Aware that there is a "rush to hold all providers delivering mental health and chemical dependency services accountable for the accessibility, quality and satisfaction of such services," the American Managed Behavioral Healthcare Association (AMBHA) recently released the second version of its Performance Measures for Managed Behavioral Healthcare Programs (PERMS 2.0).
AMBHA members manage the mental illness and substance abuse disorder health plan benefits for some 100 million enrollees. Since AMBHA's formation in 1994, one of its primary goals has been "to promote health plan, management agent and provider accountability through performance measurement."
PERMS 2.0 was produced by the AMBHA Committee on Quality Improvement and Clinical Services, chaired by Clarissa Marques, Ph.D. AMBHA members worked with a team from Harvard University to draft the technical specifications.
Membership organizations within AMBHA will be asked to submit data relevant to the PERMS 2.0 measures, according to Pamela Greenberg, M.P.P., AMBHA's executive director. Harvard researchers will analyze the data.
The goal is the release of one-fourth of the data generated by PERMS 2.0 by the second quarter of 1999, said Greenberg. The data will be aggregated into an industry-level database available for external policy development and internal benchmarking.
Individual AMBHA members can choose to release data specific to their own organizations, Greenberg added.
Examples of some PERMS 2.0 measures for access to care include the number of inpatient discharges for Mental Health and/or Substance Abuse (MH/SA) treatment and average length of stay, and the percentage of members receiving inpatient and outpatient MH/SA services.
Examples of quality indicators are ambulatory follow-up within seven and 30 days of inpatient discharge for MH/SA diagnoses, readmission rates for MH/SA diagnoses (30, 90, 365 days), the percentage of board certified psychiatrists, the availability of providers with bilingual language skills, the engagement rates for treatment of depression and substance abuse, the availability of psychotherapy and/or medication management for patients with schizophrenia, and having one family visit for children undergoing mental health treatment.
Most of these measures have been designed to be in compliance with the Health Plan Employer Data and Information Set (HEDIS), developed by the National Committee for Quality Assurance (NCQA). A set of more than 75 standardized quality performance measures of access, process and patient satisfaction, HEDIS is used by more than 90% of the nation's health plans.
Along with the behavioral health measures, PERMS 2.0 includes consumer satisfaction measures based on questions that appeared in the first version of PERMS and questions from the Consumer Assessment of Health Plans Study developed by the U.S. Agency for Health Care Policy Research. Included in PERMS 2.0 are such questions as "With the choices that were available to you through your health plan, was it easy to find a mental health or substance abuse treatment provider?" and "Did your mental health or substance abuse treatment provider encourage you to use self-help or consumer-run programs such as clubhouses and drop-in community support centers?"
AMBHA also will be testing leadership measures, "measures clearly in an early developmental stage," in PERMS 2.0. These include the number and percentage of admissions that are involuntary, prescribing of antipsychotic medications for nonpsychotic conditions, and concurrent prescribing of two or more psychotherapeutic/active medications for those aged 65 and older.
One week after the release of PERMS 2.0, the NCQA released the final specifications for the 1999 Health Plan Employer Data and Information Set (HEDIS 99).
HEDIS 99 includes new behavioral health care measures, including one assessing whether health plans are effectively managing patients with moderate to severe cases of depression and who are being treated with antidepressant medication. Specifically, the antidepressant measure looks at whether follow-up visits are sufficiently frequent to ensure optimal medical management (e.g., to adjust dosages, check tolerance) and how many patients are still on their medications after 12 weeks and after six months. Other relevant measures included in the HEDIS 99 are follow-up after hospitalization for mental illness, advising smokers to quit, availability of behavioral health care providers and a new membership satisfaction survey. Many of the measures will be included in NCQA's accreditation program which begins in July 1999. NCQA also has developed standards for its Managed Behavioral Health Accreditation Program.