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National Behavioral Health Quality Framework: Improving Health Outcomes
August 16, 2011
Peter Delany, PhD, LCSWDirector, Center for Behavioral Health Statistics and QualityRichard Frank, PhD, Special Advisor
Presentation to the SAMHSA Advisory Councils
The Need for Improvement3
2001 IOM Report highlighted the need to make real changes to the structure of the health care system to address quality, cost, and the application of health information technology to improve administrative and clinical processes.
National Quality Strategy: Three Aims
Better Care
Healthy People/ Healthy Commu-
nities
Affordable Care
Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
Improve population health through proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
4
Reduce the cost of quality health care for individuals, families, employers, and government.
National Quality Strategy Priorities
• To help achieve its aims, the strategy also establishes six priorities, to help focus efforts by public and private partners.
Making care safer by reducing harm caused in the delivery of care.
Promoting effective communication and coordination of care
Ensuring that each person and family are engaged as partners in their care.
Promoting the most effective prevention and treatment practices for the leading causes of
mortality, starting with cardiovascular disease.
5
Working with communities to promote wide use of best practices to enable healthy living
Making quality care more affordable by developing and spreading new health care
delivery models.
National Behavioral Health Quality Strategy Priorities
• To help achieve its aims, the strategy also establishes six priorities, to help focus efforts by public and private partners.
Promote the most effective prevention, treatment and recovery practices for BH
disorders
Encourage effective coordination within BH care systems and between the BH care system and
primary care and social service systems
Assure that Behavioral Health care is consumer and family-centered
Assist communities in the utilization of best practices to support health living
6
Make Behavioral Health care safer by reducing harm caused in the delivery of services
Foster affordable, quality BH care for individuals, families, employers, and governments by
developing and advancing new delivery models
National Behavioral Health Quality Framework
Priority 1: Promote the most effective prevention, treatment and recovery practices for BH disorders
Goal: Prevent and reduce the harm caused by mental illness and addictions Opportunities for success:
Reduce suicides, underage and problem drinking, binge drinking, illicit drug use, tobacco use Improve functioning and increase the number of individuals achieving goals of recovery including health,
home, purpose, and community
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Percentage of clients receiving services who
report: improved functioning; improved
living conditions; improved social
supports
Practitioner Program System Percentage of youth 12-20 reporting use of alcohol in
the past 30 days
Number of
practitioners using SBIRT as measured by
CMS codes
Number of programs
demonstrating sustainable models for improving the quality of service
Use of recovery measures in community report cards on outcomes
National Behavioral Health Quality Framework
Priority # 2 Assure Behavioral Healthcare is consumer and family-centered
Goal: Structuring services in ways that meet individual and family needs and making patients centrally involved in decision-making about their care. Includes enhancing capacity to capture and act on patient-reported information, including preferences, desired outcomes, and experiences with behavioral health care Opportunities for success:
Integrate behavioral health consumer feedback on preferences and experiences of care into all care settings
Increase use of electronic health records (EHRs) that capture the voice of the behavioral health consumer
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Number of States adopting shared decision-making
paradigms
Practitioner Program System Percentage of individuals
reporting that receive information that helps them make informed
decisions about treatment options
Adherence to standard
care practice for consumer preferences
in service planning
Percentage of facilities with
functioning EHRs that build in
consumer choice
Number of
communities that provide report
cards on behavioral health
care programs
National Behavioral Health Quality Framework
Priority 3: Encourage effective coordination within BH care, and between BH care and other health care and social support services Goal: Create a less fragmented and more coordinated behavioral health care system, and improve coordination of this system with other health care and social support systems Opportunities for success:
Reduce preventable behavioral health hospital admissions and readmissions Prevent and manage chronic illness and disability among behavioral health consumers Ensure secure information exchange to promote efficient behavioral health care delivery
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Percentage of grantees that provide screening
and/or assessments that are coordinated among
or shared across agencies
Practitioner Program System Percentage of individuals with severe mental illness
who report they can identify their accountable
provider
Number of providers
practicing in local care networks
Percentage of visits where primary care
and other practitioners are
aware each other’s contact with patient
Percentage of
individuals with readmitted within 30-, 60-, and 90-
days for the same condition, as measured by
diagnostic codes
National Behavioral Health Quality Framework
Priority 4: Assist communities to utilize best practices to enable healthy living
Goals: Support every U.S. community as it pursues local behavioral health priorities and support individuals in achieving recovery Opportunities for success:
Increase the provision of preventive behavioral health services for children and adults Increase the adoption of evidence-based behavioral health interventions to improve public health
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Percentage of service population receiving
evidence based practices
Practitioner Program System Percentage of adults with
a behavioral health disorder who report they
improvement in their quality of life
Clinical training
supporting application of best practices in the context of consumer choice and outcomes
monitoring
Percentage of adults
screened for depression and/or risky alcohol use and receiving a
documented follow-up plan/SBIRT
Number of State
and local governments using
monetary and alternative
incentive programs to support the use of evidence-based services monitored
through EHRs
National Behavioral Health Quality Framework
Priority 5: Make BH care safer by reducing harm caused in the delivery of care
Goal: Eliminate preventable and/or adverse behavioral health care induced consequences Opportunities for success:
Reduce adverse medication events Eliminate abuse and neglect in psychiatric facilities
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Percentage of complaints of alleged abuse, neglect, and
rights violations substantiated and not
withdrawn by the client that resulted in positive
change as a result of PAIMI involvement
Practitioner Program System Number of individuals
with a behavioral health disorder reporting an
emergency department visit for an adverse medication event
Number of clinicians
using EHR’s to manage patient records
Percentage of
patients maintaining positive
diabetic symptom management during
treatment in specialty factility
Percentage of communities
implementing a prescription drug
monitoring program
National Behavioral Health Quality Framework
Priority 6: Foster affordable high quality BH care for individuals, families, employers and governments by developing and advancing new delivery models Goal: Reduce behavioral health costs while improving service quality and efficiency for individuals, families, employers and government Opportunities for success:
Increase health insurance coverage Improve access to behavioral health care Reduce financial barriers to care
Illustrative Measures
SAMHSA Managed
Structural Level
Population Level
Number of admissions to substance abuse treatment programs
receiving public funding
Practitioner Program System Percentage of individuals who report that financing and/or cost is a barrier to accessing ad/or receiving behavioral health services
Percentage of allied
health care practitioners providing
SBIRT services for primary care practitioners
Enrollment success
rate among new treatment admissions
Percentage of
individuals receiving recovery support services
Stakeholders13
Stakeholders14
National Behavioral Health Quality Framework Priorities, Goals and Illustrative Measures
• Designed to begin a dialogue with stakeholders to create specific quantitative goals and measures
• SAMHSA and HHS will promote effective measurement while minimizing the burden of data collection by:• aligning measures across programs• coordinating measurement with the private sector; and • developing a plan to integrate reporting on quality
measures with the reporting requirements for meaningful use of electronic health records
15
Initial thoughts on Acton Steps
• Policy Instruments and Tools – Measurement process– Technical assistance Programs– Contract specifications– Terms and provisions on grants– Assessment and dissemination of best practices– Organizational design (SAMHSA’s role in health
homes)– Payment systems (collaborations with CMS, State
programs)
Next Steps
• Public comments on SAMHSA’s National Behavioral Health Quality Framework can be submitted through Thursday September 1st
– Send comments by email to SAMHSA at [email protected]
– Put “Quality” in email subject line