Outcomes Tools Selection

Committee Meeting

August 26, 2015

Committee Members:Dr. Keith Noble, Jason Turner, Derek Spiegel, Dr. Peter Jensen, Angie Lassiter, Patricia Gann, Dr. Roland Irwin, Bob Darling, Dixie Wallace, Noelle Stimach, Dr. Teresa Kramer

DBHS Staff:Julie Meyer, Paula Stone, Ryan Williams, Robbie Nix

In Attendance: Clay Mitchell, Donna Reed, Alan Kaufman, Joel Landreneau, Nicole May, Melissa Ortega, Kerri Brazzel

Jason Turner, Committee Chair called the meeting to order at 1:00 p.m. on August 26, 2015.

  1. Review and Approval of Minutes from August 12, 2015

Committee Chair Jason Turner asked the committee members if there were any revisions needed to the meeting minutes from the August 12thmeeting. With none being recommended, there was a motion to approve the minutes. After a seconding of the motion, the minutes from the August 12th meeting were approved as written.

  1. Population for Outcomes Measures

Mr. Turner informed the Committee that a sub-committee, including Trish Gann, Dr. Roland Irwin, and himself, had met in order to formulate possible populations to focus on for outcomes collection. He explained that the sub-committee invited any feedback from the proposed populations and asked Dr. Irwin to lead the discussion.

Dr. Irwin again explained that the goal of the sub-committee was to establish potential populations to focus on so that the committee could make a recommendation to the Division of Behavioral Health Services (DBHS) on an outcomes instrument to implement. As indicated in the previous meeting, without the committee knowing the potential population of which outcomes would be tracked, it would be difficult to make an informed recommendation to DBHS. Voting on a population to track outcomes on would allow the committee to better understand adjustments to client care and family impacts, potential costs, and implications to clinical practice.

Ms. Gann explained that requiring outcomes to be tracked on the entire U-21 population was ruled out, just as looking at only the U-21 population in residential care was ruled out.

Before continuing further discussion, Dr. Irwin inquired about allowing the committee to vote on limiting the population. Mr. Turner explained that a vote should be taken so that the committee could focus on limiting the population for focusing the outcomes instrument that will be selected in the future. There was a motion, which was seconded, and all committee members voted in favor.

There were 4 potential populations that the sub-committee proposed, all of which involved the trigger being a prior authorization for services. Those 4 populations were: (1) Any beneficiary with a submitted PA request, (2) Any SED beneficiary with submitted PA request, (3) Any beneficiary with a second submitted PA request – Any provider, and (4) Any beneficiary with a second submitted PA request – Same provider.

The rationale for using the Prior Authorization as the ‘trigger’ for the outcomes tool being administered was that this would focus on the clients with the highest needs. A comment was made by Ms. Dixie Wallace indicating that the current Episodes of Care (ADHD episode and ODD episode) remove the requirement for any Prior Authorization for a beneficiary in that episode. The group agreed that ADHD and ODD only beneficiaries would not necessarily be those in need of the more intensive Prior Authorized services.

Dr. Keith Noble explained that the key in tracking outcomes is the collection of baseline data. He explained that out of the 4 potential populations presented, 2 did not have collection of baseline data due to the requirement of obtaining a 2nd Prior Authorization. He made a motion to eliminate the proposed populations with no baseline data collected. That motion was seconded and all committee members voted in favor to remove the populations that required a 2nd Prior Authorization prior to the administration of the outcomes instrument.

That left the group to discuss the 2 remaining populations: (1) Any beneficiary with a submitted PA request and (2) Any SED beneficiary with submitted PA request. There were concerns expressed about the current SED definition and how subjective it is in its current form. While Arkansas continues to have a very high rate of children with SED, the committee did not want this to be an incentive for providers to simply no longer indicate that a child has SED.

A motion was then made for the population of which outcomes would be tracked would be any beneficiary Under the Age of 18 with a submitted PA request. The motion was seconded and all committee members voted in favor to make this the recommended population for the outcomes instrument.

The group then discussed what would be necessary to require the administration of an outcomes tool in order for a prior authorization to be reviewed by ValueOptions. Mr. Robbie Nix explained that rules would have to be promulgated in accordance with the Arkansas Administrative Procedures Act (APA) in order for this to be required. He also explained that both DBHS and DMS would need to promulgate rules to require this.

In the previous meeting, various committee members explained that they would be willing to conduct some research on 4 instruments and bring that back to the committee. Dr. Noble created a spreadsheet that documented the Strengths and Difficulties Questionnaire (SDQ) and the Child and Adolescent Family Assessment Scale (CAFAS). He indicated that the Basis-24 was used for adults only and would not be applicable to the population focus on this committee.

Various members of the committee voiced concerns about the length of time required to complete the CAFAS. A question was posed about if the administration of the outcomes instrument could be a reimbursable service by Arkansas Medicaid. Ms. Wallace explained that the administration of the tool, if leading development of the treatment plan and used as a tool to assist the clinician in that, could be reimbursed by Arkansas, but the simple administration of any outcomes instrument would not be reimbursable by Arkansas Medicaid.

Dr. Irwin explained that due to high turnover in his agency, the required training to complete the CAFAS would be an expense that he would like to avoid. Others in the group agreed that the complex training requirements to complete the CAFAS would present a burden on organizations that experience high turnover. A motion was made to eliminate the CAFAS based upon the knowledge that a complete administration of the tool takes 20-30 minutes and the high level of training required for an individual to administer the CAFAS. The motion was seconded and all committee members voted in favor to eliminate the CAFAS.

This meant that the 2 remaining instruments to be looked at are the Strengths and Difficulties Questionnaire (SDQ) and the Ohio Scales. Dr. Irwin then gave a presentation on the Ohio Scales instrument to the committee. There are three versions of the instrument: (1) Parent, (2) Youth, and (3) Agency Worker. All versions have two primary scales, which are problem severity and functioning. The Youth and Parent version have a 4 item satisfaction scale and a 4 item hopefulness scale, each of which yield a total score. This tool is cheap to license, ranging from $10 to $500. There is also a ‘one state health network’ option which costs $250. This licenses the user to simply use the scales as there is no database for tracking purposes.This tool is currently used in Oklahoma on children with the highest need of behavioral health services (high-risk population).

Members of the committee began inquiring to the State DBHS staff about IT costs for the State. There was some concern expressed by committee members that it would be difficult to make a decision without full cost estimates. Mr. Nix explained that the two instruments (SDQ and Ohio Scales) do not have a built in tracking database. He informed the committee that the State could provide some estimates on total IT cost, but that it would be just that, an estimate. Due to the nature of how this would be handled, the IT infrastructure needed to house and maintain this data would need to be developed and all State procurement law would apply. To adhere to State laws and procurement regulations, a request for activities and deliverables would be released publicly for response. A part of the selection process would include the total cost of an entity delivering those activities and deliverables, but besides providing an estimate to the group, there is no way of knowing the total IT cost to the State at this time.

Mr. Nix also reminded the committee that anything recommended by the group to DBHS would be taken under consideration and any changes would require DBHS to promulgate those changes adhering to the aforementioned Arkansas Administrative Procedures Act.

The next meeting is schedule on September 2nd, 2015 at the Arkansas State Hospital from 1:00pm to 3:00pm. The plan is for some additional information to be collected from the team responsible for tracking outcomes using the Ohio Scales in Oklahoma and a more in depth look at the SDQ.

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