Accelerating Utilization of CE Findings in Medicaid Mental Health

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DESCRIPTION (provided by applicant): State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. Ten specific clinical target areas have been identified for measurement and intervention based on CE evidence: mental health drug polypharmacy; management of metabolic risks of antipsychotics; antipsychotic utilization for children under age six; higher than recommended doses of antipsychotics; utilization of appropriate mental health services as a complement or alternative to psychotropic treatments; consistency between diagnoses and treatments; geographical, provider, racial/ethnic, and other treatment lacking clinical rationale; improvement of treatment adherence for adults with severe mental illness; identification and prediction of high risk/high utilization beneficiaries and targeting of services to these subpopulations; safe and effective psychotropic and mental health services use by foster care youth. The NET will improve treatment practices in these clinical target areas by implementing highly effective organizational practices including the systematic utilization of administrative and clinical data to monitor and guide policy, systematic provision of provider feedback, multi-state networking to support transfer of successful innovations across states, and creation of multi-agency, multi-stakeholder quality collaboratives within states in order to implement an innovative multi-state, multi-faceted, data-driven CQI program in each state. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally. The potential impact of the NET is enormous given Medicaid's central role in financing mental health care, and the large number of beneficiaries affected. PUBLIC HEALTH RELEVANCE: State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally; the potential impact is extremely large given the large number of beneficiaries affected.