Pennsylvania Office of Mental Health

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Pennsylvania Office of Mental Health Substance
Abuse Services

• ONE-MHSIP MUG
• Joint Fall Meeting
• November 6, 2003

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OMHSAS

• Every person with serious mental illness and/or
  addictive disease, and every child and adolescent
  who abuses substances and/or has a serious
  emotional disturbance will have the opportunity
  for growth, recovery and inclusion in their
  community, have access to services and supports
  of their choice, and enjoy a quality of live
  that includes family and friends

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Five Year Vision Draft Guiding Principles

• The Mental Health and Substance Abuse Service
  system will provide quality services that will
• Facilitate recovery for adults and resiliency for
  children
• Be responsive to individuals unique needs
  throughout their lives.
• Focus on prevention and early intervention
• Ensure individual human rights and eliminate
  discrimination.
• Be provided by partnering with consumers and
  family members to design, implement, and monitor
  the system as it strives for excellence.
• Be provided in a comprehensive array by unifying
  programs and funding
• Be provided to recognize the cultural diversity
  of the persons being served.

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OMHSAS

• Program Office within Department of Public
  Welfare
• Scope of Responsibility includes Mental Health,
  Drug Alcohol, Behavioral Health Medicaid
  Managed Care Program approximately 2B budget
• Maintain IS capability within OMHSAS
• Compatible with Department Commonwealth IS
  systems
• 20 year history of systems development and data
  infrastructure
• Data Uses
• Internal Management Reports
• Financial Monitoring
• Program Accountability
• Public Information
• Access Measures
• Quality Measures OUTCOMES
• Drug Alcohol Program Responsibility , Base
  Funding Federal Block Grant provided through
  the Department of Health

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Pennsylvania at a Glance

• County Based Programs ( 67 Counties)
• 46 County MH/MR programs
• 49 Single County Authorities ( DA)
• 2 Major Urban Centers
• Behavioral Health HealthChoices Program
• Mandatory Managed Care Program
• County Right of First Opportunity
• 25 Counties representing approximately 70 of the
  MA population
• Our Future Unified Systems
• Integrated Program Areas
• Integrated Funding Strategies
• Integrated Data Systems

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Pennsylvania
Tentative schedule
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Pennsylvania at a Glance

• Of the total funds appropriated for behavioral
  health services for FY 2003/04, 77 are
  administered by counties and 23 are administered
  within the state hospitals.

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Pennsylvania at a Glance

• Caseload Statistics
• Persons served across all mental health funding
  streams (SMH, County, MA FFS, HC) 210,000
• Persons served in the State Mental Hospitals
  7,278
• Persons served in County Grant system 202,460
• Adults served 134,196
• Children served 68,264
• Persons served in MA FFS 109,722
• Persons served in HealthChoices 152,240
• Adults served in HC 90,809
• Children served in HC 61,431
• Unduplicated persons served across all substance
  abuse funding streams (BHSI, Act 152, HC) 60,339
• Persons served with BHSI funds 42,694
• Persons served with Act 152 funds 5,793
• Persons served in HealthChoices 30,165
•  

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IS Highlights Recent Accomplishments

• Consumer Satisfaction Survey
• Five Southeast Counties over 20 return rate mh
  consumers, persons in recovery, families high
  percentage of satisfaction adults more satisfied
  than families of children in the program
• Greene County Survey survey all eligibles as
  indicator of ability to access behavioral health
  services (waiver requirement)
• HealthChoices Early Warning Reports
• Quarterly reports, real time data that focus on
  access and quality indicators includes
  authorization data complaints and grievances
  special attention to access for minority
  populations quality indicators include
  readmission rates involuntary psychiatric
  admissions and homelessness. Findings reviewed
  by county programs and corrective action noted in
  subsequent report. Have been able to identify
  and resolve issues including untimely claims
  payments, data and systems problems and identify
  specific access concerns that have been resolved
  more timely due to report.

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IS Highlights Recent Accomplishments

• HealthChoices Annual Report
• Annual report of the HealthChoices Program,
  includes demographic information, penetration
  rates, financial overview and program highlights,
  Report highlights increased penetration in each
  year of healthchoices program primary diagnosis
  for mh adults in schizophrenia( women is major
  depression) for da adults is opiod addiction
  children is ADD, ADHD for mh cannibis dependence
  for da
• OMHSAS Annual Report
• OMHSAS at a glance program and fiscal data
  across major program areas including state
  hospitals, CHIPPS (Community Hospital Integration
  Project Program), HealthChloices, Drug Alcohol
  Services
• Block Grant Report Cards
• Issued first series of Report Cards. Nine
  performance Indicators were developed in 2000
  they include 1) overall utilization rates for SMI
  adults, Number of homeless SMI adults served by
  PATH grant, number of CHIPPS beds rate of MH
  community inpatient days for SED children
  Percentage of readmission to community inpatient
  within 90 days for SED children Overall
  utilzation rates for SED children Rate of HC
  behavioral health children with SED having
  co-occuring disorders Rate of SED children
  living in rural areas percentage of new block
  grant funds allocated to serve children with SED

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(No Transcript)
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HealthChoices Updates

• In CY 2002, 927,294 Medicaid recipients covered
  in three zones 175,000 served through the
  Behavioral Health Program (IN CY 2001, 136,000
  persons were served through the BH Program)
• Three Zones
• Southeast (SE), Southwest (SW), Lehigh/Capital
  (L/C)
• 25 Counties including both rural and urban
• Variety of Models County operated ASO Full
  Risk Subcontracts Direct State/BH-MCO Contract
• Pennsylvania Penetration rates for overall
  utilization in both mental health drug and
  alcohol meet or exceed national HEDIS benchmark
• SE ranged from 13.7 to 17.1 in CY 2002 (
  increased from range of 13.2 to 16.5 in CY 2001)
• SW ranged from 13 to 17.8 in CY 2002 (
  increased from 11.6 to 15.6 in CY2001)
• L/C ranged from 8 to 15.4 in CY 2002

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IS Highlights On the Horizon

• County MH Plan Guidelines
• Comprehensive Data Set Provided to Counties to
  support planning efforts
• Unduplicated counts across different payor
  sources including county base funding, Fee For
  Service, State Hospital, HealthChoices
• Target Populations Prioritized includes service
  utilization and average cost
• Provides vehicle to identify funding priorities
  for county and Commonwealth
• Incorporates performance expectations planning
  goals- area planning goals

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IS Highlights On the Horizon

• Service Area Planning Goals Incorporated in
  local county plan track annually
• Within five years no person will be hospitalized
  in a state hospital beyond two years.
• Within five years no person will be involuntarily
  committed to a community hospital more than twice
  in one year.
• Within five years, the incarceration of the
  target population will be reduced

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IS Highlights On the Horizon Performance
Based Measures

• All HealthChoices Counties
• Percentage of expected annual prevalence rate
  receiving treatment in HC for adults with SMI
• No co-occurring SA diagnosis, ages 18-64
• Co-occurring SA diagnosis, ages 18-64
• Percentage of expected annual prevalence rate
  receiving treatment in HC for
• Any MH service by significant minority population
  and by age group (under 21, 21-64)
• Any SA service by significant minority population
  and by age group (under 21, 21-64)

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Performance Indicators Cont

• Discharges from psychiatric inpatient not
  readmitted within 30 days post discharge, under
  age 21, ages 21- 64,65
• Percentage of HC eligible children with
• No placement in JCAHO or non-JCAHO residential
  treatment
• No placement in JCAHO or non-JCAHO residential
  treatment with
• cumulative length of stay exceeding 120 days.
  
• Percentage of individuals discharged from RTF
  with follow-up service(s) within 7 days
  post-discharge

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Performance Indicators Cont

• Percentage of individuals discharged from
  psychiatric inpatient with follow-up service(s)
  within 7 days post-discharge, under age 21 and
  ages 21-64, 65
• Percentage of individuals discharged from DA
  residential rehab with follow-up service(s)
  within 7 days post-discharge, under age 21 and
  ages 21-64, 65

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Performance Indicators Cont

• Quality of Life Indicators
• Change in SMI Independence of Living (IOL)
• Change in SMI Vocational/ Employment/ Educational
  Status (VES)
• Change in SED Independence of Living (IOL)
• Change in SED Vocational/Employment/ Educational
  Status (VES)

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Stakeholder Feedback

• Consumer/Family Questions
• Access (getting into services)
• In the last 12 months, did you or your child have
  problems getting the help you needed?
•  Process (what happens during services)
• Were you or your child given the opportunity to
  make decisions as much as you wanted in your
  treatment?
• Outcome (results of service)
• What affect has the treatment you or your child
  got had on the quality of your life?

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Baseline TablesPerformance Indicator Benchmarks
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Baseline TablesExampleHealthChoices Baseline
Performance
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IS Highlights On the Horizon People Stat

• Department initiative to annually access program
  success based on COMSTAT models to provide
  accountability for government OMHSAS measures
• To increase access for Administrative Case
  Management Services, to reduce reliance on more
  restrictive, costly services.
• To develop pilot study measures to be used in
  determining whether DA treatment is meeting
  health outcome and social function for
  individuals.
• To ensure that the 33 long stay individuals
  moving to the community from the SMH have
  treatment and supports in place in the community
  to facilitate their continued recovery.
• To ensure that individuals served in the HC
  Behavioral Health program have improved health
  outcomes as demonstrated by performance
  measurement of specific indicators.
• To maintain or enhance the quality of care and
  services delivered in the SMH while requiring
  greater fiscal accountability through overtime
  reduction.

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Where to next?

• Integrated data sets with other services systems
  including drug alcohol, children youth, mental
  retardation, education, corrections
• Clinical Outcomes
• Performance Based Contracting
• Visit our WebSite