PMHP Administrative Data Analysis Development of Quality Measures

1. PMHP Administrative Data AnalysisDevelopment of Quality Measures Agency for Health Care Administration Briefing September 27-28, 2010 Mary Rose Murrin Gregory B. Teague, Ph.D.

2. Goals for this year’s analysis • Produce a data quality report for PMHP using most recent PMHP encounter data • Extend that data quality report to the HMOs • Produce and implement a set of service quality measures based on feedback from the 2009 AHCA Debriefing

3. Feedback from 2009 AHCA Debriefing • Assess quality based on standard HEDIS measures • Show the penetration and service density for each of five major classes of community services provided in managed care plans: • Basic Outpatient • Intensive Outpatient • Treatment Planning • Assessment • Targeted Case Management • It was more informative to show what was happening within defined treatment populations, than for the overall population using MH services.

4. New Service Quality Measures: HEDIS measures • Outpatient follow-up after inpatient episode • within 7 days • within 30 days • Medication management for major depression antidepressant therapy for persons 18 and above • % meeting acute phase criteria • % meeting continuation phase criteria • Follow-up care for children ages 6-12 prescribed ADHD medication • % meeting acute phase criteria • % meeting continuation phase criteria

5. New Service Quality Measures • Components of Care Subpopulations • 90 days after discharge from inpatient admission • 90 days after beginning of treatment episode for adult major depression • 90 days after beginning of treatment episode for child aged 6-12 ADHD medication • Major diagnoses (last three month period) • Adult Schizophrenia • Adult Major Depression • Adult Bipolar Disorder • Child Mood Disorder • Child Conduct Disorder • Child ADHD Disorder

6. Outpatient follow-up within 7 days after inpatient episode (admissions from 6/1/09-8/31/09)

7. Outpatient follow-up after inpatient episode within 30 days (admissions from 6/1/09-8/31/09)

8. Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Acute Phase (PMHPs only)

9. Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Continuation Phase (PMHPs only)

10. Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Initiation Phase (PMHPs only)

11. Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Continuation Phase (PMHPs only)

12. Plans with at least one indicator above the HEDIS adjusted 90th percentile • Healthease/Wellcare (Inpatient Follow-up) • Staywell/Wellcare (Inpatient Follow-up) • Access Behavioral Health (Inpatient Follow-up) • Community-Based Care Partnership (ADHD) • Magellan Behavioral Health (Inpatient Follow-up) • Public Health Trust Dade (ADHD and Inpatient)

13. Components of Care Analysis: 90 days after Inpatient Discharge for Admissions April 1- June 30, 2009 Key: BOP Basic Outpatient IOP Intensive Outpatient TXP Treatment Planning Asmt Assessment TCM Targeted Case Mgmt

14. Components of Care Analysis: First 90 days of Adult Antidepressant Therapy for Treatment Episodes Beginning January 1 through March 31, 2009

15. Components of Care Analysis: First 90 days of ADHD Medication Follow-up Treatment Episodes Beginning December 1, 2008 through February 29, 2009

16. Strengths, Limitations, and an Alternative to this Approach • Shows treatment patterns of recognized high-risk groups. • The N in each of these analyses is much smaller than the population of the behavioral health system • One approach is to look at the diagnostic groups that comprise the majority of people using the BH system • Within Florida Medicaid’s Managed Care BH System there are only a few diagnostic groups that cover most of the population

17. Percentages of Common Diagnoses Found in the Behavioral Health Encounters for FY 2008-2009 These diagnoses combined were able to describe 80% of adult MH users and 72% of Child MH users.

18. Components of Care Analysis: 90 days following First Schizophrenia Diagnosis March 1 through June 30, 2009

19. Components of Care Analysis: 90 days following First Adult Bipolar Disorder Diagnosis March 1 through June 30, 2009

20. Components of Care Analysis: 90 days following First Adult Major Depression Diagnosis March 1 through June 30, 2009

21. Components of Care Analysis: 90 days following First Child Mood Disorder Diagnosis March 1 through June 30, 2009

22. Components of Care Analysis: 90 days following First Child Conduct Disorder Diagnosis March 1 through June 30, 2009

23. Components of Care Analysis: 90 days following First Child ADHD Diagnosis March 1 through June 30, 2009

24. Where do we go from here? • Working assumption: we will have the necessary data this year • Planning discussions with key AHCA informants & other interested stakeholders • Prioritization of critical issues for analysis • Consideration of additional breakdowns, e.g., by administrative, geographic, demographic, &/or clinical categories • Refinements to methods & reporting • Plan for distribution & follow-up mechanism