The BHIAC met to discuss and vote on Preliminary Quality Measure Recommendation Results and Preliminary Other Recommendation Results. Recommendations were sent in from committee members, stakeholders and the general public. Approved recommendations will be published in future BHIAC recommendation reports.
Preliminary Quality Measures Recommendation Results
- Want to put forward measures and metrics not only relating to behavioral health but also physical health; have to keep thinking about integration as a whole
- Need to do a better job of engaging the community and not micromanaging programs; want to facilitate a community involved process of integration
- All of the recommendations need to be patient-centric
- There is significant research that shows people who receive peer services have a decreased usage of crisis services and their well-being improves; need to push the usage of peer specialists
- The more mandates and requirements that are put in place will cause fewer providers to accept Medicaid patients, especially in rural areas
- Need to have an open dialogue with stakeholders regarding quality measures; an ongoing public input process
- Discussed the recommendation to track physical health situations of clients at a more in-depth level
- Important because people with BH issues generally are more susceptible to general health issues and complications
- Multiple recommendations regarding reporting of access and availability information such as wait times should be combined so there is only one recommendation on that subject matter
- Need to be tracking social situations of clients; often social situations such as living arrangements, family situation, potential immigration status can lead to crisis situations
- Safety is also important; if a person does not feel safe they can’t really get to recovery
- Discussion regarding the tracking of medication adherence; some had issues with a person being tested to determine adherence and that being close to coercion when a patient is supposed to be allowed to refuse treatment; others believe it is important to know whether a patient is taking their medication because many will not let a physician know if they want to refuse and it is important for a physician to know
- The HEDIS measure only tracks whether a prescription is picked up from the pharmacy; they do not take urine samples to determine if the med is being taken
- Tracking medication from both physicians and mental health professionals will ensure true coordination of care if all providers are aware of what is happening with the patient’s care
- Discussion about certain metrics becoming an incentive not to treat certain patients; for example certain measures may be seen as a disincentive to seek out and care for homeless people because they are harder to care for and treat and they may not be as accountable for their own care
- Relapses may need to be treated as a reset and not necessarily a failure; they are important to track and is part of recovery so they need to be accounted for
- The group would like to track what attendant care services are being used before integration to be able to tell if MCOs aren’t authorizing a similar amount of services
- For all children who are prescribed psychotropic drugs, a well-child exam should be administered; it should be obvious but it isn’t happening and needs to be reinforced
- Recommendation that children being prescribed psychotropic drugs and their families should be offered family therapy
- This should be included in the definition of integrated care as well as the recommendation regarding a well-child exam
- Discussion of the current pay for quality program where a percent of capitation is withheld and paid out based on quality outcomes
Public Comment
Tegan Henke, Texas Institute for Excellence in Mental Health
- Should consider more child-specific outcomes; children’s issues get lost sometimes and things like school attendance and school relationships aren’t tracked; hobbies and community involvement are also important to consider
- Need to consider how the system is looking at transition-aged youth; are employment skills being built, are they being prepared for adulthood and what that means for their care
- A committee member noted that school related points may need to be increased in the recommendations; graduation rates as well
- A motion was made to incorporate those remarks regarding children and school/youth related metrics and building of employment skills among tracked data points
- Motion adopted
Preliminary Quality Measures Recommendation Results adopted by committee unanimously.
Preliminary Other Recommendation Results
- Would like to incentivize parties in the care program if they help consumers reach goals; this idea will be part of the larger conceptual recommendations
- Would like for clients to be able to choose some of the things that are provided for their benefit such as a gym membership or other things like that
- That is a good theory but it cannot be done without some structure; inevitably someone will come up with something not evidence based that they would like to be funded to promote their personal wellness; gym memberships may be a good one though
- It would be helpful to investigate some other pilot projects in other states and in the NorthSTAR region to determine feasibility before jumping into that one
- Would like to disseminate high quality apps that can be used in treatment and care as well as developing new apps that provide additional services
Preliminary Other Recommendation Results adopted by committee unanimously.
Next meeting will be March 11, 2015. That agenda will include discussion on health home pilots, screening tools and assessments, discussion on concept of prevention as an overall component of integrated health care, and a presentation on MCO report cards.