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
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
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
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.
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