wrbho best meeting & quarter three performance report presentation finger lakes region

WRBHO BEST Meeting &Quarter Three Performance Report Presentation

Finger Lakes RegionDecember 11, 2012

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I. Introductions and Key Findings

II. Q3 Regional Overview•Regional Overview of all domains•Sub-regional info focused on the Linkages with After Care Services domain.•Role of the BHO in supporting Health Homes

III. Q3 Sub-Regional Review (compared to the region)•Review of key metrics tied to the “Effective Linkages” domain for the sub-region •Discuss the information to determine what it means to those in attendance (Are there opportunities for improvement?)

IV. Effective practices presentations •St. Joseph’s Hospital: Effective scheduling of outpatient appointments•Intro to Consumer Centered Family Consultation and opportunity for technical assistance

IV. Identify areas of focus for improving sub-region BH system of care

VI. Next steps •Would a Learning Collaborative be helpful?

WRBHO BEST Meeting Agenda

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Presenters

• John Lee, WRBHO Program Director, Beacon• Christine Mangione, WRBHO Manager of

Clinical Operations, Beacon• Elisabeth Hager, MD, Physician Advisor,

Beacon

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INTRODUCTION & KEY FINDINGS

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Introduction

Q3 Performance Report Organization:– Domains– Metrics within each domain (Data Sources: BHO data collection and OMH

BHO Portal)

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The 5 Performance Metric Domains

Performance Domain 1: Coordination with the BHO

Performance Domain 2: Person-Centered Care Coordination during the Inpatient Stay

Performance Domain 3: Linkages to After Care Services

Performance Domain 4: Continuity of Care

Performance Domain 5: Engagement in Care

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Highlights of WRBHO FindingsObserved changes that support transformation:•Improved provider performance within the WRBHO’s 19 county region

– 6 out of 8 metrics within the Performance Domain: Linkage to After Care Services, reflect improvement: Q2 to Q3.

– A number of OMH BHO Portal metrics reflect performance in WNY that exceeds the Statewide rates: outpatient visits, readmission rates.

•County MH Directors convening meetings to engage providers about the changes that need to take place to prepare for BH Managed Care.

•Facility COO expressing appreciation that the State is monitoring data to assess the ability of providers to work as a system of care.

•MH inpatient providers expressing interest in learning how to be more effective in linking patients with PH providers.

•Facility discharge planners requesting help from the WRBHO in securing housing for a patient, recognizing impact on avoidance of readmissions.

•Providers devoting a full day to listen to feedback from those with a inpatient psychiatric experience (The WRBHO forums)

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REGIONAL & PROVIDER PROFILE PERFORMANCE

REPORTS

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Performance Domain 1 – Coordination with the RBHO

Domain includes measures helpful in ensuring complete and timely data report and review practices

Metrics:

•The number of Notices of Admission submitted by providers is consistent with established targets

•Notices of Admission are received within 24 hours of admission

•Initial Reviews are completed within 72 hours of admission

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Performance Domain 1 – Coordination with the WRBHO

Performance Metric 1(a): The number of Notices of Admission (NOAs) received is consistent with established targetsData Source: Data on NOAs provided through the eServices Portal / data gathered by WRBHO staff via telephone. Data on 2011

fee-for-service admissions provided by the NYS Office of Mental Health

Metric Calculation: Total Admissions Noticed for Period / Total FFS Medicaid Admission Reported for Period

Inpatient Admission Type

# of Admissions Noticed to

WRBHO: Q1


WRBHO: Q2


WRBHO: Q3

Total # of Admissions

Noticed through Q3

Total Admissions through Quarter 3

2011* % of Target

(2011)Mental Health Adult 816 828 849 2493

Mental Health Youth 192 164 157 513

Mental Health Total 1008 992 1006 3006 4268 70.40%

Substance Use Detox Adult

128 72 64 264 987 26.70%

Substance Use Inpatient Rehab Adult

383 264 267 914 2443 37.40%

Substance Use Total 511 336 331 1178 3430 34.30%

TOTAL 1519 1328 1337 4184 7698 54.35%

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Performance Metric 1(b): Notices of Admission are Received within 24 Hours of Admission

Data Source: Data gathered via phone by WRBHO clinician or e-portal entry

Metric Calculation: # of NOAs received within 24 hours of admission/Total admissions noticed in reporting period

Inpatient Admission TypeTotal admissions

for current quarter

NOAs within 24 hours for current

quarter

NOAs within 24 hours/admissions

for current quarter

Provider range for current quarter

NOAs within 24 hours for previous

quarter

Variance: Current vs.

Previous Quarter

Mental Health Adult 849 829 97% 78 - 100% 95% 2%

Mental Health Youth 157 156 99% 93 - 100% 98% 1%

Substance Use Detox Adult 64 58 90% 81 - 100% 98% -8%


267 253 94% 87 - 100% 89% 5%

Total 1337 1296 96% 78 - 100% 94% 2%


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Performance Metric 1(c): Initial Reviews are Completed within 72 Hours of Admission

Data Source: Gathered via phone by WRBHO clinician

Metric Calculation: Initial Reviews within 72 Hours of admission/Total admissions in reporting period

Inpatient Admission TypeTotal Admissions: Current Quarter

# of Initial Reviews w/in 72 hours: Current

Quarter

Initial Reviews w/in 72 hours /

Total Admissions: Current Quarter

Provider Range: Current quarter

Initial Reviews w/in 72 hours / Total

Admissions: Previous Quarter


Previous Quarter





267 209 78% 38 - 100% 67% 11%

Total 1337 1215 90% 38 - 100% 80% 10%


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Performance Domain 2 – Person-Centered Care Coordination During the Stay

Domain includes metrics that describes the extent to which effective, person-centered care coordination practices during the inpatient stay are evident.

• Particular interest in efforts to ensure that the individual’s needs have been identified so that an effective discharge plan can be developed.

• Additional metrics will be added under this domain over time.

Metric:• Treatment history is shared with the inpatient provider during

the Initial Review

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Performance Metric 2(a): Treatment History is Shared with the Inpatient Provider during the Initial Review

Data Source: Data recorded in FlexCare by WRBHO Clinician

Metric Calculation: Discharges w/Treatment History Shared/Total Discharges in Reporting Period


Total Discharges: Current Quarter

# of Discharges w/Treatment

History Shared: Current Quarter

% of Discharges w/Treatment

History Shared: Current Quarter

Provider Range: Current Quarter

% of Discharges w/Treatment

History Shared: Previous Quarter


Previous QuarterRegional Year-

To-Date

Mental Health Adult

842 720 85% 55 - 100% 80% 5% 83%

Mental Health Youth

152 136 89% 70 - 100% 80% 9% 86%


66 54 81% 80 - 100% 84% -3% 82%


267 242 90% 81 - 100% 74% 16% 85%

Total 1327 1152 86% 55 - 100% 79% 7% 84%

Performance Domain 2 – Person-Centered Care Coordination During the Stay

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Performance Domain 3 – Linkages to After-Care Services

Domain includes metrics that measures the extent to which steps were taken during the inpatient stay to establish linkages to needed outpatient services.

Metrics:•The current or prior mental health outpatient provider was contacted during stay•An appointment for mental health outpatient treatment was scheduled as part of the discharge plan•The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider•A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay •A SPOA application was submitted for case management, housing and other services •For youth with multi-system needs, the discharge plan includes referrals /linkages for the provision of basic needs•For youth with multi-system needs, the discharge plan documents post discharge educational needs •There is improvement in housing status for individuals who are homeless at admission

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• Provide a “drill down” on the metrics presented at the regional level to look more closely at provider-level performance• Available for the Linkages to After Care Services domain metrics

• Identification of higher performance providers

• Strategies being deployed to achieve higher levels of performance.

• Higher performing providers• Fall in the top 25% for the performance metric

• 8 or more discharges during the quarter

• Data collection process for Q3 was viewed as an accurate reflection of the providers’ work by the WRBHO Utilization Review Clinician.

• Efforts have focused on identifying barriers to performance.

Provider Profile Summaries

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Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay

Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO

Metric Calculation: # of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period

Inpatient Admission TypeTotal Discharges: Current Quarter

# Where Outpatient

Provider was Contacted During

the Stay: Current Quarter

% Where Outpatient

Provider was Contacted During the Stay: Current

QuarterProvider Range: Current Quarter

Where Outpatient Provider was

Contacted During the Stay: Previous

Quarter Variance



Total 994 802 81% 49 - 100% 68% 13%


Regional Report

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Inpatient Admission Type Adult Mental Health Youth Mental Health

Provider Average 78% 92%

Provider range 49 - 100% 71 - 100%

Higher Performing Providers D

L

P


Provider Profile Summary

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Best Practices:•Gathers collateral information from outpatient provider and is linked closely with other outpatient agencies.•Attempts to keep MH clients within their system of care, which appears to help with continuity of care.•Is protocol that the Discharge Planner notifies outpatient provider of individuals admitted (once identified) and shares appropriate collateral information. •Has a “no wrong door” philosophy and offers co-existing treatment with mental and physical health providers in close proximity of each other. Encourages effective communication.

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Barriers:

•Gaps in communication between UR clinicians and discharge planners.

•The practice is not built in to standard facility procedures.

•The treatment team does not reach out to current or active providers to collaborate and work together towards the recovery of patients.

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WRBHO Actions:

•Clarified meaning of the indicator during one-on-one provider meetings through issuing a new review template and holding provider calls.

•WRBHO System of Care Transition Coordinator’s role redefined to include contacting outpatient providers when an active client has been admitted and encouraging follow-up. This outreach continues to encourage contact between inpatient and outpatient providers.

•Focused on the importance of the transition to outpatient treatment during the February and June BEST Meetings.

•Effective linkage to after care services was the theme during the September 27 BEST Meeting.

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VIGNETTE: Linking with Past Supports to Avoid Future Readmissions

On August 31, 2012 a 51 year-old man was mental hygiene arrested after he was found lying in the road with suicidal ideation. His diagnoses included: Psychosis Not Otherwise Specified and Paranoid Schizophrenia. The individual was observed as grandiose, paranoid, delusional and unkempt. The treatment history indicated that the individual had been discharged from the facility just three days earlier. It was also noted that the he had an apartment, but little to no supports. In addition, the individual had no current outpatient providers.

Through use of PSYCKES the WRBHO Utilization Review Clinician (URC) learned that the individual had a history with the ACT team through the local psychiatric center. It also appeared likely that he was not taking his current medications. Due to his limited supports, the WRBHO URC recommended that the inpatient provider explore reestablishing the linkage with the ACT team. The provider accepted this recommendation. The individual was discharged home to his apartment and the ACT Team followed up within a very few days of the discharge. By reviewing the treatment history in PSYCKES, the WRBHO URC was able to identify a past support and encourage a linkage that will assist the beneficiary in living successfully and securely in his own apartment.


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Performance Metric 3(b): An appointment for mental health outpatient treatment was scheduled as part of the discharge plan


Metric Calculation: # of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges in Reporting Period


Total Mental Health Discharges: Current

Quarter

An Appointment for MH

Treatment was Part of the

Discharge Plan: Current Quarter

(#)

An Appointment for MH Treatment

was Part of the Discharge Plan: Current Quarter

(%)Provider Range: Current Quarter

An Appointment for MH Treatment

was Part of the Discharge Plan:

Previous Quarter


Previous Quarter

Mental Health Adult 842 641 76% 0 - 100% 81% -5%


Total 994 749 75% 0 - 100% 79% -4%

Performance Domain 3 – Linkages to After-Care ServicesRegional Report

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Performance Metric 3(b): An appointment for mental health outpatient treatment was made as part of the discharge plan



Inpatient Admission Type Adult Mental Health Youth Mental Health

Provider Average 76% 71%

Provider range 0 - 100% 0 - 100%

Higher Performing Providers AF

D

Performance Domain 3 – Linkages to After-Care ServicesProvider Profile Summary

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Best Practices:

•Strong ties to the system’s array of outpatient services facilitate effective communication and efficient scheduling.

•Follow a person-centered, thorough and comprehensive discharge planning process.

•Connecting with outpatient treatment is a standard practice for those individuals not transferring to another facility for inpatient rehabilitation (SUD).

•Standard operating practice to ensure linkage with a community- based provider prior to discharge.

•Intake coordinator assigned to client and follows him or her from inpatient to discharge.

•Outreach is performed if the aftercare appointment is missed.

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Barriers:

•In instances where the individuals do not have an outpatient provider at the time of admission, this process is more difficult to accomplish during the inpatient stay.

•Lack of outpatient capacity is a barrier in some areas.

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Performance Metric 3(b): An appointment for mental health outpatient treatment was scheduled as part of the discharge plan


WRBHO Actions:

•During September 27 BEST Meeting, providers shown to be successful in scheduling outpatient appointments spoke about their practices.

•December BEST meeting will focus on sharing practices in place at providers having success with individuals leaving inpatient care with a outpatient mental health appointment scheduled.

•WRBHO staff will follow-up directly with providers with lower performance in this area to further define barriers and identify solutions.

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Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider


Metric Calculation: # of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period


Case Summary was Sent to the

Outpatient Provider: Current

Quarter (#)

Case Summary was Sent to the

Outpatient Provider: Current

Quarter (%)Provider Range: Current Quarter

Case Summary was Sent to the Outpatient

Provider: Previous Quarter (%)


Previous Quarter





267 116 43% 9 - 83% 35% 8%

Total 1327 791 59% 0 - 100% 56% 3%


Regional Report

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Inpatient Admission Type Adult Mental Health

Youth Mental Health

Adult Substance Use Detox

Adult Substance Use Inpatient Rehab

Provider Average 65% 60% 42% 43%

Provider range 0 - 100% 40 - 100% 22 - 61% 9 - 83%

Higher Performing Providers

A AC

R C

Q K

X O

V



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Best Practices:

•Standardized practice has been implemented to submit the discharge summary so the outpatient provider is aware of the discharge diagnosis, GAF, and medications/instructions.

•It is a standard operating practice that when a patient signs a release, case summaries are sent to the outpatient provider. If patient initially declines, staff will discuss with the patient the need to send the summary for good continuity of care.

•Provider has effective linkages to outpatient programs in their organization’s system of care.

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WRBHO Actions:

•Confusion existed as to what constituted a “case summary.” WRBHO clarified definition: Discharge instructions which include dates of admission, discharge diagnosis, and medication list.

•Definition shared with providers and the WRBHO UR Clinicians are using this definition in their reviews.

•We anticipate that we will continue to see improvement on this important dimension.

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Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay

Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO

Metric Calculation: Discharges w/physical health appointment scheduled with an outpatient provider/discharges w/physical health need identified during inpatient stay for reporting period


Total Discharges w/Physical Health Needs Identified: Current Quarter

# w/Physical Health

Appointment Scheduled w/

Outpatient Provider for

those w/ Needs Identified:

Current Quarter

% w/ Physical Health


Outpatient Provider for those

w/ Needs Identified: Current

QuarterProvider Range: Current Quarter

% w/ Physical Health


Outpatient Provider for those w/ Needs

Identified: Prior Quarter


Previous Quarter



Substance Use Detox Adult 25 5 35% 0 - 100% 8% 27%


49 27 55% 0 - 100% 14% 41%

Total 365 148 40% 0 - 100% 19% 21%


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Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX’ d to the WRBHO

Metric Calculation: Discharges w/physical health appointment scheduled with an outpatient provider/discharges w/physical health need identified during inpatient stay for reporting period


Youth Mental Health




Provider range 0 – 100% 0 - 100% 0 - 100% 0 - 100%


J AA

N AC

S

Z


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Best Practices:

•Facility goal is to ensure that all patients are well connected to all areas of health care - both mental and physical.

•Provider has a protocol requiring the case manager to link the patient with a Primary Care provider if the patient is admitted without one. The provider has developed relationships with two PCP practices to help expedite creating this very important link.

•Provider strives to connect clients to previous primary care providers, if none have been established, they refer clients to the county system. The County provides a list of accepting physicians.

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Barriers:

•The responsibility is placed on the individual to follow up with their primary care physician after discharge.

•Some facilities have procedures that focus on SUD and mental health outpatient appointments only (not physical health).

•Many individuals admitted do not have a primary care provider and inpatient staff says that it is too hard to link the individuals with a PCP during the inpatient stay.

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WRBHO Actions:

•Developed a template for inpatient providers that details the rationale and offers a definition of this (and other) metric(s). Template reviewed with inpatient providers via webinar.

•WRBHO Utilization Review Clinicians engaged in a thorough review of all questions contained in the review cycle to be better prepared to extract more accurate information from the providers during these reviews.

•WRBHO will continue to work to identify effective practices for integrating physical health engagement into the behavioral health admissions through surveying providers for effective practices and sharing strategies via BEST Meetings and other provider forums.

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Performance Metric 3(e): A SPOA Application was Submitted During the Inpatient Stay

Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool Faxed to the WRBHO

Metric Calculation: # of SPOA Applications Submitted/# of Discharges in Reporting Period


# of Discharges w/SPOA

Application Submitted:

Current Quarter

% of Discharges w/SPOA


Current Quarter Provider range for

current quarter

% of Discharges w/SPOA


Previous Quarter


Previous Quarter



Substance Use Detox Adult 66 1 4% 0 - 33% 2% 2%


267 5 1% 0 - 9% 1% 0%

Total 1327 140 10% 0 - 100% 8% 2%


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Performance Metric 3(e): A SPOA Application was Submitted during the Inpatient Stay

Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool Faxed to the WRBHO

Metric Calculation: # of SPOA Applications Submitted/# of Discharges in Reporting Period


Youth Mental Health




Provider range 0 - 66% 0 - 100% 0- 33% 0 - 9%


Q F

S


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Best Practices:•Overall, SPOA referrals are made for 12% of adults discharged from inpatient care and 19% of youth. However, the range varies considerably, with several providers reporting much higher referral rates. Based on interactions with providers, we have identified a few practices that appear to be proving successful:

• SPOA “consultant” from the county is placed on each unit to help identify and assist discharge planners with application process.

• Provider uses a team approach in working with the patient. That is, the discharge planner, the social worker/therapist and the MD/NPP all meet together with the patient to assist in determining needs for a successful transition.

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Barriers:•Lack of SPOA services (care management) to support the needs of those with SU diagnosis. •SPOA review processes occur on a monthly basis only in some counties. •Inpatient facilities will start process if needed but rely on outpatient services to finish the referral.WRBHO Actions:•The WRBHO has begun to work with county directors to assess the interest in developing greater consistency in SPOA processes.•WRBHO UR Clinicians have been oriented to county specific SPOA processes so that they are in a better position to support the providers’ needs in each county.•WRBHO UR Clinicians have been encouraged to support specific SPOA requests by helping with the application or even attending SPOA meetings to represent the needs of the individual and the provider.

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Performance Metric 3(f): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic needs


Metric Calculation: # of Discharges with Indication that Basic Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period


# of Youth w/Multi-Systems Needs

Identified: Current Quarter

# of Youth w/Indication

that Basic Needs were Addressed: Current Quarter

% of Youth w/Indication that Basic Needs were

Addressed: Current Quarter


% of Youth w/Indication that Basic Needs were

Addressed: Previous Quarter


Previous Quarter



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Metric Calculation: # of Discharges with Indication that Basic Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period

Inpatient Admission Type Youth Mental Health

Provider Average 98%

Provider range 87 - 100%

Higher Performing Providers A

U


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Best Practices:•Discharge planning is comprehensive and involved all outside agencies.•Weekly team meetings are held for the interdisciplinary team and UR team.•On-site team member meetings. •Provider gathers collateral information from outpatient providers and is very knowledgeable about resources that are available in the community.

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Performance Metric 3 (g): For youth with multi-systems needs, the discharge plan documents post-discharge educational needs


Metric Calculation: # of Discharges with Indication that Educational Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period


# of Youth w/Multi-Systems Needs

Identified: Current Quarter

# of Youth w/Indication

that Educational Needs were Addressed:

Current Quarter

% of Youth w/Indication that Educational Needs were Addressed: Current Quarter


% of Youth w/Indication that Educational Needs were Addressed: Previous Quarter


Previous Quarter

Mental Health Youth 95 84 88% 0 - 100% 93% -5%


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Metric Calculation: # of Discharges with Indication that Educational Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period

Inpatient Admission Type Youth Mental Health

Provider Average 88%

Provider range 0 - 100%

Higher Performing Providers A

Z


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Best Practices:

Supporting the multi-system needs of children requires very comprehensive planning, involving a number of outside agencies in regular interdisciplinary team meetings. Higher performing providers have made school programming mandatory for children and youth.

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Performance Metric 3(f) and (g):

For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic and educational needs


WRBHO Actions:•WRBHO staff will review these measures with providers following the release of the Q3 data to ensure that data collection and reporting accurately reflect current practice.

•A Clinical Grand Rounds scheduled for 2013 will focus on children’s services and will be presented by the WRBHO Child Psychiatrist, Mario Testani. Dr. Testani will spend a portion of his presentation discussing the importance of addressing educational needs.

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Performance Metric 3(h): Improvement in housing status for individuals who are homeless at admission Data Source: Gathered by WRBHO clinician during review

Metric Calculation: # of Discharges w/Improved Housing Status/# of Discharges that were Homeless at Admission for Reporting Period


Total # Homeless at Admission: Current

Quarter

Improvement in Housing Status for Individuals Homeless at Admission:

Current Quarter (#)

Improvement in Housing Status for

Individuals Homeless at Admission:

Current Quarter (%)


Improvement in Housing Status for

Individuals Homeless at Admission:

Previous Quarter (%) Variance


Mental Health Youth No Data No Data No Data No Data 100% No Data

Substance Use Detox Adult 7 1 33% 0 - 50% No Data No Data


24 16 66% 0 - 100% 68% -2%

Total 94 37 39% 20 - 100% 30% 9%


Regional Report

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Performance Metric 3(h): Improvement in housing status for individuals who are homeless at admission


WRBHO Actions:•As access to stable housing is critical to achieving recovery this measure has been an area of focus in our review and discussion of both system and provider performance. •WRBHO UR clinicians have been asked to encourage providers to work diligently to address this need for cases we review. •WRBHO staff has also worked with county SPOAs to support an expedited review for inpatients, especially those in need of housing. • Providers have been encouraged to begin the housing planning process for individuals admitted as homeless as soon as they are admitted.

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Performance Domain 4 – Continuity of Care

Domain includes metrics that look at the extent to which individuals are connected to outpatient mental health services following discharge from inpatient – as well the timeliness of that connection. •Utilize data collected by WRBHO and data available through BHO Portal.

Metrics:•The percentage of scheduled Mental Health clinic outpatient appointments attended (WRBHO collected)•The percentage of Mental Health Discharges followed by an outpatient visit for Mental Health treatment within 7 days (BHO Portal)•The percentage of SUD Detox discharges with lower level SUD services with 14 days (BHO Portal)•The percentage of SUD rehabilitation discharges with lower level SUD services within 14 days (BHO Portal)

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Performance Metric 4(a): Percentage of scheduled Mental Health clinic outpatient appointments attended

Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO

Metric Calculation: # of Outpatient Licensed Mental Health Clinic Appointments Attended Post-Discharge / # of Outpatient Mental Health Appointments Attended / Total # of Outpatient Mental Health Appointments Scheduled


# of Outpatient Mental Health Appointments

Scheduled: Current Quarter

# of Outpatient Mental Health Appointments

Attended: Current Quarter

% of Outpatient Mental Health Appointments

Attended: Current Quarter


% of Outpatient Mental Health Appointments

Attended: Previous Quarter


Previous QuarterRegional Year-

To-Date

Mental Health Adult

286 232 81% 52-100% 79% 2% 80%

Mental Health Youth

37 30 81% 0 - 100% 85% -4% 84%

Total 320 262 81% 52 - 100% 80% 1% 80%


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Performance Metric 4(a): Percentage of scheduled Mental Health clinic outpatient appointments attended


WRBHO Actions:

•WRBHO clinicians gather these data through follow-up w/identified the outpatient mental health providers.

• WRBHO follow-up takes place for up to 60-days post discharge (or until there can be confirmation of either attendance or a “no show.”)

•Complements data available from the BHO Portal by providing a more timely way for staff to monitor the rate at which individuals are attending their outpatient mental health appointments.

•WRBHO focus will be on identifying barriers to after care attendance and strategies providers are finding effective in increasing attendance.

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Performance Metric 4 (b): Percentage of MH Discharges Followed by an Outpatient Visit for MH Treatment within 7 Days

Data Source: NYS OMH BHO Portal

Metric Definition: Frequency with which individuals receive outpatient mental health treatment within 7 days of discharge from a mental health inpatient hospitalization.


Western Region:

Q1 2012Western Region:

Q4 2011


Previous Quarter

Statewide: Q1 2012

Variance: Western Region

vs. Statewide

Mental Health Adult

44.8% 45.9% 1% 34.7% 10.1%

Mental Health Youth

44.3% 48.1% -4% 38.6% 56%


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Performance Metric 4 (c): Percentage of SUD Discharges Followed by a Lower Level SUD Service within 14 Days


Metric Definition: Frequency with which individuals receive a lower level, less intensive, substance use disorder service within 14 days following a discharge from an inpatient substance use treatment.


Western Region:


Q4 2011


Previous Quarter

Statewide: Q1 2012


vs. Statewide


58.1% 50.5% 7.5% 33.1% 25%


47.7% 47.7% 0% 39.5% 8.2


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Performance Domain 5 – Engagement in Care

Metrics

• % of Mental Health discharges followed by 2 or more MH outpatient visits within 30 days (BHO Portal)

• % of SUD Detox or Rehabilitation services followed by 2 or more SUD services within 14 days of discharge (BHO Portal)

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Performance Metric 5(a): Percentage of MH Discharges Followed by Two or More MH Outpatient Visits within 30 Days


Metric Definition: Received two or more outpatient mental health visits within thirty days of discharge.


Western Region:


Q4 2011


Previous Quarter

Statewide: Q1 2012


vs. Statewide

Mental Health Adult

42.6% 40.9% 1.7% 31.9% 10.7%

Mental Health Youth

48.9% 49.6% -.7% 43.3% 5.6%


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Performance Metric 5 (b): Percentage of SUD Detox or Rehabilitation Discharges Followed by Two or More Lower Level SUD Services within 14 Days of Discharge


Metric Definition: Frequency with which individuals discharged from inpatient detoxification or chemical dependence inpatient rehabilitation engage in 2 or more lower level substance use disorder treatment services within fourteen days of discharge.


Western Region:


Q4 2011


Previous Quarter

Statewide: Q1 2012


vs. Statewide

Substance Use Adult

32.2% 32.5% -.3% 21.4% 10.8%


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WRBHO ROLE IN HEALTH HOMES

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Role of the WRBHO in Supporting Health Homes •Notify inpatient providers when an admitted individual being reviewed by the WRBHO is enrolled in a Health Home or eligible for Health Home outreach

•Ensure the provider has contact information for the Health Home care coordinator.

•Contact Health Home care coordinators to review and assist with post-discharge follow-up as needed.

•Share past treatment history as found in PSYCKES and FlexCare

•Alert Health Home when Health Home member is admitted.

•Support community referrals to Health Homes

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SPECIAL /COMPLEX NEEDS POPULATION

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Admissions for Individuals with Complex Needs: Q3

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Detox Clients who Leave Against Medical Advice: •NYS has identified an area of interest and concern related to improving care coordination for individuals admitted to SUD detox who leave against medical advice (AMA). •These individuals do not complete treatment and often leave before discharge plans are in place, including coordinating the next level of care.

o In addition to receiving incomplete care, these individuals are at risk for rapid readmission to detox.

•Understanding the needs of these individuals as well as the barriers to their treatment may help us provide better, patient-centered care, and improve overall outcomes. •WRBHO is in a unique position to lead a process to better understand the characteristics of these individuals, system characteristics that may contribute to these discharges, to identify best practices that improve engagement / retention for this group.

Complex Needs Population Special Study

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Detox Clients who Leave Against Medical Advice (cont’d):

•Project will engage consumers and providers.

•Learning Community will be established with the ultimate plan to pilot best practices in at least two sites.

•Special emphasis is made to integrate knowledge and sensitivity of cultural issues that may impact an individual’s experience of detox services and the decision to leave AMA.

Complex Needs Population

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Detox Clients who Leave Against Medical Advice (cont’d):

•Claims data from Q 1-3, 2012 were evaluated. An evaluation of detox AMA discharges for the 19 county region shows the following:

o 16% of all detox discharges were AMAo 84% male; 16% femaleo 50% white; 32 % black; 18% Hispanico Opioids were the drug of choice (DOC) for white individuals leaving

AMA (39%) o Alcohol was the DOC for black individuals leaving AMA (71%)

Next steps include:o Developing background materials, o Establishing the Learning Communityo Identifying pilot sites to develop and test models to improve care

coordination of individuals leaving detox AMA.

Complex Needs Population

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WRBHOQ3 SUB-REGIONAL

PERFORMANCE REVIEW: Linkages to Aftercare

Services

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Sub-Regional View - Discharges


County of Residence - Current Quarter Sub-Regional vs. Regional

Allegany Chemung Livingston Ontario Schuyler Seneca Steuben Tioga Tompkins Wayne Yates

Sub-Regional Current

Qtr

Regional Current

Qtr

Sub-Regional

vs. Regional

Mental Health Adult 13 82 4 6 2 5 39 1 25 11 3 191 842 22%

Mental Health Youth 6 12 2 2 1 1 15 1 3 3 2 48 152 31%Substance Use Detox 2 N/A N/A 2 N/A N/A 8 N/A N/A 1 1 14 66 21%


2 39 2 7 N/A 4 26 2 8 4 N/A 94 267 34%

TOTALS 23 133 8 17 3 10 88 4 36 19 6 347 1327 26%

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Sub-Regional View

Performance Metric 3(a): The Current or Prior Mental Health Outpatient Provider was Contacted During the Stay




By County of Residence - Current Quarter Sub-Regional vs. Regional



Qtr

Regional Current

Qtr

Sub-Regional

vs. Regional

Mental Health Adult 61% 54% 100% 83% 50% 100% 89% 100% 72% 72% 100% 69% 78% -9%

Mental Health Youth 100% 91% 100% 83% 100% 100% 100% 100% 100% 100% 50% 95% 92% 3%

TOTALS 73% 59% 100% 83% 67% 100% 92% 100% 75% 78% 80% 74% 80% -6%

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Sub-Regional View





By County of Residence - Current Quarter Sub-Regional vs. Regional



Qtr

Regional Current

Qtr

Sub-Regional

vs. Regional

Mental Health Adult 61% 67% 66% 66% 100% 75% 82% 100% 80% 72% 100% 73% 76% -3%Mental Health Youth 40% 58% 50% 50% 100% 0% 80% 100% 50% 100% 100% 68% 53% 15%TOTALS 54% 66% 61% 62% 100% 63% 81% 100% 77% 78% 100% 72% 72% 0%

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Sub-Regional View








Qtr

Regional Current

Qtr

Sub-Regional

vs. Regional

Mental Health Adult 30% 70% 75% 40% 100% 50% 23% 100% 84% 72% 100% 58% 65% -7%

Mental Health Youth 40% 58% 50% 50% 100% N/A 16% 100% 66% 100% 100% 46% 60% -14%

Substance Use Detox 100% N/A N/A 50% N/A N/A 28% N/A N/A 100% 100% 43% 42% 1%


100% 52% N/A 66% N/A 33% 15% N/A 37% 33% N/A 32% 43% -11%

TOTALS 45% 64% 50% 53% 100% 38% 20% 100% 72% 70% 100% 52% 59% -7%

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Sub-Regional View


Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO

Metric Calculation: Discharges w/physical health appointment scheduled with an outpatient provider/Discharges w/physical health need identified during inpatient stay for reporting period





Qtr

Regional Current

Qtr

Sub-Regional

vs. Regional

Mental Health Adult 50% 87% 100% 0% 0% 0% 80% 0% 45% 0% 100% 58% 39% 19%

Mental Health Youth 0% 100% 0% 0% 0% 0% 50% 0% 0% 0% 0% 46% 50% -4%

Substance Use Detox 0% N/A N/A 0% N/A N/A 100% N/A N/A 0% 0% 43% 35% 8%


100% 84% 0% 100% N/A 0% 100% N/A 100% 100% N/A 32% 55% -23%

TOTALS 37% 87% 50% 41% 0% 0% 83% 0% 53% 21% 50% 48% 35% 13%

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• Initial sub-regional reports show performance within each sub-region by county of residence.

• While the number of cases within some counties is small, Q3 data do show some variation in performance within the sub-region when compared to the region as a whole.

• These reports will be followed with a report by county of fiscal responsibility that provides a view of provider-specific performance, which we believe will be helpful in better understanding patterns of care and identifying opportunities to strengthen effective linkages to after care services.

Sub-Regional Analysis Summary

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WRBHOEFFECTIVE PRACTICES

PRESENTATIONS•Scheduling of outpatient MH & SUD appointments: Stacy Miller, Nursing Staff Coordinator at St. Joseph’s Hospital

•Consumer Centered Family Consultation - Family Institute for Education, Practice and Research, U of R Medical Center

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Scheduling of outpatient MH & SUD appointments

Stacy Miller, Nursing Staff Coordinator at St. Joseph’s Hospital

74

The Family Institute for Education, Practice and Research (at URMC) and Consumer Centered

Family Consultation

• Family Institute has been funded by the NYS Office of Mental Health for over 10 years; has worked with over 200 agencies in a variety of settings

• Provides training and implementation support for agencies that are adopting evidence based family-involving approaches for people with severe mental illness

• Offers training and consultation related to evidence based practices as well as organizational changes related to the successful implementation of those practices

• One core offering is Consumer Centered Family Consultation (can also be called person centered family consultation)

• See 2012 article for additional detail and background

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Consumer Centered Family Consultation

• Consumer Centered Family Consultation (CCFC) is a brief, education-based engagement and consultation service that is typically completed in one to three sessions

• It promotes collaboration among adult consumers of mental health services, members of their family or social network, and service providers to support each consumer’s recovery

• The focus of CCFC is the person/consumer with a behavioral health issue (the focus is not the family or family therapy)

• There are specific shared decision-making tools embedded in the process of engaging people and their natural supports

• CCFC provides an opportunity to help prevent avoidable hospitalizations and to help facilitate linkage with outpatient services by involving people’s natural supports in meaningful ways

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SUB-REGIONAL AREAS OF FOCUS

77

• Top 4 reasons for admission for Individuals with Complex Needs

• Lack of engagement with outpatient provider

• Non-adherence to medication

• Drug & alcohol use

• Increased symptomology w/o Precipitant Noted

• Improve access to housing at discharge

• Address any gaps in the SPOA process and help county prepare for Health Homes

• Support the introduction of Consumer Centered Family Consultation across the sub-region

• Add more…

Sub-Regional Areas of Focus

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WRBHO PLANS

WRBHO Report Summary

79

• Schedule Consumer Centered Family Consultation Webinar in January

• Distribute provider-specific reports

• Distribute county of origin reports to County Directors

• Survey to identify areas of focus for each region / begin to plan for Learning Collaborative

• Support Regional Health Homes

• Grand Rounds Webinars

WRBHO Plans

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Q and A

wrbho best meeting & quarter three performance report presentation finger lakes region

Documents

bho performance domain

care services domain

domain data sources

effective linkages domain

wrbho forums

inpatient providers

improved provider performance

bho data collection