BHSD SUTS QIDS NOV. 4 TH , 2016
SUTS QIDS Behavioral Health Services Department Substance Use Treatment System Quality Improvement and Data Standards 2
SUTS QIDS • Substance Use Treatment System • Quality Improvement and Data Standards (Quality Circle idea) – Combined the QI division and the Decision Support division • Eliminate the two divisions operating independently of each other • Encourage a cross-functional work style • Org structure is “flat”/horizontal – all work is done in teams • Project management methodology • Hot Group
QIDS CURRENT STAFFING • 7 QICs (Quality Improvement Coordinators) – 4 licensed (MFT/LCSW) – 3 certified (CAADAC II’s) – 1 QIC being added – Clinical Documentation/EHR trainer • 8 Data Staff – 3 Sr. MISA – 1 MISA I/II – 1 ISM/ BITSC – 3 HCPA series • Waiver – add 1 Clinical Standards Coord. (licensed MFT/LCSW) Cont’d next page
QIDS CURRENT STAFFING CONT’D • 4 Clerical Operations (Capacity management/UM/Certification) – 3 OS IIIs – 1 Rehab Counselor (add-delete HSR) • 1 Division Director – 1 Admin
QIDS CURRENT STAFFING Cost Center Job Code Job Code Description Employee ID Last Name First Name Step FTE Total Projection Amount 4607 D09 Office Specialist III 45186 FILLED 5 1.00 $96,021 4607 F86 Mgmt Info Systems Analyst II 60098 FILLED 4 1.00 $152,574 4607 P7B Dir of Research & Outcome Measure 55021 FILLED 5 1.00 $198,063 4607 W71 Sr Health Care Prog Analyst TBH 1 1.00 $140,387 4640 B0E Division Dir, QI & DS, A&D 44099 FILLED 5 1.00 $200,683 4640 B3V Sr Mgmt Info Systems Analyst 47770 FILLED 5 1.00 $171,398 4640 B3V Sr Mgmt Info Systems Analyst 58047 FILLED 5 1.00 $167,432 4640 B3V Sr Mgmt Info Systems Analyst hired FILLED 1 1.00 $147,297 4640 B5X Health Care Program Analyst II TBH 1 1.00 $128,742 4640 B5Y Health Care Program Analyst I 42375 FILLED 5 1.00 $127,751 4640 C06 Q I Coordinator II A&D Sv 46759 FILLED 5 1.00 $162,516 4640 C06 Q I Coordinator II A&D Sv 58326 FILLED 5 1.00 $157,952 4640 C06 Q I Coordinator II A&D Sv 27321 FILLED 5 1.00 $162,516 4640 C06 Q I Coordinator II A&D Sv 10296 FILLED 5 1.00 $162,516 4640 C06 Q I Coordinator II A&D Sv 26447 FILLED 5 1.00 $162,516 4640 C60 Admin Assistant 55981 FILLED 4 1.00 $100,241 4640 C97 Q I Coordinator - MHS 5386 FILLED 5 1.00 $162,516 4640 C97 Q I Coordinator - MHS 6890 FILLED 5 1.00 $162,516 4640 D09 Office Specialist III 62545 FILLED 3 1.00 $87,124 4640 D09 Office Specialist III hired FILLED 1 1.00 $85,730 4640 D09 Office Specialist III hired FILLED 1 1.00 $85,730 4640 D2E Health Services Rep add/delete to RC TBH 1 1.00 $87,417 4640 F86 Mgmt Info Systems Analyst II TBH 1 1.00 $139,318 4640 G12 Information Systems Mgr II BITSC TBH 1 1.00 $173,198 4640 W71 Sr Health Care Prog Analyst 30616 FILLED 5 1.00 $163,064 25.00 $3,585,218
SUTS QIDS – WHAT DO WE DO? • QIC on-call • Capacity Management (residential and THU) • ILOC authorization • Care Coordination • Contract oversight (data reporting/integrity)(QA) • T/A: ASAM – Individualized tx – LOC decisions and transitions in care • Drug MediCal (QA) • CPM (clinical performance measures)(QA) • Clinical Documentation Training • Hot Groups
SUTS QIDS – DMC-ODS 1115 WAIVER • QIC on-call • Capacity Management (residential and THU) - Access and Network Adequacy • ILOC authorization AND initial Residential Authorization • Care Coordination – MH and Physical Medicine Integration • Contract oversight (data reporting/integrity) • T/A: ASAM – monitoring ASAM fidelity – Clinical Outcomes (ASAM severity scores) – Individualized tx – LOC decisions and transitions in care Authorizations for Residential Services • Drug MediCal compliance as an MCP (42CFR part 438) (see proposed org chart) • CPM (clinical performance measures) • Clinical Documentation Training • Hot Groups – QI Committee and formal QI activities (PIPs), EQRO and UCLA
SUTS QIDS – DMC-ODS 1115 WAIVER PROPOSED ORG STRUCTURE SUTS MCP QUALITY MANAGEMENT MCP QM DIRECTOR Research & Evaluation Business KAKOLI Operations MICHAEL LEILANI Data Management Sr. HCPA LONG, LEK, Sr. MISA KATHERINE Strategic Data CLINICAL HCPA COMPLIANCE STANDARDS Plan TBD TIANNA NOEL Utilization Care Training & Beneficiary Provider CQI Licensing Communication Management Coordination Relations Relations Certification QA JIM & EGLE LINH & EGLE NANCY CHERYL HCPA PAULINE DEANDRA PIPS Capacity Management QI Comm. MICHELLE JIM, DEANDRA, PAULINE STEVE & LINH OSIII RC TBD YVONNE OSIII TBD OSIII TBD
DMC-ODS 1115 WAIVER Santa Clara County SUTS Managed Care Plan (MCP) 2020 or bust
MANAGED CARE PLANS • MCPs are Beneficiary Facing – Responsible for “ covered lives ” • ALL Medi-Cal beneficiaries in SCC • SCC waiver: sponsored and unsponsored receive the same services (CGF expenditure) • MCPs are contractual organizations – DMC-ODS 1115 Waiver obligations: • ASAM is mandated – INTAKE and ON-GOING LOC (not just doing it - actual fidelity ) • Medical Necessity is mandated • Managed Care operations are mandated (42CFR part 438 – federal code)
SCC SUTS MCP – QM IMPLEMENTATION • SCC QM Implementation Plan – This plan involves and impacts all levels of the system – It reports on the MCP performance as a whole system. – It is where the rubber meets the road – accountability. • All providers in the MCP must have their own QI – QI plan, QI project(s), QI activities (must be documented and reportable). • MCP QM is data-driven – ONLY. You can tell stories BUT the stories must be about the data. (If you don’t have data it didn’t happen.) • SCC WAIVER PLAN: years one, two, three: focus on ACCESS, ENGAGEMENT, OUTCOMES
SCC SUTS MCP – QM METRICS QM Data Components detailed • Contract Performance Metrics • Outcomes Metrics (from the waiver proposal): – Operational (“QI waiver specs” doc) – Practice • Clinician Outcome – ASAM Severity Score + Action Steps completed score • Client Outcome – Treatment Effectiveness Assessment (TEA) • Customer Service Survey • Level of Care Metrics – ASAM fidelity (becomes as important as “medical necessity”) • At intake • At regular intervals throughout tx episode – establish validity of LOC – Residential authorization – Extensions of tx • Utilization Metrics – Authorizations – Capacity management • Financial Metrics – performance analysis using contract and service data
SCC SUTS MCP – QM METRICS QM Outcomes Metrics Please refer to the handouts • Operational – Waiver QI metrics ( Please refer to handout titled SCC SUTS DMC ODS Waiver) • Access • Engagement • Timeliness • Practice – Clinician Outcomes (A LOC Form) – Client Outcomes (Treatment Effectiveness Assessment (TEA)) – Customer Service Outcomes
SCC SUTS MCP – QM OUTCOME METRICS Clinician Outcomes Metrics • Total of two scores: – ASAM severity Total Score: • A LOC – Level of Care Authorization Form – Treatment Plan: • # of Action Steps Completed/Total # of Action Steps
SCC SUTS MCP – QM OUTCOME METRICS Modified COC (A LOC)-What is Different? • Registration/Financial • Authorization/Transfer • Risk Assessment on DIM #3 • Client Short-Term, Strength-Based Targets relative to specific COC – Solution Focused • ASAM risk-severity Total Score » Use with Minnesota Matrix and ASAM Criteria Intro for Patients and Family for standardized LOC decisions (please see handouts)
SCC SUTS MCP – QM OUTCOMES METRICS Client Outcomes TEA – Treatment Effectiveness Assessment All intake situations – ALL treatment situations – Regular intervals throughout treatment
SCC SUTS MCP – QM METRICS: CLIENT OUTCOMES
SCC SUTS MCP – QM OUTCOMES METRICS Customer Service • At ALL Discharge encounters • Whenever a client requests Have to wait until we get final ruling from DHCS and UCLA on what tool to use
SCC SUTS MCP – QM METRICS LOC Metrics – ASAM Fidelity Use A LOC • Intake – first F2F at ALL sites • LOC fidelity – regular intervals in ALL treatment situations Minnesota Matrix and ASAM Criteria for Patients and Family (placement fidelity)
SCC SUTS MCP – QM METRICS • LOC Metrics – ASAM Fidelity – 6 DIM scores (0 to 4) • Client Outcomes – TEA – Treatment Effectiveness Assessment (0 to 4) • Customer Service Need to collect – workflow, analyze and benchmark. Develop reporting format for meaningful and easy use.
SCC SUTS MCP – QM METRICS • Attachments: – QI waiver specs – ALOC (fillable form draft version) – TEA – Understanding Data Reporting
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