Insight and Action in Behavioral Health
Care Management Technologies
Data Analytics: A 21st Century Approach to Integrated Care and Population Health Management
OPEN MINDS Planning & Innovation InstituteJune 12, 2013
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Why Now?
Advances in use of technology in healthcare Cost of US healthcare relative to health of nation Advances in evidence-based medicine/practice Mental health parity/health integration Aging population
Drivers
Leading to:
Competition Payment Reform: value-based reimbursements and quality performance
Focus on Integration Complexity of patientCoordination Across Multiple Provider Systems
Ability to see what is going on inside and outside a provider system/health home
Evidence-based Guidance
Improving care while lowering costs
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• Benefit restriction• Prior authorization/edits• Medical services only • Limit provider rates• Pay based on utilization • Focus on utilization• 1-800 #• Outsourced• Healthy population
• Mental health parity • Genetic markers • Nonmedical benefit• Pay for performance• Incentive Based Pay• Focus on quality• Boots on the ground• Insourced• Complex needs population
20th Century vs. 21st CenturyHealth and Financial Management Techniques
20th Century 21th Century
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What is Big Data?
• Examples Web searches “you may also like” Drug companies use influence mapping to identify doctors in
common with a single patient to promote adoption of a newly introduced drug.
http://www.nytimes.com/2013/05/17/business/a-data-trove-now-guides-drug-company-pitches Obama 2012 campaign shows Facebook users the photos of ten
friends they were “most likely to influence”http://www.forbes.com/sites/kashmirhill/2013/04/16/obama-campaign-misjudged-mac-users-based-on-orbitzs-experience-says-chief-data-scientist
Big data is the term used for the evolving technology and science of data management and analysis.
Big data is the term used for the evolving technology and science of data management and analysis.
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Electronic Records Are Not Big DataDigital Age = Electronic RecordsDigital Age = Electronic Records
Data Types Pt Record Practice Mgt Pop Health Mgt
Quantitative Lab Values Productivity Value
AuthorizationCounts
Qualitative Text Docs Customer Feedback
CustomerComplaints
Transactional Data Service Codes Billing Codes Payment Codes
Rich Data Repository
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One Patient Metabolic Screening Data
CMT Healthcare OnlineName Value Method Opt-out Comments Date
Taken
✗ Height 65.00 inches Actual 02/14/2013
✗ Weight 214.00 Pounds Actual 02/14/2013
✗ BMI 35.6076 Actual 02/14/2013
✗ Waist No Data Inches Automated 02/14/2013
✗ BP Systolic 120.00 mmHg Automated 02/14/2013
✗ BP Diastolic 80.00 mmHg Automated 02/14/2013
✗ Blood Glucose 92.00 mg/dl Actual 02/14/2013
✗ HbA1c No Data % Automated 02/14/2013
✗ Total Cholesterol 218.00 mg/dl Actual 02/14/2013
✗ LDL 127.00 mg/dl Actual 02/14/2013
✗ HDL 58.00 mg/dl Actual 02/14/2013
✗ Triglycerides 163.00 mg/dl Actual 02/14/2013
✗ Antipsychotic Use Yes Yes 02/14/2013
✗ Pregnant No No 02/14/2013
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What happens when you have multiples of thousands?
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BIG DATA TECHNIQUESLeverage the Richness of Data Repository
314.940 records
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Drill Down of the Thousands
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Example 2
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Example 3
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Value Opportunity
• Expanding capacity for knowledge gains Shift best practice based on outcomes Capturing clinical nuggets from unstructured data
• Knowledge Dissemination Distillation of vast data into “news you can use”
• Personalized Medicine Tying genomics to health record data Tying personalized information to standard of practices
• Direct to Consumer Linking health data to other data – job, housing, diet,
entertainment
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Challenges
• Patient confidentiality
• Interoperability
• Balance of human vs. machine
• Using big data for specific gain
• Professional shift – independent decision to evidence-based guidance
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Tools in the Analytic Tool Kit
• Registries
• Dashboard Reports
• Health Information Exchanges
• Decision Support Tools
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Data Analytic Tools = Finding Key Determinants
http://www.moillusions.com/2009/08/camouflaged-toads-optical-illusion.html/ng9
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Registries
• Often tracks a specific clinical issue
• Track the magnitude of the problem
• Benchmark clinical care across providers
• Often is outside of the electronic record
• Often used for real world research
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One Patient Metabolic Screening Data
CMT Healthcare OnlineName Value Method Opt-out Comments Date
Taken
✗ Height 65.00 inches Actual 02/14/2013
✗ Weight 214.00 Pounds Actual 02/14/2013
✗ BMI 35.6076 Actual 02/14/2013
✗ Waist No Data Inches Automated 02/14/2013
✗ BP Systolic 120.00 mmHg Automated 02/14/2013
✗ BP Diastolic 80.00 mmHg Automated 02/14/2013
✗ Blood Glucose 92.00 mg/dl Actual 02/14/2013
✗ HbA1c No Data % Automated 02/14/2013
✗ Total Cholesterol 218.00 mg/dl Actual 02/14/2013
✗ LDL 127.00 mg/dl Actual 02/14/2013
✗ HDL 58.00 mg/dl Actual 02/14/2013
✗ Triglycerides 163.00 mg/dl Actual 02/14/2013
✗ Antipsychotic Use Yes Yes 02/14/2013
✗ Pregnant No No 02/14/2013
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What happens when you have 32,000 of these records?
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Risk Stratification via Diabetes RegistryMembers of Behavioral Health Home
(31494 members)
+ Diabetes Diagnosis (3732 members)
Service Claims Data
+ Use of 1 or more Antipsychotic Meds(411 members)
Pharmacy Claims
+ BMI > 30(109 members)
EMR Data
+ Antipsychotic medications contraindicated with Diabetes (95 members (24 members)
31,494 members
314.940 records
Members with Diabetes Diagnosis (3732 members)
3742 records
Use of 1 or More Antipsychotic Meds (411 members)
3742 records
Members with BMI > 30 (109 members)
3742 records
Antipsychotic Med Contraindication (95 members)
3742 records
Member Drill Down
95 records
Decision Support within the Registry
95 records
Health Alert 1009Diabetes and Use of Clozapine and OlanzapineAccording to our data this patient has evidence of diabetes and of treatment with Clozapine or Olanzapine. According to the Mt. Sinai Consensus Conference; clozapine and olanzapine pose an increased risk of weight gain, diabetes and worsening lipid profiles.(Am J Psychiatry 2004 161:1334-1349)
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Dashboard Reporting
• Typically tied to metrics (clinical or quality)
• Used to monitor and benchmark performance
• Can be used to improve patient specific outcomes
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Performance Tracking
Predictive ModelingMeasures
Flagged
DM17 Diabetes LDL Control (A)
% of patients 18-75 years of age with a diagnosis of diabetes (type1 or type 2) who had a LDL <100 mg/dl.
1426 29 98.01 1.99 70 -68.01
DM19 Diabetes BP Control (A)
% of patients 18-75 years of age with a diagnosis of diabetes (type1 or type 2) who had a blood pressure <140/90 mmHg.
1414 41 97.18 2.82 70 -67.182.82
CMT Healthcare Online
98.01 1.99
97.18
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MCO Dashboard Report for Call Center
Call Timeliness2012-07
2012-08
2012-09
2012-10
2012-11
2012-12
2013-01
2013-02
2013-03
2013-04
2013-05
2013-06 YTD
YTD as % Total
# Calls Answered 4,800 4,700 3,950 5,200 4,900 5,100 4,900 4,700 5,400 43,650
# Calls Abandoned 29 20 25 32 55 12 15 21 22 231
Total Number of Calls 4,829 4,720 3,975 5,232 4,955 5,112 4,915 4,721 5,422 - - - 43,881
% Abandoned (Goal <1%) 0.6% 0.4% 0.6% 0.6% 1.1% 0.2% 0.3% 0.4% 0.4% 0.5%
Avg Speed to Answer Calls (seconds)
5.8 5.8 5.7 6.0 5.6 5.8 5.9 5.8 5.4 52
% Answered within 30 seconds (Goal 100%)
99% 99% 99% 99% 99% 99% 100% 99% 100% 99%
Call Volume
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Health Information Exchanges
An Integrated IT Platform that collects data from multiple sources, mobilizes
and integrates the information and returns it to the end user.
An Integrated IT Platform that collects data from multiple sources, mobilizes
and integrates the information and returns it to the end user.
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Gaps Across Care Venues
Lab
ClinicImaging Center
Urgent Care
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Goal is to Close the Gaps
State Medicaid Office
Group Home
CMMS
Clinic
Lab
Imaging Center
Physician Office
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Decision Support
• Computer application that supports clinicians in improved decision making
• Usually rules based
• Usually tied to evidence
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Decision Support DisplayQuality Indicator™ Title Patients % Pts MDs PUPM
Use of 3 or More Psychotropics for 60 or More Days 1,537 2.62% 603 $229.52
Patient Failed to Refill Newly Prescribed Antidepressant within 30 Days of Prescription Ending 936 1.60% 438 $15.09
Use of a Non-mood Stabilizing Anticonvulsant in a Patient with Presumptive Bipolar Disorder without Evidence of a Failed Trial of a Mood Stabilizer
293 0.50% 185 $71.89
Use of an Atypical Antipsychotic at a Lower Than Recommended Dose for 45 or More Days 268 0.46% 115 $119.87
Patient Failed to Refill a Mood Stabilizer within 30 Days of Prescription Ending 236 0.40% 105 $27.81
Use of 2 or More Benzodiazepines for 60 or More Days 179 0.31% 106 $19.56
Patient Failed to Refill an Antipsychotic within 30 Days of Prescription Ending 135 0.23% 63 $126.11
Multiple Prescribers of the Same Class of Psychotropic Drug for 45 or More Days 113 0.19% 153 $127.47
Use of 2 or More Insomnia Agents for 60 or More Days 102 0.17% 77 $52.53
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Decision Support Educational Tool
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Best Practices for Analytic Tools
• Credibility of data
• Prioritization of effort – risk stratification methods
• Actionable
• Measureable
• Automated work flows
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CMT’s ProAct Analytics
A BIG DATA TOOL
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CMT is a BIG DATA TOOL
Decision Support
Aids clinical decisions Based in evidence tied to data
Registry Driven
Specific disease states
DashboardTrack performance across
providersAids patient care improvements
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CMT’s ProAct Supports
Population Health
Comprehensive Care Management
Compliance Measurement
• Evidence-based Guidelines• Quality Improvement Actions
• Care Coordination• Care Transitions• Health Promotion/Prevention• Adherence
• NOMS• SAMHSA• State Contractual Measures
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Newly Proposed NCQA Standards Quality Pathway: CMT Solution
Subheading NCQA Code CMT’s Solution
Quality Improvement Activities
QI6A Using claims data for screening, e.g., metabolic syndrome and antipsychotics; depression and chronic illness
QI8J CMT’s ProAct supports standard QI process flows
Care Coordination QI8A CMT’s ProAct provides views of integrated data to support case management outreach
CC1:ABC&D CMT uses data to track issues relevant to care fragmentation e.g., multiple prescribers
CC4A CMT’s ProAct is a technology tool
Complex Care Management
QI8A&C ProAct uses claims data to identify members in need
QI8B CMT uses claims data to update members and needs regularly
Appropriate Care QI8F CMT identifies underlying SA disorders or confounding dependencies
CC1B/CC2A&B CMT is specifically designed to track appropriate use of medicines
EBP Care QI6C CMT’s QIs can be used to track EBP
QI8E CMT’s QIs can be used to manage and communicate EBP
QI19A&B CMT’s Clinical Considerations™ and health alerts can be used to promote adoption of EBP guidelines
QI10: Element C CMT specifically tracks 3 of the 7 referenced measures
Population Health: Evidence-based Guidelines/Quality Improvement Actions Compliance Measurement: Accreditation Body
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CMT’s Solution to the New NQF Behavioral Health Measures
NQF Behavioral Health Measure Endorsed By Addressed by CMT
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment NCQA
Medical Assistance with Smoking and Tobacco Use Cessation NCQA
Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention AMA-PCPI ✔Adherence to Antipsychotic Medications for Individuals with Schizophrenia CMS ✔Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Prescribed Antipsychotic Medications NCQA ✔Cardiovascular Health Screening for People with Schizophrenia or Bipolar Disorder Who Are Prescribed Antipsychotic Medications NCQA ✔Cardiovascular Health Monitoring for People with Cardiovascular Disease and Schizophrenia NCQA ✔Diabetes Monitoring for People with Diabetes and Schizophrenia NCQA ✔Follow-Up After Hospitalization for Schizophrenia (7- and 30-day) NCQA ✔Follow-Up After Hospitalization for Mental Illness NCQA ✔
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Clinical Pathway #1High Risk-Failure to Refill
• High rate of readmission for those with serious depression who fail to refill
• 50% nonadherent rate for prescribed antidepressants
Sample data How many in 90 days: 963 adults; 46 elderly
Establish clinical criteria for outreach
• 1st refill or later refill• Other medical co-morbidities• Recent hospitalization• No evidence of BH services
Determine outreach/intervention
• Patient outreach—nurse/care management call• Assignment to ongoing care coordination/case mgt• Medical plan collaborative treatment review• Provider outreach• Write up as a QI project for accreditation or health plan
reviewScreen • Failure to refill Quality Indicators™ monthly
Comprehensive Care Management: Adherence
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Clinical Pathway #2High Risk – Use of Multiple Benzodiazepines
• High rate of readmission for those triggering 2+ Benzodiazepines for 60 or more days
Sample data How many: 105 adults; 139 elderly
Establish clinical criteria for outreach
• Other medical co-morbidities• Evidence of falls, accidents or other similar impairment• Evidence of dementia for the elderly• Recent hospitalization• No evidence of BH services
Determine outreach/intervention
• Patient outreach—nurse/care management call• Offer Stress Management/Wellness supports and
resources; peer support group• Assignment to ongoing care coordination/case mgt• Medical plan collaborative treatment review• Provider outreach
Screen • High Risk Benzodiazapine Quality Indicators™ monthly
Comprehensive Care Management: Care Coordination/Health Preventions
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Clinical Pathway #3High Risk: 5+ Psychotropics for Children
• Top six high volume clinical issue
• One patient with $10,000 in psychotropic spend in 90 day period
Sample data How many in 90 days: 43
Establish clinical criteria for outreach
• No evidence of psychiatric evaluation• Multiple prescriber pattern• Recent hospitalization• No evidence of BH services
Determine outreach/intervention
• Recommend prior authorization post 3 medicines for certain period of time
• Establish proper BH family and child services if absent• Patient outreach—nurse/care management call• Assignment to ongoing care coordination/case mgt• Provider consultation• Write up as a QI project for accreditation or health plan
reviewScreen • Failure to refill Quality Indicators™ monthly
Population Health: Evidence-based Guidelines
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Clinical Pathway #4Antipsychotic Use in Children
Sample data • Approximately 720 users• 40 with Quality Indicators™• Four children under 4 with antipsychotic script
Establish clinical criteria for outreach
• Review clinical records• Establish criteria for assignment to interventions Family-based intervention in place Developmental evaluation complete Transitions/disruptions in home or day care Other medications in combination BH specialty services in place
Determine outreach/intervention
• Recommend prior authorization • Outreach to parent with resource information• Peer consultation to prescriber• Engagement in more intensive behavioral health
services• Care coordination meeting with health plan
Screen • Repeat process quarterly to screen for newly identified children
Population Health: Evidence-based Guidelines
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Clinical Pathway #5Low Dose Antipsychotic Use in Adults
Sample data Approximately 268 adult triggers
Establish clinical criteria for outreach
• Evaluate diagnostic/treating condition • Establish criteria for assignment to interventions Off label use Dose Ineffective for treating diagnosis Other medications in combination BH specialty services in place
Determine outreach/intervention
• Peer consultation to prescriber• Engagement in more intensive behavioral health
services• Patient outreach
Screen • Repeat process quarterly to screen for newly identified adults
• Represents undertreatment or possibly off label use for sleep aid
Comprehensive Care Management: Care Coordination
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Clinical Pathway #6Multiple Prescribers
Sample data How Many: 113 prescribers associated with Prescribing of Same Class of Medicine
Establish clinical criteria for outreach
• Sort by high volume prescribers
Determine outreach/intervention
• Conduct “alert messaging” to the high volume providers• Recommend a prior authorization process for 2nd or 3rd
prescriber of same class medication• Write up as a QI project for accreditation or health plan
reviewScreen • Quarterly
Population Health: Quality Improvement ActionsComprehensive Care Management: Care Coordination
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Clinical Pathway #7Improved Prescribing
Sample data • Approximately 1/3 of prescribers trigger at least one QI
Establish clinical criteria for outreach
• Focus on the top prescribers account for majority of triggering rate.
Determine outreach/intervention
• Educational and targeted messaging• Peer consultation • Increased authorization protocol for those in your
network based on response to above • Write up as a QI initiative for your health plan or
accreditation review Screen • Process quarterly
Population Health: Evidence-based Guidelines/Quality Improvement Actions
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Reference List• Atkins, R. Using Information Systems to Develop Clinical Performance
Scorecards: Reporting Behavioral Health & Social Service Clinical Team Performance, Open Minds Archive.
• Farias, M., et al. (2013) A Better Alternative To Clinical Practice Guidelines, Health Affairs vol 32 (5) 911-918.
• Kayyali, B., Knott, D., Van Kuiken, S. The big-data revolution in US health care: Accelerating value and innovation. (April 2013) McKinsey & Company Insights & Publications. Retrieved from http://www.mckinsey.com/insights/health_systems/The_big-data_revolution_in_US_health_care
• Murdoch, T., Desky, A. (2013) The Inevitable Application of Big Data to HealthCare. JAMA, vol 309 (13)
• Punke, H. Best Practices for data analytics in value based reimbursement. (February 21, 2013) found on www.beckershospitalreview.
• Quality Management as a Strategy for Utilization Management: Using Statistical Process Control to Manage the Care of High Risk Patients, Open Minds Archive.
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Carol’s Contact Info
One Copley Parkway, Suite 534Morrisville, NC 27560
Tel: 919-674-2547Fax: 919-674-2538Cell: 919-491-0819
One Copley Parkway, Suite 534Morrisville, NC 27560
Tel: 919-674-2547Fax: 919-674-2538Cell: 919-491-0819
[email protected] Duncan Clayton, PhDChief Executive OfficerCarol Duncan Clayton, PhDChief Executive Officer
One Copley Parkway, Suite 534Morrisville, NC 27560
Tel: 919-674-2547Fax: 919-674-2538Cell: 919-491-0819
[email protected] Duncan Clayton, PhDChief Executive Officer
Insight and Action in Behavioral Health
Care Management Technologies
Case Study: How Missouri is utilizing data analytics to support the state health home initiative
OPEN MINDS Planning & Innovation InstituteJune 12, 2013
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MO Coalition of CMHCs
• Represent 33 member organizations Community Mental Health Centers Alcohol and drug abuse treatment agencies Affiliated Community Psychiatric Rehab (CPR) service providers
Clinical call center
• Over 9,000 staff providing treatment and support services to approx. 250,000 people each year
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Coalition Provider Locations
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CMHC Healthcare Homes
• Coalition is a partner in the design and development of the CMHC Healthcare Home (HCH)
• Coalition represents all 28 CMHC HCHs• Coalition provides training and technical assistance to the CMHC HCHs
• Coalition aims to improve quality and clinical outcomes
• Coalition is “hands‐on” and transparent with BIG data
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Missouri’s History with BIG Data
2005MO + CMT
2008+ Nurse Liaisons
2010+ DM3700 Outreach
2012+ HealthcareHome
Email notifications
Mailings
Disease registryProAct
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Growing Pains
• Implementation How to add MORE data What to do with the data
• Becoming “tech savy” Training, Training, Training Support, Support, Support
• More cooks in the kitchen• Transparency• Adapting to...
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Growing Pains
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Growing Pains
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Value Opportunity
• Expanding capacity for knowledge gains Know what we didn’t know before
• Knowledge Dissemination Broadcast alerts to the treatment team Celebrate successes
Achieve complianceand
Improve health outcomes
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Managing Big Data
• Avoiding information and data “overload”
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ProAct
• Behavioral Pharmacy Management (QI)• Disease Management (compliance measures)• Medication Adherence (adherence)• Integrated Health Profile (IHP)
Clinical Updates Metabolic Syndrome Screening Database
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Behavioral Pharmacy Management (BPM)
• Identifies clinicians whose prescribing patterns deviate from current clinical best practices
• Identifies consumers who fail to refill their BH medications and/or are seeing multiple prescribers for the same class of medications
• Uses CMT’s Quality Indicators™(QIs) to analyze MO’s pharmacy claims data
• Provides spend amounts and numbers of patients and prescribers that trigger each QI
• PDF of Clinical Considerations available
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BPM Healthcare Home Measures
Performance Measure Goal
Quality Prescribing Psychiatric Medications (A) ‐% of prescriptions flagged as potentially inconsistent with quality practices.(i.e. use of 3 or more antipsychotics for 45 or more days, use of 2 or more Benzodiazephinesfor 60 or more days).
<10%
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BPM MailingPrescriber Summary &Benchmark Report
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BPM MailingPrescriber Summary &Benchmark Report
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BPMClinicalConsideration
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BPM CMHC Benchmark Report (Adult)
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BPM CMHC Benchmark Report (Child)
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BPM Data Checkpoint
Population/Risk StratificationClients flagging high risk QIs or multiple QIsClients flagging failure to refillClients flagging multiple prescribers
Care Coordination Interventions with a specific outlier prescriber (internal and external docs) with high volume of clients
Interventions with a specific outlier prescriber with high cost of care
Notify case manager of multiple prescribers and failure to refill concerns
DATADATA
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HCH Management Report BPM Summary
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Disease Management (DM)
• Also known as Compliance Measures.• Identifies consumers with selected health conditions for whom appropriate screening and treatment activities appear to be lacking.
• Based on pharmacy/medical claims and Metabolic Screening data/disease registry.
• Assists care coordination by quickly identifying patients for whom intervention is necessary.
• Provides list of patients that flag each measure and the number of measures flagged by each patient.
• Ability to print letters allowing for provider feedback.
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DM Healthcare Home Measures
Performance Measure Goal
Asthma Med (A&C) ‐ % of clients 5‐64 identified as having persistent asthma and were appropriately prescribed medication during the measurement period.
70%
BP Control HTN (A) ‐ % of clients 18 and older with a dx of hypertension with reported BP <140/90 mmHg during the most recent office visit in previous 12 months.
60%
LDL Control Cardio (A) ‐ % of clients 18‐75 with a dx of CAD with reported LDL <100 mg/dL in previous 12 months.
70%
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DM Healthcare Home Measures
Performance Measure Goal
Diabetes BP Control (A) ‐ % of clients 18‐75 with a dx of diabetes (type 1 or 2) with reported BP <140/90 mmHg in previous 12 months.
65%
Diabetes A1c Control (A) ‐ % of clients 18‐75 with a dx of diabetes (type 1 or 2) with reported HbA1c <8.0% in previous 12 months.
60%
Diabetes LDL Control (A) ‐ % of clients 18‐75 with a dx of diabetes (type 1 or 3) with reported LDL <100 mg/dL in previous 12 months.
36%
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DM Healthcare Home Measures
Performance Measure Goal
No Tobacco Use (A&C) ‐ % of clients reporting no tobacco use in previous 12 months. 56%
Metabolic Screen (A&C) ‐ % of clients with completed MBS screening in previous 12 months.Includes: BMI, BP, blood glucose/HbA1c, lipid panel, and use of anti‐psychotic medication and tobacco.
80%
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DMCare Coordination &Quality Care ConsiderationProvider Letter
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DM Data Checkpoint
Population/Risk StratificationClients flagging multiple measures or measure of the same chronic condition
Clients flagging focus measuresClients flagging metabolic screening measure
Care CoordinationTEAMcare meetings for high risk clientsPrint DM Provider Letter and fax to client’s PCP and/or send copy to case manager
Refer client to chronic disease education/support groups, tobacco cessation groups, and wellness programs
DATADATA
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Healthcare Home Management Report DM (Adults)
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Medication Adherence
• Displays MPR for seven classes of maintenance medications.
• MPR is based on a 3 month or 90 day period.
• Uses Medicaid paid prescription claims data only. Not included: cash payments, samples received, and Medicare paid drugs
Anti‐hypertensivesCardiovascularDiabetesCOPD
AntipsychoticsAntidepressantsMood Stabilizers
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Adherence Healthcare Home Measures
Performance Measure Goal
All members with diagnosis, medication adherence to antipsychotics, antidepressants and mood stabilizers.
90%
All members with diagnosis, medication adherence to anti‐hypertensive and cardiovascular medications.
90%
All members with diagnosis, medication adherence to asthma and/or COPD medications. 90%
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Adherence Data Checkpoint
Population/Risk StratificationClients with MPRs < or = 0.8
Of multiple drug typesOf a targeted drug type
Clients with MPRs < or = 0.8 and flags related diabetes, hypertension or CAD treatment alerts in DM
Care CoordinationNotify case managers and PCP of adherence concerns
DATADATA
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HCH Management Report Adherence Summary
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IHP-Member List
• Looks like a mini EMR.• The IHP contains detailed information on your selected client gleaned from Medicaid claims data.
• IHP includes diagnosis, flagged measures, medication list, MPR graph, ER/inpatient data, etc.
• Contains “clinical update” feature allowing end users to note “incorrect diagnosis”, “treatment complete”, or “alternate treatment approved.”
• Contains “Metabolic Screening Data”/disease registry.
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IHP-Member List Data Checkpoint
Population/Risk StratificationClients flagging multiple indicators/measures across all reports
High hospital and ER utilizersClients with high comorbid medical diagnosis counts
Care CoordinationTEAMcare meetings for high risk clientsNotify case managers and PCP of health concerns
DATADATA
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Integrated Health Profile (IHP)
• Looks like a mini EMR.• The IHP contains detailed information on your selected client gleaned from Medicaid claims data.
• IHP includes diagnosis, flagged measures, medication list, MPR graph, ER/inpatient data, etc.
• Contains “clinical update” feature allowing end users to note “incorrect diagnosis”, “treatment complete”, or “alternate treatment approved.”
• Contains “Metabolic Screening Data”/disease registry.
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IHP
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Metabolic Screening Database
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ProAct Healthcare Home Measures
Performance Measure Goal
Use of ProAct per member per month for non‐MCO enrollees. One record access
utilization PMPM
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ProActProAct View Report
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ProActProAct Intensity Report
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Contact Info
Rachelle GlavinDirector of Clinical OperationsMissouri Coalition of Community Mental Health Centers
[email protected] – office
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