BHSD SUTS QIDSNOV. 4TH, 2016

SUTS QIDSBehavioral Health Services DepartmentSubstance Use Treatment SystemQuality Improvement and Data Standards

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SUTS QIDS

• Substance Use Treatment System

• Quality Improvement and Data Standards (Quality Circle idea)

– Combined the QI division and the Decision Support division

• Eliminate the two divisions operating independently of each other

• Encourage a cross-functional work style

• Org structure is “flat”/horizontal – all work is done in teams

• Project management methodology

• Hot Group

QIDS CURRENT STAFFING

• 7 QICs (Quality Improvement Coordinators)– 4 licensed (MFT/LCSW)

– 3 certified (CAADAC II’s)

– 1 QIC being added – Clinical Documentation/EHR trainer

• 8 Data Staff– 3 Sr. MISA

– 1 MISA I/II

– 1 ISM/ BITSC

– 3 HCPA series

• Waiver – add 1 Clinical Standards Coord. (licensed MFT/LCSW)

Cont’d next page

QIDS CURRENT STAFFING CONT’D

• 4 Clerical Operations (Capacity management/UM/Certification)

– 3 OS IIIs

– 1 Rehab Counselor (add-delete HSR)

• 1 Division Director

– 1 Admin

QIDS CURRENT STAFFING

Cost Center Job Code Job Code Description Employee ID Last Name First Name Step FTE Total Projection Amount

4607 D09 Office Specialist III 45186 FILLED 5 1.00 $96,021

4607 F86 Mgmt Info Systems Analyst II 60098 FILLED 4 1.00 $152,574

4607 P7B Dir of Research & Outcome Measure 55021 FILLED 5 1.00 $198,063

4607 W71 Sr Health Care Prog Analyst TBH 1 1.00 $140,387

4640 B0E Division Dir, QI & DS, A&D 44099 FILLED 5 1.00 $200,683

4640 B3V Sr Mgmt Info Systems Analyst 47770 FILLED 5 1.00 $171,398

4640 B3V Sr Mgmt Info Systems Analyst 58047 FILLED 5 1.00 $167,432

4640 B3V Sr Mgmt Info Systems Analyst hired FILLED 1 1.00 $147,297

4640 B5X Health Care Program Analyst II TBH 1 1.00 $128,742

4640 B5Y Health Care Program Analyst I 42375 FILLED 5 1.00 $127,751

4640 C06 Q I Coordinator II A&D Sv 46759 FILLED 5 1.00 $162,516

4640 C06 Q I Coordinator II A&D Sv 58326 FILLED 5 1.00 $157,952

4640 C06 Q I Coordinator II A&D Sv 27321 FILLED 5 1.00 $162,516

4640 C06 Q I Coordinator II A&D Sv 10296 FILLED 5 1.00 $162,516

4640 C06 Q I Coordinator II A&D Sv 26447 FILLED 5 1.00 $162,516

4640 C60 Admin Assistant 55981 FILLED 4 1.00 $100,241

4640 C97 Q I Coordinator - MHS 5386 FILLED 5 1.00 $162,516

4640 C97 Q I Coordinator - MHS 6890 FILLED 5 1.00 $162,516

4640 D09 Office Specialist III 62545 FILLED 3 1.00 $87,124

4640 D09 Office Specialist III hired FILLED 1 1.00 $85,730

4640 D09 Office Specialist III hired FILLED 1 1.00 $85,730

4640 D2E Health Services Rep add/delete to RC TBH 1 1.00 $87,417

4640 F86 Mgmt Info Systems Analyst II TBH 1 1.00 $139,318

4640 G12 Information Systems Mgr II BITSC TBH 1 1.00 $173,198

4640 W71 Sr Health Care Prog Analyst 30616 FILLED 5 1.00 $163,064

25.00 $3,585,218

SUTS QIDS – WHAT DO WE DO?

• QIC on-call

• Capacity Management (residential and THU)

• ILOC authorization

• Care Coordination

• Contract oversight (data reporting/integrity)(QA)

• T/A: ASAM– Individualized tx

– LOC decisions and transitions in care

• Drug MediCal (QA)

• CPM (clinical performance measures)(QA)

• Clinical Documentation Training

• Hot Groups

SUTS QIDS – DMC-ODS 1115 WAIVER• QIC on-call• Capacity Management (residential and THU) - Access and

Network Adequacy• ILOC authorization AND initial Residential Authorization• Care Coordination – MH and Physical Medicine Integration• Contract oversight (data reporting/integrity)• T/A: ASAM – monitoring ASAM fidelity

– Clinical Outcomes (ASAM severity scores)– Individualized tx– LOC decisions and transitions in care Authorizations for Residential

Services

• Drug MediCal compliance as an MCP (42CFR part 438) (see proposed org chart)

• CPM (clinical performance measures)• Clinical Documentation Training• Hot Groups – QI Committee and formal QI activities (PIPs), EQRO

and UCLA

SUTS QIDS – DMC-ODS 1115 WAIVER

PROPOSED ORG STRUCTURESUTS MCP QUALITY

MANAGEMENT

COMPLIANCE

Beneficiary Relations

OSIII

OSIII

Provider Relations

Utilization Management

Licensing

Certification

Training & Communication

RC

CLINICAL STANDARDS

MCP QM DIRECTOR

Care Coordination

OSIII

CQI

QA

PIPS

QI Comm.

Strategic Data Plan

Capacity Management

Data Management

Business

Operations

LONG, LEK, Sr. MISA

LEILANI

TIANNA

TBD

PAULINE CHERYLNANCYDEANDRA

JIM & EGLELINH & EGLE

NOEL

MICHAEL

Research & Evaluation

Sr. HCPA

JIM, DEANDRA, PAULINE

TBD

YVONNETBD

STEVE & LINH

KAKOLI

TBD

HCPA

HCPA

MICHELLE

KATHERINE

DMC-ODS 1115 WAIVER

Santa Clara County SUTS Managed Care Plan (MCP)2020 or bust

MANAGED CARE PLANS

• MCPs are Beneficiary Facing

– Responsible for “covered lives”

• ALL Medi-Cal beneficiaries in SCC

• SCC waiver: sponsored and unsponsored receive the same services (CGF expenditure)

• MCPs are contractual organizations – DMC-ODS

1115 Waiver obligations:

• ASAM is mandated – INTAKE and ON-GOING LOC (not just doing it - actual fidelity)

• Medical Necessity is mandated

• Managed Care operations are mandated (42CFR part 438 – federal code)

SCC SUTS MCP – QM IMPLEMENTATION

• SCC QM Implementation Plan– This plan involves and impacts all levels of the system

– It reports on the MCP performance as a whole system.

– It is where the rubber meets the road – accountability.

• All providers in the MCP must have their own QI –QI plan, QI project(s), QI activities (must be documented and

reportable).

• MCP QM is data-driven – ONLY. You can tell stories BUT the stories must be about the data. (If you don’t have data it didn’t happen.)

• SCC WAIVER PLAN: years one, two, three: focus on ACCESS, ENGAGEMENT, OUTCOMES

SCC SUTS MCP – QM METRICS

QM Data Components detailed

• Contract Performance Metrics

• Outcomes Metrics (from the waiver proposal):

– Operational (“QI waiver specs” doc)

– Practice

• Clinician Outcome – ASAM Severity Score + Action Steps completed score

• Client Outcome – Treatment Effectiveness Assessment (TEA)

• Customer Service Survey

• Level of Care Metrics – ASAM fidelity (becomes as important as “medical necessity”)

• At intake

• At regular intervals throughout tx episode – establish validity of LOC

– Residential authorization

– Extensions of tx

• Utilization Metrics

– Authorizations

– Capacity management

• Financial Metrics – performance analysis using contract and service data

SCC SUTS MCP – QM METRICS

QM Outcomes MetricsPlease refer to the handouts

• Operational

– Waiver QI metrics (Please refer to handout titled SCC SUTS DMC ODS

Waiver)

• Access

• Engagement

• Timeliness

• Practice

– Clinician Outcomes (A LOC Form)

– Client Outcomes (Treatment Effectiveness Assessment (TEA))

– Customer Service Outcomes

SCC SUTS MCP – QM OUTCOME METRICS

Clinician Outcomes Metrics

• Total of two scores:

– ASAM severity Total Score:• A LOC – Level of Care Authorization Form

– Treatment Plan: • # of Action Steps Completed/Total # of Action Steps

SCC SUTS MCP – QM OUTCOME METRICS

Modified COC (A LOC)-What is Different?

• Registration/Financial

• Authorization/Transfer

• Risk Assessment on DIM #3

• Client Short-Term, Strength-Based Targets relative to specific COC– Solution Focused

• ASAM risk-severity Total Score» Use with Minnesota Matrix and ASAM Criteria Intro for

Patients and Family for standardized LOC decisions (please see handouts)

SCC SUTS MCP – QM OUTCOMES METRICS

Client Outcomes

TEA – Treatment Effectiveness Assessment

All intake situations

– ALL treatment situations

– Regular intervals throughout treatment

SCC SUTS MCP – QM METRICS:

CLIENT OUTCOMES

SCC SUTS MCP – QM OUTCOMES METRICS

Customer Service

• At ALL Discharge encounters

• Whenever a client requests

Have to wait until we get final ruling from DHCS and UCLA on what tool to use

SCC SUTS MCP – QM METRICS

LOC Metrics – ASAM Fidelity

Use A LOC

• Intake – first F2F at ALL sites

• LOC fidelity – regular intervals in ALL treatment situations

Minnesota Matrix and ASAM Criteria for Patients and Family (placement fidelity)

SCC SUTS MCP – QM METRICS

• LOC Metrics – ASAM Fidelity

– 6 DIM scores (0 to 4)

• Client Outcomes

– TEA – Treatment Effectiveness Assessment (0 to 4)

• Customer Service

Need to collect – workflow, analyze and benchmark. Develop reporting format for meaningful and easy use.

SCC SUTS MCP – QM METRICS

• Attachments:

– QI waiver specs

– ALOC (fillable form draft version)

– TEA

– Understanding Data Reporting

Comments & Questions

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