JULY 2019 The Authors Issue Brief Katrina Connolly, Len Finocchio, and Matthew Newman, Blue Sky Consulting Group Quantifying Integrated Physical and Behavioral Health Care in Medi-Cal A resource to measure care across systems for adult Medi-Cal enrollees M any adult Medi-Cal enrollees require care Unfortunately, we understand very little about Available Measures from multiple systems. People receive how well the Medi-Cal program meets the needs Even in the current siloed system, there are some physical health services and mental health of patients requiring care across these multiple avenues by which to measure care across systems. services for low acuity (“mild-to-moderate”) condi- systems. Managed care plans and county systems In consultation with stakeholders and experts, the tions from Medi-Cal managed care plans. County do not regularly exchange information about the Blue Sky Consulting Group has identified a set of mental health plans provide specialty mental health patients they share. Providers in the various systems valid and reliable measures that managed care services for serious mental illness, and county Drug frequently complain that they do not know what plans, county mental health plans, and county sub- Medi-Cal programs provide treatment for substance kind of care their patients are receiving from other stance use disorder programs can collect, track, and use disorders. systems, including that someone in their care has use. With these measures, programs can quantify been hospitalized. Medi-Cal enrollees themselves and monitor health outcomes for people who access People Who Need Both Physical and may face health risks if their primary care provider (or should access) care across multiple systems — Behavioral Health Care is not aware of their psychiatric prescriptions, for outcomes likely to be affected by the integration of People with serious mental illness and substance example. At the county and statewide levels, there care across systems. use disorders are at greater risk of physical illnesses is no comprehensive effort to assess the health out- including obesity, diabetes, and cardiovascular dis- comes of people who receive Medi-Cal services ease.1 Despite this increased risk, they are less likely from multiple systems and who stand to benefit Even in the current siloed system, to receive routine primary care.2 Social instability, from improved integration efforts. there are some avenues by which to motivation challenges, fearfulness, and stigma may all make it more difficult for people with serious While several current Medi-Cal efforts, including measure care across systems. mental illness to seek out physical health care, and the Whole Person Care pilots and Health Homes accessing care in siloed systems can be particularly Program, are aimed at addressing these care inte- These measures are described in Table 1, which challenging because many of these patients require gration challenges for specific populations of provides specifications for each measure, including intensive coordination, outreach, engagement, clin- members, there is no comprehensive approach to how to construct the measure, suggested compari- ical information sharing, medication reconciliation, measuring the impact of these integration efforts. It son groups, and an assessment of the feasibility of and patient and family engagement.3 does not have to be this way. implementation (see page 3). Most of these measures rely on existing data sources. Using the Resource Many are based on Healthcare Effectiveness Data On the local level, the first step in putting this mea- Endnotes and Information Set (HEDIS) measures, such as surement resource to use would be for managed 1.Physical Health Conditions Among Adults with Mental those in California’s Department of Health Care care plans and county mental health plans to jointly Illnesses (PDF), The NSDUH Report, April 5, 2012; and Services (DHCS) External Accountability Set, that select a set of priority measures, based on local Cynthia Boyd et al., Clarifying Multimorbidity Patterns to are already collected by DHCS and by managed conditions and data access, to establish an integra- Improve Targeting and Delivery of Clinical Services for Medicaid Populations, Center for Health Care Strategies, care plans, and/or by counties. tion baseline. From there, progress can be assessed December 2010. over time. County behavioral health departments 2.Benjamin G. Druss and Silke A. von Esenwein, “Improving Among the questions that could be answered based and managed care plans can measure performance, General Medical Care for Persons with Mental and on this measurement resource are: compare their performance to similar communities, Addictive Disorders: Systematic Review,” General and assess the effectiveness of efforts to improve Hospital Psychiatry 28, no. 2 (March–April 2006): 145–53, 1.What percentage of adult Medi-Cal managed doi:10.1016/j.genhosppsych.2005.10.006. care integration. care members who are receiving specialty 3.Len Finocchio, Katrina Connolly, and Matthew Newman, mental health or substance use disorder ser- Improving Mental Health Services Integration in Medi-Cal: On the state level, DHCS could construct a set of Strategies for Consideration, Blue Shield of California vices had a primary care visit in the past year? measures that are both feasible and of broad inter- Foundation, May 2017. 2.What is the emergency department visit rate est, and then make this information available to for adult members receiving specialty mental local stakeholders across the state. By using the health or substance use disorder services in measures collected in this resource, local communi- About the Foundation the past year? ties and DHCS can begin to measure care across The California Health Care Foundation is dedicated systems, with the goal of improving integration and to advancing meaningful, measurable improve- 3. hat percentage of adult members receiv- W health care outcomes for affected populations. ments in the way the health care delivery system ing specialty mental health services receive provides care to the people of California, particu- screening for diabetes and cancer? Why Measurement Matters larly those with low incomes and those whose needs The measures come from the Substance Abuse and Addressing adult Medi-Cal enrollees’ physical are not well served by the status quo. We work to Mental Health Services Administration (SAMHSA), and behavioral health needs seamlessly and col- ensure that people have access to the care they Agency for Healthcare Research and Quality laboratively is important because this population need, when they need it, at a price they can afford. (AHRQ), and National Quality Forum (NQF) as well experiences co-occurring physical health, mental as peer-reviewed literature on prevalent comor- health, and substance use issues at high rates. This CHCF informs policymakers and industry leaders, bidities among people with serious mental illness resource offers plans, counties, the Department of invests in ideas and innovations, and connects with and/or substance use disorder. Blue Sky Consulting Health Care Services, and others a clear path to changemakers to create a more responsive, patient- Group also conducted interviews with leaders at assess and improve the delivery of services for a centered health care system. managed care plans, mental health plans, and other population with complex needs. experts. For more information, visit www.chcf.org. California Health Care Foundation www.chcf.org 2 Table 1. Measurement Tool for Quantifying Integrated Physical and Behavioral Health Care for Adult Medi-Cal Beneficiaries Includes measures selected based on the research from the National Quality Forum (NQF), Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Agency for Healthcare Research and Quality (AHRQ), Substance Abuse and Mental Health Services Administration (SAMHSA), and peer-reviewed empirical research. The measures focus on quantifying integration across health care delivery systems. This table is available as an Excel spreadsheet at www.chcf.org/quantifying-integrated-care. See page 9 for definitions of terms and acronyms. PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Needs Assessed What percentage of adult Implement Medicaid Adult Core Across county-plan High. Specified Physical care Kitty Purington and Rachel Yalowich, Measuring MMCP members with schizo- Measure: Diabetes screening pairings, over time measure already imple- for SMI Physical and Behavioral Health Integration, NASHP, phrenia or bipolar disorder using for people with schizophrenia mented by DHCS; uses January 2017, nashp.org (PDF); HEDIS 2018 Vol. 1, antipsychotic medications have or bipolar disorder who are administrative data NCQA, 2018, www.ncqa.org; and Core Set of Adult been screened for diabetes? using antipsychotic medications Health Care Quality Measures for Medicaid (Adult (administrative) Core Set), CMS, 2018, www.medicaid.gov (PDF). What percentage of adult Stratify EAS measure by those Across county-plan High. Specified Physical care Stephen Kisely, Elizabeth Crowe, and David MMCP members receiving SMH receiving SMH services: pairings, over time, measure already imple- for SMI Lawrence, “Cancer-Related Mortality in People services have been screened for Breast cancer screening general population mented by DHCS; uses with Mental Illness,” JAMA Psychiatry 70, no. 2 breast cancer? (administrative) administrative data that (Feb. 2013): 209–17, doi.org; Marc De Hert et al., can be stratified “Physical Illness in Patients with Severe Mental Disorders I. Prevalence, Impact of Medications and Disparities in Health Care,” World Psychiatry 10, no. 1 (Feb. 2011): 52–77, doi.org; External Accountability Set (EAS) for MCPs and SHPs: MY 2017 / RY 2018, DHCS, August 30, 2017, www.dhcs.ca.gov (PDF); and Core Set, CMS, www.medicaid.gov (PDF). What percentage of adult Implement HEDIS measure and Across county-plan Medium. Specified Physical care Kisely, Crowe, and Lawrence, “Cancer-Related MMCP members receiving SMH stratify by those receiving SMH pairings, over time, measure not currently for SMI Mortality,” www.ncbi.nlm.nih.gov; De Hert et al., services have been screened for services: Colorectal cancer general population implemented by DHCS; “Physical Illness,” doi.org; and HEDIS 2018 Vol. 1, colorectal cancer? screening (administrative) uses administrative data NCQA, www.ncqa.org. that can be stratified What percentage of adult Implement Medicaid Adult Across county-plan Low. Specified measure MH care Core Set, CMS, www.medicaid.gov (PDF); and MMCP members receiving SUD Core Measure and stratify by pairings, over time not currently imple- for SUD Constance Weisner et al., “Integrated Primary services have been screened those receiving SUD services: mented by DHCS; would Medical Care with Addiction Treatment: A for depression and, if positive, Screening for depression and require EHR data or Randomized Controlled Trial,” JAMA 286, no. 14 received a follow-up plan? follow-up plan (hybrid or EHR) hybrid data (Oct. 10, 2001): 1715–23, www.ncbi.nlm.nih.gov. What percentage of adult Implement Medicaid Adult Core Across county-plan Medium. Specified Physical care HEDIS 2018 Vol. 1, NCQA, www.ncqa.org; Core Set, MMCP members receiving Measure and stratify by those pairings, over time, measure, but may for SMI CMS, www.medicaid.gov (PDF); and De Hert et al., SMH services had their BMI receiving SMH services: Adult general population require use of hybrid “Physical Illness,” doi.org. documented by either the body mass index assessment data that would be diffi- MHP or the MMCP? (administrative or hybrid) cult to stratify What percentage of adult Implement and stratify Across county-plan Low. Specified measure SUD care HEDIS 2018 Vol. 1, NCQA, www.ncqa.org; and MMCP members receiving SMH electronic HEDIS measure by pairings, over time, not currently imple- for SMI Weisner et al., “Integrating Primary Medical Care,” services have been screened for those receiving SMH services: general population mented by DHCS; would www.ncbi.nlm.nih.gov. unhealthy alcohol use? Unhealthy alcohol use screening require EHR data that and follow-up (EHR) DHCS does not yet have California Health Care Foundation www.chcf.org 3 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Chronic Conditions Under Control What percentage of MMCP Implement Medicaid Adult Core Across county-plan Medium. Specified Physical care Core Set, CMS, www.medicaid.gov (PDF); members with diabetes Measure: HbA1c poor control pairings, over time, measure already imple- for SMI Susan M. Frayne et al.,”Disparities in Diabetes and who are receiving SMH (>0.9%) for people receiving non-SMI population mented by DHCS; but Care: Impact of Mental Illness,” JAMA Internal services have effective control SMH services (administrative with diabetes may require use of Medicine 165, no. 22 (Dec. 12/26, 2005): 2631–38, over their diabetes? or hybrid) hybrid data that would doi.org; De Hert et al., “Physical Illness,” doi.org; be difficult to stratify T. J. Lambert, D. Velakoulis, and C. Pantelis, “Medical Comorbidity in Schizophrenia,” Medical Journal of Australia 178 (May 5, 2003): S67–70, www.ncbi.nlm.nih.gov; External Accountability Set, DHCS, www.dhcs.ca.gov (PDF); and Whole Person Care Pilot Evaluation Design, DHCS, n.d., www.dhcs.ca.gov (PDF). What percentage of MMCP Stratify EAS measure by Across county-plan Low. Specified measure Physical care Cynthia Boyd et al., Clarifying Multimorbidity members receiving SMH those receiving SMH services: pairings, over time, already implemented by for SMI Patterns to Improve Targeting and Delivery of services have high blood Controlling high blood pressure non-SMI population DHCS; requires use of Clinical Services for Medicaid Populations, pressure under control? (hybrid) with hypertension hybrid data that would CHCS, December 2010, www.chcs.org; Sarah be difficult to stratify Lally, Aligning Performance Measures Across Medi-Cal Initiatives, Integrated Healthcare Assn., December 2016, www.iha.org (PDF); Whole Person Care Pilot, DHCS, www.dhcs.ca.gov (PDF); External Accountability Set, DHCS, www.dhcs.ca.gov (PDF); and Core Set, CMS, www.medicaid.gov (PDF). What percentage of MMCP Stratify EAS measure by Across county-plan Low. Specified measure Physical care Boyd, Clarifying Multimorbidity, www.chcs.org; members receiving SUD those receiving SUD services: pairings, over time, already used by DHCS; for SUD External Accountability Set, DHCS, services have high blood Controlling high blood pressure non-SUD population requires use of hybrid www.dhcs.ca.gov; Core Set, CMS, pressure under control? (hybrid) with hypertension data that would be www.medicaid.gov (PDF); S. Parthasarathy et al., difficult to stratify “Utilization and Cost Impact of Integrating Substance Abuse Treatment and Primary Care,” Medical Care 41, no. 3 (Mar. 2003): 357–67, www.ncbi.nlm.nih.gov; Weisner et al., “Integrating Primary Medical Care,” www.ncbi.nlm.nih.gov; M. D. Stein, “Medical Consequences of Substance Abuse,” Psychiatric Clinics of N. America 22, no. 2 (June 1999): 351–70, www.ncbi.nlm.nih.gov; and Whole Person Care Pilot, DHCS, www.dhcs.ca.gov (PDF). What percentage of MMCP Implement NQF 0018 measure Across county-plan Low. Specified measure Physical care De Hert et al., “Physical Illness,” doi.org; members with CVD who are and stratify for those receiving pairings, over time, not currently imple- for SMI Cardiovascular Conditions 2016–2017: receiving SMH services have SMH services: Blood pressure non-SMI population mented by DHCS; Technical Report, NQF, February 23, 2017, blood pressure under control? control for CVD (hybrid) with CVD requires use of hybrid www.qualityforum.org; and Whole Person data that would be Care Pilot, DHCS, www.dhcs.ca.gov (PDF). difficult to stratify Quantifying Integrated Physical and Behavioral Health Care in Medi-Cal www.chcf.org 4 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Monitored What percentage of MMCP Implement HEDIS measure: Across county-plan High. Specified Physical care De Hert et al., “Physical Illness,” doi.org; HEDIS members with schizophrenia and Diabetes monitoring for pairings, over time, measure not currently for SMI 2018 Vol. 1, NCQA, www.ncqa.org; Cardiovascular diabetes are being monitored people with diabetes and non-SMI population implemented by DHCS; Conditions, NQF, www.qualityforum.org; and for diabetes (e.g., had both an schizophrenia (administrative) with diabetes uses administrative data Quality of Care in Medi-Cal: Understanding HEDIS LDL-C test and HbA1c test)? for Children in Foster Care, DHCS, January 2018, www.dhcs.ca.gov. W hat percentage of MMCP Implement HEDIS measure: Across county-plan High. Specified Physical care Purington and Yalowich, Measuring Physical, members receiving SMH services Percentage of those with pairings, over time, measure not currently for SMI nashp.org (PDF); Michelle Herman Soper, who have a CVD diagnosis are CVD and SMI who had and to non-SMI implemented by DHCS; Rachael Matulis, and Christopher Menschner, being monitored for CVD LDL-C test (administrative) population with uses administrative data Moving Toward Value-Based Payment for Medicaid (e.g., had LDL-C tested)? CVD Behavioral Health Services, CHCS, June 2017, www.chcs.org (PDF); Cardiovascular Conditions, NQF, www.qualityforum.org; HEDIS 2018 Vol. 1, NCQA, www.ncqa.org; and Quality of Care in Medi-Cal, DHCS, www.dhcs.ca.gov. Use of Ambulatory Care What is the ED visit rate for Stratify EAS measure by Across county-plan High. Specified Physical care Soper, Matulis, and Menschner, Moving Toward, MMCP members receiving members receiving SMH pairings, over time, measure already imple- for SMI www.chcs.org (PDF); David Mancuso, Evaluation SMH services in the past services: ED visits per general population mented by DHCS; uses of Fully Integrated Managed Care in Southwest measurement year? 1,000 member months administrative data that Washington, Washington Dept. of Social and (administrative) can be stratified Health Services, August 31, 2017, www.hca.wa.gov (PDF); Health Home State Plan Amendment 16-007, CMS, 2017, www.dhcs.ca.gov (PDF); and External Accountability Set, DHCS, www.dhcs.ca.gov (PDF). What is the ED visit rate for Stratify EAS measure by Across county-plan High. Specified Physical care External Accountability Set, DHCS, www.dhcs.ca.gov MMCP members receiving those receiving SUD services: pairings, over time, measure already imple- for SUD (PDF); Parthasarathy et al., “Utilization and Cost,” SUD services in the past ED visits per 1,000 member general population mented by DHCS; uses www.ncbi.nlm.nih.gov; Weisner et al., “Integrating measurement year? months (administrative) administrative data Primary Medical Care,” www.ncbi.nlm.nih.gov; that can be stratified and Stein, “Medical Consequences,” www.ncbi.nlm.nih.gov. What percentage of MMCP Calculate the number of Over time and High. Unspecified Physical care Whole Person Care Pilot, DHCS, www.dhcs.ca.gov members receiving SMH services members receiving SMH general population measure, but uses for SMI (PDF); and External Accountability Set, DHCS, had a primary care visit in the services who saw a primary administrative data www.dhcs.ca.gov (PDF). past measurement year? care provider divided by the that can be stratified number of members receiving SMH services (administrative) What percentage of MMCP Calculate the number of Over time and High. Unspecified Physical care Parthasarathy et al., “Utilization and Cost,” members receiving SUD services members receiving SUD general population measure, but uses for SUD www.ncbi.nlm.nih.gov; Weisner et al., had a primary care visit in the services who saw a primary administrative data “Integrating Primary Medical Care,” past measurement year? care provider divided by the that can be stratified www.ncbi.nlm.nih.gov; and Stein “Medical number of members receiving Consequences,” www.ncbi.nlm.nih.gov. SUD services (administrative) California Health Care Foundation www.chcf.org 5 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Use of Ambulatory Care, continued What percentage of MMCP Calculate the number of Over time High. Unspecified Physical care De Hert et al., “Physical Illness,” doi.org. members who have not had a members who saw a physi- measure, but uses for SMI primary care visit in the year cal health provider within 30 administrative data preceding an encounter with days of an encounter with SMH SMH services had an encounter services divided by the number with a MMCP physical health of members who have not had provider within 30 days of the a primary care visit in the year encounter with SMH services? preceding the SMH encounter (administrative) What percentage of MMCP Calculate the number of Over time High. Unspecified Physical care Parthasarathy et al., “Utilization and Cost,” members who have not had a members who saw a physi- measure, but uses for SUD www.ncbi.nlm.nih.gov; Weisner et al., primary care visit in the year cal health provider within 30 administrative data “Integrating Primary Medical Care,” preceding an encounter with days of an encounter with SUD www.ncbi.nlm.nih.gov; and Stein “Medical SUD services had an encounter services divided by the number Consequences,” www.ncbi.nlm.nih.gov. with a MMCP physical health of members who have not had provider within 30 days of the a primary care visit in the year encounter with SUD services? preceding the SUD encounter (administrative) What was the all cause 30-day Stratify EAS measure by those Across county-plan High. Specified Physical care Soper, Matulis, and Menschner, Moving Toward, readmission rate for MMCP receiving SMH services: All pairings, over time, measure already imple- for SMI www.chcs.org (PDF); Mancuso, Evaluation, members receiving SMH services cause 30-day readmission rate general population mented by DHCS; uses www.hca.wa.gov (PDF); External Accountability in the past measurement year? (administrative) administrative data that Set, DHCS, www.dhcs.ca.gov (PDF); and Core Set, is easy to stratify CMS, www.medicaid.gov (PDF). What was the all cause 30-day Stratify EAS measure by those Across county-plan High. Specified Physical care Soper, Matulis, and Menschner, Moving Toward, readmission rate for MMCP receiving SUD services: All pairings, over time, measure already imple- for SUD www.chcs.org (PDF); Mancuso, Evaluation, members receiving SUD services cause 30-day readmission rate general population mented by DHCS; uses www.hca.wa.gov (PDF); External Accountability in the past measurement year? (administrative) administrative data that Set, DHCS, www.dhcs.ca.gov (PDF); and Core Set, can be stratified CMS, www.medicaid.gov (PDF). What percentage of MMCP Implement AHRQ PQI 90 and Across county-plan High. Specified Physical care Ishveen Chopra, Tricia Lee Wilkins, and Usha members receiving SMH services stratify by those receiving SMH pairings, over time, measure already imple- for SMI Sambamoorthi, “Ambulatory Care Sensitive had an ambulatory care sensi- services: Prevention Quality general population mented by DHCS; uses Hospitalizations Among Medicaid Beneficiaries with tive hospitalization in the past Overall Composite (administra- administrative data that Chronic Conditions,” Hospital Practice 44, no. 1 measurement year? tive) can be stratified (2016): 48–59, dx.doi.org; State Plan Amendment, CMS; “Prevention Quality Indicators Overview,” AHRQ, www.qualityindicators.ahrq.gov; and Core Set, CMS, www.medicaid.gov (PDF). What percentage of MMCP Implement AHRQ PQI 90 and Across county-plan High. Specified Physical care Chopra, Wilkins, and Sambamoorthi, “Ambulatory members receiving SUD services stratify by those receiving pairings, over time, measure already imple- for SUD Care,” www.ncbi.nlm.nih.gov; State Plan had an ambulatory care sensi- SUD services: Prevention general population mented by DHCS; uses Amendment, CMS; “Prevention Quality,” AHRQ, tive hospitalization in the past Quality Overall Composite administrative data that www.qualityindicators.ahrq.gov; and Core Set, CMS, measurement year? (administrative) can be stratified www.medicaid.gov (PDF). Quantifying Integrated Physical and Behavioral Health Care in Medi-Cal www.chcf.org 6 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Use of Ambulatory Care, continued What percentage of adult MMCP Implement Medicaid Adult Core Across county-plan Low. Specified measure Physical care Core Set, CMS, www.medicaid.gov (PDF); HEDIS members receiving SMH services Measure and stratify by those pairings, over time, not currently imple- for SMI 2018 Vol. 1, NCQA, www.ncqa.org; “Quality who are current smokers received receiving SMH services: Medical general population mented by DHCS; would Positioning System (QPS) Measure Description advice to quit, were recom- assistance with smoking and require use of EHR data Display Information: Measure No. 0027,” NQF, mended cessation medications, or tobacco use cessation (EHR) that DHCS does not yet www.qualityforum.org (PDF); and De Hert et al., were provided cessation methods? have “Physical Illness,” doi.org. What percentage of adult MMCP Implement Medicaid Adult Core Across county-plan Low. Specified measure Physical care Core Set, CMS, www.medicaid.gov (PDF); HEDIS members receiving SUD services Measure and stratify by those pairings, over time, not currently imple- for SUD 2018 Vol. 1, NCQA, www.ncqa.org; “Measure who are current smokers received receiving SUD services: Medical general population mented by DHCS; would No. 0027,” NQF, www.qualityforum.org (PDF); and advice to quit, were recom- assistance with smoking and require use of EHR data Weisner et al., “Integrating Primary Medical Care,” mended cessation medications, or tobacco use cessation (EHR) that DHCS does not yet www.ncbi.nlm.nih.gov. were provided cessation methods? have What percentage of members Implement Medicaid Adult Core Over time and Low. Specified measure Physical care HEDIS CAHPS Survey 5.0, NQF, www.ncqa.org; receiving SMH services received Measure and stratify by those general population not currently imple- for SMI NQF #0039: Flu Shots for Adults Age 50 and Over: a flu vaccination in the past receiving SMH services: Flu mented by DHCS; would Measure Submission and Evaluation Worksheet 5.0, measurement year? vaccinations for adults (EHR) require use of EHR data NQF, August 10, 2009, www.qualityforum.org; and that DHCS does not yet Core Set, CMS, www.medicaid.gov (PDF). have What percentage of members Implement Medicaid Adult Core Over time and Low. Specified measure Physical care HEDIS CAHPS Survey 5.0, www.ncqa.org; NQF receiving SUD services received Measure and stratify by those general population not currently imple- for SUD #0039, NQF, www.qualityforum.org; and Core Set, a flu vaccination in the past receiving SUD services: Flu mented by DHCS; would CMS, www.medicaid.gov (PDF). measurement year? vaccinations for adults (EHR) require use of EHR data that DHCS does not yet have Transitions Facilitated What percentage of members with Implement Medicaid Adult Across county-plan High. Specified MH contin- Purington and Yalowich, Measuring Physical, a principal diagnosis of mental Core Measure: Follow up after pairings and over measure not currently uum of care nashp.org (PDF); Core Set, CMS, www.medicaid.gov illness who visit the ED receive ED visit for mental illness time implemented by DHCS; (PDF); and HEDIS 2018 Vol. 1, NCQA, www.ncqa.org. follow-up mental health treatment (administrative) uses administration data within 7 or 30 days of ED visit? What percentage of ED visits for Implement Medicaid Adult Core Across county-plan High. Specified SUD Purington and Yalowich, Measuring Physical, members with a principal diagno- Measure: Follow up after ED pairings and over measure not currently Continuum nashp.org (PDF); Core Set, CMS, www.medicaid.gov sis of alcohol and other drug visit for AOD (administrative) time implemented by DHCS; of Care (PDF); and HEDIS 2018 Vol. 1, NCQA, www.ncqa.org. abuse or dependence received uses administration data follow-up SUD treatment within 7 or 30 days of ED visit? What percentage of MMCP Calculate the number of Over time Low. Unspecified MH Len Finocchio, Katrina Connelly, and Matthew members stepping down from members that receive MH care measure; statewide data continuum Newman, Improving Mental Health Services SMH services to mild/moderate from MMCP providers divided not currently available of care Integration in Medi-Cal: Strategies for Consideration, services received care from a by the number of members Blue Shield of California Foundation, May 2017, MMCP mental health provider? referred for mild/moderate blueshieldcafoundation.org. treatment after SMHS treatment California Health Care Foundation www.chcf.org 7 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Transitions Facilitated, continued What percentage of MMCP Calculate the number of Over time Low. Unspecified MH Finocchio, Connelly, and Newman, Improving Mental members referred by MMCP members assessed by the measure; statewide continuum Health Services, blueshieldcafoundation.org. providers to the MHP for MHP divided by the number data not currently of care assessment are assessed? of members referred by available MMCP providers What percentage of MMCP Calculate the number of Over time Low. Unspecified MH Finocchio, Connelly, and Newman, Improving Mental members assessed by the members treated by the MHP measure; statewide continuum Health Services, blueshieldcafoundation.org. MHP attended a mental health (for SMI) or MMCP (for mild/ data not currently of care appointment at either the MMCP moderate) divided by the total available or MHP in the past year? number assessed for MH needs. What percentage of members Calculate the number of Over time Medium. Unspecified Physical care De Hert et al., “Physical Illness,” doi.org. receiving SMH services who members who subsequently measure; no unique for SMI self-reported medical received medical care as identifier across conditions subsequently indicated in MMCP claims and administrative received medical care?  encounters data divided by the data sets number of members receiving SMH services who responded to question S-34.0 or S-35.0 in the CSI data set What percentage of members Calculate the number of Over time Medium. Unspecified Physical care Boyd, Clarifying Multimorbidity, www.chcs.org receiving SMH services who members who subsequently measure; no unique for SMI (PDF); and “Mental Health and Substance Use self-reported substance use/ received SUD services as identifier across Disorders,” SAMHSA, last updated April 13, 2019, dependence subsequently indicated in CalOMS data administrative www.samhsa.gov. received medical care? divided by the number of data sets members receiving SMH services who responded affirmatively to question S-37.0 in the CSI data set What percentage of members Calculate the percentage of Over time Medium. Unspecified MH care Parthasarathy et al., “Utilization and Cost,” receiving SUD services and members receiving SUD services measure; uses for SUD www.ncbi.nlm.nih.gov; Weisner et al., self-reported recent ED use, who replied affirmatively to administrative data “Integrating Primary Medical Care,” psychiatric facility use, or questions 3.9.2, 3.9.3, or 3.9.4 in www.ncbi.nlm.nih.gov; and Stein “Medical medication use for a mental CalOMS data and subsequently Consequences,” www.ncbi.nlm.nih.gov. health condition subsequently received mental health services received mental health services? from either the MMCP or MHP Quantifying Integrated Physical and Behavioral Health Care in Medi-Cal www.chcf.org 8 PROPOSED EXAMPLE INTEGRATION MEASUREMENT STRATEGY COMPARISON GROUP FEASIBILITY DOMAIN SOURCES Follow Up What percentage of MMCP Implement HEDIS measure Across county-plan Medium. Specified Physical care HEDIS 2018 Vol. 1, NCQA, www.ncqa.org; and Boyd, members receiving SMH services and stratify by those pairings, over time, measure not currently for SMI Clarifying Multimorbidity, www.chcs.org (PDF). who had a hospital encounter receiving SMH services: and non-SMI used by DHCS for COPD received appropri- Pharmacotherapy population with ate medication (i.e., systematic management of COPD corticosteroid within 14 days and COPD exacerbation bronchodilator within 30 days)? What percentage of MMCP Implement HEDIS measure Across county-plan Medium. Specified Physical care HEDIS 2018 Vol. 1, NCQA, www.ncqa.org; and Boyd, members receiving SUD services and stratify by those pairings, over time, measure not currently for SUD Clarifying Multimorbidity, www.chcs.org (PDF). who had a hospital encounter receiving SUD services: and non-SUD used by DHCS for COPD received appropri- Pharmacotherapy population with ate medication (i.e., systematic management of COPD corticosteroid within 14 days and COPD exacerbation bronchodilator within 30 days) What percentage of adolescent Implement Medicaid Over time Medium. Specified SUD Core Set, CMS, www.medicaid.gov (PDF); and and adult members with a new Adult Core Measure: measure not currently Continuum Attachment MM: Whole Person Care Pilot episode of AOD use/dependence Initiation of AOD treatment used by DHCS of Care Requirement and Metrics, DHCS, October 20, 2016, initiate treatment within 14 days www.dhcs.ca.gov (PDF). of diagnosis? Key Administrative — This method for constructing an EAS, CMS, or NCQA measure uses administrative data (e.g., claims and encounters). AOD — alchohol or other drug BMI — body mass index COPD — chronic obstructive pulmonary disease DHCS — Department of Health Care Services EAS — DHCS External Accountability Set ED — emergency department Hybrid — This method for constructing an EAS, CMS, or NCQA measure involves extracting a sample of the eligible population, and allows for medical record review when administrative data do not show evidence that a service was provided. Member — Adult Medi-Cal beneficiary / member of a Medi-Cal managed care plan MMCP — Medi-Cal managed care plan MHP — County Mental Health Plan for specialty mental health services MH — mental health NASHP — National Academy for State Health Policy SMH — specialty mental health SMI — severe mentall illness SUD — substance use disorder California Health Care Foundation www.chcf.org 9