CPotter - IDP2-Outcome Driven System Development

Opportunities To Better Understand System Of Care Dynamics: Engaging Community Behavioral Health Providers in Using Dynamic

System of Care Data and seeking Collaborative Solutions to Community Health Challenges

Integrating Data into Practice Motivating Value-based Decisions

by Chris Potter, M.Ed.December, 2014

In the Spring of 2006, I had the opportunity to work on developing an agency wide data-supported quality improvement process, that I called “Outcome Driven System Development (ODSD).” This put into play a process of ‘Quality Improvement’ based upon a ‘Scorecard Benchmarking’ process, with monthly feedback on progress toward the established benchmark goals. In June of 2006, I started work on several initiatives with the intent:

1.To provide data trend analysis, monthly reports, and consultation for Behavioral Health Managers and Supervisors on progress toward improving productivity and clinical outcomes.

2.To assist Community Health Teams in determining and implementing service delivery improvement processes, evaluating their impact

3.To provide Supervisors, Managers, and community stakeholders with data supported reports on Clinical Productivity and Quality Outcomes as part

of Quality Improvement and Utilization management process

Outcome Driven System Development (ODSD)

Developed by Chris Potter, M. Ed.

Integrating Performance and Outcome Data into System DevelopmentIntegrating Performance and Outcome Data into System Development ProcessProcess

SystemsIntegration

Staff Productivity

Clinical Effectiven ess

Outcome Outcome Driven System Driven System

DevelopmentDevelopment

Total Services delivere d Client Serv ice Hours/month

Clinicia n Direct Serv ice hours/monthNumber of ne w cases/ month

Number of uni que i ndiv iduals seenCost of Serv ice per Lev el of Care

Efficiencies to reduce cos ts

Quali ty of care*Client S tatus Assess ment:

•Symptom/ Functi oni ng status c hange•Risk fac tors a nd res ponse•Functi oni ng Sta tus: Voca tional/Educati onal/•Coor dina tion of care be twe en prov iders

Outcomes per i nterv enti on & Populati on Group: Ev idence Based Prac tices v s. Outcomes of Sta ndar d Care

Anal ysis of Hi gh Serv ice Utilizers & Treatment v ariance be twee n clini cians:

Customer sa tisfa ctionServ ice Access time: from call to 1st appointmentSatisfac tion wi th care

Ma nage ment Str uctureStaff W orkloa d Mana ge ment:

•Documentation Timeliness•Staff Satisfaction

•Incentives for Performance•Recognition of Innovation

Multi-S yste m interface:

Cross-system service integrationPartner relation ships

*Assessme nt drawn from ‘Na tional Outcome Measures’, DS M IV criteria, ‘Prime -MD S urv ey’, ‘Common Fac tors i n Ps ychotherapy’

2007 ODSD Priorities:

Goal: To Integrate Multiple System Databases into an Outcome Driven Utilization Management Process to improve Treatment Outcomes, Increase

Efficiency in Service Delivery, and to Encourage Staff Initiative

Objectives: To Develop Data Integration System, to build capacity for utilizing disparate Data bases to evaluate progress toward agency benchmark goals by:

•Providing monthly reports on Scorecard goal outcomes•Evaluating Intervention Outcomes per population groups•Assessing practice variances to assist in coaching staff•Monitoring resource utilization patterns•Tracking and Analyzing Higher Utilizers of service•Assisting in Team, and Clinician, outcome improvement planning•Facilitating Service Integration: Primary Care & Behavioral Services,

then Social & Vocational Services

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1. Scorecard Benchmark Goal Feedback Process

To meet State/Fed. QI Requirements

To build staff motivation, and initiative to improve Service Quality & Productivity

Monthly Feedback to Teams on UM & QI (Scorecard) Benchmark Goals

Develop Report format: Provide monthly, and ad-hoc,

feedback to Managers, Supervisors, and Clinicians

Monthly 1

2. Treatment Plan Revision

To meet new Medicaid

regulations To improve Quality of

Care

Upgraded Treatment Plan to meet new Medicaid Rule Encourage ‘Golden Thread of Treatment’

Roll out Updated Tx. Plan: 1. Meet with Teams –

introduce changes 2. Initiate ‘Individualized

Tx. Plan 3. Monitor and Follow-up

Stage 2 1

3. System Change Facilitation

To meet State/Fed. QI Requirements

To reinforce motivation toward trying new initiatives for improving Quality & Productivity

‘System Process Initiative Trial’ Procedures – to target high level change needs, encourage innovation, and monitor impact of initiatives

Implement ‘SPIT’ Process: Work with teams on testing

‘initiatives’ – evaluating impact upon ‘outcomes and

outputs’. integrating initiatives into System

Stage 1 1

4. Integrated Data Base Development

To meet State/Fed. QM Requirements by creating a central, integrated database needed to evaluate System Status and Change over time

Integrated Database to support QI/UM Process

Over-see development of integrated database to

support UM & QI processes Stage 3 1

5. Outcomes Measurement Facilitation

To meet State EBP & Medicaid QI Requirements

To improve Quality of Care

Monthly Outcome Measures Reports, for use in UM & QI Processes

Revise current Tool - encourage use: provide

analysis & reports Monthly 2

6. SPQM Consultation

Facilitate understanding of using data trends to evaluate system status

Facilitation of monthly SPQM consultation meetings: integrate data feedback into system development

Facilitate SPQM sessions with all teams

F/up with teams as needed

Ongoing Monthly

Meetings: all teams to

process, follow up

2

7. EBP Oversight

To meet State EBP Requirements

To improve Quality of Care

To meet new Medicaid regulations

EBP registry, report to state, facilitate Increased use of EBPs when indicated

Develop EBP Oversight process: work with SUPs &

Teams on Compliance. Participate in bi-monthly stakeholders meetings in

Salem

Monthly 2

8. Utilization Management

To meet State/Fed. QM Requirements

To improve process of Service utilization

To improve Quality of Care

Client/Team/Provider Service Utilization Reports: monitor trends: Work with teams on developing plans to manage outliers

Develop Report format: Monitor & Report to SUPs –

Provide ‘client service profiles’ as requested.

Monthly 3

9. Policy & Procedures Review

To meet State/Fed. QI Requirements

To assure that QM related P&Ps can be supported by data collected

Practice Guidelines, Protocols, and Quality Assurance policies:

Review & Develop Necessary Practice

Guidelines & Procedures: Develop Clinician Training

packages

Monthly – doing some development

of MHO P&Ps 3

10. Adult QIC Liaison

To work with partners on shared Quality Benchmarks – using data supported reports in evaluating progress

‘State Quality Benchmark Collaboration’ Process; facilitate process with community partners toward meeting state DHS Quality Benchmarks

Facilitate & Participate in partner QB meetings: Not developed 3

COUNTY COMMUNITY HEALTH DIVISION BEHAVIORAL SERVICES SCORECARD:

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Operations Perspective (internal business processes) Integrity: We conduct our business in an open and accountable manner.

Teamwork: We work collaboratively to ensure positive, creative solutions

Customer Perspective Superior Service: We deliver proactive, dignified and courteous community health services.

Diversity: We honor diversity and value individual rights.

Goals Data source Benchmarks Goals Data source Benchmarks

I. Providers work together to deliver high quality care

a. BH: Increase in patients completing Treatment

b. BH: Engagement in Outpatient Treatment Within 1 week of Hospital Discharge

c. BH: Increased use of Evidenced Based Practices and Best Practices that demonstrate Effectiveness

Electronic Medical Record (EMR)

EMR

EMR

Ia.1 > 75% clients report stability in *Symptom Management and Functioning ability upon completing treatment

Ib.1 95 % of Discharged Clients receiving Outpatient care within 1 week.

Ic.1 At least 80% of Treatment Services Delivered to patients tied to Evidence Based Interventions or Improved Outcomes

II. Customers demonstrate satisfaction with services

a. Reduced Barriers in Accessing services i) BH: Clients keep

scheduled appointments

ii) BH: Clients can access treatment when needed

b. Customers reported

staff:

Listened, understood concerns

Were able to help

Explained procedures

Recognized cultural values

EMR

Customer Satisfaction

Survey

IIa.1 Clients keep

> 80% of scheduled Individual treatment appointments

IIa.2 > 80% of Clients attend initial Assessment

IIb.1 > 80% of customers report high satisfaction with services received.

* 1)Client self assessment of Symptom & Functional status, 2)Clinician evaluation of GAF/CGAS& Voc/Ed status & Resource Utilization

Customer Satisfaction (In) = Quality, Access, & Equity of Care

Quality = Effectiveness

COUNTY COMMUNITY HEALTH DIVISION BEHAVIORAL SERVICES SCORECARD:

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Financial Perspective Stewardship: We carefully and responsibly manage resources.

Innovative (Staff) Perspective (learning and growing) Innovation: We strive to find positive solutions and continuously improve our business practices.

Our Workforce: We value our employees. We recognize their skills and creative vision enable us to achieve our mission.

Goals Data Source Benchmarks Goals Data Source Benchmarks

Staff Resources are managed well to provide cost-effective care

o BH: Direct Service standards are met or exceeded

o BH: Caseloads Sizes are managed equitably between clinicians, appropriate to Evidence-based Treatment Standards

EMR

EMR

& Evidence Based

practice Standards

III a.1 60% Direct Service Ratio is maintained

IIIb.1 90% of clinicians maintain equitable caseload size: based upon Evidence Based Standards, or compared to similar clinicians on team.

Workload is managed well

o BH: Clinicians are able to effectively manage workload, as indicated by timely documentation

o BH: Clinicians are satisfied with support in managing workload

EMR

Clinician Workload

Satisfaction Survey,

Staff Satisfaction

Survey.

IVa.1 90% of Clinicians meet Timeliness Standards for completing Documentation

IVb.1 > 90% of Clinicians report in Workload Survey that they feel supported by management in effectively managing their Workload

Productivity = Efficiency

Employee Initiative = Workload Management

Indicator /Benchmark GoalsTeam FTE

Jan

DCs

Jan

Ave.

Feb

DCs

Feb

Ave.

Mar

DCs

Mar

Ave.

Apr

DCs

Apr

Ave.Ia.1. Clients are stable upon

completing treatment C&F 14.2

 47%

 35%

 38%

 33%

> 75% DCd clients complete treatment: per DC code

Adult 12 

39% 

21% 

35%  33%

  Discv 9 14 50% 11   22 67% 7    Sandy 8.3   29%   32%   31%      Intsv. 6 18 50% -2 29 21 21 65% 20 30%

  FmlPsy 1 

       %

  Crisis 10 

100%-2 

14%  17%   25%

  Psych 6.8 27 50% -2 16 10% 31 24% 16 16%  Cntrct 5       45%   78%   67%

  Agency   

       30%

Indicator /Benchmark GoalsTeam FTE

Jan

Total

Jan

Ave.

Feb

Total

Feb

Ave.

Mar

Total

Mar

Ave.

Apr

Total

Apr

Ave.IIa.1 Clients keep appointments C&F 14.2   91%   86%   84%   86%

80% of appointments

-Individual Sessions kept-Adult 12

 88%

 88%

 87%

  86%

  Discv 9   95%   97%   97%   88%  Sandy 8.3   87%   82%   91%   81%  Intsv. 6   90%   93%   88%   83%

  FmlPsy 1 

85% 

92% 

93%  83%

  Crisis 10   86%   91%   96%   97%  Psych 6.8   74%   78%   77%   83%  Cntrct 5   85%   70%   88%   60%  Agency

               83%

County Behavioral Services 2007 Team Scorecard - Compiled by Chris Potter, Systems Evaluator

Indicator /Benchmark Goals Team FTE

Jan

Total

Jan

Ave.

Feb

Total

Feb

Ave.

Mar

Total

Mar

Ave.

Apr

Total

Apr

Ave.

III a.1 60% Direct Service maintained

C&F14.2

 53 hours

 62 hours

 63 hours

 59 hours

Standard = 85 HOURS/month Adult 12   70 hours   70 hours   76 hours   62 hours  Discv 9   49 hours   48 hours   54 hours   52 hours  Sandy 8.3   41 hours   53 hours   54 hours   49 hours  Intsv. 6   55 hours   58 hours   54 hours   48 hours

 FmlPs

y1

 34 hours

  38 hours

  Crisis 10   22 hours   35 hours   44 hours   hours  Psych 6.8   54 hours   51 hours   40 hours   hours  Cntrct 5   89 hours   80 hours   83 hours   hours

 Agenc

y 

  hours

IIIb.1 Clinicians maintain appropriate caseload size to Practice

C&F14.2

 39 cases

 41 cases

 45 cases

  cases

80% of clinicians maintain appropriate caseload size

Adult 12 

48 cases 

54 cases 

57 cases  cases

  Discv 9   41 cases   41 cases   42 cases   cases  Sandy 8.3   67 cases   64 cases   55 cases   cases  Intsv. 6   14 cases   15 cases   16 cases   cases

 FmlPs

y1

 23 cases

 23 cases

 22 cases

  cases

  Crisis 10   13 cases   13 cases   12 cases   cases  Psych 6.8   127 cases   128 cases   128 cases   cases  Cntrct 5   28 cases   29 cases   27 cases   cases

 Agenc

y 

  cases

County Behavioral Services 2007 Team Scorecard - Compiled by Chris Potter, Systems Evaluator

County Behavioral Services 2007 Team Scorecard - Compiled by Chris Potter, Systems Evaluator

Indicator /Benchmark Goals Team FTE Jan Feb Mar Apr

IVa.1 Standards for documentation met C&F 14.2   94% 93%  

90% of Timeliness Standards Adult 12   81% 92%  

  SPMI 9   83% 86%  

  Sandy 8.3   85% 94%  

  Intsv. 6   99% 89%  

  FmlPsy 1   94% 98%  

  Crisis 10   70% 95%  

  Psych 6.8   84% 84%  

  Cntrct 5   92% 97%  

  Agency          

Percentage of Clients Discharged, who completed treatment

26%

21%

27%28%

25% 25%

28%

23%25%

32%

27%

22%

24%

20%

28%

13%

17%

28%

0%

20%

40%

7/1/

2006

8/1/

2006

9/1/

2006

10/1

/200

6

11/1

/200

6

12/1

/200

6

1/1/

2007

2/1/

2007

3/1/

2007

4/1/

2007

5/1/

2007

6/1/

2007

7/1/

2007

8/1/

2007

9/1/

2007

10/1

/200

7

11/1

/200

7

12/1

/200

7

Yes No Linear (Yes) Linear (No)

ServerName (All) AnasaziSupervisorName (All) ClinicianType (All)

Average of PercentDischargedZeroThree

MonthOfData

ODSD?

Percentage of individuals Discharged having 'completed Tx.' (with DC code '3') against all Discharged Clients (with DC codes: '3, 2. 5, 6, 8, 9, 13')Benchmark Ia.1 > 75% clients are stable upon completing treatment

Percentage of Clients who 'Showed' for individual Sessions: 2007

79%

83%82%

84%

81%83%

79%

84%85%

83%

86%84%

87%86%

84% 85% 84%83%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

7/1/

2006

8/1/

2006

9/1/

2006

10/1

/200

6

11/1

/200

6

12/1

/200

6

1/1/

2007

2/1/

2007

3/1/

2007

4/1/

2007

5/1/

2007

6/1/

2007

7/1/

2007

8/1/

2007

9/1/

2007

10/1

/200

7

11/1

/200

7

12/1

/200

7

Yes No Linear (Yes) Linear (No)

AnasaziSupervisorName (All) ServerName (All) ClinicianType (All)

Indiv. Show %

MonthOfData

ODSD?

Benchmark IIa.1 Clients keep > 80% of scheduled Individual appointments

Clinician Average Direct Service hoursBenchmark IIIa.1 60% Direct Service Ratio is maintained 1FTE = 977 hours/year (81.4

hours/month)

35

42

36

43

39

34

38

43

5047

50

44 43

47

37

45

38

33

0

10

20

30

40

50

60

70

80

7/1/

2006

8/1/

2006

9/1/

2006

10/1

/200

6

11/1

/200

6

12/1

/200

6

1/1/

2007

2/1/

2007

3/1/

2007

4/1/

2007

5/1/

2007

6/1/

2007

7/1/

2007

8/1/

2007

9/1/

2007

10/1

/200

7

11/1

/200

7

12/1

/200

7

Yes No Linear (Yes) Linear (No)

AnasaziSupervisorName (All) ServerName (All) ClinicianType (All)

Average of AdjustedDirectServerHours

MonthOfData

ODSD?

Unduplicated Cases (Caseload Size)

3254 3260 32743402 3431 3412 3437 3463 3486 3533 3583 3543 3555

3650 3591 3540 3510

3315

0

500

1000

1500

2000

2500

3000

3500

4000

4500

7/1/2006 8/1/2006 9/1/2006 10/1/200611/1/200612/1/2006 1/1/2007 2/1/2007 3/1/2007 4/1/2007 5/1/2007 6/1/2007 7/1/2007 8/1/2007 9/1/2007 10/1/200711/1/200712/1/2007

Yes No Linear (Yes) Linear (No)

AnasaziSupervisorLastName (All) ServerName (All) ClinicianType (All)

Sum of UndupCases

MonthOfData

ODSD?

Benchmark: IIIb.1 90% of clinicians maintain equitable caseload size: based upon Evidence Based Standards, or compared to similar clinicians on team.

Percentage of Progress Notes complete

67%

73%

69%

75%74%

72% 72% 73%75% 75%

74%76% 77%

76%

85%

77%76%

79%

20%

30%

40%

50%

60%

70%

80%

90%

7/1/

2006

8/1/

2006

9/1/

2006

10/1

/200

6

11/1

/200

6

12/1

/200

6

1/1/

2007

2/1/

2007

3/1/

2007

4/1/

2007

5/1/

2007

6/1/

2007

7/1/

2007

8/1/

2007

9/1/

2007

10/1

/200

7

11/1

/200

7

12/1

/200

7

Yes No Linear (Yes) Linear (No)

AnasaziSupervisorName (All) ServerName (All) ClinicianType (All)

Average of DocumentationPercentage

MonthOfData

ODSD?

Benchmark IVa.1 90% of Clinicians meet Timeliness Standards for completing Progress notes

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12

2006

Yes

No

Linear (No)

Linear (Yes)

Hospital (All) AdmitCode(All) InsuranceCode(All) Age (All)

Count of AdmitsDate

YOA Month

ODSD?

BH Hospital Admissions: 2006

BH Hospital Admissions: 2006 - 2007

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12

Yes - 2006

Yes - 2007

No - 2006

No - 2007

Linear (No - 2006)

Linear (Yes - 2007)

Linear (Yes - 2006)

Hospital (All) AdmitCode(All) InsuranceCode(All) Age (All)

Count of AdmitsDate

Month

ODSD?YOA

System Process Improvement Initiative Trial Title:

Date: Initiator: Agency/component(s):

Initiative Purpose:

Initiative Procedures:

Desired Outcomes: 1.

Potential negative consequences: 1.

Data Set(s): 1.

Initiative Timeline (Initiation, Process stages, Review points):

1.

County BH System Process Initiative Trial Title: Prescriber & Care Coordination Teams

Date: 9/20/2007 Initiator: Chris Potter, Policy Analyst Agency component(s): Psychiatric, Care Coordination Initiative Purpose: Over the previous year County BH prescriber and care coordinator direct service

totals fell below desired benchmark goals. Audited treatment plans did not consistently identify measurable, rehabilitation objectives per discipline. These concerns were partially explained by:

Inconsistencies in service coding Excessive case management responsibilities performed by psychiatric providers Insufficient appointment times scheduled for care coordinators High no-show rates for prescribers (especially on initial appointments) Poorly coordinated inter-disciplinary treatment planning and review processes Insufficient coordination of care between care coordinators and prescribers

This System Process Initiative Trial aims to address these concerns by creating teams comprised of a care coordinator and a prescriber. The care coordinator’s primary role would be to assist prescribers with clients who require more intensive case management in order to make progress on rehabilitative goals.

Initiative Process Trial: This initiative entails a trial period of at least one month in which two care coordinators are teamed up with two prescribers. Each care coordinator would work along side the prescriber, providing intensive case management services to clients in order to enhance the treatment response. These Care Coordination services, defined in treatment plan objectives and interventions, would include Managing the treatment plan and tracking client’s progress Providing resource development services necessary for rehabilitation Providing referrals for community services, as agreed upon with the prescriber Calling clients between medical appointments to inquire on health status, follow-through on

medication administration, use of coping skills and of other resources. Meeting with the client for 15 – 20 minutes prior to medical appointments to review progress Developing an aftercare plan that reflects a less intensive level of care Coordinating care between other health care providers (including therapists) Starting treatment plan revisions, or reviews, preceding the prescriber appointment

Desired Outcomes: 1. Increased prescriber direct service totals 2. Improved treatment response (outcomes) 3. Improved quality of the treatment plan, reflecting good care coordination 4. Decreased no-show rates

Possible negative consequences: 1. Higher case loads for care coordinators ‘not’ teamed up with prescribers 2. Scheduling issues: assuring care coordinators & prescribers are available at right times. 3. Decrease in care coordination direct service totals (due to more ‘non-direct’ service

Data Set(s): 1. Prescriber and care coordinator direct service hours/month 2. Audits of treatment plan quality 3. Client ‘show rate’ 4. Client treatment Outcomes (GAF & Client Outcome Rating Scales)

During the ODSD Project, Program Managers were provided with Data Reports and Charts on a monthly basis. Also, upon request, they would receive customized reports and charts pertaining to: 1.Diagnostic Analyses, 2.Access, 3.Utilization of Services, 4.Treatment Outcomes, and 5.Benchmark Performance The following slides demonstrate three examples of how data was collected and presented to Program Managers for assistance in making data informed Program Policy decisions.

Available appointments per week

Total

10

14

5

10

6

2

0

2

4

6

8

10

12

14

16

Monday Tuesday Wednesday Thursday Friday Alternate Fridays

Total

Therapist (All) Time (All)

Intake Appointments

Day of Week

Total

8

10

7

17

7

0

2

4

6

8

10

12

14

16

18

Mon Tue Wed Thu Fri

Total

Supervisor Rohrer-Heyerly, LeonUnit (All) Appointment Appointment KeptFTE (All) Service Initial AssessmentStart (All) StaffName (All) Date (All) Month 12

Intakes

Day

Actual appointments for 4 weeks: 12/06

10 11 6 10 5 919 23

3024

81

82

77

104

142

7387

187

163

181

163

180 195

138125

154

127

175

134126

114

131

103

149

128119

101

137

142

100

161

1 10

50

100

150

200

250

3 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 4 6

Sun Mon Tue Wed Thu Fri Sat

Dingman, Patty

Group Individual

Div (All) StaffName (All) Service (All) Unit (All) Date (All) StartHr (All) Appointment Appointment Kept

Events

Supervisor Day Month

Grp-Ind

Events of Service by Day and Month

To assess basic functioning ability for individuals receiving treatment, and individuals’ response to treatment, Self-Assessment Tools were integrated into the Electronic Health Record. The following slides show examples of the Outcome Assessment Tools that were used (the initial version and the short version).Analysis of this data had just begun prior to cessation of the ODSD Project.

* Outcomes Assessment Tool Case #:

Client Name: Date:

Today’s appointment is scheduled with: First Appointment

Reason for today’s visit:

Considering the past 2 weeks, circle your best choice for each of the following questions:

1. How well have you been sleeping?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 2. What has your mood been like?

1- Very down, upset, or nervous 2- Down, upset, or nervous 3- Fair mood 4- Good mood 5- Very good mood 3. How well have people been getting along at home?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 4. How has your physical health been?

1-Very poor 2-Poor 3-Fair 4-Good 5-Very good 5. How often have you been drinking alcohol (over 2 drinks at a time)?

1- Every day 2- Most days 3-3 to 4 times weekly 4- Weekly or less 5- Not at all 6. How often have you been using illegal, street drugs?

1- Every day 2- Most days 3-3 to 4 times weekly 4- Weekly or less 5- Not at all 7. How well have you been able to get things done, to accomplish your goals?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 8. How well have you been doing with others?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 9. How well has your provider listened to, and understood you? First session

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 10. How helpful has treatment been? First session

1- not at all 2-very little 3-somewhat 4-helpful 5-Very helpful

For clinician: Current GAF/CGAS: Evaluating Clinician: * Outcomes Assessment Tool: derived from ‘National Outcome Measures’ & ‘Common Factors in Psychotherapy’ Updated 10/16/2007

* Outcomes Assessment Tool (Short Version) Case #:

Client Name: Date:

Today’s appointment is scheduled with: First Appointment

Circle your best choice for each of the following questions (since last session):

1. How well have you been sleeping?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 2. What has your mood been like?

1- Very down, upset, or nervous 2- Down, upset, or nervous 3- Fair mood 4- Good mood 5- Very good mood 4. How has your physical health been?

1-Very poor 2-Poor 3-Fair 4-Good 5-Very good 5. How well have you been able overcome problems and make progress toward your goals?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 6. How well have you been getting along with others?

1-Very poorly 2-Poorly 3-Fair 4-Well 5-Very well 7. How much has treatment been helping? First session

1-Very little 2-Little 3-Somewhat 4-Much 5-Very Much

For clinician: Current GAF/CGAS: Evaluating Clinician:

* Outcomes Assessment Tool: derived from ‘National Outcome Measures’ & ‘Common Factors in Psychotherapy’ Updated 10/16/2007

*Health Care Coordinator Provides Behavioral **LOC Needs Assessment, Referrals, Brief Therapy, and

Resource Coordination Provides Behavioral Treatment integration

with PC plan, coordination or care, and Utilization oversight for Specialty Services

Patient Presents with Physical, A&D and/or

Mental Health Symptoms

Referred by self, PCP, community

provider, etc.

Data Point

Specialty Services: •Medically appropriate Level of

Need treatment setting •Specific Evidence Based Programs•Intensive Care Management• Community Resources• Prevention and Early intervention

Data Point

*HCC: Health Care Coordinator **Level Of Care Need developed by Chris Potter, M. Ed.

Outcome Driven System Integration ProcessOutcome Driven System Integration ProcessProvides multi-system Performance Outcome Data feedback Establishes, tracks, and reports on progress toward Benchmark Performance Goals Consults in Quality Improvement & Utilization Management ProcessesEncourages use of Outcome Driven System Development Initiatives

Data Point

With increased pressures upon the health care system to contain costs and provide higher quality of care, insurance utilization managers appear to be requiring more stringent authorization requirements for specialty services. As a result, care providers are encouraged to be more strict about their scope of services. This has lead to an environment of ‘it’s not my responsibility’, in which the patient is vulnerable to more fragmented care.

Consequently, it is even more important that we develop a system that reinforces the integration of care. Hopefully, an Outcome Driven System Development approach can create incentives to encourage Primary Care, Behavioral Health, and other care providers to work together in the best interest of the patient customer.

ODSD Model for integrating Care

Outcome Driven System Development

A Strategic Process Improvement Model for Behavioral Health Systems

by Chris Potter, M. Ed.

[email protected]

503-740-1494