System Outcomes

250 Quality Measures for Individuals with Behavioral Health Disorders 
In the last several years seven National Quality Reporting Programs have focused effort to identify 250 quality measures that are relevant to individuals with behavioral health disorders. These include:
  1. The Certified Community Behavioral Health Clinic (CCBHC) program that was part of the 2014 Excellence in Mental Health Act (32 measures);
  2. The National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) (29 measures);
  3. The Bureau of Primary Health Care’s Uniform Data System (UDS) for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) (26 measures);
  4. The Centers for Medicare & Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS) (41 measures); 
  5. The Medicare and Medicaid EHR Incentive Programs (Meaningful Use) (67 measures); 
  6. SAMHSA’s Uniform Reporting System (URS) that collects behavioral health-related performance measures from States, including the National Outcome Measures (NOMS) (27 measures);
  7. SAMHSA’s National Behavioral Health Quality Framework (NBHQF) (113 measures).
The measures address a number of areas including access to care, patient experience, mental health disorders, substance use disorders, medical conditions, housing, employment, and more. 
The full list of measures can be downloaded here.
Implementing a Systems Outcomes Measurement Process
Where do the RBHAs and Providers start when it comes to identifying what measures to track? We have three suggestions.

1. Build on the Existing Framework: The State of Arizona has a Performance Measurement Framework that will continue to evolve and serve as the foundation for Systems Outcome Measurement. The 2014 measures can be downloaded here. In addition, AHCCCS has worked with the Medicaid Health Plans to identify a set of Value-Based Purchasing measures that would be used by all of the Health Plans.

2. Consider the CCBHC Measures: The new Certified Community Behavioral Health Clinic is likely to be the foundation for the transformation of the community behavioral health system in the United States. There is funding for CCHBC Planning Grants that will lead to the selections of eight states that will share $1 billion to pilot the CCBHC program for two years. More information can be found at http://www.samhsa.gov/grants/grant-announcements/sm-16-001.

States that are interested in leveraging this opportunity will need to implement the 17 CCBHC-level Measures and 15 State Required Reporting Measures, all of which should be integrated into the AHCCCS/DBHS Performance Measurement Framework.
CCBHC Measures
  1. Number/Percent of clients requesting services who were determined to need routine care
  2. Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients
  3. Mean number of days before the comprehensive person-centered and family centered diagnostic and treatment planning evaluation is performed for new clients
  4. Number of Suicide Deaths by Patients Engaged in Behavioral Health (CCBHC) Treatment
  5. Documentation of Current  Medications in the Medical Records
  6. Patient experience of care survey
  7. Family experience of care survey
  8. Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up
  9. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) (see Medicaid Child Core Set)
  10. Controlling High Blood Pressure (see Medicaid Adult Core Set)
  11. Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention
  12. Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
  13. Initiation and engagement of alcohol and other drug dependence treatment (see Medicaid Adult Core Set)
  14. Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment (see Medicaid Child Core Set)
  15. Adult major depressive disorder (MDD): Suicide risk assessment (use EHR Incentive Program version of measure)
  16. Screening for Clinical Depression and Follow-Up Plan (see Medicaid Adult Core Set)
  17. Depression Remission at 12 months
State Required Reporting Measures
  1. Housing Status (Residential Status at Admission or Start of the Reporting Period Compared to Residential Status at Discharge or End of the Reporting Period)
  2. Number of Suicide Attempts Requiring Medical Services by Patients Engaged in Behavioral Health (CCBHC) Treatment
  3. Follow-Up After Discharge from the Emergency Department for Mental Health or Alcohol or Other Dependence
  4. Plan All-Cause Readmission Rate (PCR-AD) (see Medicaid Adult Core Set)
  5. Diabetes Screening for People with Schizophrenia or Bipolar Disorder who Are Using Antipsychotic Medications
  6. Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)
  7. Metabolic Monitoring for Children and Adolescents on Antipsychotics
  8. Cardiovascular health screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications
  9. Cardiovascular health monitoring for people with cardiovascular disease and schizophrenia
  10. Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder
  11. Adherence to Antipsychotic Medications for Individuals with Schizophrenia (see Medicaid Adult Core Set)
  12. Follow-Up After Hospitalization for Mental Illness, ages 21+ (adult) (see Medicaid Adult Core Set)
  13. Follow-Up After Hospitalization for Mental Illness, ages 6 to 21 (child/adolescent) (see Medicaid Child Core Set)
  14. Follow-up care for children prescribed ADHD medication (see Medicaid Child Core Set)
  15. Antidepressant Medication Management (see Medicaid Adult Core Set)
3. Develop a Well Organized Implementation Process: The following diagram illustrates a best-practice process for implementing a performance measurement system.