Building a Quality Agenda: SAMHSA s Behavioral Health Quality Framework

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Earl Mathews
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2 Building a Quality Agenda: SAMHSA s Behavioral Health Quality Framework Peter J. Delany, Ph.D., LCSW-C. RADM, USPHS Director Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration U.S. Department of Health & Human Services 2012 NASADAD Annual Meeting June 27,

3 Principles that Guide the Quality Agenda Evidence we should be guided by evidence about what works, not ideology about what should work. Equity because the people we serve with mental health and substance abuse disorders deserve high quality services that lead to recovery. 3

4 Principles that Guide the Quality Agenda (Cont d) Scalability it is not enough to provide great prevention and treatment services to a limited number of people; we must provide access to quality services in all of our communities. Sustainability improvement in services should withstand budget cycles and political shifts, and must outlast changes in program and government leadership. 4

5 Quality Drivers In 2010, the Affordable Care Act (ACA) directed DHHS to develop a National Quality Strategy (NQS) to provide all Americans with safe, effective, and affordable healthcare. In March 2011, the Secretary of DHHS reported to Congress on a National Strategy for Quality Improvement in Health Care. Through the NQS, SAMHSA developed the strategic plan for a practical and strategic National Behavioral Health Quality Framework (NBHQF). 5

6 Overview SAMHSA plays an important role in supporting and paying for: delivering safe, high quality behavioral health care; monitoring quality and disparities; providing technical assistance; supporting research; and in limited instances, directly providing care. 6

7 Overview (Cont d) The National Behavioral Health Quality Framework (NBHQF) is concordant with the National Quality Strategy (NQS) and supports three broad aims: Better Care: Improve the overall quality by: making behavioral health care more person-, family-, and community-centered; and reliable, accessible, and safe. Healthy People/Healthy Communities: Improve the U.S. behavioral health by: supporting interventions to address behavioral, social, and environmental determinants of positive behavioral health; and delivering higher quality behavioral health care. Affordable Care: Increase the value (cost-effectiveness) of behavioral health care for individuals, families, employers, and government. 7

8 The aim is to: National Behavioral Health Quality Framework establish national priorities, goals, and opportunities for improving the delivery of behavioral health services, achieve better behavioral health outcomes, and improve the behavioral health of the U.S. population, especially those with substance abuse and mental health disorders. 8

9 Organization of National Behavioral Health Quality Framework The SAMHSA Quality Strategy follows six priorities that parallel the National Quality Strategy and are based in the Institute of Medicine s Quality Chasm reports: 1. Promote the most effective prevention, treatment, and recovery practices for behavioral health disorders. 2. Assure behavioral health care is person-, family-, and community-centered. 3. Encourage effective coordination within the behavioral health care field and between behavioral health care providers and other health care, recovery, and social support services. 9

10 Organization of National Behavioral Health Quality Framework (Cont d) 4. Assist communities to utilize best practices to enable healthy living. 5. Make behavioral health care safer by reducing harm caused in the delivery of care. 6. Foster affordable, high quality behavioral health care for individuals, families, employers, and governments by developing and advancing new- and recoveryoriented-delivery. 10

11 Organization of National Behavioral Health Quality Framework (Cont d) The impact of each of the six behavioral health priorities is tracked across three targets/ domains that include: SAMHSA; providers and payers; and individuals, families and communities. 11

12 Outcome Measurement Process Federal SAMHSA Outcome: Finance, demonstrate, and disseminate medication assisted treatment (MAT) knowledge and standards State, Payer, Provider Outcome: Payment, protocols, delivery of MAT Patient Outcome: Compliance with MAT, abstinence and/or reentry Patient, Family, Community Outcome: Healthy, productive, engaged life 12

13 Strategies to Implement NBHQF Align payment and incentives Enhance data collection and reporting Build capacity development functions 13

14 Align Payment and Incentives Structure payments to encourage and promote the appropriate use and supervision of evidence-based practices and widely recognized experience-based practices. Revise payment format to one that encourages treatment of an episode vs. isolated symptoms of addictions or mental health disorders. 14

15 Align Payment and Incentives (Cont d) Shift payment levels and forms to encourage prevention, identification, and treatment of related mainstream and behavioral health conditions (e.g., diabetes & alcohol or hypertension & depression) in order to promote integrated care. Develop standards and performance indicators for financial agreements and contracts among payers, third party managers, and providers that recognize the use and form of payments to improve quality. 15

16 Data Collection and Reporting SAMHSA is implementing its goal of an integrated approach to data collection and reporting Continue to build on and coordinate data systems Harmonize the quality framework and measures with SAMHSA grant programs and other health care processes and outcomes including electronic health records (not all 1-1 concordance) Create data warehouses and access to data to help make case for behavioral health investments 16 Policy and research

17 Building Capacity Collaborate with relevant Federal partners to align work of behavioral health and primary care providers and payers. Promote targeted technical assistance to develop business practices in behavioral health provider organizations that support delivery of quality and effective treatment and recovery supports. 17

18 Building Capacity (Cont d) Develop and disseminate model contract, performance standards, and related quality standards that payers and providers can employ to effectively achieve better care and healthy people and communities. Monitor and assess the capacity of the behavioral health system to adequately meet the needs of patients, families, and their communities. 18

19 Status of the NBHQF Feedback on an earlier draft has been solicited and input from SAMHSA leadership has informed goals & beginning strategies for measure selection associated with three measurement tracks & a revised version is being prepared. Outside experts will be engaged in a computer-based Delphi process leading to core set of measures for public review. A new public document with core measures will be developed with input from payers, providers, federal and non-federal partners, & other key stakeholders. 19

20 20 Thank you!!

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