June 16, 2011 Michael Reiter, PharmD Executive Director

1. Overview of APS California External Quality Review Organizationwith a Special Focus on Older AdultsCalifornia Mental Health Planning Council Older Adult Committee June 16, 2011 Michael Reiter, PharmD Executive Director Saumitra SenGupta, PhD Sandra Sinz, LCSW, CPHQ Information Systems Director Operations Director

2. Data: Hui Zhang, PhD • Production: Esperanza Calderon

3. CAEQRO Activities Quality and Performance Improvement Data Analysis Information Systems Capabilities Assessment Performance Improvement Projects EQRO Reviews Performance Measurement Consumer and Family Member Focus Groups Wellness, Recovery, and Resilience Cultural Competence Key Informant Interviews Final Report Technical Assistance and Training August 2008 Our Approach

4. Consistent core phases Pre-site planning Site visit Post-site analysis Customized to MHP Seven years’ data Input from many individuals Year-to-year follow up Annual update and revision of review materials Site Review Process Highlights We Heard From… • 1,047 people (FY05) • 1,612 people (FY06) • 2,666 people (FY07) • 663 Consumers and family members • 2,857 people (FY08) • 713 Consumers and family members • 3,274 people (FY09) • 767 Consumers and family members • 2,875 people (FY10) • 612 Consumers and family members

5. Key Components Tables Components • Quality • Access • Timeliness • Outcomes

6. Key Components Tables 1. Quality Components • A current strategic plan/initiatives drives the service delivery system • Quality management and performance improvement are organizational priorities • Data is used to inform management and guide decisions • Investment in information technology infrastructure is a priority • Integrity of Medi-Cal claim process, including determination of beneficiary eligibility and timely claims submission • Effective communication from MHP administration • Stakeholder input and involvement in system planning and implementation • Consumers and family members are employed in key roles throughout the system

7. Key Components Tables 2. Access Components • Service accessibility and availability are reflective of cultural competence principles and practices • Manages and adapts its capacity to meet service needs • Penetration Rates are used to monitor and improve access • Integration and/or collaboration with community based services

8. Key Components Tables 3. Timeliness Components • Tracks and trends access data from initial contact to first appointment. • Tracks and trends access data from initial contact to first psychiatric appointment. • Tracks and trends access data for timely appointments for urgent conditions. • Has a mechanism to assure timely access (within 7 days) to follow up appointments after hospitalization. • Tracks and trends No Shows and implements quality improvement activities to improve overall timeliness to services.

9. Key Components Tables 4. Outcomes Components • Consumer run and or consumer driven programs • Measures clinical and/or functional outcomes of consumers served • Has one active and ongoing (clinical) PIP • Clinical PIP shows post-intervention results • Has one active and ongoing (non-clinical) PIP • Non-Clinical PIP shows post-intervention results • Utilizes information from DMH/POQI Satisfaction Surveys • Utilizes information from Consumer Satisfaction Surveys

10. Consumer/Family Member Process • How do the EQRO reviews compare to other reviews of County Mental Health Plans? • What parts of the review do the C/FM consultants typically participate in? • Pre- and post-site, on-site • Key components • Focus groups • Highlights in conducting CFM focus groups (both the positives and the challenges).

11. Promising Practices County Webinar Presentations • Monterey • Using data for quality management and client centered care: Monterey experience post-EMR implementation • Presented on November 15, 2010 • Trinity • Process Mapping and Workflow Analysis: What, Why, How • Presented on December 16, 2010 • Marin • Providing Behavioral Health & Primary Care Services under One Roof: The Marin County Mental Health Experience • Presented on February 10, 2011

12. Access Key Findings — Eligibles v. Beneficiaries Served

13. Quality: Performance Improvement Projects • What is a Performance Improvement Project (PIP)? • In general terms, a PIP is “a systematic process for improving the quality of care and service designed, conducted and reported in a methodologically sound manner.” • To elaborate, the Protocol defines a PIP as “a set of related activities designed to achieve measurable improvement in processes and outcomes of care. Improvements are achieved through interventions that target health care providers, practitioners, plans, and/or beneficiaries.” (Human Services Research Institute, 2004) • PIPs are generally more functional if the MHP receives support than creating it in isolation. • Examples: SCERP I, SCERP II, CalMEND • Challenges • Rapid cycle measurements have been problematic; CalMEND can be of assistance

14. Quality: Performance Improvement Projects • Other PIP categories include: • Business process improvement • Co-occurring disorders • Physical health care • Psychiatrist/medication appointment • Retention • Wellness, recovery and resilience • Other

15. Outcomes High Cost Beneficiaries

16. Timeliness We ask counties for data on timeliness of first appointment, first psychiatric appointment, access to urgent care, post-hospitalization services, and No Shows

17. Information Systems

18. Information Systems # = Number of MHPs

19. CAEQRO Website - Homepage • www.caeqro.com • Register online, if you have not done so already

20. CAEQRO Website – Register

21. CAEQRO Website – Log-on Page

22. CAEQRO Website – Finding Data • Reports and Presentations Tab

23. CAEQRO Website – Finding Data • Data Analysis Tab

24. Penetration Rates by Age Groups

25. Number of Beneficiaries by Age Groups

26. Approved Claims by Age Groups

27. Penetration Rates by Race/Ethnicity

28. Number of Beneficiaries by Race/Ethnicity

29. Approved Claims by Race/Ethnicity

30. Number of Beneficiaries by Gender

31. Approved Claims by Gender

32. Older Adult Beneficiaries by Gender

33. Older Adult Approved Claims by Gender

34. Older Adult Beneficiaries by Age and Gender

35. Older Adult Approved Claims by Age and Gender

36. Older Adult Beneficiaries by Race/Ethnicity

37. Older Adult Approved Claims by Race/Ethnicity

38. Older Adult Beneficiaries by Age and Ethnicity

39. Older Adult Approved Claims by Age and Ethnicity

40. Number of Beneficiaries by Service Categories

41. Approved Claims by Service Categories

42. Number of Beneficiaries by Age Groups and Service Categories

43. Approved Claims by Age Groups and Service Categories

44. Older Adult Beneficiaries by Age and Service Categories

45. Older Adult Approved Claims by Age and Service Categories

46. Number of Older Adult Beneficiaries by MHP Size

47. Older Adult Approved Claims by MHP Size

48. Number of Older Adult Beneficiaries by Region

49. Older Adult Approved Claims by Region

50. Older Adult Service Retention