Much of this report has focused on operational criteria and expected results from the implementation of best practices in the public behavioral health system. For Arizona, it will be useful to establish a series of baseline measures that can be tracked over time in an attempt to quantify the effects of changes on the system and its priority consumers.

Increasingly, publicly funded behavioral health systems have turned to the collection and reporting of performance indicators in order to measure the effectiveness of systems of care or health plans. In recent years, a host of efforts have been undertaken by various organizations to standardize these performance indicators to allow comparisons between health plans and systems of care. A review of efforts undertaken by the National Committee on Quality Assurance (NCQA), the American Managed Behavioral Health Association (AMBHA), Health Plan Employer Data and Information Set (HEDIS), and the Mental Health Statistics Improvement Program (MHSIP) has resulted in a collection of performance and outcome indicators that are now being collected and reported in public and private systems of care throughout the nation. The collection and reporting of these indicators varies somewhat throughout the country, and performance reporting is still in the beginning stages. However, as with other aspects of public behavioral health, the knowledge and technology are improving rapidly, and improved approaches to measuring performance and outcomes are now becoming available.

The following is a brief description of performance indicators that could track changes over time as efforts to implement best practices are developed and implemented. These indicators include measures of access to and appropriateness of the care provided on a system level, allowing comparison of RBHAs throughout the state. The indicators have been included in this report because they are generally accepted national measurement standards that can be applied in Arizona, and they are supported by available and reliable data already collected throughout the Arizona Public behavioral health system.

Penetration Rates - Comparison of RBHA Penetration Rates of Enrolled Consumers by Program Indicator. This can be used to monitor the progress of RBHAs in delivering services to severely mentally ill adults, seriously emotionally disabled children, and general mental health/substance abuse populations as compared to the overall statewide average for the penetration rate of enrolled consumers receiving services by these same population groups. Over time, the RBHAs should focus on increasing the penetration rates of defined priority consumer populations. This can be measured through comparing average monthly users to the estimated number of persons potentially eligible for mental health and substance abuse services.

Inpatient Days per 1,000 or 100,000 Population. This can be used to assess the level of utilization of acute service types versus lesser intensity community-based services.

Inpatient Average Length of Stay. This indicator should be applied to psychiatric health facilities (PHFs) and other facilities to determine whether lengths of stay are in acceptable ranges for the acute and intermediate levels of care. Long lengths of stay may indicate a need for development of residential services or supportive services in the community.

Person Served by Program Indicator. This measure can be used to determine which population group is consistently receiving the most services by RBHA. Although there is a possibility of variation in demand by RBHA, these measures in combination with penetration indicators could be used to assess whether adults, children and/or persons with substance abuse are receiving less or more treatment than the general mental health (GMH) population.

Expenditures - Comparison of RBHA Expenditures per Capita by Level of Service. This measure can be used to assess whether RBHA to RBHA expenditure for behavioral health care are achieving a minimum statewide standard. By breaking this down and reporting it by level of service, the data can provide illustration of whether one service disproportionately comprises the bulk of the expenditures. Case management service expenditures are now a significant component of expenditures. Over time it will be important to assess if these expenditure patterns change.

The use of acute services versus lesser intensive treatment can be monitored at an aggregate level by assessing the expenditures per capita by service type. This too should be monitored over time.

30-Day Acute Readmission Rates. This can be used to determine the availability of community resources and provides a rough indicator of appropriateness of care provided. If there is a high degree of recidivism, it may be an indicator that there is a lack of lesser intensive service alternative in the community.

The above indicators could be augmented over time. However, given currently available data, they will provide the most effective and reliable measures of system performance. The use of these indicators over time will provide useable tools to assess the progress of the publicly funded behavioral health care system.