Massachusetts Behavioral Health Partnership ValueOptions

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Massachusetts Behavioral HealthPartnership /
ValueOptions

• Implementing a Clinical Outcomes Management
  Protocol in a
• Medicaid Behavioral Health
• Provider Network

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MBHP A ValueOptions General Partnership

• Contracting with Commonwealth of Massachusetts
  MassHealth (Medicaid) and Dept of Mental Health
• Contract began July 1, 1996
• 230 employees in four sites (including three
  regional offices)
• Provider Network
• Over 250 organizations (400 sites)
• Over 1000 individual practitioners

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Overview of MBHP Member Services

• 320,000 Medicaid enrollees
• About 100,000 utilizers, annually
• Process 3.2 million claims, annually
• Emergency services for all populations
• Services for all levels of care
• Outpatient
• Diversionary
• Acute Care

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Key Definitions

• Outcome
• Clinical change during the course of treatment as
  measured by a standardized assessment tool
• Outcomes measurement
• Administering the same assessment tool at
  different points during treatment to measure the
  rate of clinical change over time
• Outcome management
• Using outcomes data to evaluate, inform and
  improve clinical practices

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Why Measure Outcomes?

• Clients have a right to a comprehensive intake
  assessment, with periodic re-assessments.
• Treatment is improved when clinicians receive
  objective feedback on the clinical progress of
  their clients.
• The centralized collection of outcomes data
  across a provider network allows for the
  identification and promotion of best practices.
• Reports of network-wide achievements in outcomes
  allow the EOHHS administration and the
  legislature to hold MBHP and its providers
  accountable.

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Goals the MBHPOutcomes Management Initiative

• Care Management
• Improve intake assessments and treatment planning
  through use of a structure outcomes instrument.
• Practice Management
• Identify, promote and support best practices
  among MBHP network providers.
• Accountability Management
• Improve accountability for publicly-funded
  behavioral health services.

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MBHPs Outcomes Policy(Core Principles)

• All network providers for all levels of care are
  required to
• 1. Select a standardized assessment instrument
  from the list of MBHP-approved instruments
• 2. Begin administering the selected instrument
  for all new intakes of PCC Plan MassHealth
  Members
• 3. Incorporate the findings of the assessment
  into the Members treatment plans, with feedback
  to Members about the assessment results and
• 4. Incorporate the aggregated findings of the
  outcomes assessments into the providers quality
  management program.

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Scope of the Outcomes Policy

• All providers in the MBHP network
• 250 provider agencies (with over 400 sites) and
  1000 individual practitioners
• All levels of care inpatient, outpatient,
  diversionary
• With the exception of a few exempt services, such
  as medication management, psychological testing,
  and case consultation
• All Member ages
• Children, adolescents, adults up to age 65
• All Members are assessed
• Sampling is not allowed

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Implementing the Outcomes Policy

• Providers can select from 20 MBHP-supported
  outcomes instruments.
• Providers may apply for approval to use
  standardized assessment tools with good
  psychometric properties that are not supported by
  MBHP.
• The Brief Psychiatric Rating Scale will be
  included in the pre-certification and discharge
  protocol for all 24-hour acute admissions and
  discharges.

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MBHP Policy on Use of Outcomes Data

• MBHP will use outcomes data as a means of
  offering technical assistance to providers in
  areas where improved outcomes is a desired goal.
• MBHP will not use outcomes data to manage Member
  benefits.
• MBHP will not use outcomes data as a sole
  indicator for taking disciplinary action against
  a provider.
• MBHP will continue, as it has, to conduct quality
  audits on provider practices and will require
  corrective actions when service quality does not
  meet provider performance specifications.

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Turning the Outcomes Initiative into aBest
Practices Initiative

• The Central Role of
• Behavioral Health Laboratories (BHL)
• Treatment Outcome Package (TOP)

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Selecting BHLs TOP as theMBHP Preferred
Outcomes Instrument

• BHLs TOP is an excellently designed outcomes
  measurement and clinical information system.
• Providers using TOP would be in immediate
  compliance with the MBHP outcomes policy.
• With its centralized outcomes data collection,
  MBHPs access to TOP data allows achievement of
  the three project goals improving care
  management, practice management, and
  accountability management.

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What is Unique About TOP?
Clinically rich data Strengths Separation
Anxiety Eating Sexual Issues Sleep ADHD Conduct As
sertiveness Depression Psychosis Accidents Suicide
Violence
Sensitivity to change gt90 No floors or
ceilings Fair comparisons Extensive risk-
adjustment Immediate STAT lab tests Largest
dataset Data analysis included
Exceptional support Toll free Toolsets Child Adol
escent Adult Leading academics See Advisory
Panel Extensive validation MA Medicaid Ngt250,000
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MBHPs Subsidy Arrangement for TOP

• MBHP is paying all fees associated with the use
  of TOP (except for mailing and fax charges).
• Providers register with BHL and use TOP at
  virtually no cost to them.
• In return for the subsidy, providers agree that
  MBHP will collect their outcomes data from BHL.

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Current Status of Implementationas of March, 2004

• The MBHP provider network has about 250 agencies
  and 1000 individual practitioners.
• 75 of the agencies and 40 of the individual
  practitioners (or 50 of all providers) have
  declared their choice of instrument.
• Over 470 (70) of the declared providers have
  chosen to use TOP.
• When fully operational, TOP outcomes data will be
  collected on more than 60,000 Members.

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The Power of BHL Data and Reports

• Client Empowerment
• Clinical Decision Support
• Clinician and Agency Accountability
• Clinician and Agency Quality Improvement
• National, State, and Agency Benchmarking
• Legislative Reports for Performance Accountability

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TOP 4.0 Child Outcomes Report(lower values
improvement)
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TOP 4.0 Client Report of Stress Indicators
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TOP 4.0 Client Report of Risk Indicators
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Using BHL Benchmarked Reports toIdentify Best
Practice Providers

• BHL generates benchmarked reports that can be
  used at the agency-level or network-level for
  quality improvement.
• These benchmarked reports show provider
  performance in achieving good outcomes relative
  to other providers.
• MBHP will use the benchmarked reports to identify
  best practice providers and to promote their
  successful methods.

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BHLs Benchmarked Reports for Provider-
orNetwork-Level Child Practice Management
Best Practice
Needs Improvement
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Developments in Process

• Combining TOP outcomes data with MBHP claims data
  to assess the relationship of clinical outcomes
  to service utilization and cost.
• Improving and expanding provider profiling
  reports for quality improvement and performance
  management.
• Generating accountability reports for the
  Commonwealth that will be a national model for
  performance management.

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MBHP Contact
Wayne Stelk, Ph.D., VP, Quality
Management Massachusetts Behavioral Health
Partnership 150 Federal Street, 3rd Floor Boston,
MA 02110 617-790-5612 wayne.stelk_at_valueoptions.co
m www.masspartnership.com