Peter J. Delany, Ph.D., LCSW-C. RADM, USPHS
Director Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration U.S. Department of Health & Human Services
Building a Quality Agenda: SAMHSA’s
Behavioral Health Quality Framework
2012 NASADAD Annual Meeting June 27, 2012
Principles that Guide the Quality Agenda
Evidence
—we should be guided by evidence
about what works, not ideology about what
should work.
Equity
—because the people we serve with
mental health and substance abuse disorders
deserve high quality services that lead to
recovery.
Principles that Guide the Quality Agenda
(Cont’d)
Scalability
— it is not enough to provide great
prevention and treatment services to a limited
number of people; we must provide access to
quality services in all of our communities.
Sustainability
—improvement in services
should withstand budget cycles and political
shifts, and must outlast changes in program
and government leadership.
Quality Drivers
In 2010, the Affordable Care Act (ACA) directed DHHS
to develop a National Quality Strategy (NQS) to provide all Americans with safe, effective, and affordable healthcare.
In March 2011, the Secretary of DHHS reported to
Congress on a National Strategy for Quality Improvement in Health Care.
Through the NQS, SAMHSA developed the strategic
plan for a practical and strategic National Behavioral Health Quality Framework (NBHQF).
Overview
SAMHSA plays an important role in supporting
and paying for:
delivering safe, high quality behavioral health care; monitoring quality and disparities;
providing technical assistance; supporting research; and
in limited instances, directly providing care.
Overview (Cont’d)
The National Behavioral Health Quality Framework (NBHQF) is
concordant with the National Quality Strategy (NQS) and supports three broad aims:
Better Care: Improve the overall quality by: making behavioral
health care more person-, family-, and community-centered; and reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the U.S. behavioral
health by: supporting interventions to address behavioral, social, and environmental determinants of positive behavioral health; and delivering higher quality behavioral health care.
Affordable Care: Increase the value (cost-effectiveness) of
behavioral health care for individuals, families, employers, and government.
National Behavioral Health
Quality Framework
The aim is to:
establish national priorities, goals, and
opportunities for improving the delivery of behavioral health services,
achieve better behavioral health outcomes, and improve the behavioral health of the U.S.
population, especially those with substance abuse and mental health disorders.
Organization of National Behavioral
Health Quality Framework
The SAMHSA Quality Strategy follows six priorities that
parallel the National Quality Strategy and are based in the Institute of Medicine’s Quality Chasm reports:
1. Promote the most effective prevention, treatment, and recovery practices for behavioral health disorders.
2. Assure behavioral health care is person-, family-, and community-centered.
3. Encourage effective coordination within the behavioral health care field and between behavioral health care providers and other health care, recovery, and social support services.
Organization of National Behavioral
Health Quality Framework (Cont’d)
4. Assist communities to utilize best practices to enable
healthy living.
5. Make behavioral health care safer by reducing harm caused in the delivery of care.
6. Foster affordable, high quality behavioral health care for individuals, families, employers, and governments by developing and advancing new- and
recovery-oriented-delivery.
Organization of National Behavioral
Health Quality Framework (Cont’d)
The impact of each of the six behavioral health
priorities is tracked across three targets/
domains that include:
SAMHSA;
providers and payers; and
individuals, families and communities.
Outcome Measurement Process
Federal SAMHSA Outcome: Finance, demonstrate, and disseminate medication assisted treatment (MAT) knowledge and standards State, Payer, Provider Outcome: Payment, protocols, delivery of MATPatient Outcome: Compliance with MAT, abstinence and/or reentry Patient, Family, Community Outcome: Healthy, productive, engaged life 12
Strategies to Implement NBHQF
Align payment and incentives
Enhance data collection and reporting
Build capacity development functions
Align Payment and Incentives
Structure payments to encourage and promote
the appropriate use and supervision of
evidence-based practices and widely
recognized experience-based practices.
Revise payment format to one that encourages
treatment of an episode vs. isolated symptoms
of addictions or mental health disorders.
Align Payment and Incentives (Cont’d)
Shift payment levels and forms to encourage
prevention, identification, and treatment of related mainstream and behavioral health conditions (e.g., diabetes & alcohol or hypertension & depression) in order to promote integrated care.
Develop standards and performance indicators for
financial agreements and contracts among payers, third party managers, and providers that recognize the use and form of payments to improve quality.
Data Collection and Reporting
SAMHSA is implementing its goal of an integrated approach to data collection and reporting
Continue to build on and coordinate data systems
Harmonize the quality framework and measures with
SAMHSA grant programs and other health care
processes and outcomes including electronic health records (not all 1-1 concordance)
Create data warehouses and access to data to help
make case for behavioral health investments
• Policy and research 16
Building Capacity
Collaborate with relevant Federal partners to
align work of behavioral health and primary
care providers and payers.
Promote targeted technical assistance to
develop business practices in behavioral
health provider organizations that support
delivery of quality and effective treatment
and recovery supports.
Building Capacity (Cont’d)
Develop and disseminate model contract,
performance standards, and related quality
standards that payers and providers can
employ to effectively achieve better care and
healthy people and communities.
Monitor and assess the capacity of the
behavioral health system to adequately meet
the needs of patients, families, and their
communities.
Status of the NBHQF
Feedback on an earlier draft has been solicited and input
from SAMHSA leadership has informed goals & beginning strategies for measure selection associated with three
measurement tracks & a revised version is being prepared.
Outside experts will be engaged in a computer-based
Delphi process leading to core set of measures for public review.
A new public document with core measures will be
developed with input from payers, providers, federal and non-federal partners, & other key stakeholders.
