180 SCAN: SYSTEM PERFORMANCE – DMC-ODS 6 MONTHS POST IMPLEMENTATION PRESENTED BY RESEARCH & OUTCOME MEASUREMENT (ROM), QUALITY IMPROVEMENT & DATA SUPPORT & ADMINISTRATION SUBSTANCE USE TREATMENT SERVICES FEBRUARY 28 2018 1
Agenda Welcome Overview DMC-ODS Changes– Presenter: Kakoli Banerjee Authorization, Placement & QI measures – Presenters: Olena Chesnakova, Katherine Christian Contract performance measures – Presenters: Patricia Rubio-Corona, Sujung Kim Waiver services trends: Presenter: Kakoli Banerjee Client outcomes: Presenter: Kimberly D'zatko Service efficiency: Presenter: Leilani Villanueva Wrap up: Kakoli Banerjee 2
The 180 SCAN A 180 scan is analogous to a wide angled view or perspective of a landscape in which the entire field is visible. 3
Goals of the 180 SCAN The goals of the 180 Scan are to: Review the state of the System of Care six-months post implementation of the DMC-ODS, also known as the Medi-Cal Waiver The 180 Scan examines the following elements of the SUTS System of Care: clinical processes, client outcomes, system performance, system efficiency 4
180 SCAN Series Purpose To foster a culture of data driven system improvement in the SUTS system of care To provide managers, decision makers, clinicians and others with a high level view of how the system is functioning To develop a common understanding of the strengths & weaknesses of the system 5
Brief Overview of DMC-ODS Pilot: The 3 Main Components of the Medi-Cal Waiver Clinical: ASAM-based clinical framework of treatment delivery Operational philosophy: Use of managed care principles (based on 438) to operate the business side of the delivery system Quality improvement: Monitoring service quality according to Managed Care Plan’s Quality Improvement Plan 6
Clinical Framework of Tx Delivery Pre-& Post-Waiver Domain Pre-Waiver Post-Waiver OP 1.0, 2.1 OP 2.5 ASAM Levels Residential 3.1 Residential 3.3, 3.5 WM 3.2 Recovery Svcs Additional MAT Authorization for svcs None Authorization-Residential Tx Medical necessity limited Application to all SUTS Medical Necessity to few SUTS services services 7
Managed Care Changes Pre-& Post-Waiver Domain Pre-Waiver Post-Waiver Operations based on 42 CFR 438 County Operations Managed care for principles (Federal managed care Framework some functions principles) DHCS certification not DHCS certification for Certification mandatory billing Expanded array of Medi-Cal billable Limited billable billable modalities & services modalities & Svcs svcs 8
Quality Improvement Requirements Pre- & Post-Waiver Domain Pre-Waiver Post-Waiver Distinctions between LPHA Service provider Functions of credentialed and credentialed staff, & licensed staff not particularly for billable credentials services clearly defined Evidence –based Required- at least two per tx modality treatment Recommended Quality External Quality Review No external review Organization (EQRO) Improvement 9
180 SCAN OF SUTS SYSTEM OF CARE: Key Components System ALOC & Access Waiver Client Efficiency performance measures Services outcomes measures measures 10
Crosswalk Between 180 Scan & External Requirements 180 SCAN EXTERNAL REQUIREMENTS Clinical measures (ALOC) EQRO – Quality (Transitions in ASAM care, Authorization for residential tx, indicated versus actual LOC) System Performance measures SUTS contract performance metrics EQRO – Access metrics, admissions by AID code DHCS – Timeliness metrics IGA – Section 24 – Timeliness metrics, care coordination, Waiver services IGA Section Quality Management & Services utilization Client outcomes IGA – Section 24 –Assessment of beneficiaries experience Efficiency measures EQRO- Access/Cost effectiveness 11
Scope of the 180 Scan The 180 Scan reviews data for approximately 6 months of the DMC -ODS July 1 – December 31, 2017 Covers about 3,400 admissions across all tx modalities in AOSC & YSOC The analysis focuses mainly on DMC providers, but data from the whole system of care is presented where relevant The 180 Scan is designed as a point in time system assessment The first year DMC-ODS evaluation results will be presented in December 2018 12
Admissions by Modality in the Adult System of Care (n=3,068 admissions) 13
Admissions by Modality - Youth System (n= 350 admissions) 14
ALOC & Access Measures Clinical state of the system 15
Access to System of Care Gateway timeliness: Screen to referral date, Referral date to admission ALOCs: How is ALOC used? Admission ALOCs Discharge ALOCs Approvals of Residential Admissions Other ASAM levels needed that are not yet offered Extension of Residential LOS requests Clinical measures: Risk Ratings for six dimensions Change in Risk Rating from Admission to Discharge Discharge Status and Risk Rating Actions Steps – assigned and completed at Discharge 16
Access to Residential Services: This section will cover: Timeliness between First Screening Date to Referral Date (Gateway); Timeliness between Referral Date to Admission Date (Gateway) (Requirement: 10 business days). 17
Timeliness: Gateway Screen Date to Referral Date & Referral Date to Residential Admission (n=685) Jul – Dec 2017 Time between Referral Date and Admission Date (n=439) Time between First Screening Date and Referral Date (n=425) 250 180 160 n=339; Average 8 n=100; 23% Average = 7 200 NUMBER OF ADMISSIONS 77% Business Days Business Days 140 NUMBER OF ADMISSIONS 120 150 100 100 80 60 50 40 20 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 33 35 37 39 41 43 46 70 75 93 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 29 31 34 37 41 44 47 67 111 BUSINESS DAYS BUSINESS DAYS Weekends and County Holidays are excluded. If Referral Date is missing, the Screening Day is used as the Referral Day. Data intervals of less than 0 days are excluded. DMC-ODS requirement is placement within 10 Business days. 18
Timeliness of Gateway Calls: Residential Admissions (n=685) Jul - Dec 2017 Percent of Admissions with Direct Gateway Calls Total Admissions (n=685 ) (n=439 ) 100% 100% 9% 90% 23% 15% 80% 80% 70% 60% 60% 50% 50% 40% 40% 77% 30% 20% 20% 27% 10% 0% 0% No Gateway Calls Last 6 Months 11 Days and more 10 Business Days 11 Days and more 10 Business Days Gateway Call Last 6 Months 77% of Residential Admissions occur within 10 business days of the Gateway Referral. The average is 7 business days. 19
ALOC is the ticket into the SUTS System of Care ASAM determines the appropriate placement of clients into intervention or treatment services. Clinical data is collected at both admission and discharge Requirements: A QI determination and approval is required for each residential admission. An ALOC is required for each Residential and OP admission and discharge. Data Analysis: At waiver start (7-1-17), ALOCs were saved in PDF format. Starting mid-August, ALOCs were entered into Profiler. The ALOC PDF and Profiler data were merged for analysis. Timeframe: Client admissions to residential tx are from July 1, 2017 – Dec. 31, 2017 unless otherwise noted. Residential discharges are linked to admissions that occurred in the first 6 months of the waiver. DMC and non-DMC clients are included in the ALOC and Access section. 20
Residential Authorizations can occur on 3 ‘types’ of ALOCs ALOC Organization Residential authorizations can occur on 3 ‘types’ of ALOCs B1 – Initial authorization for residential LOC Request from Residential directly B2 – Authorization of extension for residential LOC Increased LOC request from OP & OTP/NTP B3 – Assessments – Not authorization requests When Admitted to WM , received Only one section: B1, B2 or B3 is required Residential approval to be completed per ALOC . 21
Initial Authorization for Residential LOC (B1) Percent of Total ALOCs (n=861) (Jul – Dec 2017) 100% 90% 80% 67% % of Total ALOCs 70% 60% 50% 40% 30% 22% 20% 11% 10% 0% Increased LOC request Other Request from from OP Residential “Other” includes: Not open; needs other LOC than indicated by GW screen; Pre-auth request from DWC/Juvenile Hall etc..; Request from call center 22
Residential Admission ALOCs & QI Determination (n = 685) (Jul – Dec 2017) Missing QI determination 11% Missing ALOC 9% Approved by QI 79% Rejected <1% Denied <1% Missing ALOC includes: Admit/Discharge within 2 days ; Residential transfer; Missing. 23
Time between Receipt of ALOC Assessment & QI Authorization (n=587) Jul- Dec 2017 More than 97% of all requests were completed at the same day or within 1 <3% Same Business Day business day. Less than 3% of requests were completed after 1 1 Business Day 16% business day. 2 or more Business Days 81% *The requirement is that authorization for residential tx will be provided within 24 hours. Weekends and County Holidays are excluded. 24
Recommend
More recommend
