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Document Sample
Strategies of Performance
Measurement & Outcome Monitoring
Peter F. Luongo, Ph.D.
November 15, 2007
Treatment Effectiveness
l Alcohol and Drug dependent people who participate in
drug treatment
l Decrease substance use
l Decrease criminal activity
l Increase employment
l Improve their social and intrapersonal functioning
l Improve their physical health
l Drug use and criminal activity
⇓⇓ for virtually all who enter treatment Þ
ÝÝ results the longer they stay in treatment.
Statewide Maryland Automated
Record Tracking (SMART)
l SMART is a full electronic clinical record (EHR)
l All funded treatment providers report data online
l SMART addresses key EHR concerns:
l Admission, treatment encounters and discharge
l Privacy, Practitioner control, Administrative oversight
l Interoperability = shares information through XML
l Additional Modules
l eCourt
l Contract Monitoring and Billing
Under development
l Stand Alone Data Analyzer – December 2007
l Real time access to data
l Providers
l Jurisdiction decision makers
l State oversight (ADAA)
l Automated Drug Testing – January 2008
l Additional Clinical Assessments and
Screening
l Homicide and suicide lethality assessments
l HIV and TB risk assessments
l Many Others
What do Substance Abuse Systems
Need To Do?
l Standardize Assessment
l Standardize Patient Placement Criteria
l Standardize Performance Measures
l Share Information with Other Social
Systems
What To Do!
lPublish Data
lBe Transparent
lNo False Anonymity
Problem Determination and
Treatment Entry
n = 50,859
Enters Treatment
65% 50%
Problem Drinker 13%
DWI assessment
DWI assessment
19952003
19952003 Social Drinker 50%
n = 77,845 n = 26,986
35% 87% Does Not Enter
Does Not Enter
Treatment
Treatment
Countylevel Variation in the Proportion of
Problem Drinkers Entering Treatment
100
90
% of Problem Drinkers entering
80
70
60
Treatment
50
40
30
20
10
0
A B C D E F G H I J K L M N 0 P Q R S T U V W X
County of Assessment Center
Treatment Funding
FY 2003 – FY 2007
2003 2007 % change
Appropriation $119,219,304 $126,447,179 6%
Individuals Treated* 45,722 52,306** 14%
Cost per Individual $2,607 $2,417 (7%)
*Unduplicated individuals treated **Estimate based on 10 month data
Outpatient Adult Community Treatment
Selected Outcomes
FY 2003 – FY 2007
2003 2007 % change
Completed Treatment 37% 43% 16%
LOS ≥ 90 days 56% 59% 5%
Reduction in Substance Users 10% 33% 230%
Increase in Employment 10% 13% 30%
Level III.1 Residential Treatment*
Selected Outcomes
FY 2003 – FY 2007
2003 2007 % change
Completed Treatment 36% 42% 16%
LOS ≥ 90 days 54% 56% 4%
Reduction in Substance Users 0% 34%
* Variable length of stay moderate intensity
Summary Table
Treatment Awards Utilizing Performance Compensation
Amount of Grant
Treatment Funding subject to % Performance
Total Award
Category Performance Compensation
Compensation
Residential $ 41,207,873 $ 21,431,628 52%
Non
$ 73,029,601 $ 24,819,233 34%
Residential
$ 114,237,474 $ 46,250,861 40%
Pay for Performance Pilot
l Pilot based on:
l January – April 2007
l Data from Outpatient Programs – excluding:
l Adolescents
l Jailbased population
l Data in the system as of July 1, 2007
Performance Standards
l >65% retained at least 90 days
l >50% successful completion
l Both standards = 100% performance
payment
l One standard = 50% performance
payment
Pay for Performance Incentive Breakdown
County Discharges LOS >= 90 Complete
Jurisdictional Category A 12 Outpatient Clinics
Allegany 126 63.5% 57.9%
Caroline 91 68.1% 52.7%
Cecil 132 68.2% 37.1%
Charles 273 72.9% 58.2%
Dorchester 26 50.0% 34.6%
Frederick 117 49.6% 32.5%
Garrett 80 36.3% 28.8%
Kent 92 54.3% 43.5%
Queen Anne's 88 61.4% 47.7%
Talbot 84 60.7% 53.6%
Wicomico 126 61.9% 38.9%
Jurisdictional Category B 36 Outpatient Clinics
Carroll 139 66.9% 54.7%
Harford 89 51.7% 38.2%
Howard 63 57.1% 27.0%
Montgomery 352 67.9% 45.5%
Somerset 80 73.8% 50.0%
St. Mary's 89 78.7% 65.2%
Washington 214 74.3% 57.5%
Worcester 153 51.6% 42.5%
Jurisdictional Category C 7+ Outpatient Clinics
Anne Arundel 579 63.6% 43.0%
Baltimore County 406 63.3% 51.2%
Prince George's 249 55.0% 41.8%
Baltimore City 1043 49.6% 31.2%
Statewide 36 55.6% 30.6%
Pay for Performance Incentive
Breakdown
Full Incentive 100% of Standards Met
County Juris. Cat. Discharges LOS >= 90 Complete
Caroline A 91 68.1% 52.7%
Charles A 273 72.9% 58.2%
Carroll B 139 66.9% 54.7%
Somerset B 80 73.8% 50.0%
St. Mary's B 89 78.7% 65.2%
Washington B 214 74.3% 57.5%
Partial Incentive 50% of Standards Met
County Juris. Cat. Discharges LOS >= 90 Complete
Allegany A 126 63.5% 57.9%
Cecil A 132 68.2% 37.1%
Talbot A 84 60.7% 53.6%
Montgomery B 352 67.9% 45.5%
Baltimore Co. C 406 63.3% 51.2%
Financial Incentive
For the initial year, a prorated amount is assigned to each classification. The following
table shows both the annualized and the prorated figures.
Jurisdiction Annual Incentive Prorated (4months)
A $15,000 $5,000
B $20,000 $6,667
C $30,000 $10,000
Full Incentive 100% of Standards Met
County Jurisdiction Category Prorated
Caroline A $5,000
Charles A $5,000
Carroll B $6,667
Somerset B $6,667
St. Mary's B $6,667
Washington B $6,667
Partial Incentive 50% of Standards Met
County Jurisdiction Category Prorated
Allegany A $2,500
Cecil A $2,500
Talbot A $2,500
Montgomery B $3,334
Baltimore County C $5,000
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