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Performance Outcomes Adult Specialty Mental Health Services Report Report Date March 22, 2018

Background This report measures the effectiveness of adult specialty mental health services. It models reports developed to measure Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services as mandated by Welfare and Institutions Code Section 14707.5. The intent of these reports is to improve outcomes at the individual, program, and system levels and inform fiscal decision-making related to the purchase of services.

Since 2012 DHCS has worked with several groups of stakeholders to create a structure for reporting, to develop a Performance Measurement Paradigm, and to design indicators and measures. The Performance Outcomes System will be used to evaluate the domains of access, engagement, service appropriateness to need, service effectiveness, linkages, cost effectiveness and satisfaction. Further information on the Performance Measures System implementation is available on the DHCS website. Documents posted include the relevant legislation, plans submitted to the Legislature, and handouts for meetings with the Stakeholder Advisory Committee back to the first meeting in 2012. To obtain this information go to: http://www.dhcs.ca.gov/provgovpart/pos/Pages/default.aspx.

Overview Three reports will be provided: statewide aggregate data; population-based county groups; and county-specific data. These aggregate reports provide adult information on the initial indicators that were developed for the Performance Outcomes System. DHCS plans to move to annual reporting of these data for the Performance Outcomes System.

The first series of charts and tables focus on the demographics of adults 21* and older who are receiving SMHS based on approved claims for Medi-Cal eligible beneficiaries. Specifically, this includes demographics tables of this population by age, gender, and race/ethnicity. Utilization of services reports are shown in terms of dollars, as well as by service in time increments. Two types of penetration information are provided; both penetration rate tables are also broken out by demographic characteristics. The snapshot table provides a point-in-time view of adults arriving, exiting, and continuing services over a two-year period. The time-to-step-down table provides a view over the past four years of the time to stepdown services following inpatient discharge.

Where possible, the reports provide trend information by displaying information for Fiscal Years (FY) 13/14, 14/15, 15/16, and 16/17.

Definitions *Population - Beneficiaries with approved services adjudicated through the Short Doyle/Medi-Cal II claiming system that were:• Age 21 or older during the approved date of service on the claim.

Data Sources - ▪Short-Doyle/Medi-Cal II (SD/MC II) claims with dates of service in FY 13/14 through FY 16/17.▪Medi-Cal Eligibility Data System (MEDS) data from the Management Information System/Decision Support System (MIS/DSS) FY 13/14 through FY 16/17.

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http://www.dhcs.ca.gov/provgovpart/pos/Pages/default.aspx

Performance Outcomes Adult Specialty Mental Health Services Report Report Date March 22, 2018

Additional Information The Measures Catalog is the companion document for these reports and provides the methodology and definitions for the measures. Each measure is defined and the numerator and denominator used to develop the metrics are provided with relevant notes and additional references. The Measures Catalog may be found at: http://www.dhcs.ca.gov/services/MH/Documents/MedCCC/Library/POSMeasuresCatalog_Sept15Reporting_Final_1.11.15.pdf

Note on Privacy: The Health Insurance Portability and Accountability Act (HIPAA) and Code of Federal Regulations (CFR) 42 rules protect most individually identifiable health information in any form or medium; whether electronic, on paper, or oral. DHCS has strict rules in place to protect the identification of individuals in public reports. A “Public Aggregate Reporting – DHCS Business Reports” process has been established to maintain confidentiality of client Personal Information. The Performance Outcomes System complies with Federal and State privacy laws. Thus, the POS must appropriately and accurately de-identify data for public reporting. Due to privacy concerns, some cells in this report may have been suppressed to comply with state and federal rules. When necessary, these data are represented as follows: 1) Data that are missing is indicated as "-" 2) Data that have been suppressed due to privacy concerns is indicated as "^".

Report Highlights

*County-specific findings may be interpreted alongside the POS statewide and population-based report findings.

*The penetration rates reported here were calculated using a different methodology than that used by the External Quality Review Organization (EQRO). The differences in methodology makes comparison between the POS penetration rates and the EQRO penetration rates not appropriate nor useful. The POS methodology for calculating penetration rates was selected because it is easier to compute, more straightforward to interpret, and is in use by other states and counties. For the POS, the penetration rate is calculated by taking the total number of adults who received a number of SMHS (1 or 5 for POS) in a FY and dividing that by the total number of Medi-Cal eligible adults for that FY. This methodology results in lower penetration rates as compared to the EQRO rates, but it does so across the board so that all counties and the state will be similarly impacted.

*The snapshot report provides a point-in-time look at adults' movement through the SMHS system. The report uses five general categories to classify if an adult is entering, exiting, continuing services, or a combination of these categories (e.g., arriving and exiting). As of now, this report only classifies adults and their service usage for FY 12/13 through FY15/16. Eventually the snapshot data will be used along with measures of service effectiveness to identify whether adults are improving as a result of receiving services from the time they first arrived in the system to when they exit the system. This methodology was adapted from the California Mental Health and Substance Use System Needs Assessment (2012). More information on the original methodology can be found here: http://www.dhcs.ca.gov/provgovpart/pos/Pages/Performance-Outcomes-System-Reports-and-Measures-Catalog.aspx

*The psychiatric emergency services/hospital data measured in the time to step-down services report relies solely on claims data from Short Doyle/Medi-Cal II. Currently, the number of days is capped at 365 days (to mitigate the impact of extreme statistical anomalies) when calculating the mean and max for time between discharge and step down service. This methodology will be updated in the next reporting cycle. Additionally, county specific and population-based reports are based on the county of fiscal responsibility for the patient who receives step-down services.

Please contact [email protected] for any questions regarding this report.

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http://www.dhcs.ca.gov/services/MH/Documents/MedCCC/Library/POSMeasuresCatalog_Sept15Reporting_Final_1.11.15.pdf

http://www.dhcs.ca.gov/provgovpart/pos/Pages/Performance-Outcomes-System-Reports-and-Measures-Catalog.aspx

http://www.dhcs.ca.gov/provgovpart/pos/Pages/Performance-Outcomes-System-Reports-and-Measures-Catalog.aspx

Demographics Report: Unique Count of Adults Receiving SMHS by Fiscal YearSan Diego County as of March 22, 2018

SFYUnique Count

Receiving SMHS*

Year-Over-Year

Percentage Change

Unique Count of

Medi-Cal Eligibles

Year-Over-Year

Percentage Change

FY 13-14 22,759 377,219

FY 14-15 26,678 17.2% 500,625 32.7%

FY 15-16 26,344 -1.3% 562,732 12.4%

FY 16-17 25,669 -2.6% 585,689 4.1%

Compound

Annual Growth

Rate SFY**

4.1% 15.8%

*SMHS = Specialty Mental Health Services. See Measures Catalog for more detailed information.

**SFY = State Fiscal Year which is July 1 through June 30.

22,759

26,678 26,344 25,669

0

5,000

10,000

15,000

20,000

25,000

30,000

FY 13-14 FY 14-15 FY 15-16 FY 16-17

Unique Count of Adults Receiving SMHS

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Fiscal

Year

Alaskan

Native or

American

Indian Count

Alaskan

Native or

American

Indian %

Asian or

Pacific

Islander

Count

Asian or

Pacific

Islander %

Black Count Black % Hispanic

Count Hispanic % White Count White % Other Count Other %

Unknown

Count Unknown %

FY 13-14 177 0.8% 1,615 7.1% 2,336 10.3% 3,660 16.1% 9,143 40.2% 2,289 10.1% 3,539 15.5%

FY 14-15 210 0.8% 1,791 6.7% 2,690 10.1% 4,313 16.2% 10,727 40.2% 3,064 11.5% 3,883 14.6%

FY 15-16 233 0.9% 1,764 6.7% 2,679 10.2% 4,360 16.6% 10,425 39.6% 3,149 12.0% 3,734 14.2%

FY 16-17 218 0.8% 1,606 6.3% 2,624 10.2% 4,414 17.2% 9,997 38.9% 3,244 12.6% 3,566 13.9%

Please note: This report uses the Medi-Cal Eligibility Data System to obtain race/ethnicity data. CDSS uses Child Welfare Services/Case Management System to obtain race/ethnicity data. For more information, please refer to the Measures Catalog.

^ Data has been suppressed to protect patient privacy.

1%

7%

10%

16%

40%

10%

16%

Fiscal Year 13-14 Race Distribution

Alaskan Native or AmericanIndianAsian or Pacific Islander

Black

Hispanic

White

Other

Unknown

1%

7%

10%

16%

40%

12%

15%



Black

Hispanic

White

Other

Unknown

1%

7%

10%

17%

40%

12%

14%



Black

Hispanic

White

Other

Unknown

1%

6%

10%

17%

39%

13%

14%



Black

Hispanic

White

Other

Unknown

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Fiscal

Year

Adults 21-44

Count Adults 21-44 %

Adults 45-64

Count Adults 45-64 %

Adults 65+

Count Adults 65+ %

FY 13-14 10,376 45.6% 11,270 49.5% 1,113 4.9%

FY 14-15 12,959 48.6% 12,440 46.6% 1,279 4.8%

FY 15-16 12,984 49.3% 12,067 45.8% 1,293 4.9%

FY 16-17 12,627 49.2% 11,625 45.3% 1,417 5.5%

45.6%

49.5%

4.9%

Fiscal Year 13-14 Age Group Distribution

Adults 21-44

Adults 45-64

Adults 65+

48.6%

46.6%

4.8%


Adults 21-44

Adults 45-64

Adults 65+

49.3%

45.8%

4.9%


Adults 21-44

Adults 45-64

Adults 65+

49.2%

45.3%

5.5%


Adults 21-44

Adults 45-64

Adults 65+

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Fiscal

Year

Female

Count Female %

Male

Count Male %

FY 13-14 12,431 54.6% 10,328 45.4%

FY 14-15 13,986 52.4% 12,692 47.6%

FY 15-16 13,460 51.1% 12,884 48.9%

FY 16-17 12,924 50.3% 12,745 49.7%

54.6%

45.4%

Fiscal Year 13-14 Gender Distribution

Female Male52.4%

47.6%


Female Male

51.1%

48.9%


Female Male50.3%

49.7%


Female Male

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Penetration Rates* Report: Adults With At Least One SMHS Visit** San Diego County as of March 22, 2018

Adults and

Older Adults

with 1 or

more SMHS

Certified

Eligible

Adults and

Older Adults

Penetration

Rate

Adults and

Older Adults

with 1 or

more SMHS

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

Adults and

Older Adults

with 1 or more

SMHS Visits

Certified

Eligible

Adults and

Older Adults

Penetration

Rate

Adults and

Older Adults

with 1 or more

SMHS Visits

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

All 22,759 377,219 6.0% 26,678 500,625 5.3% 26,344 562,732 4.7% 25,669 585,689 4.4%

Adults 21-44 10,376 177,295 5.9% 12,959 255,779 5.1% 12,984 295,442 4.4% 12,627 309,968 4.1%

Adults 45-64 11,270 129,359 8.7% 12,440 168,707 7.4% 12,067 185,394 6.5% 11,625 189,754 6.1%

Adults 65+ 1,113 70,565 1.6% 1,279 76,139 1.7% 1,293 81,896 1.6% 1,417 85,967 1.6%

Alaskan Native or American Indian 177 2,009 8.8% 210 2,662 7.9% 233 2,967 7.9% 218 3,061 7.1%

Asian or Pacific Islander 1,615 46,137 3.5% 1,791 59,444 3.0% 1,764 66,753 2.6% 1,606 66,177 2.4%

Black 2,336 28,793 8.1% 2,690 35,469 7.6% 2,679 38,684 6.9% 2,624 39,580 6.6%

Hispanic 3,660 106,441 3.4% 4,313 144,124 3.0% 4,360 164,746 2.6% 4,414 176,337 2.5%

White 9,143 109,100 8.4% 10,727 143,239 7.5% 10,425 156,787 6.6% 9,997 159,200 6.3%

Other 2,289 51,220 4.5% 3,064 73,638 4.2% 3,149 87,244 3.6% 3,244 95,551 3.4%

Unknown 3,539 33,519 10.6% 3,883 42,049 9.2% 3,734 45,551 8.2% 3,566 45,783 7.8%

Female 12,431 218,318 5.7% 13,986 279,703 5.0% 13,460 311,433 4.3% 12,924 323,287 4.0%

Male 10,328 158,901 6.5% 12,692 220,922 5.7% 12,884 251,299 5.1% 12,745 262,402 4.9%

*Penetration Rate is defined as the percentage of SMHS eligible beneficiaries that have received a SMHS that was claimed via the Short-Doyle/Medi-Cal claiming system. This does not include non-specialty mental health services provided in Medi-Cal Managed Care system.

**Adults and Older Adults at least one SMHS that was claimed through the Short-Doyle/ Medi-Cal claiming system on at least one (1) day in the Fiscal Year.

^ Data has been suppressed to protect patient privacy. of 14

FY 13-14 FY 14-15 FY 15-16 FY 16-17

5.9%

5.1%

4.4%4.1%

8.7%

7.4%

6.5%6.1%

1.6% 1.7% 1.6% 1.6%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

FY 13-14(n= 177,295)

FY 14-15(n= 255,779)

FY 15-16(n= 295,442)

FY 16-17(n= 309,968)

FY 13-14(n= 129,359)

FY 14-15(n= 168,707)

FY 15-16(n= 185,394)

FY 16-17(n= 189,754)

FY 13-14(n= 70,565)

FY 14-15(n= 76,139)

FY 15-16(n= 81,896)

FY 16-17(n= 85,967)

Adults 21-44 Adults 45-64 Adults 65+

Penetration Rates by AgeAdults With At Least One SMHS Visit**, By Fiscal Year

Penetration Rates* Report: Adults With At Least One SMHS Visit** San Diego County as of March 22, 2018


**Adults and Older Adults at least one SMHS that was claimed through the Short-Doyle/ Medi-Cal claiming system on at least one (1) day in the Fiscal Year.


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8.8%

7.9% 7.9%

7.1%

3.5%3.0%

2.6% 2.4%

8.1%7.6%

6.9%6.6%

3.4%3.0%

2.6% 2.5%

8.4%

7.5%

6.6%6.3%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

FY 13-14(n= 2,009)

FY 14-15(n= 2,662)

FY 15-16(n= 2,967)

FY 16-17(n= 3,061)

FY 13-14(n= 46,137)

FY 14-15(n= 59,444)

FY 15-16(n= 66,753)

FY 16-17(n= 66,177)

FY 13-14(n= 28,793)

FY 14-15(n= 35,469)

FY 15-16(n= 38,684)

FY 16-17(n= 39,580)

FY 13-14(n=

106,441)

FY 14-15(n=

144,124)

FY 15-16(n=

164,746)

FY 16-17(n=

176,337)

FY 13-14(n=

109,100)

FY 14-15(n=

143,239)

FY 15-16(n=

156,787)

FY 16-17(n=

159,200)

Alaskan Native or American Indian Asian or Pacific Islander Black Hispanic White

Penetration Rates by RaceAdults With At Least One SMHS Visit**, By Fiscal Year

5.7%5.0%

4.3% 4.0%

6.5%5.7%

5.1% 4.9%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

FY 13-14(n= 218,318)

FY 14-15(n= 279,703)

FY 15-16(n= 311,433)

FY 16-17(n= 323,287)

FY 13-14(n= 158,901)

FY 14-15(n= 220,922)

FY 15-16(n= 251,299)

FY 16-17(n= 262,402)

Female Male

Penetration Rates by GenderAdults With At Least One SMHS Visit**, By Fiscal Year

Penetration Rates* Report: Adults with Five or More SMHS Visits**San Diego County as of March 22, 2018

Adults and

Older Adults

with 5 or more

SMHS Visits

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

Adults and

Older Adults

with 5 or more

SMHS Visits

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

Adults and

Older Adults

with 5 or more

SMHS Visits

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

Adults and

Older Adults

with 5 or more

SMHS Visits

Certified

Eligible Adults

and Older

Adults

Penetration

Rate

All 13,409 377,219 3.6% 15,735 500,625 3.1% 15,439 562,732 2.7% 14,547 585,689 2.5%

Adults 21-44 5,935 177,295 3.3% 7,295 255,779 2.9% 7,318 295,442 2.5% 6,985 309,968 2.3%

Adults 45-64 6,896 129,359 5.3% 7,755 168,707 4.6% 7,408 185,394 4.0% 6,798 189,754 3.6%

Adults 65+ 578 70,565 0.8% 685 76,139 0.9% 713 81,896 0.9% 764 85,967 0.9%

Alaskan Native or American Indian 101 2,009 5.0% 119 2,662 4.5% 125 2,967 4.2% 126 3,061 4.1%

Asian or Pacific Islander 897 46,137 1.9% 1,074 59,444 1.8% 1,009 66,753 1.5% 915 66,177 1.4%

Black 1,367 28,793 4.7% 1,544 35,469 4.4% 1,535 38,684 4.0% 1,481 39,580 3.7%

Hispanic 2,208 106,441 2.1% 2,487 144,124 1.7% 2,591 164,746 1.6% 2,472 176,337 1.4%

White 5,473 109,100 5.0% 6,399 143,239 4.5% 6,140 156,787 3.9% 5,746 159,200 3.6%

Other 1,188 51,220 2.3% 1,631 73,638 2.2% 1,681 87,244 1.9% 1,659 95,551 1.7%

Unknown 2,175 33,519 6.5% 2,481 42,049 5.9% 2,358 45,551 5.2% 2,148 45,783 4.7%

Female 7,180 218,318 3.3% 8,246 279,703 2.9% 7,906 311,433 2.5% 7,263 323,287 2.2%

Male 6,229 158,901 3.9% 7,489 220,922 3.4% 7,533 251,299 3.0% 7,284 262,402 2.8%


**Adults and Older Adultsthat have received at least five SMHS that were claimed through the Short-Doyle/ Medi-Cal claiming system on at least five (5) or more different days in the Fiscal Year.


FY 13-14 FY 14-15 FY 15-16 FY 16-17

3.3%

2.9%

2.5%2.3%

5.3%

4.6%

4.0%

3.6%

0.8% 0.9% 0.9% 0.9%

0%

1%

2%

3%

4%

5%

6%

FY 13-14(n= 177,295)

FY 14-15(n= 255,779)

FY 15-16(n= 295,442)

FY 16-17(n= 309,968)

FY 13-14(n= 129,359)

FY 14-15(n= 168,707)

FY 15-16(n= 185,394)

FY 16-17(n= 189,754)

FY 13-14(n= 70,565)

FY 14-15(n= 76,139)

FY 15-16(n= 81,896)

FY 16-17(n= 85,967)

Adults 21-44 Adults 45-64 Adults 65+

Penetration Rates by AgeAdults With Five or More SMHS Visits**, By Fiscal Year

Penetration Rates* Report: Adults with Five or More SMHS Visits**San Diego County as of March 22, 2018


**Adults and Older Adultsthat have received at least five SMHS that were claimed through the Short-Doyle/ Medi-Cal claiming system on at least five (5) or more different days in the Fiscal Year.


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5.0%4.5% 4.2% 4.1%

1.9% 1.8% 1.5% 1.4%

4.7% 4.4% 4.0% 3.7%

2.1% 1.7% 1.6% 1.4%

5.0%4.5%

3.9% 3.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

FY 13-14(n= 2,009)

FY 14-15(n= 2,662)

FY 15-16(n= 2,967)

FY 16-17(n= 3,061)

FY 13-14(n= 46,137)

FY 14-15(n= 59,444)

FY 15-16(n= 66,753)

FY 16-17(n= 66,177)

FY 13-14(n= 28,793)

FY 14-15(n= 35,469)

FY 15-16(n= 38,684)

FY 16-17(n= 39,580)

FY 13-14(n= 106,441)

FY 14-15(n= 144,124)

FY 15-16(n= 164,746)

FY 16-17(n= 176,337)

FY 13-14(n= 109,100)

FY 14-15(n= 143,239)

FY 15-16(n= 156,787)

FY 16-17(n= 159,200)

Alaskan Native or American Indian Asian or Pacific Islander Black Hispanic White

Penetration Rates by RaceAdults With Five or More SMHS Visits**, By Fiscal Year

3.3% 2.9% 2.5% 2.2%

3.9%3.4% 3.0% 2.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

FY 13-14(n= 218,318)

FY 14-15(n= 279,703)

FY 15-16(n= 311,433)

FY 16-17(n= 323,287)

FY 13-14(n= 158,901)

FY 14-15(n= 220,922)

FY 15-16(n= 251,299)

FY 16-17(n= 262,402)

Female Male

Penetration Rates by GenderAdults With Five or More SMHS Visits**, By Fiscal Year

Utilization Report*: Approved Specialty Mental Health Services for Adults

Mean Expenditures and Mean Service Quantity per Unique Beneficiary by Fiscal Year*San Diego County as of March 22, 2018

Fiscal Year SDMC Total Approved Case Management/

Brokerage (Minutes)

Mental Health

Services (Minutes)

Medication Support

Services (Minutes)

Crisis Intervention

(Minutes)

Crisis Stabilization

(Hours)

Full Day Treatment

Intensive

(Hours)

Full Day Rehabilitation

(Hours)

Hospital Inpatient

(Days)

Hospital Inpatient

Admin (Days)

Fee for Service

Inpatient (Days)

Crisis Residential

Treatment Services

(Days)

Adult Residential

Treatment Services

(Days)

Psychiatric Health

Facility (Days)

FY 13-14 3,311$ 440 527 233 132 21 0 209 7 22 11 12 125 2

FY 14-15 3,792$ 437 503 255 129 22 0 218 7 25 12 13 100 6

FY 15-16 4,007$ 455 498 262 122 21 0 0 4 9 12 12 101 8

FY 16-17 4,206$ 459 504 271 125 24 6 630 5 20 12 13 122 8

MEAN 3,829$ 448 508 255 127 22 6 352 6 19 12 13 112 6

*The graphs are color coded so that those reported in the same unit of analysis (e.g., minutes) are colored similarly.

Please note that (n) values listed at the bottom of each bar graph represent the actual number of children/youth that received the SMHS represented in their respective graph by Fiscal Year.


$3,310.66

$3,791.67 $4,006.71

$4,206.35

$-

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

$3,500.00

$4,000.00

$4,500.00

FY 13-14(n = 22,759)

FY 14-15(n = 26,678)

FY 15-16(n = 26,344)

FY 16-17(n = 25,669)

Total Approved Per Unique Beneficiary By Service Fiscal Year

440437

455

459

425

430

435

440

445

450

455

460

465

FY 13-14(n = 6,953)

FY 14-15(n = 8,422)

FY 15-16(n = 8,255)

FY 16-17(n = 8,398)

Case Management/Brokerage Minutes Per Unique Beneficiary By Service Fiscal Year

527503 498 504

-

100

200

300

400

500

600

FY 13-14(n = 17,111)

FY 14-15(n = 20,799)

FY 15-16(n = 20,781)

FY 16-17(n = 19,623)

Mental Health Services Minutes Per Unique Beneficiary By Service Fiscal Year

233255 262 271

-

50

100

150

200

250

300

FY 13-14(n = 17,568)

FY 14-15(n = 20,072)

FY 15-16(n = 19,746)

FY 16-17(n = 19,308)

Medication Support Services Minutes Per Unique Beneficiary By Service Fiscal Year

132 129122 125

-

20

40

60

80

100

120

140

FY 13-14(n = 813)

FY 14-15(n = 1,119)

FY 15-16(n = 1,157)

FY 16-17(n = 1,304)

Crisis Intervention Minutes Per Unique Beneficiary By Service Fiscal Year

21.222.3 21.5

23.8

-

5

10

15

20

25

30

FY 13-14(n = 1,291)

FY 14-15(n = 1,955)

FY 15-16(n = 2,082)

FY 16-17(n = 2,953)

Crisis Stabilization Hours Per Unique BeneficiaryBy Service Fiscal Year

0 0 0

6

-

1

2

3

4

5

6

7

FY 13-14(n = )

FY 14-15(n = )

FY 15-16(n = )

FY 16-17(n = ^)

Full Day Treatment Intensive Hours Per Unique BeneficiaryBy Service Fiscal Year

209 218

0

630

-

100

200

300

400

500

600

700

FY 13-14(n = ^)

FY 14-15(n = ^)

FY 15-16(n = )

FY 16-17(n = ^)

Full Day Rehabilitation Hours Per Unique Beneficiary By Service Fiscal Year

77

45

-

1

2

3

4

5

6

7

8

FY 13-14(n = 36)

FY 14-15(n = 59)

FY 15-16(n = 52)

FY 16-17(n = 45)

Hospital Inpatient Days Per Unique BeneficiaryBy Service Fiscal Year

Utilization Report*: Approved Specialty Mental Health Services for Adults

Mean Expenditures and Mean Service Quantity per Unique Beneficiary by Fiscal Year*San Diego County as of March 22, 2018

*The graphs are color coded so that those reported in the same unit of analysis (e.g., minutes) are colored similarly.

Please note that (n) values listed at the bottom of each bar graph represent the actual number of children/youth that received the SMHS represented in their respective graph by Fiscal Year.


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125.5

99.9 101.1

121.6

-

20

40

60

80

100

120

140

FY 13-14(n = 38)

FY 14-15(n = 42)

FY 15-16(n = 36)

FY 16-17(n = 32)

Adult Residential Treatment Services Days Per Unique Beneficiary

By Service Fiscal Year

2.4

5.9

8.47.7

-

1

2

3

4

5

6

7

8

9

FY 13-14(n = ^)

FY 13-14(n = ^)

FY 15-16(n = 16)

FY 16-17(n = 14)

Psychiatric Health Facility Days Per Unique BeneficiaryBy Service Fiscal Year

22

25

9

20

-

5

10

15

20

25

30

FY 13-14(n = ^)

FY 14-15(n = ^)

FY 15-16(n = ^)

FY 16-17(n = ^)

Hospital Inpatient Admin Days Per Unique BeneficiaryBy Service Fiscal Year

1112 12 12

-

2

4

6

8

10

12

14

FY 13-14(n = 2,561)

FY 14-15(n = 3,384)

FY 15-16(n = 3,618)

FY 16-17(n = 3,246)

Fee for Service Inpatient Days Per Unique BeneficiaryBy Service Fiscal Year

12.4

12.6

12.4

13.0

12

12

12

13

13

13

13

FY 13-14(n = 1,153)

FY 14-15(n = 1,535)

FY 15-16(n = 1,567)

FY 16-17(n = 1,799)

Crisis Residential Treatment Services Days Per Unique Beneficiary

By Service Fiscal Year

Snapshot Report: Unique Count of Adults Receiving SMHS

Arriving, Exiting, and with Service Continuance by Fiscal YearSan Diego County as of March 22, 2018

Service

Fiscal Year

Arrivals

Count Arrivals %

Service

Continuance

(>= 2 YR)

Count

Service

Continuance

(>= 2 YR) %

Service

Continuance

(<2 YR) Count

Service

Continuance

(< 2 YR) %

Exiting

Count Exiting %

Arriving &

Exiting

Count

Arriving &

Exiting %

Service

Continuance

(>= 2 YR) &

Exiting Count

Service

Continuance

(>= 2 YR) and

Exiting %

Total

Count Total %

FY 13-14 6,164 27.1% 2,787 12.2% 2,037 9.0% 2,539 11.2% 8,808 38.7% 424 1.9% 22,759 100%

FY 14-15 4,551 17.1% 2,708 10.2% 3,406 12.8% 4,373 16.4% 11,139 41.8% 500 1.9% 26,677 100%

FY 15-16 4,573 17.4% 3,180 12.1% 2,803 10.6% 4,172 15.8% 11,105 42.2% 511 1.9% 26,344 100%

FY 16-17 3,854 15.0% 3,136 12.2% 2,382 9.3% 4,250 16.6% 11,274 43.9% 773 3.0% 25,669 100%

Category

Arrivals

Exiting

Service Continuance

Arriving & Exiting

Service Continuance &

Exiting

Description (Please refer to the Measures Catalog for more detailed descriptions on all Performance Outcomes System measures.)

Adults that did not receive any SMHS within 3 months of their first date of service in the Fiscal Year.

Adults receiving continuous services with no breaks in service greater than 90 days for a period of at least 2 years (>= 2 YR) or a period of 1 to 2 years (< 2 YR).

Adults that did not receive any SMHS within 3 months after their last date of service in the Fiscal Year.

A distinct category in which Adults met both the criteria for Arrivals and Exiting above for the fiscal year.

A distinct category in which Adults had at least 2 years of Service Continuance going into the Fiscal Year and then Exited within the same Fiscal Year.

27%

12%

9%11%

39%

2%

Fiscal Year 13-14 Arrivals, Service Continuance, &

Exits Distribution

17%

10%

13%

16%

42%

2%


Exits Distribution

17%

12%

11%

16%

42%

2%


Exits Distribution

15%

12%

9%

17%

44%

3%


Exits Distribution

Arrivals

Service Continuance(>= 2 YR)

Service Continuance(< 2 YR)

Exiting

Arriving & Exiting

Service Continuance (>= 2 YR) & Exiting

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Time to Step Down Report: Adults Stepping Down in SMHS Services Post Inpatient Discharge*San Diego County as of March 22, 2018

Service FY

Count of Inpatient

Discharges with Step

Down within 7 Days

of Discharge

Percentage of

Inpatient

Discharges with

Step Down within

7 Days of

Discharge

Count of Inpatient

Discharges with

Step Down

Between 8 and 30

Days

Percentage of

Inpatient

Discharges with

Step Down

Between 8 and 30

Days

Count of Inpatient

Discharges with a

Step Down > 30

Days from

Discharge

Percentage of

Inpatient

Discharges with a

Step Down > 30

Days from

Discharge

Count of Inpatient

Discharges with

No Step Down*

Percentage of

Inpatient

Discharges with

No Step Down*

Minimum Number

of Days between

Discharge and

Step Down

Maximum

Number of Days

between

Discharge and

Step Down

Mean Time to

Next Contact Post

Inpatient

Discharge

(Days)

Median Time to

Next Contact Post

Inpatient

Discharge

(Days)

FY 13-14 1,929 53.2% 454 12.5% 807 22.3% 433 12.0% 0 364 35.3 5

FY 14-15 3,001 51.4% 780 13.4% 1,088 18.6% 968 16.6% 0 365 37.0 6

FY 15-16 3,072 49.3% 807 12.9% 1,343 21.6% 1,010 16.2% 0 365 40.7 7

FY 16-17 3,513 52.5% 797 11.9% 1,033 15.4% 1,346 20.1% 0 365 32.4 6

* No Step Down is defined as no Medi-Cal eligible service was claimed through Short-Doyle/Medi-Cal after a claimed inpatient service was billed with a discharge date. This category may include data currently unavailable to DHCS, such as beneficiaries that

were moved to a community-based program or beneficiaries that were incarcerated.

5

6

7

6

0

1

2

3

4

5

6

7

8

FY 13-14 FY 14-15 FY 15-16 FY 16-17

Median Time Between Inpatient Discharge and Step Down Service in Days

35.3 37.040.7

32.4

0

10

20

30

40

50

FY 13-14 FY 14-15 FY 15-16 FY 16-17

Mean Time Between Inpatient Discharge and Step Down Service in Days

53.2% 51.4% 49.3% 52.5%

12.5% 13.4% 12.9% 11.9%

22.3% 18.6% 21.6% 15.4%

12.0% 16.6% 16.2% 20.1%

0%

20%

40%

60%

80%

100%

FY 13-14( 2,036 Unique Beneficiaries with 3,623 Total Inpatient Discharges )




Percentage of Discharges by Time Between Inpatient Discharge and Step Down Service

Within 7 Days Within 8 - 30 Days 31 Days + No Step Down

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