PMHP Administrative Data Analysis Development of Quality Measures
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PMHP Administrative Data AnalysisDevelopment of Quality Measures
Agency for Health Care Administration Briefing
September 27-28, 2010
Mary Rose Murrin
Gregory B. Teague, Ph.D.
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Louis de la Parte Florida Mental Health Institute
Goals for this year’s analysis
Produce a data quality report for PMHP using most recent PMHP encounter data
Extend that data quality report to the HMOs
Produce and implement a set of service quality measures based on feedback from the 2009 AHCA Debriefing
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Louis de la Parte Florida Mental Health Institute
Feedback from 2009 AHCA Debriefing
Assess quality based on standard HEDIS measures
Show the penetration and service density for each of five major classes of community services provided in managed care plans:
♦ Basic Outpatient
♦ Intensive Outpatient
♦ Treatment Planning
♦ Assessment
♦ Targeted Case Management
It was more informative to show what was happening within defined treatment populations, than for the overall population using MH services.
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Louis de la Parte Florida Mental Health Institute
New Service Quality Measures: HEDIS measures
Outpatient follow-up after inpatient episode
♦ within 7 days
♦ within 30 days
Medication management for major depression antidepressant therapy for persons 18 and above
♦ % meeting acute phase criteria
♦ % meeting continuation phase criteria
Follow-up care for children ages 6-12 prescribed ADHD medication
♦ % meeting acute phase criteria
♦ % meeting continuation phase criteria
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Louis de la Parte Florida Mental Health Institute
New Service Quality Measures
Components of Care Subpopulations
♦ 90 days after discharge from inpatient admission
♦ 90 days after beginning of treatment episode for adult major depression
♦ 90 days after beginning of treatment episode for child aged 6-12 ADHD medication
♦ Major diagnoses (last three month period)• Adult Schizophrenia
• Adult Major Depression
• Adult Bipolar Disorder
• Child Mood Disorder
• Child Conduct Disorder
• Child ADHD Disorder
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Louis de la Parte Florida Mental Health Institute
Outpatient follow-up within 7 days after inpatient episode (admissions from 6/1/09-8/31/09)
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Louis de la Parte Florida Mental Health Institute
Outpatient follow-up after inpatient episode within 30 days (admissions from 6/1/09-8/31/09)
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Louis de la Parte Florida Mental Health Institute
Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Acute Phase (PMHPs only)
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Louis de la Parte Florida Mental Health Institute
Medication Management for major depression antidepressant therapy for persons 18 and above for Treatment Episodes January 1 through March 31, 2009: Continuation Phase (PMHPs only)
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Louis de la Parte Florida Mental Health Institute
Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Initiation Phase (PMHPs only)
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Louis de la Parte Florida Mental Health Institute
Follow-up care for children ages 6 to 12 prescribed ADHD medication for Treatment Episodes Beginning Dec 1, 2008 through February 29, 2009: Continuation Phase (PMHPs only)
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Louis de la Parte Florida Mental Health Institute
Plans with at least one indicator above the HEDIS adjusted 90th percentile
Healthease/Wellcare (Inpatient Follow-up)
Staywell/Wellcare (Inpatient Follow-up)
Access Behavioral Health (Inpatient Follow-up)
Community-Based Care Partnership (ADHD)
Magellan Behavioral Health (Inpatient Follow-up)
Public Health Trust Dade (ADHD and Inpatient)
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days after Inpatient Discharge for Admissions April 1- June 30, 2009
Key:BOP Basic OutpatientIOP Intensive OutpatientTXP Treatment PlanningAsmt AssessmentTCM Targeted Case Mgmt
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: First 90 days of Adult Antidepressant Therapy for Treatment Episodes Beginning January 1 through March 31, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: First 90 days of ADHD Medication Follow-up Treatment Episodes Beginning December 1, 2008 through February 29, 2009
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Louis de la Parte Florida Mental Health Institute
Strengths, Limitations, and an Alternative to this Approach
Shows treatment patterns of recognized high-risk groups.
The N in each of these analyses is much smaller than the population of the behavioral health system
One approach is to look at the diagnostic groups that comprise the majority of people using the BH system
Within Florida Medicaid’s Managed Care BH System there are only a few diagnostic groups that cover most of the population
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Louis de la Parte Florida Mental Health Institute
Percentages of Common Diagnoses Found in the Behavioral Health Encounters for FY 2008-2009
Percentages of All MH Users with at least one claim in diagnostic group
Children Adults
Schizophrenia 27%
Major Depression (included Depressive disorder for children)
13% 33%
Bipolar Disorder 9% 28%
Conduct Disorder/Oppositional Defiant Disorder 22%
Attention Deficit Disorder 44%
Anxiety Disorders 8%
These diagnoses combined were able to describe 80% of adult MH users and 72% of Child MH users.
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Schizophrenia Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Adult Bipolar Disorder Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Adult Major Depression Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Child Mood Disorder Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Child Conduct Disorder Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Components of Care Analysis: 90 days following First Child ADHD Diagnosis March 1 through June 30, 2009
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Louis de la Parte Florida Mental Health Institute
Where do we go from here?
Working assumption: we will have the necessary data this year
Planning discussions with key AHCA informants & other interested stakeholders
♦ Prioritization of critical issues for analysis
♦ Consideration of additional breakdowns, e.g., by administrative, geographic, demographic, &/or clinical categories
♦ Refinements to methods & reporting
♦ Plan for distribution & follow-up mechanism