Tim Knettler, MBA, CAE Executive Director/CEO

1. Ensuring Quality Outcomes in Behavioral Health Care with the Integration of HealthcareNASMHPD Annual MeetingWashington, DC July 29, 2014 Tim Knettler, MBA, CAE Executive Director/CEO National Association of State Mental Health Program Directors Research Institute, Inc. (NRI)

3. Table of Contents • NRI’s New Initiatives • 2013 State Profiles • 2014 Case Studies of Early Innovator States • Health/Behavioral Health Integration • Assessing two Outcomes for Consumers Served by State Mental Health Agencies: (1) Improving Competitive Adult Employment & (2) Reducing Homelessness • Psychiatric Hospital Reporting Performance Requirements – The New Landscape

4. New NRI Initiatives Strategic Planning and New Initiatives NRI Vision, Mission, Values • Vision: No person's life will be limited by mental illness or addiction. • Mission: NRI products and services support and enable actions that improve mental health and wellness. • Values: NRI pursues its mission according to the following core values: • Lack of bias • Life enhancing value • Insight

5. New NRI Initiatives NRI is working with its Board and States to develop new initiatives to meet State needs • Pilot/Develop an Integrated Medicaid Claims and State Behavioral Health Agency Data System • Customized State Reports to help SBHAs with budgeting, planning, operations and policy • Help SBHAs respond to critical incidents and legal actions by accessing the latest state and national data customized to state needs • Assessing the Premature Mortality of SBHA Clients • Psychiatric Hospital Analytics/Consultations to comply with new requirements and Improve Outcomes

6. 2013 State Profiles: Funding and Characteristics of SMHAs and SSAs • New SAMHSA publication that focuses on how SMHAs and SSAs are organized, financed and major policy initiatives • Jointly produced by NRI, NASADAD, and Truven Health Analytics • Focus on SMHA and SSA activities to integrate health-BH care and impact of ACA implementation • Report will be available on the SAMHSA website in August, 2014

7. 2014 State MH Profiles: Case Studies of Early Innovator States • Activities in 3 major policy areas— • Health-Behavioral Health Integration • Implementing Evidence-Based Practices • Changing SBHA Business Practices (including EHRs) • How Parity and ACA impact SBHA activities? • Effects on State General Funds and MH Block grants?

8. Health-Behavioral Health Integration: Early Results Factors that Impact Health-BH Integration: • Medicaid Support: Support for health integration initiatives from State Medicaid Agencies was a key to successful integration across the early innovator states. • State Leadership: Identifying a common cause, issue, report, or topic to rally state leadership around a focus on behavioral health was seen as vital.

9. Health-Behavioral Health Integration: Early Results (continued) Factors that Impact Health-BH Integration: • Long Term Planning:a long-term planning effort to comprehend the complexities of integration of system changes (can easily take from 1.5 to 3 years). • 42 CFR Part 2:limits the sharing of patient information on substance use clients restricts state’s ability to share substance use treatment data with primary care providers and HIEs.  

10. Focus on Two SAMHSA MH National Outcome Measures (NOMS) Improving Competitive Employment Reducing Homelessness Uses information from: the Annual CMHS/SAMHSA Uniform Reporting System (which collects information on 7.2 million persons served by SMHAs each year) MH-Client Level Data: de-identified client level data from SMHAs

11. Competitive Employment of Adults in the SMHA System: 2013 26.8% of all SMHA Adult Consumers had an unknown employment status in 2013, an improvement from 30% in 2003 Source: 2013 SAMHSA Uniform Reporting System (URS)

12. Percent of SMHA Mental Health Consumers Competitively Employed: 2003 to 2013

13. Adult Employment:Diagnostic Group2012, Employed At Start of Reporting Period , Ages 18-64 Total N=1,344,579 (59.8%); missing=902,982 (40.2%)

14. Employment Change During 2012 from T1 to T2 (For Clients Ages 18-64 who were Employed at T1) 2014 NASMHPD Commissioners Meeting: July 29, 2014 N=701,581

15. Living Situation of Adult Consumers: 2012

16. Homelessness Rate: Age & Gender2012, At Start of Reporting Period Male: N=1,070,796 (68.0%); missing=503,423 (32.0%) Female: N=1,143,532 (69.0%); missing=512,679 (31.0%)

17. Homelessness Rates: Major Diagnostic Groups2012, At Start of Reporting Period, Ages 18+ Total N=1,508,607 (63.6%); missing=864,935 (36.4%)

18. Living Situation at T2 (End of Year or Discharge) for SMHA Adult (age 18+) Consumers who were Homeless at T1 (Admission/Start of Year) Total N=1,054,951

19. Living Situation at T2 (End of Year or Discharge) for SMHA Adult (age 18+) Consumers who were Living in a Homelike Setting at T1 (Admission/Start of Year) Total N=1,054,951

20. Psychiatric Hospital Reporting Performance Requirements – The New Landscape

21. CMS Requirements - IPFQR • IPFQR program: Inpatient Psychiatric Facility Quality Reporting program • Free-standing psychiatric hospitals and psychiatric units (IPF) (approximately 1800) • Measures apply to the Medicare certified units reimbursed under the IPF Prospective Payment System (PPS) • Independent of accreditation • Failure to report quality measure results in a 2 percentage point reduction in the hospital’s annual payment update determination

22. Requirement – FFY2014 - Completed • Oct 2012 – Mar 2013 data on HBIPS 2 -7 • HBIPS: Hospital Based Inpatient Psychiatric Services core measure set. • Measure steward: The Joint Commission • 100% of NRI facilities met the requirement • 62 facilities lost 2 percentage points in their Annual Payment Update for not meeting the requirements (none of the NRI facilities lost revenue)

23. Current & Proposed CMS Reporting Requirements Reporting Requirements

24. Requirements – Current and Future • FFY2015 • April 2013 – Dec 2013 data on HBIPS 2-7 • FFY2016 • Calendar 2015 data on HBIPS 2-7; SUB-1: Alcohol Use Screen. • FUH: Follow-up after hospitalization. (Note: this measures will be calculated by CMS based on Claims data) • Attestation: Is facility conducting a “Patient Experience of Care” survey • Possible New Attestation: What level of Electronic Health Record (EHR) the facility is using during transitions of care

25. Requirements – Current and Future • FFY2017 • Continuation of all previous measures • Proposed new measures: • TOB1 – Tobacco Use Screen; TOB2 – Tobacco Use Treatment provided or offered, TOB2A– Tobacco Use Treatment provided • IMM-2: Influenza Immunization for patients • Influenza vaccination among health care personnel • Aggregate Population and Sample Counts, by Medicare/Not Medicare, Age Group, Diagnostic group • Also undergoing testing/development • Screenings within 1 day of admission • All cause, any location readmission rate

26. The Joint Commission Requirements • Complete reporting • Underreporting patient-level records will be questioned and must be corrected • The Joint Commission has had patient-level data for HBIPS since the beginning (2008) • The Joint Commission data integrity process mirrors the CMS process, although CMS only receives aggregate data for IPF at this time • Accountability rate • Summary calculation across the HBIPS measure must be at least 85% • Failure to meet performance levels will result in a ‘Request for Improvement Action Plan’ during the triennial review

27. Assisting your hospitals with compliance Know the rules, prepare to respond to proposed rule-making Ensure hospital commitment to meeting the performance expectation Encourage moving beyond the minimum expectation to use the data/information to improve care and coordination with other providers NRI – BHPMS resources include numerous reports to assist with quality initiatives and personal technical assistance

29. Contact Tim Knettler, MBA, CAE Executive Director/CEO www.nri-inc.org 3141 Fairview Park Dr., Suite 650 Falls Church, Virginia 22042-4539 Phone: (703) 738-8161 TKnettler@nri-inc.org