Connecticut Community KidCare Performance Indicator Project

1. Connecticut Community KidCare Performance Indicator Project Presentation to the Behavioral Health Oversight Committee, Quality Management and Access Subcommittee Virginia Mulkern, Ph.D. Human Services Research Institute May 27, 2005

2. What is Performance Measurement? “…the selection and use of quantitative measures of program capacities, processes, and outcomes…to inform the public or a designated public agency about critical aspects of a program, including its effects on the public.” Perrin, E.B., Durch, J.S., and Skillman, S.M. (eds) Health Performance Measurement in the Public Sector. National Academy of Sciences (1999)

3. Why Develop Performance Measures? • Clarify program mission • Create efficient monitoring mechanisms • Identify performance targets/benchmarks • Institutionalize the evaluation process • Allow regular reporting on performance to: • Consumers/potential consumers • Providers • Legislators • Regulators • Managers

4. Major National Efforts • Substance Abuse and Mental Health Services Administration • Mental Health Statistics improvement Program • Washington Circle Group • National Committee on Quality Assurance: Health Plan Employer Data and Information Set • American College of Mental Health Administrators • American Psychiatric Association • Exemplary state and local efforts • VT Performance Measurement Project • MA Performance monitoring project

5. How Performance Indicators are Used • Allocating resources • Rewarding performance • Promoting public MH system goals • Providing internal feedback to management and administration to identify and remediate problems • Providing information to external constituents • Selecting/contracting with providers

6. Outstanding Issues • Consensus on appropriate indicators (especially for children’s services) • Construction of specifications (numerators and denominators • Adequacy of information bases • Reliance on measures of structure and process • Methods of case mix adjustment • Consensus on standards/benchmarks • Mechanisms to verify data • Effective use of derived information

7. Goals of the KidCare PI Project • Develop a performance measurement system that includes a comprehensive set of PIs that reflect the shared goals for the KidCare system of care and have sound psychometric properties; • Implement the performance measurement system that will: • Provide data at the state, regional and contractor levels • Provide a means of monitoring: • Overall access • Quality • Cost-effectiveness • Performance-based contracts • Provide data for a periodic KidCare performance report card

8. Project Tasks • Assess stakeholders’ goals for the system of care • Identify a conceptual framework for the indicator set • Review performance measures currently used in the field (N= approx. 275) • Select candidate measures (N=75 – 100) • Identify final measures set (N=50) • Audit available data • Operationalize measures • Develop confidentiality procedures

9. Project Tasks (Cont.) • Develop full system documentation • Develop data collection and processing procedures (incl. risk adjustment) • Hold stakeholder conference • Implement system • Design and implement KidCare quarterly management reports

10. Where We Are Completed assessment of stakeholders’ goals for the system of care Findings • Capacity • Responsiveness • Efficiency • Effectiveness Identifying a framework for the measures set • Quality Indicators: Defining and Measuring Quality in Psychiatric Care for Adults and Children. Report of the APA Task Force on Quality Indicators and Report of the APA Task Force on Quality Indicators for Children. American Psychiatric Association 2002.

11. Quality Framework Access Prevention (access & quality) Quality/process/ appropriateness Satisfaction/ perceptions of care Outcomes/ effectiveness 1. Universal 2. Selected 3. Indicated 4. Prevention-minded treatment 1. Access to appropriate evaluation 2. Access to appropriately qualified clinicians 3. Access to appropriate treatment 4. Access to continuum of coordinated care 5. Access to culturally & linguistically competent services and providers 1. Comprehensive evaluation 2. Appropriate & effective treatment 3. Coordination of services 4. Continuity of care 1. Patient 2. Family 3. Clinician (provider) 1. Maximization of treatment participation 2. Reduction or stabilization of symptoms 3. Improvement of level of functioning of child 4. Improvement of quality of life for child 5. Improvement of quality of life for family 6. Minimization of social and economic costs 7. Minimization of restrictive care a. Global b. Cultural & linguistic competence c. Confidentiality a. Psychosocial treatment b. Medication a. Psychosocial treatment b. Medication c. Specialized services a. Access b. Cultural & linguistic competence c. Global d. Treatment planning e. Informed consent

12. Where We Are (Cont.) • Review existing measures • Literature search complete • 260 potential measures identified • Measures matrix nearly complete

13. Next Steps • Select candidate measures for DSS, DCF and Committee review (June 21, 2005) • Audit available data (September 15, 2005) • Select final measure set • Operationalize measures and create system documentation