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 Transforming the Mental Health System Through
Evidence-Based Practices and Performance Measures

• Ronald Manderscheid, Ph.D.
• Chief of the Survey and Analysis Branch of the
  Center for Mental Health Services, Substance
  Abuse and Mental Health Services Administration

Presented at Implementing Evidence-Based
Practices and Performance Measures for
Massachusetts Mental Health Services An
Educational Forum Brandeis University, September
28, 2005
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Transformation and Quality ImprovementA
Necessary Partnership for Success
Ronald W. Manderscheid, Ph.D. U.S.
Department of Health and Human Services
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TRANSFORMATION
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Transformation is

• Changing Yourself
• Changing Your Program
• Changing Your Programs Environment
• 
  
  
  

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Presidents New Freedom Commission

• The mental health system in the U.S. is in
  shambles.
• We need to create a mental health system that is
  recovery-oriented and consumer and family
  directed.

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Presidents New Freedom Commission Goals

• Americans understand that mental health is
  essential to overall health.
• Mental health is consumer and family driven.
• Disparities in mental health services are
  eliminated.
• 
  
• 
  
  
  

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Presidents New Freedom Commission Goals

• Early Mental Health Screening, Assessment, and
  Referral to Services are Common Practice.
• Excellent Mental Health Care is Delivered and
  Research is Accelerated.
• Technology is used to access mental health care
  and information.
• 
  
  
  

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Institute of Medicine,National Academy of
Sciences
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IOM

• We have a large and growing chasm between
  actual healthcare delivery and the quality of the
  healthcare we need.
• 
  

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IOM Crossing the Quality Chasm Goals

• SAFE
• PERSON-CENTERED
• EFFECTIVE
• EFFICIENT
• EQUITABLE
• TIMELY

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FOUR IOM STRATEGIES

• 1. Transforming Financing
• 2. Transforming Human Resources
• 3. Adopting EBPs
• 4. Using IT Performance Measures

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LinkagePresidents Commission Define
GoalsIOM Project Define StrategiesTransfor
mation
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Major 2005 U.S Mental Health Initiatives

• State Transformation Grants
• Acute Care Work Group
• Transformation of Human Resources
• Transformational Leadership
• Information and IT Initiatives

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Quality Improvement

• Community Collaborations
• Quality Circle
• Quality Management
• Quality Service
• Measurement
• Informative Technology

Consumer and Family Direction
Transformational Leadership
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A Short History of Performance Measurement

• MHSIP Consumer Oriented Report Card (Access,
  Quality, Outcome)
• NASMHPD (28 indicators)
• 5 State Pilot Project (32 indicators)
• 16 State Demonstration Project (32 indicators)
• State DIG, Phase 1 (2002-2004) (21 indicators)
• (Uniform Reporting System)
• State DIG, Phase II (2005-2007) (23 indicators)
• (URS National Outcome Measurement System)

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IT and Performance Initiatives

• National Strategic IT Plan.
• New Project Electronic Health Records/Personal
  Health Records/Local Health Information
  Infrastructure

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IT and Performance Initiatives

• Forum on Common Performance Measures
• JCAHO/NAPHS/NRI Performance Measures Project
• MHSIP Quality Report
• State Data Infrastructure Grants and Uniform
  Reporting System

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State Data Infrastructure Grants Phase II

1. Reporting of all URS/NOMS measures
2. Working with local providers-common definitions
   and common data collection procedures
3. Building an electronic bridge to local providers

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Uniform Reporting System Data

• Individuals servedage, race/ethnicity, gender
• Services providedmental health and related
  community-based services according to the five
  criteria in the current Center for Mental Health
  Services (CMHS) statute
• Community-based service system
• Mental health data and epidemiology
• Childrens services
• Services for rural and homeless persons
• Management systems

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Uniform Reporting System Data

• Services for special needs populations, including
  homeless persons and persons with co-occurring
  disorders
• Financial and staffing resources to support the
  service system

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National Outcome Measures

• Decreased mental illness symptomatology/ improved
  functioning1
• Increased/retained employment (adults) return
  to/retention in school (children)1
• Decreased criminal justice involvement1
• 1. Developmental

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National Outcome Measures

• 4. Increased stability in family and living
  conditions
• 5. Increased access to services
• (number of persons served by age, gender, race,
  and ethnicity)2
• 6. Reduced utilization of psychiatric inpatient
  beds
• (rates of admission for 30 and 180 days)1, 2
• Developmental
• Required by the Office of Management and Budget
  Performance Assessment Rating Tool (PART) review
  
• 
  
  

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National Outcome Measures

• 7. Increased social supports/social
• connectedness3
• 8. Client perception of care outcome2
• 9. Use of evidence-based practices (EBP)
• (Cost effectiveness)
• (number of persons receiving EBPs and number of
  EBPs provided by State)2
• 2. Required by the Office of Management and
  Budget Performance Assessment Rating Tool
• (PART) review
• 3. For Access To Recovery, social support of
  recovery is measured by client participation
• in voluntary recovery or self-help groups
  as well as interaction

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Desired Linkages
State Mental Health Agency
STATE
SYSTEM
Electronic Bridge
Local Provider
LOCAL
SYSTEM
Personal Recovery Plan
CONSUMER
LIFE
COMMUNITY
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What is DS2000 ?

• DS2000 HIPAA Transactions
• www.mhsip.org/DS2K.htm
• User-friendly master data sets and handbooks
• Shared transactional data
• Added-value for behavioral health data

• DS2000 Core and
• Stakeholder Data Sets
• Population
• Person/enrollment
• Encounter
• Financial
• Human Resources
• Organizational
• Clinical/System Guidelines
• Outcomes
• Report Cards
• Performance Measures

• DS2000 Advancing the
• Public Health Model
• Common Data Standards for
• Recording/Reporting
• Decision Support for all
• Stakeholders
• Quality Improvement
• Accountability

I N F O R M A T I O N

• DS2000
• Stakeholder Input
• Focus Groups
• Expert Panels
• Web Site Feedback

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DS2000 Onlinewww.ds2kplus.org

• The DS2K Initiative
• About DS2K
• Updates
• Document Library
• Data Standards for MH
• Feedback and Input
• Links

• Databases
• HIPAA 834 and 837 Transactions (OK, Alliance)
• MHSIP Consumer Survey Data from 16 State Pilot
• (11 States)
• Quality Indicators (Alliance)

• HIPAA Mapper
• For all HIPAA
• Transactions
• (OK, Wash Pub Co)

• Medicare/Medicaid/Private Insurance Tables
• Several Hundred Structured
• Tables (Medstat/RTI/Brandeis)

• Analytical Tools
• OLAP Cubes to Construct
• Queries
• Standard Reports
• Custom and Ad Hoc Analyses

• On-Line Surveys
• Version I MHSIP Consumer Survey (ID, WY)
• Provider Satisfaction Survey (Alliance)

• Privacy and Security
• Owner Controls Access to
• Information
• Encryption, Firewalls,
• Passwords

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Decision Support 2000 Outcomes Module
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PROJECT GOALS

• Develop data standards for outcome measurement
• - follow consensus-based development model
• - core and stakeholder specific components
• Develop a web-based mental health outcome
• reporting and feedback system
• - a plug-in module to DS2000 Online
• - test functionality in key areas of care
  system
• - develop an implementation plan

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STAKEHOLDER WORKGROUPS

• Stakeholders
• - Consumers
• - Families
• - Providers
• - State Mental Health Agencies
• - MBHCOs
• Multi-stakeholder Group
• Special groups
• - children, adults, elderly
• Allied Fields
• - Substance Abuse

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TECHNICAL EXPERT WORKGROUP

• Content Development
• Technical Development
• Field Feedback and Acceptance
• Building and Internal Testing of Module
• Field Testing and Revision
• National Implementation Plan

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Looking into the Future

• Transformation and Quality Improvement are
  Necessary Partners
• Quality Improvement will Occur Through Community
  Collaborations
• A National Strategy is Essential to Promote
  Collaborations and to Provide the Service,
  Measurement and IT Foundation Necessary for their
  Success