180 SCAN: SYSTEM PERFORMANCE – DMC-ODS 6 MONTHS POST IMPLEMENTATION PRESENTED BY RESEARCH & OUTCOME MEASUREMENT (ROM), QUALITY IMPROVEMENT & DATA SUPPORT & ADMINISTRATION SUBSTANCE USE TREATMENT SERVICES FEBRUARY 28 2018 1
Agenda Welcome Overview DMC-ODS Changes– Presenter: Kakoli Banerjee Authorization, Placement & QI measures – Presenters: Olena Chesnakova, Katherine Christian Contract performance measures – Presenters: Patricia Rubio-Corona, Sujung Kim Waiver services trends: Presenter: Kakoli Banerjee Client outcomes: Presenter: Kimberly D'zatko Service efficiency: Presenter: Leilani Villanueva Wrap up: Kakoli Banerjee 2
The 180 SCAN A 180 scan is analogous to a wide angled view or perspective of a landscape in which the entire field is visible. 3
Goals of the 180 SCAN The goals of the 180 Scan are to: Review the state of the System of Care six-months post implementation of the DMC-ODS, also known as the Medi-Cal Waiver The 180 Scan examines the following elements of the SUTS System of Care: clinical processes, client outcomes, system performance, system efficiency 4
180 SCAN Series Purpose To foster a culture of data driven system improvement in the SUTS system of care To provide managers, decision makers, clinicians and other with a high level view of how the system is functioning To develop a common understanding of the strengths & weaknesses of the system 5
Brief Overview of DMC-ODS Pilot: The 3 Main Components of the Medi-Cal Waiver Clinical: ASAM-based clinical framework of treatment delivery Operational philosophy: Use of managed care principles (based on 438) to operate the business side of the delivery system Quality improvement: Monitoring service quality according to Managed Care Plan’s Quality Improvement Plan 6
Clinical Framework of Tx Delivery Pre-& Post-Waiver Domain Pre-Waiver Post-Waiver OP 1.0, 2.1 OP 2.5 ASAM Levels Residential 3.1 Residential 3.3, 3.5 WM 3.2 Recovery Svcs Additional MAT Authorization for svcs None Authorization-Residential Tx Medical necessity limited Application to all SUTS Medical Necessity to few SUTS services services 7
Managed Care Changes Pre-& Post-Waiver Domain Pre-Waiver Post-Waiver Operations based on 42 CFR 438 County Operations Managed care for principles (Federal managed care Framework some functions principles) DHCS certification not DHCS certification for Certification mandatory billing Expanded array of Medi-Cal billable Limited billable billable modalities & services modalities & Svcs svcs 8
Quality Improvement Requirements Pre- & Post-Waiver Domain Pre-Waiver Post-Waiver Distinctions between LPHA Service provider Functions of credentialed and credentialed staff, & licensed staff not particularly for billable credentials services clearly defined Evidence –based Required- at least treatment two per tx modality Recommended Quality External Quality Review No external review Improvement Organization (EQRO) 9
180 SCAN OF SUTS SYSTEM OF CARE: Key Components System ALOC & Access Waiver Client Efficiency performance measures Services outcomes measures measures 10
Crosswalk Between 180 Scan & External Requirements 180 SCAN EXTERNAL REQUIREMENTS Clinical measures (ALOC) EQRO – Quality (Transitions in ASAM care, Authorization for residential tx, indicated versus actual LOC) System Performance measures SUTS contract performance metrics EQRO – Access metrics, admissions by AID code DHCS – Timeliness metrics IGA – Section 24 – Timeliness metrics, care coordination, Waiver services IGA Section Quality Management & Services utilization Client outcomes IGA – Section 24 –Assessment of beneficiaries experience Efficiency measures EQRO- Access/Cost effectiveness 11
Scope of the 180 Scan The 180 Scan reviews data for approximately 6 months of the DMC -ODS July 1 – December 31, 2017 Covers about 3,400 admissions across all tx modalities in AOSC & YSOC The analysis focuses mainly on DMC providers, but data from the whole system of care is presented where relevant The 180 Scan is designed as a point in time system assessment The first year DMC-ODS evaluation results will be presented in December 2018 12
Admissions by Modality in the Adult System of Care (n=3,068 admissions) 13
Admissions by Modality - Youth System (n= 350 admissions) 14
ALOC & Access Measures Katherine Christian & Olena Chesnakova 15
Timeliness of admission to OP treatment & OP ALOCs 16
Access to System of Care Gateway timeliness metrics: Screening to referral date, Referral date to admission date ALOCs: How is the ALOC used? Admission ALOCs Discharge ALOCs Clinical measures: Risk ratings for six dimensions Change in risk rating from admission to discharge Discharge status and risk rating Actions steps – assigned and completed at discharge 17
Access to OP Services: This section will cover: Interval between first screening date and referral date (Gateway) Interval between referral date and admission date (Gateway) (Requirement: 10 business days) 18
Interval between Screen Date & Referral Date & Referral date & Admission Date -OP Admissions Jul - Dec 2017 (n=2329) First Screening Date and Referral Date (n=1243) Referral Date and Admission Date (n=1273) 600 180 160 n=300; n=973; AVG = 8 Business Days 500 24% 76% AVG 6.8 Business Days 140 400 120 ADMISSIONS 100 300 80 200 60 40 100 20 0 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 35 37 39 41 44 50 53 61 75 80 83 94 0 3 6 9 12 15 18 21 24 27 30 33 38 41 46 51 54 61 68 74 86 BUSINESS DAYS *Weekends and County Holidays are excluded. If Referral Date is missing, the screening day is used as the referral day. Interval of less than 0 days are excluded. DMC-ODS requirement for timeliness is 10 business days. 19
Gateway Screens and OP Admissions - Jul - Dec 2017 (n=2329) Gateway Referrals , Admissions (n=2329) Referral Date to First Intake (n=1273) 100% 100% 13% 90% 90% 24% 80% 80% 28% 70% 70% 60% 60% 50% 50% 40% 40% 42% 76% 30% 30% 20% 20% 10% 10% 17% 0% 0% Gateway Call Last 6 Months 10 Business Days 10 Business Days 11 Days and more No Gateway Calls Last 6 Months 11 Days and more 76% of admissions occurred within 10 business days of the Gateway Referral. Average time to placement was 8 business days. 20
ALOC is the ticket into our System of Care ASAM determines the appropriate placement of clients into intervention or treatment services. Clinical data is collected at both admission and discharge Requirements: An ALOC is required for each Residential and OP admission and discharge. Data Analysis: At waiver start (7-1-17), ALOCs were collected in PDF format. Starting mid-August, ALOCs were entered into Profiler. PDF data and Profiler data were merged for analysis. Timeframe: Outpatient client admissions that occurred between 10/1/17 & 12/31/17 are analyzed unless otherwise noted. Outpatient discharges are linked to admissions that occurred during this time period. Both DMC and non-DMC clients are included in the ALOC and Access measures Residential section. 21
ALOC Organization B1 – Initial authorization for residential LOC B2 – Authorization of an extension for residential LOC B3 – Assessments – Non-authorization requests Only one section B1, B2 or B3 is to be completed per ALOC . 22
Outpatient -- ALOC Assessments – Non-authorization Requests (B3) Percent of total ALOCs (n=889) (Oct – Dec 2017) Intake - NotAuthRequest 51% Transfer to different provider same LOC 4% Routine LOC change - Not authorization request 5% Interval Assessment 2% DMC extension of OP treatment services 0% Discharge ALOC - no follow up services 12% Other 26% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% % of Total ALOC's 23
Outpatient Admission ALOCs (n = 963) ( Oct – Dec 2017) Admissions with ALOC's Admissions Missing ALOCs 25% 24
Indicated vs Actual LOC -ALOCs Percent of Total ALOCs (n= 1,117) Outpatient & IOP (Oct - Dec 2017) 1 OP to 0.5 Early Intervention .2% 1 OP to 1 OP 91% 1 OP to 1 OP/MAT/NTP .5% 1 OP to 3.1 RES .4% 1 OP to 3.2 WM .1% 1 OP to Recovery Services .1% 2.1 IOP to 1 OP .9% 2.1 IOP to 2.1 IOP 5% None 3% 0 10 20 30 40 50 60 70 80 90 100 Percent of Total ALOC's 25
Total OP ALOC assessments - Oct – Dec 2017 (n=1,108) ALOC assessments not associated with 80% 824 an admission: 74% 70% 1. Missing or N/A for current provider 60% 2. Missing or incorrect admission date 3. No admissions found in Unicare on 50% January 16th. 40% 30% 20% 169 118 15% 10% 11% 0% ALOC ASSESSMENTS Youth Adult Not Assosoated with Admission 26
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