NYS Behavioral Health Readmission Collaborative, Edith Kealey ...

The Readmissions
Quality Collaborative
Edith Kealey, MSW
Kate M. Sherman, LCSW
New York State Office of Mental Health, 2013

Overview
• Background and Scope of the Problem
• The Readmissions Quality Collaborative
• Participants and Activities
• Strategies to Reduce Readmissions
• Resources
• PSYCKES indicators
• PSYCKES public website and training webinars

Behavioral Health
Inpatient Readmissions:
Background and
Scope of the Problem

Reducing Hospital Readmissions:
A National Quality Focus
• Hospital readmissions are common and costly
• 19.6% of Medicare beneficiaries discharged were re-hospitalized within 30
days; cost to Medicare of unplanned readmissions estimated at $17.4 billion
(Jencks, 2009)
• Medicaid enrollees aged 21-64 had 10.7% 30-day readmission rate (HCUP
Statistical Brief #89, 2010)
• National/multi-state initiatives to address preventable
readmissions include
• Partnership for Patients Community-Based Care Transitions Program:
national initiative to reduce unnecessary hospital readmissions by 20%
• Project BOOST (Society of Hospital Medicine): 60 sites in 26 states
• IHI STAAR (State Action to Reduce Avoidable Readmissions) Initiative: 4-
state collaborative in 148 hospitals
• While most attention nationally is on medical readmissions, behavioral
health readmissions are an important component of the overall picture.

30-Day Readmission by Major Diagnostic
Category at Initial Hospital Stay for Medicaid
Recipients Age 21-64, 2007
Among 15 states, behavioral health discharges ranked among the top 5
diagnostic categories for 30-day readmissions.
AHRQ Health Care Utilization Project Statistical Brief #89, 2010

30-day Behavioral Health Readmission
Rates in the NYS Medicaid BH
Population, April 2011- April 2012
New York State Office of Mental Health, 2012

Characteristics of NYS Medicaid BH
Recipients with 30-day BH Readmissions
NYS Office of Mental Health, 2012

The Readmissions Quality
Collaborative

The Readmissions
Quality Collaborative
• Goal: Reduce readmission rates among adults
discharged from behavioral health inpatient
services
• Projected time frame: June 2012-December 2013
• Sponsors: GNYHA, HANYS, OMH/PSYCKES
• Steering Committee of peer institutions decides:
• Focus of project (i.e., readmissions)
• Strategies and activities
• Reporting requirements

Participating Hospitals and
Service Types
• 47 Participating Hospitals Statewide
• NYC (23), LI (9), Hudson River (6), Central (5),
Western (3)
• 50 Inpatient Services
• 44 Psychiatry, 6 Detox / Rehab
• 16 Outpatient Services
• 12 Mental Health, 2 Chemical Dependency, 2 Dual
Diagnosis
• 3 Psychiatric Emergency Departments / CPEPs

• Conferences
Key Activities
of the Collaborative
• Monthly Learning Collaborative Calls
• Interactive, report on progress
• Strategies calls: Training on specific strategies
• Data reporting
• Monthly self-report
• Quarterly Medicaid data
• Site Visits (selected hospitals)

Strategies to Reduce
Behavioral Health
Readmissions

Core Project Activities
• Case finding: Implement admission protocol to identify
clients at risk of readmission, using Screening Tool
and/or PSYCKES data.
• Identify and address risk factors: Assess for risk
factors and implement policy that identified risks for
readmission are addressed explicitly on treatment plan
and discharge plan.
• Optimize discharge process: Implement a protocol or
checklist to ensure best practices in discharge
planning, including procedures for bridging time
between discharge and first outpatient session.
Coordinate discharge planning efforts with the BHO.

Priority Targets for Intervention
• Improve medication practices
• Improve engagement in outpatient care
• Improve delivery of integrated treatment for
co-occurring psychiatric and substance use
disorders

Intervention: Improving
Medication Practices

Intervention: Improving
Engagement in Outpatient Care

Intervention: Improving
Delivery of Integrated Treatment for
Co-Occurring MH and SUD
■
■
Using the evidence-based Integrated Dual Diagnosis
Treatment (IDDT) model
**On-line training available via OMH “Focus on Integrated
Treatment” Modules.**

Inpatient Strategies: Services Delivered
Self report data:

Enhanced Discharge Processes
Among 50 participating inpatient services

Outpatient Strategies:
Interventions/Services Initiated
Self report data:

Examples from
Participating Hospitals
• At several hospitals, if a potential readmission comes
to ED, the inpatient treatment team who knows the
client is called to ED for consultation.
• Hospitals are attending more carefully to barriers such
as insurance, e.g., checking which LAIs the client’s
insurance will cover before initiating a regimen.
• At Woodhull Hospital, clients at high risk of
readmission receive two individual sessions focused
on preventing readmission.

Examples from
Participating Hospitals, cont’d
• Several hospitals, including LIJ and Maimonides, are
implementing “plan for discharge” workbooks and
worksheets.
• Lutheran Hospital “Warm Hands” initiative to improve
transitions from inpatient detox to outpatient chemical
dependency, e.g., before 1 st appointment, clinician
makes provides motivational interviewing on
reminder call.

• Midyear conference
Next Steps
• Analysis of Medicaid and other data to review
trends over time
• Identify which strategies are most effective and
result in best return on investment
• Site visits to identify best practices and provide
technical assistance

Resources:
The PSYCKES Application
and Public Website

Brief Introduction to PSYCKES
• A HIPAA-compliant, web-based application that
provides access to Medicaid claims data for
clinical decision-making and quality
improvement
• Includes fee for service and managed Medicaid, but
not Medicare or private insurance
• Includes data on NYS Medicaid behavioral
health population
• Up to 5 years of data across treatment settings
• Quality measures calculated at state, region,
county, and provider level

PSYCKES Quality Measures
• Acute Care Utilization
• High Utilization
(Inpatient/ER)
• Behavioral Health
Readmission
• Preventable
Hospitalization
• Physical Health
• Outpatient Medical
Visits
• Lab monitoring
• Psychotropic
Medications
• Adherence
• Cardiometabolic Risk
• High Dose
• Polypharmacy
• Psychotropic
Prescribing for Youth
• Too much, too many,
too young

Access to Client-Level Data

PSYCKES QI Overview
Indicator sets associated with readmission risk

QI Indicators within the Set
All behavioral health vs. hospital-specific

Quality Indicators Link to
List of Flagged Clients

Clinical Summary
• Integrated view of all services
• Service Summary Tables by Category
• Medications
• Outpatient
• Inpatient/ER
• And more …
• Drill down to view linked claims/encounters
• Can be exported to Excel/PDF

Clinical Summary: Graphs
Rapid identification of service utilization patterns

Inpatient and ER Services
Service type (ER or Inpt, BH or Medical), hospital name, date of admission/discharge,
LOS, last diagnosis, procedures, “See all Data” > links to each invoice/claim

PSYCKES Home Page
www.psyckes.org
• Public website, PYSCKES access not needed
• Click on “Hospital Collaborative”

PSYCKES Website:
Readmissions Collaborative Page

Tools on PSYCKES Website:
Readmission Risk Assessment

Tools on PSYCKES Website:
Slides from “Strategies” Calls

For Further Information
• PSYCKES website
• www.psyckes.org
• PSYCKES Help (PSYCKES support)
• 9:00AM – 5:00PM, Monday – Friday
• PSYCKES-help@omh.ny.gov
• OMH Help Desk (PSYCKES access, SMS support)
• 7:00AM – 8:00PM, 7 days
• 800-HELP-NYS (800-435-7697)
• Helpdesk@omh.ny.gov

Question and Answer