The focus groups with state Medicaid and mental health leaders, as well as with MBHO staff, yielded remarkably consistent results. Key points included:
Claims data are unreliable for identifying some behavioral health services, particularly evidence-based psychosocial treatments.
Variation in financing of services for people with SMI limits the ability to consistently measure the quality of care across Medicaid programs. For example, while some states reimburse for a bundled set of services collectively known as assertive community treatment (ACT), other states reimburse individual services that resemble services included in the ACT model. In other states, some of these services are provided outside of the Medicaid program, such as through the state mental health authority.
Some candidate measures address problems that are not unique to patients with schizophrenia; measures could be broadened to include patients with bipolar disorder, schizophrenia, and severe forms of depression (SPMI).
While focus group participants generally viewed the proposed measure concepts as important and relevant topics, they noted some gaps. In particular, Medicaid officials raised concerns about the lack of candidate measures addressing perceived problems of overuse of care for people with schizophrenia (for example, polypharmacy or hospital readmissions).
The panels offered specific advice on technical specifications and testing. In particular, they recommended that the measures apply to patients not included in MAX files, specifically TANF enrollees and people with dual Medicare beneficiaries, who receive treatment through Medicaid programs.