180 SCAN: SYSTEM PERFORMANCE DMC-ODS 6 MONTHS POST IMPLEMENTATION - - PowerPoint PPT Presentation

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

• f 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

7

Domain ASAM Levels Authorization for svcs

Medical Necessity

Pre-Waiver

OP 1.0, 2.1 Residential 3.1 WM 3.2

None

Medical necessity limited to few SUTS services

Post-Waiver

OP 2.5 Residential 3.3, 3.5 Recovery Svcs Additional MAT

Authorization-Residential Tx

Application to all SUTS services

Managed Care Changes Pre-& Post-Waiver

Domain County Operations Framework Certification Medi-Cal billable services Pre-Waiver Managed care for some functions

DHCS certification not mandatory

Limited billable modalities & Svcs Post-Waiver

Operations based on 42 CFR 438 principles (Federal managed care principles)

DHCS certification for billing

Expanded array of billable modalities & svcs

8

Quality Improvement Requirements Pre- & Post-Waiver

Domain Service provider credentials Evidence –based treatment Quality Improvement Pre-Waiver

Functions of credentialed & licensed staff not clearly defined

Recommended No external review Post-Waiver

Distinctions between LPHA and credentialed staff, particularly for billable services

Required- at least two per tx modality

External Quality Review Organization (EQRO)

9

180 SCAN OF SUTS SYSTEM OF CARE: Key Components

10

ALOC & Access measures System performance measures Waiver Services Client

• utcomes

Efficiency measures

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

16

Timeliness of admission to OP treatment & OP ALOCs

Access to System of Care

17

 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

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)

100 200 300 400 500 600 0 3 6 9 12 15 18 21 24 27 30 33 38 41 46 51 54 61 68 74 86 ADMISSIONS BUSINESS DAYS

First Screening Date and Referral Date (n=1243)

AVG 6.8 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.

20 40 60 80 100 120 140 160 180

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

Referral Date and Admission Date (n=1273)

n=973; 76% n=300; 24% AVG = 8 Business Days

19

Gateway Screens and OP Admissions - Jul - Dec 2017 (n=2329)

17% 42% 28% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Gateway Referrals , Admissions (n=2329) Gateway Call Last 6 Months 10 Business Days No Gateway Calls Last 6 Months 11 Days and more 76%

24%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Referral Date to First Intake (n=1273) 10 Business Days 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

21

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.  ASAM determines the appropriate placement of clients into intervention or treatment services.  Clinical data is collected at both admission and discharge

22

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 .

Outpatient -- ALOC Assessments – Non-authorization Requests (B3)

Percent of total ALOCs (n=889)

(Oct – Dec 2017)

23

26% 12% 0% 2% 5% 4% 51% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Other Discharge ALOC - no follow up services DMC extension of OP treatment services Interval Assessment Routine LOC change - Not authorization request Transfer to different provider same LOC Intake - NotAuthRequest % of Total ALOC's

Outpatient Admission ALOCs (n = 963)

(Oct – Dec 2017)

24

Admissions with ALOC's Admissions Missing ALOCs 25%

Indicated vs Actual LOC -ALOCs

Percent of Total ALOCs (n= 1,117)

Outpatient & IOP (Oct - Dec 2017)

25

3% 5% .9% .1% .1% .4% .5% 91% .2% 10 20 30 40 50 60 70 80 90 100 None 2.1 IOP to 2.1 IOP 2.1 IOP to 1 OP 1 OP to Recovery Services 1 OP to 3.2 WM 1 OP to 3.1 RES 1 OP to 1 OP/MAT/NTP 1 OP to 1 OP 1 OP to 0.5 Early Intervention Percent of Total ALOC's

Total OP ALOC assessments - Oct – Dec 2017 (n=1,108)

ALOC assessments not associated with an admission:

• 1. Missing or N/A for current provider
• 2. Missing or incorrect admission date
• 3. No admissions found in Unicare on

January 16th.

11% 74% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% ALOC ASSESSMENTS Youth Adult Not Assosoated with Admission

118 824 169

26

OP Discharge ALOCs (n=82) vs. OP Discharges (n=285) Oct -Dec 2017

963 285 82 200 400 600 800 1000 1200 Admissions Discharges Discharge ALOCs Assessments 71% 29% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% OP Discharges (n=285) with Discharge ALOC Assessments (n=82)

No Discharge ALOCs Discharge ALOCs Assessments *Discharge ALOC Assessment are defined as the assessments with Discharge ALOC - no follow up services, Routine LOC change - Non authorization request , Transfer to different provider same LOC in the ‘Progress Report, Transfer or Other Re-Assessment Documentation’ field, or the last ALOC Assessment of the

• Admission. Only 29% (82) discharge ALOC s were completed as of 1/16/2018.

27

Change in average risk rating (Summary) Oct - Dec 2017 (n=285)

No Discharge ALOCs (n=207)

71%

Discharge ALOC Assessments (n=82)

29%

22% 18% 60% DECREASE AVG (2.4)INCREASE AVG(2.8) NO CHANGE

22% of clients exhibited a decrease in the severity of risk ratings with an average decrease of 2.4; 28% of clients exhibited an Increase in the severity of risk ratings with an average increase of 2.8; 60 % of clients exhibited no changes in the severity of risk ratings.

28

CalOMS Discharge Status & Changes in Severity of Risk Ratings- Oct – Dec 2017 (n=82)

CalOMS Discharge Status Decrease Increase No Change Completed treatment 2% 0% 2% Left before completion 2% 1% 10% Administrative Discharge 13% 13% 21% No Caloms Discharge 4% 4% 27%

29

Risk Rating Severity by Dimension at OP Admission Oct – Dec 2017 (n=963)

Risk Rating

• 1. Acute Intoxication

and/or Withdrawal Potential;

• 2. Biomedical

Conditions and Complications

• 3. Emotional,

Behavioral, or Cognitive Conditions and Complications;

• 4. Readiness to

Change;

• 5. Relapse, Continued

Use, or Continued Problem Potential;

• 6. Recovery

Environment. *Shades of green indicate the percentage of clients by level of risk, with light green indicating low percentage. **Risk rating is indicated from dark blue to pink, with blue indicating Very Low (0) and pink- Critical(4).

• 1. AIWP
• 2. BIOCC
• 3. EBCCC
• 4. RTC
• 5. RCCPP
• 6. RE

63% 42% 43% 49% 12% 31% 1 9% 28% 22% 15% 27% 23% 2 2% 5% 10% 9% 29% 17% 3 0% 0% 1% 2% 6% 3% 4 0% 0% 0% 1% 0% 0% Missing 25% 25% 25% 25% 25% 25%

30

Change in Risk Rating between Admission & Discharge by Dimension Oct - Dec 2017 (n=82)

• 1. Acute

Intoxication and/or Withdrawal Potential

• 2. Biomedical

Conditions and Complications

• 3. Emotional,

Behavioral, or Cognitive Conditions and Complications

• 4. Readiness to

Change

• 5. Relapse,

Continued Use, or Continued Problem Potential

• 6. Recovery

Environment.

• 1. AIWP
• 2. BIOCC
• 3. EBCCC
• 4. RTC
• 5. RCCPP
• 6. RE

No Change 91% 84% 90% 83% 76% 82% Increase 4% 9% 7% 7% 11% 9% Decrease 5% 7% 2% 10% 13% 10% 5% 7% 2% 10% 13% 10% 4% 9% 7% 7% 11% 9% 91% 84% 90% 83% 76% 82% Decrease Increase No Change

31

Action Steps Assigned vs Completed at Discharge for Discharges with ALOC Assessments - Oct – Dec 2017 (n=82)

11% 2% 1% 27% 59% 100% between 99% and 50% less than 50% 0% Missing

59% of discharge ALOCs did not provide information on assigned/ completed steps. 27% of discharge ALOCs showed 0 on assigned and/or completed steps. 11% of discharge ALOCs showed that 100% of assigned steps had been completed.

32

Take Home Message

Only 82 (29%) of discharge /transfer ALOC Assessments were completed for 285 discharges There is insufficient information to provide reliable clinical outcomes at the moment Admission and discharge/transfer ALOC assessments should be completed for each admission

33

Contract Performance Measures

Patricia Rubio-Corona & Sujung Kim

34

DMC-ODS Adult Outpatient

35

Introduction

 Contract performance measures are included in the contract (Exhibit 3-A) to monitor services and outcomes.  All data used in this report are extracted from Profiler (Unicare).  Please note that the report assumes that all agencies are entering their data regularly and accurately. (Admission data were pulled from UNICARE on Jan 16th 2018)  Research & Outcome Measurement staff have developed standard formulas for computing.  Each measure and the same process is used to generate numbers for all Outpatient agencies.

36

Adult Outpatient Client Flow: Jul – Dec 2017

• Adult monthly admissions to outpatient treatment
• Open (unduplicated) adult clients in outpatient treatment
• Adult monthly discharges from outpatient treatment
• Adult monthly discharge status from outpatient treatment

https://www.americanprogress.org/issues/immigration/reports/2013/03/08/55674/living-in-dual-shadows/

37

Adult Monthly Admissions Jul – Dec 2017 (n=1,894)

329 334 300 420 305 206 50 100 150 200 250 300 350 400 450 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Number of Admissions Monthly average: 316 clients

38

Adult Monthly (unique) Open Clients Jul – Dec 2017 (n=3,360)

1,301 1,282 1,263 1,393 1,406 1,351

200 400 600 800 1,000 1,200 1,400 1,600 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Number of Clients

Monthly average: 1,333 clients

39

Adult Monthly Discharges Jul – Dec 2017 (n=1,655)

324 319 263 284 255 210 50 100 150 200 250 300 350 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Number of Discharges Monthly average: 276 clients

40

CalOMS Adult Discharge Status Jul – Dec 2017 (n=1,655)

59% 48% 53% 51% 53% 44% 25% 33% 27% 28% 27% 40% 5% 5% 5% 9% 12% 4% 11% 14% 14% 12% 9% 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of Discharges

No CalOMS discharge status Left before treatment completion (Not administrative discharge) Completed Treatment/Recovery Plan Adminstrative discharge

41

Adult Outpatient Treatment Measures: Jul - Dec 2017

 Operational Capacity  Number of days between intake and first treatment session  Percent of clients with ≥ 4 services in the first 30 days after admission  Percent of clients with a service gap greater than 30 days

42

Adult Outpatient Operational Capacity

Jul – Dec 2017 (n=1,784)

73% 72% 71% 78% 79% 76% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Percent of Operational Capacity

1,301 1,282 1,263 1,393 1,406 1,351

Six month average: 75%

43

For adult outpatient, the average wait time between intake date and first treatment session during July 2017 – December 2017 DMC-ODS (Waiver) was TEN days. Performance standard is that the average wait time between intake date and first treatment session is less than 14 days. System wide this measure has been met for adult outpatient. Timely access is a critical measure in the DMC-ODS era, and DHCS expects all Medi-Cal certified providers to demonstrate timely access.

Adult Outpatient Average Wait Time Between Intake and First Treatment Session

44

Adult Outpatient Clients with 4+ Services In The First 30 Days Jul – Dec 2017 (n=1,894)

40% 46% 49% 47% 45% 45% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Percent of Clients

Six month average: 45%

45

No Services in 30+ Days Jul – Dec 2017 (n=3,360)

16% 18% 16% 20% 10% 11% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of Clients Six month average: 15%

46

DMC-ODS YOUTH OUTPATIENT

47

Youth Outpatient Client Flow: Jul – Dec 2017

 Youth monthly admissions to outpatient treatment  Open (unduplicated) youth clients in outpatient treatment  Youth monthly discharges from outpatient treatment  Youth monthly discharge status from outpatient treatment

https://www.americanprogress.org/issues/immigration/reports/2013/03/08/55674/living-in-dual-shadows/

48

Youth Monthly Admissions Jul – Dec 2017 (n=353)

38 87 71 67 55 35 10 20 30 40 50 60 70 80 90 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Number of Clients

Monthly average: 59 clients

49

Youth Monthly (unique) Open Clients Jul – Dec 2017 (n=473)

119 167 181 221 235 225 50 100 150 200 250 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Number of Clients

Monthly average: 192 clients

50

Youth Monthly Discharges Jul – Dec 2017 (n=237)

36 41 41 39 39 41 5 10 15 20 25 30 35 40 45 50 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Number of Discharges

Monthly average: 40 clients

51

CalOMS Youth Discharge Status Jul – Dec 2017 (n=237)

69% 49% 59% 79% 62% 44% 14% 24% 12% 8% 21% 29% 6% 20% 27% 5% 8% 20% 11% 7% 2% 8% 10% 7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of Discharges No CalOMS discharge status Left before treatment completion (Not administrative discharge) Completed Treatment/Recovery Plan Adminstrative discharge

52

Youth Outpatient Treatment Measures: Jul - Dec 2017

 Operational Capacity  Number of days between intake and first treatment session  Percent of clients with ≥ 4 services in the first 30 days after admission  Percent of clients with a service gap greater than 30 days

53

Youth Outpatient Operational Capacity

Jul – Dec 2017 (n=475)

25% 35% 38% 47% 49% 47% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of operational capacity

167 181 221 235 225 119

Six month average: 40%

54

 For Youth outpatient, the average wait time between intake date and first treatment session during July 2017 – December 2017 DMC-ODS (Waiver) was 6.5 days.  Performance standard is that the average wait time between intake date and first treatment session is less than 14 days. System wide this measure has been met for Youth outpatient.  Timely access is a critical measure in the DMC-ODS era, and DHCS expects all Medi-Cal certified providers to demonstrate timely access.

Youth Outpatient Average Wait Time Between Intake and First Treatment Session

55

Youth Outpatient Clients with ≥ 4 Services In the First 30 Days Jul – Dec 2017 (n=353)

68% 55% 76% 72% 62% 54% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of Clients Six month average: 65%

56

No Services in ≥ 30 Days Jul – Dec 2017 (n=473)

17% 36% 31% 25% 9% 9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Percent of Clients Six month average: 21%

57

Take home message

58

 Performance measurements are only as good as the data uploaded to Profiler by treatment agencies.

Waiver Services

Kakoli Banerjee

59

Waiver services

This section focuses on ASOC & YSOC DMC-ODS providers

The figuResidential shown do not include NTP/OTP, county clinics, and contract agencies that are not currently certified to provide DMC services All data are from UniCare, extracted on January 17 2018. December data was refreshed on February 16 2018

This section covers:

Length of stay Categories of OP services Medi-Cal payors for services Cancellations and no shows

60

OP, IOP, Residential & Recovery Services Adult System – Jul-Dec 2017 (n=30386)

61

579 1,456 1,467 3,803 3,620 3,078 6 35 43 68 87 76 1,089 2,680 3,017 2,878 2,579 2,730 42 159 56 323 286 370 1,000 2,000 3,000 4,000 July Aug Sep Oct Nov Dec Units of service OP Rec Svcs Bed days IOP

Length of stay residential Tx-Adult System – Jul-Dec 2017 (n=641 discharges)

87 89 101 176 26 26 26 27 26 25 21 25 20 40 60 80 100 120 140 160 180 200 Mariposa P House Horizon SoC Number of days Max Mean Median

62

Type of OP service by month -Adult System Jul-Dec 2017 (n=14,325)

5% 10% 13% 7% 8% 5% 41% 16% 13% 6% 6% 5% 47% 37% 30% 31% 32% 34% 7% 37% 44% 57% 54% 56% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% July Aug Sep Oct Nov Dec % of all OP services TCM Intake Ind Tx Grp Tx

63

OP, IOP, Rec Svcs, Residential Tx by Medi-Cal Payor- Adult System – Jul-Dec 2017 (n=30,646 services)

63% 56% 57% 53% 52% 48% 62% 49% 68% 62% 56% 39% 67% 57% 23% 25% 35% 28%

68% 77% 75% 84% 84% 84%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

July Aug Sep Oct Nov Dec % of services

OP IOP REC SVCS RES

64

No shows & cancellations-OP Tx – Adult System Jul- Dec 2017 (n=14,153)

4% 4% 4% 7% 7% 7% 11% 18% 17% 22% 23% 25% 85% 78% 79% 71% 70% 67% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% July Aug Sep Oct Nov Dec % of recorded svcs Cancellation No shows Services

566 1,474 1,514 3,882 3,652 3,065

65

OP Services-Youth System Jul-Dec 2017 (n=3,824)

134 412 610 908 1,012 748 200 400 600 800 1000 1200 July Aug Sep Oct Nov Dec Number services

66

Maximum, Mean & Median Length of stay- OP-Youth System – Jul-Dec 2017 (n=339)

137 81 131 174 134 174 64 36 35 47 70 52 66 37 45 56 62 59 50 100 150 200 CFCS SchoolBased CFCS Clinic HR 360 Pway Youth Advent youth YSOC Days in treatment Max Median Mean

67

Type of OP service by month -Youth System Jul-Dec 2017 (n=3,369)

4% 0% 6% 7% 5% 7% 23% 0% 9% 9% 5% 3% 43% 0% 54% 48% 57% 60% 30% 0% 31% 36% 33% 30% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% July Aug Sep Oct Nov Dec % of all services for month TCM Intake Ind Tx Grp Tx

68

OP Services by Medi-Cal Payor Youth System Jul-Dec 2017 (n=3,824)

36% 27% 19% 22% 23% 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% l % of DMC services

July Aug S ep Oct Nov Dec MC payor

48 113 117 199 228 23

All S vcs

134 412 610 908 1012 748

69

No shows & cancellations-OP Tx – Youth System Jul- Dec 2017 (n=3,593)

9% 5% 3% 2% 2% 3% 90% 1% 96% 97% 97% 96% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% July Aug Sep Oct Nov Dec % of services Cancellation No shows Services

70

Take home message

 The DMC-ODS pilot provides an opportunity to expand our service array.  SUTS capacity to track these services depends on timely and accurate data entry.  My take home message:

Enter data early and often!

Client Outcomes

Kimberly D’zatko

72

Client Outcomes

 Treatment episodes over time (Data sources: CalOMS, Profiler)  Change in substance use from admission to discharge (Data source: CalOMS  Other outcomes:

• Connection to school or employment (CalOMS)
• Income change (Client Feedback Survey),
• Housing status change (Client Feedback Survey),
• Legal issues change (Client Feedback Survey)

Outcomes pertain to clients who were discharged during the period Jul– Dec. 2017

73

79% 14% 4% 2% 1% < 1% < 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 3 4 5 6 7 Percent of Clients Number of Distinct Treatment Episodes*

Vast Majority of Clients Discharged during the Period (n=2,568) were in SCC Treatment System for the First Time

History of the clients who were discharged Jul– Dec 2017 (n=2,568)

*Treatment episode defined for these analyses as an admission occurring 50 or more days from previous discharge.

74

Substance use at discharge Jul-Dec 2017 (n = 2,787*)

52% 1% 8% 5% 1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

No substance use Used once Used between 2 and 20 days Used between 21 and 29 days Used every day

Percent of Discharged Clients

Number of Days Used During 30 Days Leading up to Discharge

Substance use leading up to discharge

*No reported substance use data for 1,379 (33%)discharged clients

75

Just Over Half of Discharged Clients (n = 2,787*) Reported Complete Abstinence in 30 Days Prior to Discharge

Substance Use in 30 Days Prior to Discharge by Modality Jul-Dec 2017 (n=2,568 unduplicated clients; n=2,871 discharges)

43% 1% 4% 1% 1% 50% 71% 2% 5% 1% <1% 20% 7% 12%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

NO SUBSTANCE USE USED ONCE USED BETWEEN 2 AND 20 DAYS USED BETWEEN 21 AND 29 DAYS USED EVERY DAY NO DATA

Percent of Discharged Clients

OP/IOP (n=2,027) Res (n=385) WM (n=459)

76

Housing status after having been in treatment Sep - Dec 2017 (n=680)

 After having been in treatment, 80% of those clients (n=216) reported having STABLE HOUSING  At the time they entered treatment, 40% (269)of OP clients who completed the survey (n=680) reported HOUSING INSTABILITY (couch-surfing, homeless)

77

Income status after having been in treatment Sep - Dec 2017 (n=324)

 24% of clients with CalOMS data reported being connected to school or work at discharge  After having been in treatment, 55% of those clients (n=178) reported that their INCOME HAD IMPROVED  At the time they entered treatment, 48% (324) of OP clients who completed the survey (n=680) reported INSUFFICIENT INCOME

78

Unresolved legal issues after being in treatment Sep - Dec (n=430)

 After having been in treatment, 58% of those clients (n=249) reported having RESOLVED OR BEING IN THE PROCESS OF RESOLVING THEIR LEGAL ISSUES  At the time they entered treatment, 63% (430) of OP clients who completed the survey (n=680) reported

UNRESOLVED LEGAL ISSUES

79

Activities of Daily Living after having received treatment Sep – Dec (n=145)

 After having been in treatment, 22% of those clients (n=32) reported NO LONGER HAVING DIFFICULTY MANAGING THEIR DAILY LIVING ACTIVITIES  At the time they entered treatment,  21% (145) of OP clients who completed the survey (n=680) reported  DIFFICULTY WITH ACTIVITIES OF DAILY LIVING

80

Efficiency Measures

Leilani Villanueva

81

County clinic efficiency measures-Adult & Youth System Jul– Nov 2017

97%

81% 69% 50% 60% 63% 90% 10% 73%

100%

100% 100% 100% 100% 100% 100% 18% 100% 36% 26% 32% 30% 29% 28% 38% 55% 32%

100% 80% 50% <1% <1% <1% 90% <1% 60% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Central Valley Central TAP Perinatal YSOC South County Alexian Health Re-Entry Center Re-Entry Center BH Total County System

Percentages

Staff Productivity Capacity Efficiency Service Efficiency Fiscal Efficiency

82

Contract agency efficiency measures-Adult & Youth System- July – Nov 2017

53% 68% 26% 49% 41% 42% 40% 6% 48% 100% 100% 72% 100% 100% 100% 100% 15% 100% 32% 22% 37% 16% 17% 24% 15% 42% 24%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caminar GFC Advent HR360 A HR360 Y IHC Pathway AACI Total Contracts Percentages Staff Productivity Capacity Efficiency Service Efficiency Fiscal Efficiency

83

Contract Agency Efficiency Measure – Adult Intensive Outpatient Jul– Nov 2017

70% 70% 100% 100% 67% 67% 0% 20% 40% 60% 80% 100% Caminar Total Contracts

Percentages

Staff Productivity Capacity Efficiency Service Efficiency Fiscal Efficiency

84

Contract Agency Efficiency measures – Adult & Youth Residential Jul-Nov 2017

44% 48% 36% 39% 49% 10% 40% 80% 100% 90% 100% 80% 0% 100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

CADS 10 Horiz 30 Path 56 (PH) Path 48 (ML) Parisi 41 Advent 8 Total Contracts Percentages Capacity Efficiency Fiscal Efficiency

85

WRAP UP

Kakoli Banerjee

86

WRAP – UP- I

Access & ALOCs

77 % of residential clients are placed in treatment within 10 days of the referral 76 % of OP clients are placed in treatment within 10 days of referral ALOCs are being used regularly for residential authorizations BUT, ALOCS are not being used consistently for placement in other modalities or for continuum of care referrals Why is this important? In an ASAM-driven system, placements must be linked to the 6-dimensional assessment.

WRAP – UP- II

Capacity utilization & Services

Adult OP operational capacity was about 75% for the July to December 2017 period. In other words, ¼

• f the slots were not used.

Only 45% of adults clients received 4 services in 30 days. By comparison, 65% of youth clients received 4 services in 30 days. Adult residential vacancy rate was 31% for the July to December 2017 period.

In other words, about 1/3 bed days were underutilized.

Residential drop rate (clients leaving within 9 days of admission) out was 22% for the July to December 2017 period. The Demand & Capacity Hotgroup will address these issues.

WRAP UP - III

Waiver Services

Over 80% of residential bed days recorded in Unicare indicated Medi-Cal as payor in the past quarter (Oct-Dec 2017) Adult OP services lagged behind and only about 50% of services had a Medi-Cal payor attached at the point of service

This means that once the non-submissions, late submissions, denials, etc. are accounted for, actual Medi-Cal reimbursements for OP services could fall below 50%

This is clearly a matter of concern to SUTS and has been addressed by SUTS administration inface-to-face meetings with providers.

WRAP UP - IV

Waiver services Another data point to bear in mind is the ratio of individual to group sessions in outpatient treatment.

In the first quarter, individual sessions outnumbered group sessions although the ratio became less skewed by December

However, some providers had unusually high number of individual services relative to group services, which had the effect of reducing overall system capacity. When one or two providers reduce their capacity, it cascades through the whole system and creates problems elsewhere in the system The goal is to manage the System of Care so that all providers operate more or less at the same utilization level

WRAP UP - V

Client outcomes An important question for the system is whether clients improve with the treatment they receive in this system of care.

The data on client outcomes is limited; clients improve with treatment. Definitive results cannot be provided as long as discharge data and client feedback surveys cover only a percent of all discharges.

Data collection at discharge needs to be improved to answer questions about client outcomes.

Administrative discharges rates should be reduced and the percentage of clients who complete the Client Feedback Survey increased.

WRAP UP - VI

SUTS administration has begun to monitor efficiency measures and these will be refined in the months to come

A question for the system is: How can service efficiency (which is the expected quantity of services per client) can be low while staff productivity is high? Data needed to calculate fiscal efficiency, which is the cost of each staff hour, needs to become available in real time.

FINIS! THANK YOU!

93

Contact information

Katherine Christian – QIDS – katherine.christian@hhs.sccgov.org Olena Chesnakova – QIDS – olena.chesnakova@hhs.sccgov.org Patricia-Rubio Corona – ROM patricia.rubio-corona@hhs.sccgov.org Kimberly D’zatko –ROM – kimberly.w.dzatko@hhs.sccgov.org Sujung Kim – ROM – Sujung.kim@hhs.sccgov.org Leilani Villanueva -Administration – Leilani.Villanueva@hhs.sccgov.org Kakoli Banerjee –ROM – kakoli.banerjee@hhs.sccgov.org