PMHP Administrative Data Analysis Development of Quality Measures

PMHP Administrative Data AnalysisDevelopment of Quality Measures

Agency for Health Care Administration Briefing

September 27-28, 2010

Mary Rose Murrin

Gregory B. Teague, Ph.D.

Louis de la Parte Florida Mental Health Institute

Goals for this year’s analysis

Produce a data quality report for PMHP using most recent PMHP encounter data

Extend that data quality report to the HMOs

Produce and implement a set of service quality measures based on feedback from the 2009 AHCA Debriefing


Feedback from 2009 AHCA Debriefing

Assess quality based on standard HEDIS measures

Show the penetration and service density for each of five major classes of community services provided in managed care plans:

♦ Basic Outpatient

♦ Intensive Outpatient

♦ Treatment Planning

♦ Assessment

♦ Targeted Case Management

It was more informative to show what was happening within defined treatment populations, than for the overall population using MH services.


New Service Quality Measures: HEDIS measures

Outpatient follow-up after inpatient episode

♦ within 7 days

♦ within 30 days

Medication management for major depression antidepressant therapy for persons 18 and above

♦ % meeting acute phase criteria

♦ % meeting continuation phase criteria

Follow-up care for children ages 6-12 prescribed ADHD medication

♦ % meeting acute phase criteria

♦ % meeting continuation phase criteria


New Service Quality Measures

Components of Care Subpopulations

♦ 90 days after discharge from inpatient admission

♦ 90 days after beginning of treatment episode for adult major depression

♦ 90 days after beginning of treatment episode for child aged 6-12 ADHD medication

♦ Major diagnoses (last three month period)• Adult Schizophrenia

• Adult Major Depression

• Adult Bipolar Disorder

• Child Mood Disorder

• Child Conduct Disorder

• Child ADHD Disorder


Outpatient follow-up within 7 days after inpatient episode (admissions from 6/1/09-8/31/09)


Outpatient follow-up after inpatient episode within 30 days (admissions from 6/1/09-8/31/09)


Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Acute Phase (PMHPs only)


Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Continuation Phase (PMHPs only)


Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Initiation Phase (PMHPs only)


Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Continuation Phase (PMHPs only)


Plans with at least one indicator above the HEDIS adjusted 90th percentile

Healthease/Wellcare (Inpatient Follow-up)

Staywell/Wellcare (Inpatient Follow-up)

Access Behavioral Health (Inpatient Follow-up)

Community-Based Care Partnership (ADHD)

Magellan Behavioral Health (Inpatient Follow-up)

Public Health Trust Dade (ADHD and Inpatient)


Components of Care Analysis: 90 days after Inpatient Discharge for Admissions April 1- June 30, 2009

Key:BOP Basic OutpatientIOP Intensive OutpatientTXP Treatment PlanningAsmt AssessmentTCM Targeted Case Mgmt


Components of Care Analysis: First 90 days of Adult Antidepressant Therapy for Treatment Episodes Beginning January 1 through March 31, 2009


Components of Care Analysis: First 90 days of ADHD Medication Follow-up Treatment Episodes Beginning December 1, 2008 through February 29, 2009


Strengths, Limitations, and an Alternative to this Approach

Shows treatment patterns of recognized high-risk groups.

The N in each of these analyses is much smaller than the population of the behavioral health system

One approach is to look at the diagnostic groups that comprise the majority of people using the BH system

Within Florida Medicaid’s Managed Care BH System there are only a few diagnostic groups that cover most of the population


Percentages of Common Diagnoses Found in the Behavioral Health Encounters for FY 2008-2009

Percentages of All MH Users with at least one claim in diagnostic group

Children Adults

Schizophrenia 27%

Major Depression (included Depressive disorder for children)

13% 33%

Bipolar Disorder 9% 28%

Conduct Disorder/Oppositional Defiant Disorder 22%

Attention Deficit Disorder 44%

Anxiety Disorders 8%

These diagnoses combined were able to describe 80% of adult MH users and 72% of Child MH users.


Components of Care Analysis: 90 days following First Schizophrenia Diagnosis March 1 through June 30, 2009


Components of Care Analysis: 90 days following First Adult Bipolar Disorder Diagnosis March 1 through June 30, 2009


Components of Care Analysis: 90 days following First Adult Major Depression Diagnosis March 1 through June 30, 2009


Components of Care Analysis: 90 days following First Child Mood Disorder Diagnosis March 1 through June 30, 2009


Components of Care Analysis: 90 days following First Child Conduct Disorder Diagnosis March 1 through June 30, 2009


Components of Care Analysis: 90 days following First Child ADHD Diagnosis March 1 through June 30, 2009


Where do we go from here?

Working assumption: we will have the necessary data this year

Planning discussions with key AHCA informants & other interested stakeholders

♦ Prioritization of critical issues for analysis

♦ Consideration of additional breakdowns, e.g., by administrative, geographic, demographic, &/or clinical categories

♦ Refinements to methods & reporting

♦ Plan for distribution & follow-up mechanism

PMHP Administrative Data Analysis Development of Quality Measures

Documents

Transcript of PMHP Administrative Data Analysis Development of Quality Measures