Measurement Year: 2011 Mark Hawkins M.Ed., Victor Argothy, Ph.D, Gerry Foeman Ph.D Jennifer Li, Alan Dashoff

(1)

Pay

Pay--for

for--Performance

Performance

D&A Residential Rehab

Measurement Year: 2011

C th B lt

Ph D R b

R b

Ph D

Cathy Bolton, Ph.D, Rebecca Robare, Ph.D

Mark Hawkins M.Ed., Victor Argothy, Ph.D, Gerry Foeman Ph.D

Jennifer Li, Alan Dashoff

(2)



Thank you for joining us in this pilot of

a

you o jo

g us

s p o o

GoToMeeting!



We are looking forward to discovering how

we feel about this technological possibility.



After this meeting, we will be e-mailing

h t

li

f f db k

you a short online survey for feedback

and additional information.

GoToMeeting

(3)



CBH/DBHIdS

/



Providers of non-Hospital Residential

Rehab:

Long term

◦

Long-term

◦

Short-term

◦

Adolescents

◦

Women with Children

◦

Medication-Assisted

(methadone)

( et ado e)

◦

RINTs

P4P Participants

(4)



In the webinar format, your microphone is

automatically muted If you would like to say

automatically muted. If you would like to say

something to everyone, please use the control

panel on the right hand side of your screen to

“raise your hand” and we will take you off mute

raise your hand , and we will take you off mute.



If you have questions during the meeting, type

them into the chat box on the lower right. We

will read your question, and answer it.

ead you quest o , a d a s e t



When speaking, please identify yourself by name

and agency.



We will ask you for questions at regular intervals,

y

q

g

,

so please use this opportunity to raise your

electronic hand or send us questions by chat.

Housekeeping

(5)



Preview of Pay-for-Performance nearly

y

4 months earlier than last year

◦

Is this real data?

-- Yes



New measures?



New measures?

◦

Readmissions data



We wish to discuss whether and how

to use this data



Blinded matrix with comparison data

C l

di

b

d

l t

’

◦

Color-coding based on last year’s

thresholds and methodology

Welcome and Overview

(6)



Rehab Utilization Metrics

ab U

a o

s



2011 Performance Data

◦

Measures

◦

Thresholds

◦

Weights

The Outcomes Transformation Project:



The Outcomes Transformation Project:

Post-Treatment Monitoring



Discussion



Discussion

Topics for Today

(7)

Rehab Utilization Metrics

(8)

500

Average Daily Census by Program Type

400

450

500

300

350

Adolescent

Women with Children

150

200

250

Women with Children

Short Term

Long Term

50

100

150

Census by Program Type

-2009 2010 2011

Census by Program Type

(9)

$40 000 000 00

Overall Cost by Program Type

$35,000,000.00

$40,000,000.00

$25,000,000.00

$30,000,000.00

Adolescent

W

ith

Child

$15,000,000.00

$20,000,000.00

Women with Children

Short Term

Long Term

$5,000,000.00

$10,000,000.00

Cost by Program Type

$-2009 2010 2011

Cost by Program Type

(10)

Cost per Bed Day

$250.00 $300.00 $200.00 Adolescent $100.00 $150.00 Adolescent

Women with Children Short Term

Long Term

$50.00

Cost per Bed Day

$-2007 2008 2009 2010 2011

Cost per Bed Day

(11)

$40 000 00

Mean Cost per Client

$35,000.00

$40,000.00

$25,000.00

$30,000.00

Adolescent

$15,000.00

$20,000.00

Women with Children

Short Term

Long Term

$5,000.00

$10,000.00

Cost per Client

$-2007 2008 2009 2010 2011

Cost per Client

(12)

$35 000 00

Mean Cost per LOS

$30,000.00

$35,000.00

$20,000.00

$25,000.00

Adolescent

$10 000 00

$15,000.00

Women with Children

Short Term

Long Term

$5,000.00

$10,000.00

Cost per LOS

$-2007 2008 2009 2010 2011

Cost per LOS

(13)

2011 Performance Data

(14)

Includes

Excludes

Includes

All less acute levels

Excludes

Individuals readmitted to All less acute levels

of care Examples: readmitted to Rehab, Detox, or Inpatient Individuals who Examples: Outpatient, BHRS, etc. Individuals who become ineligible for Health Choices

Those transferred Those transferred directly to a hospital (based on discharge disposition code on claims)

Based on claims received for follow-up levels

7/14/30

7/14/30--Day Follow

Day Follow--Up Rate

Up Rate

Based on claims received for follow up levels

of care within 30 days of the last claim for

Rehab

7/14/30

(15)

7/14/30 Day

Follow Up Rate

Medication-Assisted

Non-Medication

Assisted

Treatment

Assisted

Adolescent

Women with

Children

Long-Term

Short-Term

7/14/30

7/14/30--Day Follow

Day Follow--Up Rate

Up Rate

7/14/30

(16)

2010 7 Day 2010 14 Day 2010 30 Day 7 Day Rate

2010 7 Day

Rate/Change 14 Day Rate

2010 14 Day

2010 30 Day

Rate/Change

94.0% 87.9%‐‐Improved 98.9% 96.8% ‐‐Improved 99.8% 99.1% ‐‐Same

55.6% 51% ‐Improved 66.7%

69.4%‐

Deteriorated 77.8% 83.7%‐Deteriorated

100.0% Baseline 100.0% Baseline 100.0% Baseline

65.5% 37.5% ‐Improved 87.9% 60.9 %‐improved 93.1% 82.8 %‐improved

7/14/30

(17)

7 Day Rate

2010 7 Day

2010 14 Day

2010 30 Day

Rate/Change

34.6% 17%‐improved 45.7% 29.5%‐improved 59.3% 39.8%‐improved 41.2% 42.4%‐Deteriorated 55.9% 51.5%‐improved 70.6% 54.5% ‐improved

15.0% 0.0%‐improved 20.0% 2.3%‐improved 27.5% 61% ‐Deteriorated 34.4% 27.5% improved 52.5% 45.1%‐improved 59.0% 52.9%‐improved

7/14/30

7/14/30--Day Follow

Day Follow--Up Rate:

Up Rate:

Adolescent

(18)

7 Day Rate

2010 7 Day

2010 14 Day

2010 30 Day

Rate/Change

35.5% 44.6%‐Deteriorated 46.8% 55.4%‐Deteriorated 53.2% 61.5%‐Deteriorated 35.5% 44.6% Deteriorated 46.8% 55.4% Deteriorated 53.2% 61.5% Deteriorated 33.3% 22.7%‐improved 43.2% 42.7% ‐improved 53.1% 60% ‐Deteriorated 39.2% 39.9% ‐Same 47.1% 46.4% ‐improved 66.7% 58.9% ‐improved 26.5% 42.1% ‐Deteriorated 32.4% 52.6% ‐Deteriorated 50.0% 71.1%‐Deteriorated 69.0% 56% ‐improved 79.3% 72%‐improved 82.8% 76%‐improved

7/14/30

7/14/30--Day Follow

Up Rate:

Women with Children

(19)

7 Day Rate

2010 7 Day

2010 14 Day

2010 30 Day

Rate/Change

37.5% 25% ‐improved 43.8% 39.3%‐improved 50.0% 50%‐same 35.4% 18.8% ‐improved 44.1% 32.6%‐improved 60.6% 46.4% ‐improved 45.3% 40.3%‐improved 63.5% 54.2%‐improved 72.4% 63% ‐improved 30.9% 28.6% ‐improved 43.1% 39.8%‐improved 50.8% 46.7%‐improved 54 0% 43 8% improved 69 8% 56 3% improved 74 6% 62 5% improved 54.0% 43.8%‐improved 69.8% 56.3%‐improved 74.6% 62.5%‐improved 31.5% 16.8% ‐improved 41.1% 31.9%‐improved 52.1% 41.6%‐improved 37.0% 26.9%‐improved 49.2% 40.3%‐improved 59.6% 57.9%‐improved 29.3% 22.1% ‐improved 43.2% 35.6% ‐improved 50.9% 45% ‐improved 27.1% 22.4% ‐improved 38.4% 37.8% ‐improved 49.1% 50.2%‐Deteriorated 46.8% 26.7% ‐improved 56.3% 39.6% ‐improved 63.3% 53.1% ‐improved 52.8% 25% ‐improved 54.7% 39.1% ‐improved 60.4% 46.9% ‐improved 64.9% 25.9% ‐improved 71.0% 44% ‐improved 76.7% 55.4% ‐improved 38.1% 25% ‐improved 47.6% 42.9% ‐improved 61.9% 53.6% ‐improved 44 8% 35 3% improved 57 6% 49 7% improved 63 4% 58 8% improved 44.8% 35.3% ‐improved 57.6% 49.7% ‐improved 63.4% 58.8% ‐improved 35.5% 20% ‐improved 41.9% 30.9% ‐improved 54.8% 38.2% ‐improved 56.9% 36.9% ‐improved 74.3% 59.8% ‐improved 79.2% 67.2% ‐improved 67.4% 37.3% ‐improved 73.3% 53.3% ‐improved 75.6% 57.3% ‐improved 32.7% 66.7% ‐Deteriorated 52.7% 66.7% ‐Deteriorated 67.3% 83.3%‐Deteriorated

7/14/30

7/14/30--Day Follow

Up Rate:

Short Term

(20)

7 Day Rate

2010 7 Day

2010 14 Day

2010 30 Day

Rate/Change

48.0% 28%‐Improved 60.0% 46.0%‐‐Improved 72.0% 60.0%‐‐Improved 40.7% 25.9% ‐Improved 49.7% 40.3% ‐Same 57.2% 47.5% ‐Improved 82 2% 70 7% Improved 91 1% 79 3% Same 91 1% 82 8% Improved 82.2% 70.7%‐Improved 91.1% 79.3% ‐Same 91.1% 82.8%‐Improved 54.8% 28% ‐Improved 61.3% 37.5% ‐Improved 64.5% 52% ‐Improved 25.0% 28.6%‐Deteriorated 33.3% 46.4%‐Deteriorated 54.2% 57.1% ‐Improved 66.7% 14.8%‐improved 66.7% 33.3% ‐improved 71.4% 44.4% ‐improved 70.0% 33.3% ‐Improved 70.0% 51.9% ‐improved 80.0% 70.4% ‐improved

62 5% 48 9% i d 75 0% 57 4% i d 87 5% 59 6% i d

7/14/30

7/14/30--Day Follow

Up Rate:

Long

Long--Term

Term

62.5% 48.9% ‐improved 75.0% 57.4% ‐improved 87.5% 59.6%‐improved

Long

(21)

Includes

Excludes

Includes

Excludes

Readmission only

to an Rehab

Individuals

admitted to

Detox or

Inpatient

Readmission can

be to the

Inpatient

Individuals who

be to the

discharging

Rehab or to

another Rehab

d dua s

o

become ineligible

for Health

Choices

7/30

7/30--Day Readmission Rate

Day Readmission Rate

Based on claims received for Rehab within 30

days of the final day of a Rehab episode

7/30

(22)



We looked at the following scenarios for Rehab

Readmission

◦

Readmission following an AMA discharge

◦

Readmission following a successful discharge

◦

Readmission to the same Rehab provider

p

◦

Rehab to a different Rehab provider



We learned

◦

Readmission rates to Rehab within 30 days are very low in

general

◦

Repeated stays in Rehab are often denied if the individual

has not carried out his/her follow-up plan

◦

Individual choice of provider is less of a factor than bed

availability and the location where the individual presents



We are looking forward to your thoughts and

comments on these data

7/30

7/30--Day Readmission Rate

Day Readmission Rate

7/30

(23)

Readmission Readmission Same Provider AMA/AWOL/ AFA Readmission Same Provider AMA/AWOL/ AFA Readmission Different Provider AMA/AWOL/ AFA Readmission Different Provider AMA/AWOL/ AFA Readmission Same Provider Non‐ AMA/AWOL/AFA Readmission Same Provider Non‐ AMA/AWOL /AFA Readmission Different Provider Non‐ AMA/AWOL/AFA Readmission Different Provider Non‐ AMA/AWOL/AFA 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate

0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.2%

0.00% 0.0% 0.0% 0.0% 0.0% 6.7% 0.0% 0.0%

0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

7/30

7/30--Day Readmission Rate:

Day Readmission Rate:

Methadone

(24)

Readmission Same Provider AMA/AWOL/ AFA Readmission Same Provider AMA/AWOL/ AFA Readmission Different Provider AMA/AWOL/ AFA Readmission Different Provider AMA/AWOL/ AFA Readmission Same Provider Non‐ AMA/AWOL/AFA Readmission Same Provider Non‐ AMA/AWOL/AFA Readmission Different Provider Non‐ AMA/AWOL/AFA Readmission Different Provider Non‐ AMA/AWOL/AFA AFA 07 Day Rate AFA 30 Day Rate AFA 07 Day Rate AFA 30 Day Rate AMA/AWOL/AFA 07 Day Rate AMA/AWOL/AFA 30 Day Rate AMA/AWOL/AFA 07 Day Rate AMA/AWOL/AFA 30 Day Rate 0.00% 33.3% 0.0% 0.0% 6.4% 10.3% 1.3% 1.3% 0.00% 0.0% 0.0% 0.0% 6.1% 6.1% 0.0% 3.0% 0 00% 0 0% 0 0% 0 0% 6 % 6 % 0 0% 3 0% 0.00% 0.0% 0.0% 0.0% 2.5% 32.5% 0.0% 0.0% 0.00% 5.6% 0.0% 0.0% 0.0% 7.0% 0.0% 0.0%

7/30

7/30--Day Readmission Rate:

Adolescents

(25)

Readmission Readmission Readmission iff

Readmission iff

Readmission Readmission Readmission

iff d i i Same Provider AMA/AWOL/ AFA 07 Day Rate Same Provider AMA/AWOL/ AFA 30 Day Rate Different Provider AMA/AWOL/ AFA 07 Day Rate Different Provider AMA/AWOL/ AFA 30 Day Rate Same Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Same Provider Non‐ AMA/AWOL/ AFA 30 Day Rate Different Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Readmission Different Provider Non‐ AMA/AWOL/AFA 30 Day Rate 0.00% 5.3% 0.0% 10.5% 0.0% 0.0% 2.3% 4.7% 0.00% 3.1% 3.1% 3.1% 0.0% 0.0% 2.0% 4.1% 0 00% 0 0% 5 9% 11 8% 0 0% 0 0% 0 0% 0 0% 0.00% 0.0% 5.9% 11.8% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 5.9% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 4.8%

7/30

7/30--Day Readmission Rate:

Women with Children

(26)

Readmission Readmission Readmission Readmission Readmission Readmission Same Provider AMA/AWOL/A FA 07 Day Rate Readmission Same Provider AMA/AWOL/AFA 30 Day Rate Readmission Different Provider AMA/AWOL/AFA 07 Day Rate Readmission Different Provider AMA/AWOL/ AFA 30 Day Rate Readmission Same Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Readmission Same Provider Non‐ AMA/AWOL/ AFA 30 Day Rate Readmission Different Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Readmission Different Provider Non‐ AMA/AWOL/ AFA 30 Day Rate 0 00% 0 00% 0 00% 33 3% 0 00% 0 00% 0 00% 0 00% 0.00% 0.00% 0.00% 33.3% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 2.0% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.0% 0.64% 1.28% 0.00% 0.00% 0.00% 0.00% 0.00% 7.4% 0.00% 0.00% 0.00% 0.73% 0.00% 0.00% 0.00% 14.3% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.0% 0.00% 0.00% 1.61% 1.61% 0.00% 0.00% 0.00% 0.0% 1.57% 4.31% 1.57% 1.96% 0.00% 0.00% 0.00% 5.3% 0.00% 0.00% 0.00% 0.85% 0.00% 0.40% 1.59% 3.6% 2.45% 3.54% 0.00% 0.00% 0.00% 0.00% 0.00% 1.3% 0.84% 0.84% 0.84% 1.67% 0.00% 0.00% 0.00% 0.0% 0.00% 2.38% 0.00% 0.00% 0 00% 0 00% 0 00% 2 8% 0 30% 1 19% 0 00% 0 00% 0.00% 0.00% 0.00% 2.8% 0.30% 1.19% 0.00% 0.00% 0.00% 100.00% 0.00% 0.0% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 2.56% 5.1% 1.50% 1.50% 1.50% 2.26% 0.00% 0.00% 0.00% 16.7% 0.00% 0.00% 0.00% 4.00% 0.00% 0.00% 0.00% 0.0% 1.49% 1.49% 0.00% 0.00% 0.00% 0.00% 6.25% 6.3% 0.00% 0.00% 0.00% 1.43%

7/30

7/30--Day Readmission Rate: Short

Day Readmission Rate: Short

Term

0.00% 0.00% 0.00% 0.0% 1.92% 1.92% 0.00% 0.00%

Term

(27)

Readmission Same Provider AMA/AWOL/ AFA 07 Day Rate Readmission Same Provider AMA/AWOL/ AFA 30 Day Rate Readmission Different Provider AMA/AWOL/ AFA 07 Day Rate Readmission Different Provider AMA/AWOL/ AFA 30 Day Rate Readmission Same Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Readmission Same Provider Non‐ AMA/AWOL/ AFA 30 Day Rate Readmission Different Provider Non‐ AMA/AWOL/ AFA 07 Day Rate Readmission Different Provider Non‐ AMA/AWOL/ AFA 30 Day Rate 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate 07 Day Rate 30 Day Rate

0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 0.0% 0.0% 1.7% 0.0% 0.9% 0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 0.0% 5.6% 16.7% 0.0% 0.0% 0.00% 0.0% 0.0% 16.7% 0.0% 0.0% 0.0% 0.0% 0.00% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 00% 0 0% 14 3% 14 3% 5 9% 5 9% 0 0% 0 0%

7/30

7/30--Day Readmission Rate: Long

Day Readmission Rate: Long

Term

0.00% 0.0% 14.3% 14.3% 5.9% 5.9% 0.0% 0.0%

Term

(28)



Based on claims for Rehab, Detox, or

as d o

a

s o

ab,

o , o

Inpatient on or after the day of discharge

from Rehab

Excludes

Individuals

readmitted to

Acute levels

of care

Individuals

who lose

eligibility

90

90--Day Recovery Initiation Rate

Day Recovery Initiation Rate

g

y

90

(29)

2010 Recovery Initiation

90

Day

Recovery

Initiation

Rate

2010

Recovery

Initiation

Rate/Change

94.1% 94.5%‐same 94.4% 91.8%‐improved 100.0% Baseline 98.3% 93.8%‐improved

90

90--Day Recovery Initiation Rate:

Day Recovery Initiation Rate:

MAT

(30)

90

Day

Recovery

Initiation

Rate

2010

Recovery

Initiation

Rate/Change

82.7% 90.91% ‐Deteriorated

66.3% 44.27% ‐Improved

90

90--Day Recovery Initiation Rate:

Adolescents

(31)

90 Day Recovery Initiation Rate

2010 Recovery Initiation Rate/Change

90

Day

Recovery

Initiation

Rate

2010

Recovery

Initiation

Rate/Change

87.1% 89.23% ‐Deteriorated 85.2% 76%‐improved 92.2% 87.5%‐improved 91.2% 65.79%‐improved 86.2% 72%‐improved

90

Women with Children

(32)

90

Day

Recovery

Initiation

Rate

2010

Recovery

Initiation

Rate/Change

87.5% 92.86% ‐Deteriorated 86.6% 82.61% ‐Improved 90.1% 92.59% ‐Deteriorated 86 9% 84 17% Improved 86.9% 84.17% ‐Improved 90.5% 93.75%‐Deteriorated 95.9% 84.96% ‐Improved 89.9% 82.87% ‐Improved 84.6% 73.91% ‐Improved 84.8% 83.69% ‐Improved 91.5% 83.90% ‐Improved 86.8% 79.69% ‐Improved 95.2% 92.77% ‐Improved 90.5% 78.57% ‐Improved 88.4% 89.54%‐Deteriorated 74.2% 81.82%‐Deteriorated 93.8% 94.26%‐Deteriorated 95.3% 89.33% ‐Improved 96 4% 100%‐Deteriorated

90

Short Term

96.4% 100% Deteriorated

Short Term

(33)

90 Day Recovery Initiation Rate

2010 Recovery Initiation Rate/Change

90

Day

Recovery

Initiation

Rate

2010

Recovery

Initiation

Rate/Change

92.0% 90% ‐Improved 85.5% 77.70% ‐Improved 97.8% 94.83% ‐Improved 83.9% 68% ‐Improved 79.2% 53.57% ‐improved 90.5% 77.78% ‐improved 90.0% 92.59% ‐deteriorated 70 8% 85 11%‐deteriorated

90

Long Term

70.8% 85.11% deteriorated

Long Term

(34)



Data on this measure is not available yet,

a a o

s

asu

s o a a ab

y ,

but it will be included in the individual

performance summaries you receive.

AMA/AWOL/AFA Rate

(35)



7/14/30-Day Follow-Up

/

/30

ay o o

Up



7/30 Readmission



90-Day Recovery Initiation

y



AFA/AWOL/AMA Rate



Our questions:

◦

Do we use readmission data, and how?

◦

Should CRC visits and/or 23-hr beds “break”

recovery for the recovery initiation mesure?

◦

Should we use follow-up for adolescents?

Measures Summary

(36)

Outcomes Transformation Project

(37)



Very soon, you will receive a letter laying

y

, y

y g

out a timeline for a quality improvement

project

We will provide you with a monitoring tool



We will provide you with a monitoring tool

– a post-treatment monitoring survey



This fall, you will conduct a baseline

, y

survey in your agency



You will use the results of that baseline to

i f

lit i

t j t

inform a quality improvement project

during 2013

What to Expect

(38)

Discussion

(39)



Are there measures you use that show

asu s you us

a s o

individuals getting better over time?

◦

Structured tools and assessments



Do you currently measure and report on

family involvement?

H

d

th

t l t i f



How do you use these tools to inform

practice at your agency?

What Do You Measure and Report

On?

(40)



What are your obstacles in using pay-for-

a a

you obs a

s

us g pay o

performance data to drive agency

change?



Is pay-for-performance improving your

agency’s quality of care?

Barriers to Change

(41)



Feedback survey post-meeting (next week)

y p

g (

)



Your individual performance data will be

made available shortly.



If you have any questions about the data for

your agency, please let us know by Oct 25.



Post-treatment monitoring information will be



Post-treatment monitoring information will be

sent out by Oct 25.



Send recommendations for future measures

to us by Dec. 1.

Next Steps