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Performance Outcomes Adult Specialty Mental Health Services Report Report Date August, 2017 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) 12/13, 13/14, 14/15, and 15/16. 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 12/13 through FY 15/16. ▪Medi-Cal Eligibility Data System (MEDS) data from the Management Information System/Decision Support System (MIS/DSS) FY 12/13 through 15/16. 1 of 11 ---PAGE BREAK--- Performance Outcomes Adult Specialty Mental Health Services Report Report Date August, 2017 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 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 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 the hospital from which the patient is discharged and receives step-down services. Please contact [EMAIL REDACTED] for any questions regarding this report. 2 of 11 ---PAGE BREAK--- Demographics Report: Unique Count of Adults Receiving SMHS by Fiscal Year Alpine County as of August, 2017 SFY Unique Count Receiving SMHS* Year-Over-Year Percentage Change Unique Count of Medi-Cal Eligibles Year-Over-Year Percentage Change FY 12-13 13 134 FY 13-14 18 38.5% 250 86.6% FY 14-15 25 38.9% 291 16.4% FY 15-16 29 16.0% 282 -3.1% Compound Annual Growth Rate SFY** 30.7% 28.1% *SMHS = Specialty Mental Health Services. See Measures Catalog for more detailed information. **SFY = State Fiscal Year which is July 1 through June 30. Page 3 of 11 ---PAGE BREAK--- Demographics Report: Unique Count of Adults Receiving SMHS by Fiscal Year Alpine County as of August, 2017 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 12-13 ^ ^ 0 0.0% 0 0.0% 0 0.0% ^ ^ ^ ^ 0 0.0% FY 13-14 ^ ^ 0 0.0% 0 0.0% 0 0.0% 11 61.1% ^ ^ ^ ^ FY 14-15 ^ ^ 0 0.0% 0 0.0% 0 0.0% 15 60.0% ^ ^ ^ ^ FY 15-16 11 37.9% 0 0.0% 0 0.0% 0 0.0% 15 51.7% ^ ^ ^ ^ 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. Page 4 of 11 ---PAGE BREAK--- Demographics Report: Unique Count of Adults Receiving SMHS by Fiscal Year Alpine County as of August, 2017 Fiscal Year Adults 21-44 Count Adults 21-44 % Adults 45-64 Count Adults 45-64 % Adults 65+ Count Adults 65+ % FY 12-13 ^ ^ ^ ^ 0 0.0% FY 13-14 ^ ^ ^ ^ 0 0.0% FY 14-15 15 60.0% ^ ^ ^ ^ FY 15-16 ^ ^ 11 37.9% ^ ^ ^ Data has been suppressed to protect patient privacy. Page 5 of 11 ---PAGE BREAK--- Demographics Report: Unique Count of Adults Receiving SMHS by Fiscal Year Alpine County as of August, 2017 Fiscal Year Female Count Female % Male Count Male % FY 12-13 ^ ^ ^ ^ FY 13-14 ^ ^ ^ ^ FY 14-15 ^ ^ ^ ^ FY 15-16 ^ ^ ^ ^ ^ Data has been suppressed to protect patient privacy. Page 6 of 11 ---PAGE BREAK--- Penetration Rates* Report: Adults With At Least One SMHS Visit** Alpine County as of August, 2017 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 13 134 9.7% 18 250 7.2% 25 291 8.6% 29 282 10.3% Adults 21-44 ^ 57 ^ ^ 124 ^ 15 148 10.1% ^ 136 ^ Adults 45-64 ^ 53 ^ ^ 99 ^ ^ 108 ^ 11 110 10.0% Adults 65+ 0 24 0.0% 0 27 0.0% ^ 35 ^ ^ 36 ^ Alaskan Native or American Indian ^ 62 ^ ^ 104 ^ ^ 102 ^ 11 112 9.8% Asian or Pacific Islander 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% Black 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% Hispanic 0 ^ 0.0% 0 ^ 0.0% 0 16 0.0% 0 15 0.0% White ^ 52 ^ 11 110 10.0% 15 141 10.6% 15 131 11.5% Other ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ Unknown 0 ^ 0.0% ^ 13 ^ ^ 19 ^ ^ 15 ^ Female ^ 77 ^ ^ 123 ^ ^ 147 ^ ^ 140 ^ Male ^ 57 ^ ^ 127 ^ ^ 144 ^ ^ 142 ^ *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 day in the Fiscal Year. ^ Data has been suppressed to protect patient privacy. Page 7 of 11 FY 12-13 FY 13-14 FY 14-15 FY 15-16 ---PAGE BREAK--- Penetration Rates* Report: Adults With At Least One SMHS Visit** Alpine County as of August, 2017 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 ^ 134 ^ 15 250 6.0% 18 291 6.2% 21 282 7.4% Adults 21-44 ^ 57 ^ ^ 124 ^ ^ 148 ^ ^ 136 ^ Adults 45-64 ^ 53 ^ ^ 99 ^ ^ 108 ^ ^ 110 ^ Adults 65+ 0 24 0.0% 0 27 0.0% ^ 35 ^ ^ 36 ^ Alaskan Native or American Indian ^ 62 ^ ^ 104 ^ ^ 102 ^ ^ 112 ^ Asian or Pacific Islander 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% Black 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% 0 ^ 0.0% Hispanic 0 ^ 0.0% 0 ^ 0.0% 0 16 0.0% 0 15 0.0% White ^ 52 ^ ^ 110 ^ 11 141 7.8% 11 131 8.4% Other ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ Unknown 0 ^ 0.0% ^ 13 ^ ^ 19 ^ ^ 15 ^ Female ^ 77 ^ ^ 123 ^ ^ 147 ^ ^ 140 ^ Male ^ 57 ^ ^ 127 ^ ^ 144 ^ ^ 142 ^ *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 have received at least five SMHS that were claimed through the Short-Doyle/ Medi-Cal claiming system on at least five or more different days in the Fiscal Year. ^ Data has been suppressed to protect patient privacy. Page 8 of 11 FY 12-13 FY 13-14 FY 14-15 FY 15-16 ---PAGE BREAK--- Utilization Report*: Approved Specialty Mental Health Services for Adults Mean Expenditures and Mean Service Quantity per Unique Beneficiary by Fiscal Year* Alpine County as of August, 2017 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) Health Facility (Days) FY 12-13 5,417.47 $ 942 887 340 480 0 0 0 0 0 0 0 0 0 FY 13-14 10,062.36 $ 443 1,698 443 105 0 0 0 0 0 0 0 0 0 FY 14-15 6,787.17 $ 195 1,214 297 265 0 0 0 0 0 0 0 0 2 FY 15-16 6,161.63 $ 393 1,036 372 316 0 0 0 0 0 0 0 0 2 MEAN 7,107.16 $ 493 1,209 363 291 0 0 0 0 0 0 0 0 2 *The graphs are color coded so that those reported in the same unit of analysis minutes) are colored similarly. Please note that 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. ^ Data has been suppressed to protect patient privacy. Page 9 of 11 ---PAGE BREAK--- Snapshot Report: Unique Count of Adults Receiving SMHS Arriving, Exiting, and with Service Continuance by Fiscal Year Alpine County as of August, 2017 Service Fiscal Year Arrivals Count Arrivals % Service Continuance 2 YR) Count Service Continuance 2 YR) % Service Continuance 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 12-13 ^ ^ ^ ^ - 0.0% ^ ^ ^ ^ - 0.0% 13 100% FY 13-14 ^ ^ ^ ^ ^ ^ - 0.0% ^ ^ - 0.0% 18 100% FY 14-15 ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ - 0.0% 25 100% FY 15-16 ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ 29 100% 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. Page 10 of 11 ---PAGE BREAK--- Time to Step Down Report: Adults Stepping Down in SMHS Services Post Inpatient Discharge County as of August 2017 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 within 30 Days of Discharge Percentage of Inpatient Discharges with Step Down within 30 Days of Discharge 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 10-11 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0 0.0 0 FY 11-12 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0 0.0 0 FY 12-13 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0 0.0 0 FY 13-14 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0 0.0 0 * 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. 0 0 0 0 0 1 2 3 4 5 6 7 8 9 10 FY 10-11 FY 11-12 FY 12-13 FY 13-14 Median Time Between Inpatient Discharge and Step Down Service in Days 0.0 0.0 0.0 0.0 0 0 0 1 1 1 FY 10-11 FY 11-12 FY 12-13 FY 13-14 Mean Time Between Inpatient Discharge and Step Down Service in Days 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0% 20% 40% 60% 80% 100% FY 10-11 ( Unique Beneficiaries with Total Inpatient Discharges ) FY 11-12 ( Unique Beneficiaries with Total Inpatient Discharges ) FY 12-13 ( Unique Beneficiaries with Total Inpatient Discharges ) FY 13-14 ( Unique Beneficiaries with 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 TABLES AND CHARTS NOT PRODUCED FOR THIS INDICATOR DUE TO SMALL CELL SIZES. 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