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November Data Jam
Mastering PSYCKES: Maximizing Multiple Data Sources to Operationalize a Population Health
Approach
Anni Kramer, LMSW & Erica Van De Wal-Ward, MA New York Office of Mental Health
Anni Kramer, LMSWPSYCKES Implementation DirectorNew York State Office of Mental Health
Elizabeth Arend, MPHQuality Improvement AdvisorNational Council for Behavioral Health
Erica Van De Wal-WardPSYCKES Medical Informatics Project Director New York State Office of Mental Health
CMS Change Package: Primary and Secondary Drivers
Patient and Family-Centered Care Design
1.1 Patient & family engagement 1.2 Team-based relationships 1.3 Population management 1.4 Practice as a community partner1.5 Coordinated care delivery 1.6 Organized, evidence-based care1.7 Enhanced access
Continuous, Data-Driven Quality Improvement
2.1 Engaged and committed leadership 2.2 QI strategy supporting a culture of quality and safety 2.3 Transparent measurement and monitoring2.4 Optimal use of HIT
Sustainable Business Operations
3.1 Strategic use of practice revenue 3.2 Staff vitality and joy in work 3.3 Capability to analyze and document value 3.4 Efficiency of operation
Review & Update: CTN Data Dashboards
• Dashboard data are derived from Medicaid claims data
• Provides easy access to aggregate, practice-level data on 13 clinical quality measures
• Shows your most recent PAT scores and progress through CMS Phases of Transformation
• Financial and utilization data from the Medicaid Data Warehouse will be added to the dashboards soon!
• See: October 2016 Data Jam
CTN Clinical Quality Measures
# IndicatorNational Standard
NumeratorDenominator
(all 18-64 years)Target
1All-cause 30-day readmission rate following MH inpatient discharge
NYS Number of all-cause hospital readmissions after MH inpatient discharge in measurement period
Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period
25%
2 30-day MH re-admission NYS Number MH readmissions in measurement period
Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period
25%
3Follow-Up After Hospitalization for Mental Illness, 7 Days
NQF 0576PQRS 391HEDIS FUH-A
The number of MH discharges who had a MH outpatient visit, intensive outpatient encounter, or partial hospitalization with a mental health practitioner within 7 days of discharge
Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period
50%
4Follow-Up After Hospitalization for Mental Illness, 30 Days
NQF 0576PQRS 391HEDIS FUH-B
The number of MH discharges who had an MH outpatient visit, intensive outpatient encounter, or partial hospitalization within 30 days of discharge
Total number of MH inpatient discharges (primary mental health diagnosis) in measurement period
50%
5
Adherence to antipsychotic medications (PDC) for people with schizophrenia (%)
NQF 1879PQRS 383HEDIS 2016
Number of people with schizophrenia or schizoaffective disorder with adherence to antipsychotic medication [defined as a Proportion of Days Covered (PDC)] of at least 0.8 during the measurement year.
Total number of people with schizophrenia or schizoaffective disorder with 2+ claims for any antipsychotic medication during measurement year
80%
6
Adherence to mood stabilizers for people with bipolar I disorder (%)
NQF 1880
Number of people with Bipolar I Disorder that received a mood stabilizer that had a Proportion of Days Covered (PDC) for mood stabilizer medications (including AP) ≥ 0.8 during the measurement year.
Total number of people with Bipolar I Disorder who fill 2+ prescriptions for a mood stabilizer in measurement year
80%
7Use of Antipsychotic Drug Clozapine for Schizophrenia
(NYS OMH)
Number of people with schizophrenia with 1 or more clozapine claims in measurement year
Total number of people with schizophrenia during measurement year
25%
8Use of antipsychotic long acting injectable (LAIs) for schizophrenia
(NYS OMH)
Number of people with schizophrenia who are exposed to LAIs (1 or more prescriptions in measurement year)
Total number of people with schizophrenia during measurement year
25%
9
Use of multiple concurrent antipsychotics
HEDIS v2016
The number of people on antipsychotic medication and who received two or more concurrent antipsychotic medication prescriptions for > 90 days during measurement year.
Total number of people ages 18-64 years who were on antipsychotic medication > 90 days in the measurement year
25%
10
Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (%)
NQF 1932
Number of people with schizophrenia and bipolar who were dispensed an antipsychotic medication and had a diabetes screening during the measurement year
Total number of people with schizophrenia or bipolar disorder who were dispensed an antipsychotic medication in the measurement year
80%
# IndicatorNational Standard
NumeratorDenominator
(all 18-64 years)Target
11
LDL screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (%)
NQF 1927
Number of people with schizophrenia and bipolar who were dispensed an antipsychotic medication and had an LDL-C test during measurement year
Total number of people with schizophrenia or bipolar disorder with 1+ antipsychotic in the measurement year
80%
12
14-day initiation and engagement of alcohol and other drug (AOD) dependence treatment (14 days)
NQF 004MU 137v4PQRS 305
Number of people with a new AOD episode in first 10.5 months of the measurement year and received AOD treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the index episode start date
Total number of people diagnosed with a new AOD episode (alcohol or other drug dependency) during the first 10.5 months of the measurement year
25%
1330-day initiation and engagement of AOD dependence treatment
NQF 004MU 137v4PQRS 305
Number of people diagnosed with a new AOD episode during the first 10.5 months of the measurement year and received AOD treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 30 days of the index episode start date
Total number of people diagnosed with a new AOD episode during the first 10.5 months of the measurement year
25%
# IndicatorNational Standard
NumeratorDenominator
(all 18-64 years)Target
CTN Dashboard Key Points• Data are aggregated from Medicaid claims; dual eligible patients are not
represented in the data
• Each quarter, a full 12 months of data are uploaded to the dashboard
• Data are “mature” - the October 2017 data upload reflects data from January-December 2016
• If the denominator of eligible clients is less than 10, you will not see any data in the dashboard
• Dashboard data can help you track population-level trends and identify where to focus your QI efforts
Using PSYCKES with your CTN Data Dashboard
• PSYCKES provides one way to “drill down” from the aggregate data you see on your CTN data dashboard
• There is not a 1:1 relationship between the CTN dashboard measures and the measures in PSYCKES
• Nonetheless, PSYCKES can help you:• Analyze CTN dashboard numbers
• Identify clients in your current population where you can intervene to improve those numbers
• Make individual clinical decisions
• Understand your general client population for quality improvement and risk stratification
• Explore your client utilization and provider network for VBP
PSYCKES Data: Who & What • Who is Viewable?
• Over 7 million NYS Medicaid enrollees (currently or previously enrolled)
• Fee for service, Managed Care encounters, Medicaid data only for dual eligible Medicaid/Medicare
• The Behavioral Health population: a paid claim with either a psychiatric or substance use service, diagnosis or medication
• What is Available?1. Medicaid data: All paid services; time lag varies from weeks to months depending
on how quickly providers bill and Managed Care plans submit to DOH
2. Non-Medicaid data: “real time” (0-7 day lag)• State Psychiatric Center EMR data
• ACT & AOT provider and contact information
• Health Home enrollment and Care Management provider information
• Managed Care Plan & HARP Status
• NIMRS suicide attempts
PSYCKES Navigation: Screens
PSYCKES is organized in the following 8 tabs:• My QI Report
• Statewide Reports
• Provider Search
• Recipient Search
• Registrar Menu
• Usage Reports
• Utilization Reports
• User Settings
• Not all providers will have access to all tabs
Example 1: Intervene with current clients
• You identify a CTN dashboard measure that you want to improve
• Use PSYCKES Quality Indicators in “My QI Reports” to find current clients that are flagged for that same quality concern
• Drill down to individual clients and export list
• Provide client names to applicable staff to support intervention• When a client has a quality flag, you can also access that individual’s PSYCKES clinical
summary for additional clinical history and decision support
• Review PSYCKES data over time to see if that flag has dropped and numbers improve
Quality Indicator “QI Flag” Definitions• 10 Indicator Sets:
• BH QARR- DOH Performance Tracking Measures
• BH QARR – Improvement Measures
• General Medical Health
• HARP Enrolled – Not Health Home Enrolled
• High Utilization – Inpatient/ER
• Polypharmacy
• Preventable Hospitalization
• Readmission Post-Discharge from any Hospital
• Readmission Post-Discharge from this Hospital
• Treatment Engagement
• Each indicator set is made up of several measures
Example 2: Analysis of CTN data• You identify a CTN dashboard measure that you want to explore further:
• The numbers don’t match your internal program data or your experience
• Over time, your %s improve and you want to understand why so you can do that more
• Over time, your %s get worse and you want to understand why so you can do that less
• Use PSYCKES “My QI Report” and “Recipient Search” to (approximately) find the individual clients in that cohort • Depends on measure: PSYCKES has people with a quality concern; some CTN measures
are for those without the quality concern
• Cohorts may not match perfectly (time frame or specifications different)
• Export and review client list/charts
• Identify some hypotheses about what systems/client care could have impacted those numbers (root cause analysis)
• Develop QI project and PDSA!
Other PSYCKES Uses
• Clinical Summaries for individual clinical decision-support
• Utilization Reports to Support VBP Preparation
• Recipient Search to identify high need cohorts/cohorts of interest
• And more for future Data Jams!
Clinical Summary: Levels of Access
Clinical Summary: How to Consent
1. Consent clients (at intake) using PSYCKES consent form:• At www.psyckes.com and go to “About PSYCKES” page
2. Go to “Recipient Search” screen
3. Search for client using unique identifier
4. Click “Change PHI Access Level”
5. Select level of access
6. Confirm client identity
7. Submit
How to Consent: Find Client in Recipient Search
How to Consent: Search for Client w/ Unique Identifier
Main Street Agency
• Medicaid ID or Social Security # (SSN), or
• First Name (at least 2 characters) and Last Name (full) and DOB
How to Consent: “Change PHI Access Level”
How to Consent: Select Level of Access
How to Consent: Confirm Client Identity & Submit
Review Clinical Summary
Three Utilization Reports to Support VBP1. Payer Mix
• Which Managed Care Plans and product lines are my clients enrolled in?
• Which plans and product lines should I focus on?
2. Provider Network• Which other providers do I share clients with, for what service types?
–For example, my mental health clinic clients use which SUD services, medical ERs, or outpatient medical services?
• Who should I partner with?
3. Service Settings and Volume • What services are my clients consuming – from me, and from other providers?
• How many encounters per year, by service type (at my agency, at other providers, and in total)
Report 1: Medicaid Managed Care Plan & Product Line
Report 2: Provider Network
Report 3: Service Settings & Volume
Recipient Search to Identify High Need Cohorts
• Use Recipient Search to generate list of clients meeting specified criteria
• “Characteristics” Filters:
• Health and Recovery Plan (HARP) Status
• Managed Care (MC) Plan
• Assisted Outpatient Treatment (AOT) Status
• Alerts & Incidents: Suicide Attempts, Suicidal Ideation, Self-Harm
• “Service Setting” Categories:
• Health Home Enrolled (Source: DOH)
• Inpatient & Emergency Room (ER)
• ACT – MH Specialty
• Search by “Quality Flag” or add to any Search
Recipient Search “Characteristic” Filters
Example: Look at Alerts & Incidents
Recipient Search “Service Setting” Options
Example: Look at Inpatient and ER
Recipient Search: Add a Quality Flag to Any Search
Example: Look at 2+ Inpatient/ER - BH
Helpful Resources • October 2016 Data Jam
• Data dashboard user guide (attached as a handout)
• “Cheat sheet” --Data upload schedule / timeframes covered
• “Cheat sheet” –Measure list and targets
• PSYCKES Helpdesk Support: [email protected]• Monday to Friday, 9 am – 5 pm
• PSYCKES Trainings:• Recorded webinars:
https://www.omh.ny.gov/omhweb/psyckes_medicaid/webinars/
• Live trainings: https://www.omh.ny.gov/omhweb/psyckes_medicaid/calendar/
Thank you!www.CareTransitionsNetwork.org
The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.
Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
