotherapy 15 19 Moderate - Medication and/or therapy Severe 20 Severe Medication and therapy Additional factors: Other diagnoses, service/system utilization, polypharmacy, social determinants, client self-report, clinician judgement
Population Health Registry Example Client Primary Provider Initial Contact Date Initial PHQ-9 Treatment Plan Follow up Contact Date Follow up PHQ- 9 Smith, S. Hernandez 12/19/10 12 Therapy, education 4/26/11 13 Gimatta, M. Williams 1/28/10 10 Education, monitoring 2/28/10 4 Brown, H. Crane 4/30/10 20 Medication, therapy 5/17/10 17 Jones, H. Williams 2/21/10 16 Medication 4/1/10 22 Hart, D.. Williams 3/18/10 26 Medication, therapy, close monitoring 3/30/10 26
How to Conduct Population Health Case Reviews 1. Regular, brief, consistent meeting/huddle 2. Care team for that population 3. Everyone looking at same info, rotating scribe 4. Focus: All new cases, all those not improving 5. Treat to target
What is your Goal Statement? As of November 15, 2017, 75% of all clients seen by Awesome Care Team are screened annually with the PHQ-9. Baseline as of October 1, 2017 = 25% By December 31, 2017, 50% of all client intakes at Awesome Clinic have a baseline BMI documented in the EHR. Baseline as of October 1, 2017 = 48%
Dashboards Serve as objective visual representations that help agencies evaluate how well they re doing. Target Goal Numerator (as of 10/17) Denominator (as of 10/17) Change needed Measure Actual 1. 30-day hospital readmission, MH dx 8% 68 925 7% 1% 2. Follow up after hosp for mental illness w/in 7 days 10 47 765 10% 0 30 10 15 0 65 ACT clients with a documented primary care visit in the last year 0 20 Cases with documentation completed within 24 hrs of appt 0 # of days without dirty dishes left in breakroom 30
Using Data to Engage & Activate Staff Awesome, we increased our SBIRT enrollment! What organizational factors contributed? Which staff were part of this increase? What is working?
Using Data to Engage & Activate Staff Great! No one received only an RT! Who were the clients that didn t receive a BI or RT when it was indicated? What were the circumstances?
Using Data to Engage & Activate Staff Hey we ve had 7 clients with documented improvement! What can we learn from the staff who worked with them? Where can we promote these results to demonstrate our value?
What Attracts Us to Change? It saves time or money It s easier to do It allows more autonomy or choice It enhances image/reputation It appeals to one s values It improves quality or safety
Making It Stick All team members have a shared understanding of the objectives & strategy Each team member can articulate how they contribute and add value to the objectives Data is a team member Positive gossip is promoted Rising stars are identified
Questions
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