QUALITY MEASURES

INCENTIVE PROGRAM FY 2017

Designed to support our Mission:

To promote overall health and improve quality of life

by ensuring the delivery of effective behavioral and

physical health care that meets the needs of

communities we serve.

POP QUIZ!

• How many months are included in the Billed Hours score?

• 12 months

• What is the minimum number of clients in a group to

require two co-therapists?

• 11 clients

• True or False: Admin time qualifies as an exception.

• False

2

Quality Measures

• View Point Health's Quality Measures Program is

designed to measure performance and

incentivize outcomes.

• Quality Measures promotes staff to maximize

their clinical and professional potential, by

meeting and exceeding a comprehensive set of

metrics.

• Incentives are earned by staff who consistently

perform at a level above what is expected.

• Through this measurement system, we can

identify the areas in which staff and centers excel,

as well as the areas in which we can improve.

3

Targets Tiers and Scores

Target

The number or

percentage goal

associated with the

metric

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Tier

The level of

achievement based

on the target that

was reached

75%

70%

65%

Score

The number of

points received,

based on the tier

awarded

Automated Vs Manual Metrics

Automated Metrics

• Data is pulled from

Carelogic through a

query calculation

• More complicated to

adjust

Manual Metrics

• Data is gathered from

various sources (KPI

Pentaho Reports,

Director/Manager

submissions, etc…)

and manually entered

• Less complicated to

adjust (timeliness

matters!)

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Metr ic changes shou ld on ly be made once per f i sca l year.

Automated Metrics

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Metric Metric Description Denominator Numerator Result

ADATAR ADA quarter target Total Attendance Days Avg Attendance

AVGDOC24 Staff average documentation

w/in 24 hrs

Avg % Docs Signed w/In 24

BH Billed Hours Hours Worked Hours Billed % Billed

BR Billed ratio Billable Services Billed Services % Billed

CFUP % Clients attending follow-up Intakes Follow-Ups % Clients w/Follow-Ups

CSCLD Clients served by caseload Caseload Caseload w/Activity % Served

CSCTR Clients served by center Center Caseload Center Caseload

w/Activity % Served

DOC24 Documentation w/in 24 hrs Appts w/Doc Signed w/In 24 Hrs % Docs Signed w/In 24

Hrs

DOCEOS Documentation by end of shift Appts w/Doc Signed by End Of

Shift % Docs Signed by EOS

ICMMINCON Team Min Mthly Contacts ICM ICM Clients Qualified Clients % Qualified

MTGTAR % Staff meeting BH target Staff Count Met Target % of Staff Who Met BH

Target

NOTES Notes w/in 24 hrs ratio Appts w/Notes Signed w/In 24 Hrs % Notes Signed w/In 24

Hrs

REHABMINCN Team Min Mthly Contacts Rehab Rehab Clnts Qualified Clients % Qualified

Outpatient Day Services DD Services

ICM

CSS GRAN

Manual Metrics

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Metric Metric Description Denominator Numerator Result

CDINV Contract dollars invoiced per

month Avg Dollars Invoiced

CMARG Center margin % Margin

CREQ Contract requirements Total

Requirements Requirements

Met % Requirements Met

DCLVL3 % Clients d/c Level 3 Total # D/c Total D/c at Level

3 % D/c Level 3

DOC24MAN Documentation w/in 24 hrs Appts w/Doc Signed w/In 24

Hrs % Docs Signed w/In

24 Hrs OUTINGS Meaningful Outings Outings

PEER Peer Review Score Responses Considered

Marked "Full Compliance"

% "Full Compliance"

QAS Quality Audit Score Total Pts Possible Quality Audit

Score % Scored

SCR Support Coordination Rating Total Ratings Ratings of "1" Percentage of "1"

Ratings

SQAS Staff Quality Audit Score Total Pts Possible Avg Staff QAS Avg % Scored ALL STAR STAR rating Avg Rating

Outpatient

Day Services DD Services

ICM

CSS GRAN

Clubhouse

KPI Manual Metrics (Outpatient Centers)

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Metric Metric Description Denominator Numerator Result

KPI 5.2 KPI 5.2 SA Clients Receiving Group SA Clients Clients w 5+

Groups Percent Met

KPI1.1 KPI 1.1 Days to Intake Met=1 NM=0

KPI1.2 KPI 1.2 Intake to Tx Appt Met=1 NM=0

KPI1.3 KPI 1.3 Intake to MD Appt Met=1 NM=0

KPI2.1 KPI 2.1 GCAL Avg Days to Scheduled

Appt Met=1 NM=0

GCAL GCAL Outreach GCAL Outreaches Within 24 Hours Percent Met

KPI3.1 KPI 3.1 Hospital Discharge to Tx Appt Hospital

Discharges Scheduled Appt 7

Days Percent Met

KPI3.2 KPI 3.2 Hospital Discharge to MD Appt Hospital

Discharges Scheduled Appt

14 days Percent Met

Center Director Program Manager

Access

Engagement Specialist

Front Office SA OP Center Director

Billed Hours • Definition: Of a staff’s available hours

to work during a month, how many hours successfully billed during that month? The current quarter results include a twelve month rolling calculation.

• Hours Worked: The base value is calculated from the average available clinic days during a month. Holidays are taken into account to arrive at the base, so they do not need to be submitted as exceptions.

• Next Up: • Exceptions

• Groups

• Grace Period

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Month Hours

Worked Hours

Billed

January 167.33 60

February 167.33 65

March 167.33 65

April 167.33 75

May 167.33 80

June 167.33 95

July 167.33 100

August 167.33 100

September 167.33 110

October 167.33 115

November 167.33 115

December 167.33 120

Current Quarter

Results 2007.96 1100

350 / 501.99 = 70%

1100 / 2007.96 = 55%

Similar to a GPA!

Billed Hours - Exceptions 10

Approved Pre-approval required Not approved or applicable

VPH

Training

AMSR VPH CEU trainings –

facilitator

External CEU trainings – non

mandated by VPH (includes DBT

& CBT per Suicide Prevention

Policy)

ANSA/CANS

ASAM

CPI Renewal Grant-required external

trainings (DBT Intensively

Trained Team, EMDR)

VPH CEU trainings – attendee

(includes DBT & CBT per Suicide

Prevention Policy)

CPR/First Aid Renewal

Trauma Informed Care (attendee or facilitator)

Clinical Aspects (facilitator)

VPH

Activity

Celebrate VPH (sign in roster must show name and

signature of attendee)

QA mandated training (typically related to EHR or

workflow changes)

Leadership Academy (participant or presenter)

Peer Review (include # of charts assigned) and/or Peer

Review training

Program

Specific

APEX (details and schedule must reflect specific activity)

Court Services (details and schedule must reflect specific

activity)

C&A- Spring into Wellness planning (details and schedule

must reflect specific activity)

Other

PTO (must be on schedule and entered in ESS) Working on failed claims and

activities Court Subpoenas

Jury Duty (must provide documentation)

Billed Hours - Groups

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Extra credit is added to the actual group duration in order to account for the time needed to complete group paperwork, etc.

For groups of 10 or less clients, extra credit of 30 minutes will be provided, only to the primary therapist. A co-therapist for this group will receive no credit for the duration nor extra credit.

For groups of 11 or more clients, extra credit of 60 minutes will be provided, to be split between co-therapists.

For groups that were partially Kept and Co-staffed between two therapists, each therapist will receive credit for the clients for which they Kept/documented.

Only clients whose group service BILLED will be included in the count.

Group sessions with only one participant are eliminated from consideration. They do not become counted as an individual appointment.

Exception: Lawrenceville Anger Management Group

Billed Hours – Grace Period 12

Newly employed staff or staff changing programs / job positions will receive a 90-day grace period

The data for the grace period will display on the scorecard as “Excluded Results.”

If any Billed Hours tier is awarded, the data during this period will become “Included,” and roll into the 12 month calculation.

If no Billed Hours tier is awarded, the data from this period will remain excluded.

CareLogic Claim Engine

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A claim is generated

and claim validation

runs

Claim validation

passes or fails

Failed claims are

resolved or

overridden FAIL

Activity marked

as KEPT on the

schedule

Claim Engine

run begins

(daily 11:59pm)

Activity

validation runs

Activity

validation

passes or fails

FA

IL

PA

SS

Failed activities are

resolved or overridden

Start

CareLogic Billing Process Flow

14

Activities marked

as KEPT Claim engine runs Claim approval

1 2 3

Claim Maintenance

4

Generate client

statements

Batch Claims

5

6

Send claims to

payers

Send statements to

guarantors

7

8

Efficient Scheduling

65% Floor

9a-10a

10a-11a

11a-12p

12p-1p

1p-2p

2p-3p

3p-4p

4p-5p

15

26 hours / week

5.2 hours / day

55% Floor

9a-10a

10a-11a

11a-12p

12p-1p

1p-2p

2p-3p

3p-4p

4p-5p

22 hours / week

4.4 hours / day

30% Floor

9a-10a

10a-11a

11a-12p

12p-1p

1p-2p

2p-3p

3p-4p

4p-5p

12 hours / week

2.4 hours / day

CHECK FAILED CLAIMS AND ACTIV IT IES!

Directors and Managers

Quarterly Workflow

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Month

1 Submit staffing

changes by deadline

• New hires

• Terminated staff

• Program transfers

• Staff type changes

Submit manual metric data by deadline

• STAR Ratings

• Peer Reviews

• Program-specific manual data

Month

2 Receive and

distribute quarterly scorecards

Answer staff questions based on available resources

• Detail reports

• Scorecard and Metrics Guide

• Presentations and notes

For further questions or explanation, submit a QA ticket

Month

3 Begin Peer Reviews

Resolve outstanding failed claims and activities so they are batched before the deadline

Submi t except ions by the 5 th o f the fo l low ing month

Final Tips

• Encourage staff to review their scorecards

• Use supervision or team meetings to review scorecards

• Plan, plan, plan! Schedule time to complete Quality

Measures tasks (peer reviews, STAR ratings, manual

metrics data, etc…)

• Become familiar with the guides, reports, and other

resources

• Focus on the areas that really need improvement

• Make it a PDSA!

• Ask questions early

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Testimonials • S. Edu: “One of the things I do at the beginning of the

relationship with a client is focusing on creating rapport so that the client learns the importance of being on time, scheduling and cancelling appts accordingly, and more importantly discussing barriers that keep them from being consistent. On the numbers side of things, I try to manage my caseload monthly by printing out a report of my active clients and going down the list, as I have time, to see who needs to be engaged or discharged. If they need to be discharged, I will send the list to our engagement specialist.”

• A. Almas: “The only way I know how to make productivity is to work hard, pick up BHA’s and SPD’s if time allows if I have a cancellation, and for my Admin time, I often will not have that set in my schedule at the beginning of the day. I will add it in in the place of a cancellation.”

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Thank you!

Questions?

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