Measuring Disparities Using MH Performance Indicators The California

Measuring Disparities Using MH Performance Indicators: The California External Quality Review Experience Saumitra Sen. Gupta, Ph. D. Hui Zhang, Ph. D. Sheila Baler, Ph. D. MPH California External Quality Review Organization (CAEQRO) Paper presented at the American Evaluation Association Annual Conference Denver, CO November 5 -8, 2008

This Presentation will n n Introduce the work of CAEQRO in Mental Health Plans Evaluation Examine ways to look at Mental Health Disparities in California n n Gender Race/Ethnicity Plan size Region

California Medicaid Waiver n n n Social Security Act, Section 1915(b) Specialty Mental Health Carve-out Two EQROs APS Healthcare is the MH EQRO 56 MHPs serving 58 Counties

Overview Our Approach

Some of the domains we look at n n n Access Timeliness Quality Outcomes Leadership n n n Wellness & Recovery Consumer Employment Cultural Competence Information Systems Business Practices

Data Sources n DMH Approved Claims n Short/Doyle Medi-Cal n Inpatient Consolidation n Eligibility Files (MMEF) n Denied Claims n Provider File

Performance Measures Analysis Goals n n Determine if key variables such as gender, age and ethnicity contribute to understanding service delivery patterns Identify the most striking differences among various groups Highlight consistencies and changes from prior year studies Stimulate discussions by stakeholders about whether these patterns necessitate further review and study

The Big Picture Medi-Cal Mental Health Beneficiaries Statewide Medi-Cal Eligibles & Beneficiaries Served Approved Claims Summary CY 05 -07 CY 05 Total Medi-Cal Eligibles CY 06 CY 07 6, 810, 962 6, 783, 625 6, 837, 351 Total Beneficiaries Served 430, 877 427, 232 423, 037 Total Approved Claims (in Billions) $1. 68 $1. 85 $1. 88

CY 2007 Statewide Medi-Cal Eligibles & Beneficiaries by Race/Ethnicity

A few key concepts n n “Penetration rate ratio” is a ratio of one demographic or ethnic group to another. A ratio of 1. 0 reflects an equitable penetration rate based upon the beneficiary population. The further the value is from 1. 0, the greater the disparity. “Average payment ratio” is a ratio of the average payment per beneficiary served for one demographic or ethnic group to another. Again, a ratio of 1. 0 reflects an equitable payment rate based upon the beneficiary population. The further the value is from 1. 0, the greater the disparity.

Note: CY 07 dollars adjusted to CY 05 dollars using California CPI

MHPs by size and region Categories Size Characteristics Count of MHPs Small-Rural <54, 999 14 Small 55, 000 to 199, 999 15 Medium 200, 000 to 749, 999 14 Large 750, 000 to 3, 999 12 Very Large >4, 000 Region Superior 1 Northern counties 16 Bay Area SF Bay Area 12 Central CA Central Valley 18 Southern other than LA 9 Los Angeles County of Los Angeles 1

Source: SD/MC approved claims as of May 2008, IPC approved claims as of May 2008 and MMEF as of April 2008 Note: CY 07 dollars adjusted to CY 05 dollars using California CPI

Pros and Cons n n Robust statistics even with various slicing and dicing Helps in quick identification of issues for further examination on a timely basis n Aids in policy making n Relatively easy to construct indicators n n n Allows comparison across various subgroups on same indicators and comparable data Allows MHPs to compare their own status against statewide, similar size and region n Limited to Medi-Cal Specialty Mental Health Approved Claims Requires significant resources in managing large volume of data both in terms of technology and security Certain artifacts may appear due to varying business practices and/or information systems Allows proxy measures since uniform clinical information is lacking For more information, please visit our website at www. caeqro. com For a copy of the presentation, e-mail ssengupta@apshealthcare. com

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