Overview of APS California External Quality Review Organization

Overview of APS California External Quality Review Organization with a Special Focus on Older Adults California Mental Health Planning Council Older Adult Committee June 16, 2011 Michael Reiter, Pharm. D Executive Director Saumitra Sen. Gupta, Ph. D Sandra Sinz, LCSW, CPHQ Information Systems Director Operations Director

. § Data: Hui Zhang, Ph. D § Production: Esperanza Calderon © 2011 APS Healthcare, Inc. 2

Our Approach CAEQRO Activities Quality and Performance Improvement Data Analysis Information Systems Capabilities Assessment Performance Measurement Wellness, Recovery, and Resilience Key Informant Interviews August 2008 © 2011 APS Healthcare, Inc. EQRO Reviews Performance Improvement Projects Consumer and Family Member Focus Groups Cultural Competence Final Report 3 Technical Assistance and Training

Site Review Process Highlights We Heard From… § Consistent core phases – Pre-site planning – Site visit – Post-site analysis § Customized to MHP – Seven years’ data – Input from many individuals – Year-to-year follow up § Annual update and revision of review materials © 2011 APS Healthcare, Inc. 4 § 1, 047 people (FY 05) § 1, 612 people (FY 06) § 2, 666 people (FY 07) – 663 Consumers and family members § 2, 857 people (FY 08) – 713 Consumers and family members § 3, 274 people (FY 09) – 767 Consumers and family members § 2, 875 people (FY 10) – 612 Consumers and family members

Key Components Tables Components 1. Quality 2. Access 3. Timeliness 4. Outcomes © 2011 APS Healthcare, Inc. 5

Key Components Tables 2 1. Quality Components § A current strategic plan/initiatives drives the service delivery system § Quality management and performance improvement are organizational priorities § Data is used to inform management and guide decisions § Investment in information technology infrastructure is a priority § Integrity of Medi-Cal claim process, including determination of beneficiary eligibility and timely claims submission § Effective communication from MHP administration § Stakeholder input and involvement in system planning and implementation § Consumers and family members are employed in key roles throughout the system © 2011 APS Healthcare, Inc. 6

Key Components Tables 3 2. Access Components § Service accessibility and availability are reflective of cultural competence principles and practices § Manages and adapts its capacity to meet service needs § Penetration Rates are used to monitor and improve access § Integration and/or collaboration with community based services © 2011 APS Healthcare, Inc. 7

Key Components Tables 4 3. Timeliness Components § Tracks and trends access data from initial contact to first appointment. § Tracks and trends access data from initial contact to first psychiatric appointment. § Tracks and trends access data for timely appointments for urgent conditions. § Has a mechanism to assure timely access (within 7 days) to follow up appointments after hospitalization. § Tracks and trends No Shows and implements quality improvement activities to improve overall timeliness to services. © 2011 APS Healthcare, Inc. 8

Key Components Tables 5 4. Outcomes Components § Consumer run and or consumer driven programs § Measures clinical and/or functional outcomes of consumers served § Has one active and ongoing (clinical) PIP § Clinical PIP shows post-intervention results § Has one active and ongoing (non-clinical) PIP § Non-Clinical PIP shows post-intervention results § Utilizes information from DMH/POQI Satisfaction Surveys § Utilizes information from Consumer Satisfaction Surveys © 2011 APS Healthcare, Inc. 9

Consumer/Family Member Process § How do the EQRO reviews compare to other reviews of County Mental Health Plans? § What parts of the review do the C/FM consultants typically participate in? – Pre- and post-site, on-site – Key components – Focus groups § Highlights in conducting CFM focus groups (both the positives and the challenges). © 2011 APS Healthcare, Inc. 10

Promising Practices County Webinar Presentations § Monterey – Using data for quality management and client centered care: Monterey experience post-EMR implementation – Presented on November 15, 2010 § Trinity – Process Mapping and Workflow Analysis: What, Why, How – Presented on December 16, 2010 § Marin – Providing Behavioral Health & Primary Care Services under One Roof: The Marin County Mental Health Experience – Presented on February 10, 2011 © 2011 APS Healthcare, Inc. 11

Access Key Findings — Eligibles v. Beneficiaries Served © 2011 APS Healthcare, Inc. 12

Quality: Performance Improvement Projects § What is a Performance Improvement Project (PIP)? – In general terms, a PIP is “a systematic process for improving the quality of care and service designed, conducted and reported in a methodologically sound manner. ” – To elaborate, the Protocol defines a PIP as “a set of related activities designed to achieve measurable improvement in processes and outcomes of care. Improvements are achieved through interventions that target health care providers, practitioners, plans, and/or beneficiaries. ” (Human Services Research Institute, 2004) § PIPs are generally more functional if the MHP receives support than creating it in isolation. – Examples: SCERP I, SCERP II, Cal. MEND § Challenges – Rapid cycle measurements have been problematic; Cal. MEND can be of assistance © 2011 APS Healthcare, Inc. 13

Quality: Performance Improvement Projects 2 § Other PIP categories include: – Business process improvement – Co-occurring disorders – Physical health care – Psychiatrist/medication appointment © 2011 APS Healthcare, Inc. 14 – Retention – Wellness, recovery and resilience – Other

Outcomes High Cost Beneficiaries © 2011 APS Healthcare, Inc. 15

Timeliness We ask counties for data on timeliness of first appointment, first psychiatric appointment, access to urgent care, post-hospitalization services, and No Shows © 2011 APS Healthcare, Inc. 16

Information Systems © 2011 APS Healthcare, Inc. 17

Information Systems 2 # = Number of MHPs © 2011 APS Healthcare, Inc. 18

CAEQRO Website - Homepage § www. caeqro. com § Register online, if you have not done so already © 2011 APS Healthcare, Inc. 19

CAEQRO Website – Register © 2011 APS Healthcare, Inc. 20

CAEQRO Website – Log-on Page © 2011 APS Healthcare, Inc. 21

CAEQRO Website – Finding Data § Reports and Presentations Tab © 2011 APS Healthcare, Inc. 22

CAEQRO Website – Finding Data § Data Analysis Tab © 2011 APS Healthcare, Inc. 23 2

Penetration Rates by Age Groups Statewide Penetration Rates by Age Groups CY 07 -09 10, 00% 9, 00% 8, 00% 7, 00% 6, 00% 5, 00% 4, 00% 3, 00% 2, 00% 1, 00% 0, 00% CY 07 Statewide © 2011 APS Healthcare, Inc. CY 08 0 -5 6 -17 24 CY 09 18 -59 60+

Number of Beneficiaries by Age Groups Statewide Beneficiaries Served by Age Groups CY 07 -09 500 000 450 000 400 000 350 000 300 000 250 000 200 000 150 000 100 000 50 000 0 CY 07 Statewide © 2011 APS Healthcare, Inc. CY 08 0 -5 6 -17 25 CY 09 18 -59 60+

Approved Claims by Age Groups Statewide Approved Claims per Beneficiaries Served by Age Groups CY 07 -09 $5 000 $4 500 $4 000 $3 500 $3 000 $2 500 $2 000 $1 500 $1 000 $500 $0 CY 07 Statewide © 2011 APS Healthcare, Inc. CY 08 0 -5 6 -17 26 CY 09 18 -59 60+

Penetration Rates by Race/Ethnicity Statewide Penetration Rate by Race/Ethnicity CY 07 -09 14, 00% 12, 00% 10, 00% 8, 00% 6, 00% 4, 00% 2, 00% 0, 00% CY 07 White © 2011 APS Healthcare, Inc. Hispanic CY 08 African-American Asian/Pacific Islander 27 CY 09 Native American Other

Number of Beneficiaries by Race/Ethnicity Statewide Beneficiaries Served by Race/Ethnicity CY 07 -09 180 000 160 000 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0 CY 07 White © 2011 APS Healthcare, Inc. Hispanic CY 08 African-American 28 Asian/Pacific Islander CY 09 Native American Other

Approved Claims by Race/Ethnicity Statewide Approved Claims Per Beneficiary Served by Race/Ethnicity CY 07 -09 $6 000 $5 500 $5 000 $4 500 $4 000 $3 500 $3 000 CY 07 White © 2011 APS Healthcare, Inc. Hispanic CY 08 African-American 29 Asian/Pacific Islander CY 09 Native American Other

Number of Beneficiaries by Gender Statewide Beneficiaries Served by Gender CY 07 -09 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0 0 -5 CY 07 Female © 2011 APS Healthcare, Inc. 6 -17 CY 07 Male CY 08 Female 30 18 -59 CY 08 Male 60+ CY 09 Female CY 09 Male

Approved Claims by Gender Statewide Approved Claims Per Beneficiary Served by Gender CY 07 -09 $8 000 $7 000 $6 000 $5 000 $4 000 $3 000 $2 000 $1 000 $0 0 -5 CY 07 Female © 2011 APS Healthcare, Inc. 6 -17 CY 07 Male CY 08 Female 31 18 -59 CY 08 Male 60+ CY 09 Female CY 09 Male

Older Adult Beneficiaries by Gender Older Adult Beneficiaries Served by Gender CY 07 -09 30 000 25 000 20 000 15 000 10 000 5 000 0 CY 07 CY 08 Female © 2011 APS Healthcare, Inc. CY 09 Male 32

Older Adult Approved Claims by Gender Older Adult Approved Claims Per Beneficiary Served by Gender CY 07 -09 $6 000 $5 000 $4 000 $3 000 $2 000 $1 000 $0 CY 07 CY 08 Female © 2011 APS Healthcare, Inc. CY 09 Male 33

Older Adult Beneficiaries by Age and Gender Older Adult Beneficiaries Served by Age and Gender CY 07 -09 20 000 18 000 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 55 -59 CY 07 Female © 2011 APS Healthcare, Inc. 60 -64 CY 08 Female 65 -69 70 -74 CY 09 Female 34 75 -79 CY 07 Male 80 -84 CY 08 Male 85+ CY 09 Male

Older Adult Approved Claims by Age and Gender Older Adult Approved Claims Per Beneficiary Served by Age and Gender CY 07 -09 4000 3500 3000 2500 2000 1500 55 -59 © 2011 APS Healthcare, Inc. 60 -64 65 -69 70 -74 75 -79 80 -84 CY 07 Female CY 08 Female CY 09 Female CY 07 Male CY 08 Male CY 09 Male 35 85+

Older Adult Beneficiaries by Race/Ethnicity Older Adult Beneficiaries Served by Race/Ethnicity CY 07 -09 20 000 18 000 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 CY 07 White © 2011 APS Healthcare, Inc. Hispanic CY 08 African-American 36 Asian/Pacific Islander CY 09 Native American Other

Older Adult Approved Claims by Race/Ethnicity Older Adult Approved Claims Per Beneficiary Served by Race/Ethnicity CY 07 -09 $6 000 $5 000 $4 000 $3 000 $2 000 $1 000 $0 CY 07 White © 2011 APS Healthcare, Inc. Hispanic CY 08 African-American 37 Asian/Pacific Islander CY 09 Native American Other

Older Adult Beneficiaries by Age and Ethnicity Older Adult Beneficiaries Served by Age and Ethnicity CY 09 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 CY 09 55 -59 White © 2011 APS Healthcare, Inc. Hispanic CY 09 60 -64 CY 09 65 -69 African-American CY 09 70 -74 CY 09 75 -79 Asian/Pacific Islander 38 CY 09 80 -84 Native American CY 09 85+ Other

Older Adult Approved Claims by Age and Ethnicity Older Adult Approved Claims Per Beneficiary Served by Age and Ethnicity CY 09 $6 000 $5 000 $4 000 $3 000 $2 000 $1 000 $0 CY 09 55 -59 White © 2011 APS Healthcare, Inc. Hispanic CY 09 60 -64 CY 09 65 -69 African-American CY 09 70 -74 Asian/Pacific Islander 39 CY 09 75 -79 CY 09 80 -84 Native American Other CY 09 85+

Number of Beneficiaries by Service Categories Statewide Beneficiaries Served by Service Activity CY 07 -09 400 000 350 000 300 000 250 000 200 000 150 000 100 000 50 000 0 TBS Day Treatment 23 Hours Services CY 07 © 2011 APS Healthcare, Inc. 24 Hours Services CY 08 40 Linkage/ Brokerage Medication Support CY 09 Outpatient Services

Approved Claims by Service Categories Statewide Approved Claims Per Beneficiary Served by Service Activity CY 07 -09 $18 000 $16 000 $14 000 $12 000 $10 000 $8 000 $6 000 $4 000 $2 000 $0 Linkage/ Brokerage Medication Support 23 Hours Services CY 07 © 2011 APS Healthcare, Inc. Outpatient Services CY 08 41 24 Hours Services Day Treatment CY 09 TBS

Number of Beneficiaries by Age Groups and Service Categories Older Adult Beneficiaries Served by Age and Service Activity CY 09 180 000 160 000 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0 0 -5 24 Hours Services Outpatient Services © 2011 APS Healthcare, Inc. 6 -17 23 Hours Services TBS 42 18 -59 Day Treatment Medication Support 60+ Linkage/Brokerage

Approved Claims by Age Groups and Service Categories Approved Claims Per Beneficiary Served by Age and Service Activity CY 09 $16 000, 00 $14 000, 00 $12 000, 00 $10 000, 00 $8 000, 00 $6 000, 00 $4 000, 00 $2 000, 00 $0, 00 0 -5 24 Hours Services Outpatient Services © 2011 APS Healthcare, Inc. 6 -17 23 Hours Services TBS 43 18 -59 Day Treatment Medication Support 60+ Linkage/Brokerage

Older Adult Beneficiaries by Age and Service Categories Older Adult Beneficiaries Served by Age and Service Activity CY 09 25 000 20 000 15 000 10 000 5 000 0 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85+ 24 Hours Services 23 Hours Services Day Treatment Linkage/Brokerage Outpatient Services Medication Support © 2011 APS Healthcare, Inc. 44

Older Adult Approved Claims by Age and Service Categories Older Adult Approved Claims Per Beneficiary Served by Age and Service Activity CY 09 $12 000 $10 000 $8 000 $6 000 $4 000 $2 000 $0 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85+ 24 Hours Services 23 Hours Services Day Treatment Linkage/Brokerage Outpatient Services Medication Support © 2011 APS Healthcare, Inc. 45

Number of Older Adult Beneficiaries by MHP Size Older Adult Beneficiaries Served by MHP Size CY 07 -09 20 000 18 000 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 CY 07 Large © 2011 APS Healthcare, Inc. CY 08 Medium Small 46 CY 09 Small-Rural Very Large

Older Adult Approved Claims by MHP Size Older Adult Approved Claims Per Beneficiary Served by MHP Size CY 07 -09 $6 000 $5 000 $4 000 $3 000 $2 000 $1 000 $0 CY 07 Large © 2011 APS Healthcare, Inc. CY 08 Medium Small 47 CY 09 Small-Rural Very Large

Number of Older Adult Beneficiaries by Region Older Adult All Beneficiaries Served by Region CY 07 -09 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 CY 07 Bay Area © 2011 APS Healthcare, Inc. CY 08 Central Los Angeles 48 CY 09 Southern Superior

Older Adult Approved Claims by Region © 2011 APS Healthcare, Inc. 49

Older Adult Service Retention Rates - Ages 55 -85+ CY 09 100% 80% 34, 88 32, 4 33, 63 34, 02 31, 67 31, 29 26, 74 60% 39, 65 41, 8 36, 71 35, 54 6, 22 5, 94 7, 26 5, 36 6, 44 8, 13 10, 24 10, 52 34, 64 33, 72 6, 46 40% 20% 0% 6, 18 5, 51 6, 08 7, 69 55 -59 1 service © 2011 APS Healthcare, Inc. 28, 14 6, 54 5, 42 5, 92 7, 93 60 -64 2 services 65 -69 70 -74 3 services 50 4 services 5, 8 6, 18 8, 02 5, 4 6, 21 8, 63 10, 01 13, 69 14, 75 18, 5 75 -79 80 -84 5 -15 services 10, 14 85+ > 15 services

Questions? Comments?