Quality Measures in Managed Care Conference Beacon Health Strategies
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1 Quality Measures in Managed Care Conference Beacon Health Strategies APRIL 15, 2013 BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
2 Agenda 1. Intro to Beacon Health Strategies / New York Experience 2. Quality Framework CQI Cycle 3. Case Study #1 QARR 4. Case Study #2 Medication Safety 5. Case Study #3 Rhode Island System of Care Transformation 6. Questions Discussion BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
3 Beacon was founded to meet the needs of individuals with complex behavioral needs HIGHLIGHTS BEACON S NY FOOTPRINT 1.Beacon was founded in 1996 to develop an integrated behavioral health solution for a community-based health plan 2.Beacon works with over 25 Medicaid Plans in 17 States 3.Full quality accreditation from: i. NCQA ii.urac accreditation 4. Operating in NY since 1997 A.8 health plan partnerships B. RBHO/CIDP work 800, , , , ,567 ABD/SSI/SPMI Other Lives NY Covered Lives BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
4 Beacon s Quality Framework Technology, Data, Analytics, Self-Report and Outcomes Plan Do Member Measure Check Act BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
5 Case Study #1 - QARR/HEDIS 7 & 30 Day Post Hospitalization Follow up Far reaching implications to the individual and the delivery system when aftercare is not successful HEDIS seeks to drive national improvement Member Poor compliance with Aftercare Increased readmissions Low medication adherence Increased ER usage Health Plan Visible measure of Quality Peer Pressure Enrollment algorithm Premium bonus Supports mission Provider Inadequate hand-off from acute setting Loss of revenue Window of opportunity for engagement is brief Payors seek access and outcomes BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
6 Case Study #1 QARR/HEDIS 7 & 30 Day Post Hospitalization Intervention Employing a CQI Framework to improve post-hospitalization follow up Member Peer partnering/mentoring while in acute setting Activate natural supports Meet individual where they are at Recognize treatment resistance post acute tx Beacon Sought innovative and entrepreneurial provider IT system enhancement Dedicated staff resources Procured pre-paid slots Supports mission Provider/Home Based Therapy Program Facilitate transition into community Use of dedicated slots Mobile interventions Peers as key members of community support Text appointment reminders Increased revenue Outcome BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
7 Selected HEDIS/QARR Results for Beacon Partners New York QARR Rankings 2012 service year 2011 : Measure Plans State Rate Measure Plans State Rate Ranking Ranking FUH 7days NHPNY 3 rd 82 FUH 30 days NHPNY 2 nd 91 Affinity 4 th 80 Affinity 3 rd 89 Hudson 7 th 72 Hudson 6 th 85 Medicaid FUH National rankings HEDIS 2012 service year 2011 based on Quality Compass data. Measure Plans National Ranking FUH 7days Rate Measure Plans National Ranking NHP 3 rd FUH 30 FCHP 1 st days NHPRI 6 th NHP 3 rd BMCHP 7 th NHPRI 5 th FCHP 8 th BMCHP 8 th DC 14 th DC Chartered Chartered 90 th Percentile 68% 90 th Percentile 83% Rate BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
8 Case Study # 2 Health Plan Partner Brings to Beacon Concerns with Increasing Rate of Prescribing of BH Medications in Children Areas of Concern Increasing utilization of behavioral health (BH) medications in children Inadequate evidence base to support certain prescribing practices (limited research in children) Establishing prevalence rates has been challenging Drugs used for behavioral health conditions may also be used for other indications unrelated to BH management Multiple prescribers are often involved in the prescribing of BH medications for children BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
9 Case Study #2: Analysis: Trends in Rates of Antipsychotic Prescriptions in Children (6-17 years of age) BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
10 Case Study #2: Analysis: Poly-pharmacy (4+ medications) Among Health Plan's Children Prescribed BH Medications 15.00% 13.75% Age range 0 to < 6 Count Prevalence rate Children on "poly-pharmacy" 54 Children on BH meds % 10.00% 7.76% 8.62% Age range 6 - <15 Count Prevalence rate Children on "poly-pharmacy" % Children on BH meds % Age range 15 - > 19 Count Prevalence rate Children on "poly-pharmacy" % 0to<6 6to<15 15 to <19 Children on BH meds % BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
11 Case Study #2 CQI Intervention Interventions for Members, PCPs and Prescribers Data Analysis Sub Optimal dosing Off Label dosing Poly Pharmacy Contra indications Age stratification PCP Support Coordination of Prescribers Case Mgmt Support MD consult real time Member Support Appropriate dosing Case Mgmt Coordination of treaters Refill assistance BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
12 Case study # 2: BH Prescribing to Children Outcomes of Pharmacy Intervention to Prescribers BEHAVIOR CHANGE AFTER MED SAFE INITIATIVE CHILDREN ON POLY-PHARMACY 80.0% 73.4% 9.00% 8.00% 8.462% 60.0% 7.00% 6.00% 6.38% 5.932% 5.59% 40.0% 20.0% 0.0% 18.4% % Change Poly- Pharmacy 28.6% % Change Med Posession Ratio Non- Adherence % Change Sub-Optimal Dosing 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% 5.185% 3.91% 4.132% 2.90% 3.361% 2.21% 1.92% 2.04% 2.158% Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
13 Case Study #3 Rhode Island System of Care Rhode Island s Continuum for BH Services Was Overly Reliant on an Acute System of Care LOW SERVICE INTENSITY HIGH ALTERNATIVE LEVELS OF CARE OFFICE BASED OP PARTIAL HOSPITALIZATION INPATIENT ACUTE CARE LOW PRICE OF UNIT OF SERVICE HIGH BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
14 Case Study #3 Rhode Island System of Care CQI Analysis, Stakeholder Focus Groups, Entrepreneurial Providers RHODE ISLAND STUCK KIDS ANALYSIS CQI APPROACH Facility Admin Process 2.9% No ARTS beds 2.9% School Admin Process 4.6% DCYF Unavailable 5.0% 100% 80% Waiting for Out of State LTR 12.2% Waiting for Foster Care 11.1% RIGOROUS ANALYSIS Data collection methods Barrier Analysis PARTNER WITH PROVIDERS Co-location at major child hospital to deal with consent and custodial issues In home services 60% 40% DCYF Administrative Process 84.6% Waiting for In-State LTR 76.7% Co location of BH at PCP site Comprehensive assessment at intake INNOVATIVE REIMBURSEMENT STRATEGIES AGENCY ENGAGEMENT Co-location at child welfare agency offices 20% Education and involvement with the court system PARTNER WITH ADVOCATES 0% Reason for "Stuck Day" DCYF Administrative Barrier Identify concerns and needs BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
15 Case Study #3 Rhode Island System of Care Resulting Continuum Emphasized Community Based Care LOW SERVICE INTENSITY HIGH ALTERNATIVE LEVELS OF CARE PARTIAL HOSPITALIZATION DAY TREATMENT HOME-BASED TREATMENT INTENSIVE OUTPATIENT OFFICE BASED OP FAMILY SUPPORT SERVICES INPATIENT ACUTE CARE Crisis Stabilization ACT Teams ACUTE RESIDENTIAL LOW PRICE OF UNIT OF SERVICE HIGH BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
16 Case Study #3 Enhanced Continuum resulted in a $5.4 million reduction in expenditures for foster kids / children w special needs REDUCING STUCK KIDS PROBLEMS BEHAVIORAL HEALTH COSTS $40 $ ,000 $33 $30 $20 $10 PMPM Stuck Kids Cost $18 Spend in Millions (Bar) Spend in Millions ,000 2,000 1,000 Unique Utilizers (Line) $ BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
17 Thank You! Questions Discussion BEACON HEALTH STRATEGIES beaconhealthstrategies.com April 17,
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