Strengthening the System of Behavioral Health Care in the District of Columbia

In partnership with the District of Columbia’s Department of Behavioral Health (DBH), Aurrera Health Group is excited to announce the release of Measuring Provider Performance: Building a stronger system of behavioral health care.  This is the first time that provider-specific data on the performance of behavioral health providers across seven DBH fiscal year (FY) 2020 key performance indicators (KPIs) have been made publicly available. These seven KPIs are used to measure and monitor progress and outcomes in mental health and substance use disorder (SUD) services delivered by DBH-certified, community-based providers in DC.Intended to provide data that DBH and stakeholders can use to drive improvements in timely access to appropriate behavioral health services, the report shows DBH providers performing well on some indicators of behavioral health services, with opportunities for improvement for others. In the context of these findings, the report also discusses DBH efforts to improve performance, such as providing technical assistance and offering training for providers.

Background and Project Approach

This report was developed through a collaborative effort across multiple teams, informed by research by Aurrera Health, as well as discussions with key stakeholders, including behavioral health providers, advocates, and DBH leadership. To begin this project, Aurrera Health assessed publicly available provider-specific reports on behavioral health performance at the state and local levels to provide insight on the strengths and weaknesses of different approaches for reliably reporting provider-level behavioral health performance data. Several key takeaways were gleaned from this assessment, including:

• The most effective reports were those intentionally developed for a public audience;

• Presenting data in various formats (e.g., charts, tables, graphs) provided stakeholders with a range of options for interpreting findings;

• Including summary statistics and benchmarks helps to contextualize provider performance; and

• The use of methodologies to suppress or denote statistics based on small sample sizes should be considered to protect patient privacy.

Additionally, stakeholders emphasized the importance of assisting the reader in understanding key findings by using plain language and simple data visualizations.

Methodology

Working closely with DBH, Aurrera Health analyzed the performance of 67 DBH-certified providers, each of whom served between 21 and 5,757 consumers and clients in FY 2020. The 56 providers that had data for at least one KPI were the focus of the report.To protect sensitive client and consumer information, Aurrera Health and DBH set a minimum threshold for the display of provider data and did not report provider-specific information if this threshold was not met. Given the wide range in the number of consumers and clients each provider served in FY 2020, Aurrera Health stratified providers by the volume of consumers/clients served in FY 2020 (i.e., small, midsize, large) to understand whether there was a relationship between volume and performance. Aurrera Health presents provider-and system-level performance data in relation to DBH-established performance targets (i.e., far below, near, met or exceeded), using a system of colors and symbols to help the reader easily contextualize provider performance. The report displays provider-level summary data as means, medians, and percentages in a series of charts, graphs, and tables.A detailed report reference guide describes these and other methodological considerations and provides explanations for key findings across the report.

Key Findings from the FY 2020 Provider Report

The findings for FY 2020 include:

• Providers met or nearly met the performance targets for four of the seven KPIs:

  • Timely Service - Adult Enrollment/Transfer (met)

  • Behavioral Health Satisfaction Survey – Person-Centered Planning Domain (nearly met)

  • Timely Service - Children Enrollment/Transfer (nearly met)

  • Opioid Treatment Program (Methadone): Retention Rate (nearly met)

  • Providers had the highest absolute performance on the Opioid Treatment Program (Methadone): Retention Rate measure, with 87% of methadone clients served in two consecutive quarters

  • The Timely Service – Post Psychiatric Hospital Discharge indicator had the greatest room for improvement relative to the target

  • While the volume of consumers/clients and providers served appeared to be associated with performance for some KPIs, no consistent patterns were observed

  • There was differential performance across KPIs and providers

Preparing for a Future of Quality Reporting

Access to high-quality behavioral health services is vital to the health and wellbeing of those served by the District’s behavioral health system. Public reporting of performance data can serve as a valuable tool in fostering improvements and timely access to high-quality behavioral health services. As the District is working towards a behavioral health redesign and transformation effort, reporting and monitoring performance data will be a key requirement for providers as they work with Medicaid managed care organizations to deliver and improve care.Aurrera Health is proud to support our clients in efforts to promote transparency and drive improvements in care delivery and health outcomes through quality measurement and reporting. Moving forward, Aurrera Health will continue to support DBH through the development of future reports that will include new KPIs and present information on how provider performance has changed over time.For more information, Measuring Provider Performance: Building a stronger system of behavioral health care can be found on DBH’s website. Supplemental documents, including detailed tables of provider-specific performance, as well as visual representation of variation in provider performance can be found also be found through DBH’s website.

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Authors

Jenneil Johansen [Deputy Director]

Megan Thomas [Managing Principal]