Measuring Performance—Data Integration Matters

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

Most provider organization executive teams don’t have an option for what performance metrics they report to their payers—whether states, counties, employers, Medicaid, Medicare, or health plans. The challenge is that those measures are not the same from one payer to the next—at last count, more than 500 different measures of behavioral health performance alone. And those measures can change—as payers’ areas of focus and policies change.

For most organizations, coping operationally with the wide range of metrics requested by payers depends on having the right framework for data collection and the right reporting platform. Key capabilities include the ability to integrate data from a variety of sources within the organization, interoperability to accept data from outside the organization, and customizable analysis and reporting of performance data.

This was the focus of the discussion in the session, Preparing For CalAIM: Performance Measurement & Performance Management Under CalAIM, at The 2022 OPEN MINDS Performance Management Institute. The session featured Alyson Albano, M.S., Director of Clinical Quality; Alexa (Baghdassarian) Jawlakian, Director of Operations; and Diane Sayegh, Director of Utilization Review, all with Discovery Behavioral Health (DBH). DBH—facilitated by OPEN MINDS senior associate, Richard Louis. DBH operates a network of 130 mental health, addiction, and eating disorder treatment centers.

The DBH team provided a great example of changing measures of performance—and best practices in making that happen. On January 1, 2022, Medi-Cal health plans began contracting with community-based behavioral health and social services provider organizations for Enhanced Case Management (ECM) and Community Support (In Lieu of Services) as part of their population health management strategies under CalAIM. These services target the most complex Medi-Cal consumers who have severe mental health conditions, need significant social supportive services, and are at high risk for unnecessary emergency department visits and/or avoidable inpatient hospitalization.

California provider organizations will need to develop the capability to track and report performance measures as the roll out of CalAIM continues over the next few years. DBH is a good example of an organization that has an established performance measurement approach and metrics model for performance measurements required by payers in value-based arrangements. DBH tracks six different domains of value-based metrics—provider rating, medication assisted treatment (MAT) tracking, transitions of care, care coordination, re-admission rates, and symptom monitoring. The data for these metrics is pulled from five internal systems that collect data from ten different collection points, from pre-admission through one-year post discharge. The system integrates a risk-management system (ERM), their electronic medical record (EMR), a center of excellence instrument (COE), their customer relationship platform (CRM), and an outcomes measurement system.

Collecting the data is only the first step. The DBH team shared their process for analyzing the date, determining strategies to address gaps, and applying the information and strategies to improve outcomes and deliver on their value-based requirements. For DBH, the system for getting the necessary outcomes, created by Ms. Albano, is based on their four-dimension Clinical Intelligence Model—clinician best practices, therapeutic working alliance, evidence-based practices, and quality performance measures.

Clinician best practices—DBH uses a “four-prong supervision framework” to ensure a high level of clinical acumen and highlight the expectations their clinical professionals are expected to achieve. This includes case conceptualization, patient engagement/milieu management, therapist development, and clinical documentation.

Therapeutic working alliance—This dimension focuses on the relationship between clinical professionals and consumers, as well as prioritizes access to care and telehealth. This dimension is also a chance to individualize eclectic modalities and focus on the consumer experience and satisfaction.

Evidence-based practices—This dimension uses clinical best practices by focusing both on the interventions and the timing of the interventions, or knowing what to apply and when to apply it.

Quality performance measures—This dimension uses data to inform treatment planning, with a large focus on value-based reimbursement metrics that are part of the clinical model, alignment with HEDIS measures, measurement-based treatment planning, and a biannual comprehensive assessment, the COE tool.

Executive teams of provider organizations can expect the focus on performance—as one half of the value equation—to continue. While the measures will change, the framework for metric-based management will remain constant—visible metrics, actionable insights, accountability, real-time performance feedback, performance recognition, and data-informed strategic decisionmaking.