Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. F. Quality Monitoring and Incentives


LBHP developed a comprehensive quality strategy to guide the measurement and oversight of the program (see DHH 2012b). The quality strategy describes specific goals, measures, and reporting processes. OBH and Magellan are collecting a wealth of information that can be used to examine trends in the utilization, quality, and outcomes of services. Here we briefly summarize the approach to monitoring and reporting of quality measures and describe some of the incentives in place to encourage use of evidence-based and promising practices.

OBH and Magellan established the Inter-Departmental Monitoring Team (IMT) to develop and implement a plan for monitoring and improving the quality of behavioral health care. All LBHP state agencies participate in the IMT, which incorporates the input of Magellan and consumers. Consumer input is gathered through public forums, state and regional advisory councils, analysis of grievances, and a consumer satisfaction survey. In addition, an external quality review organization (EQRO) conducts an annual independent review to ensure that Magellan complies with federal Medicaid managed care regulations and to validate the results of performance measures and performance-improvement projects (PIPs) (DHH 2012b).

OBH and the IMT identified three overarching quality goals for the Medicaid program: (1) foster individualized behavioral health services for adults, youth, and families through increased access to a fuller array of evidence-based in-home and community services that promote hope, recovery, and resilience; (2) improve quality by establishing and measuring outcomes; and (3) manage cost through effective use of state, federal, and local resources. Progress toward these goals is tracked using several measures that map to more specific quality objectives, and performance on several quality measures is tied to financial incentives or penalties for Magellan (see Table III.2).

Several mechanisms are in place to encourage the use of evidence-based or promising practices. As part of its quality strategy, Magellan created a clinical advisory committee of network providers to annually review practice guidelines and offer advice on implementing and monitoring them. The service definition manuals contain several evidence-based practices for which providers receive higher reimbursement. In addition, the performance measures monitor the percentage of adult high service users (those having two or more inpatient admissions or four ED visits in a year) who enroll in Assertive Community Treatment (ACT) or psychosocial rehabilitation programs.

TABLE III.2. Selected LBHP Quality Objectives and Performance Measures for Adults
Objectives Corresponding Measures
  • Ensure easy access to services and providers.
  • Encourage evidence-based and culturally competent in-home and community-based services.  
  • Ensure individualized person and family assessment, planning, and service delivery.
  • Ensure competence of network providers.
  • Promote early identification and intervention.
  • Increase use of local resources.
  • Improve functioning and daily living and social skills.
  • Reduce severity of symptoms.
  • Follow-up after discharge from an inpatient mental health facility and readmission to such a facilitya.
  • Follow-up after discharge from an inpatient substance abuse facility and readmission to such a facility.  
  • Readmission ratesa.
  • Number of persons receiving ACT services or psychosocial rehabilitationa.
  • ED utilization.
  • Inpatient admission and average length of stay.
  • Drug utilization review and identification of behavioral health needs.
  • Authentication of pharmacy data for high-risk population.
  • Denied claims.
  • Consumer surveysa.
  • Cost per person saved per month.
  • Consumer and family surveys.
  • Use of in-home and community-based services.
  • Number of inpatient admissions and lengths of stay.
  • Community tenure for those at-risk of rehospitalization.
SOURCE: Adapted from DHH 2012a.
NOTES: Several LBHP quality strategy goals and performance measures are not shown here because they relate to children and youth, populations that are not the focus of this report.
  1. Performance on these measures is tied to financial incentives or penalties for Magellan.

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