Decision Support and Management Information Systems
The Health Plan shall develop and maintain a database which will track utilization and outcomes for the four groups across all levels of care, ensuring comparability of benefits, access, and outcomes. The Health Plan shall also develop and manage databases of social and mental health indicators on the covered population from the four groups and the community at large.
- The database shall include qualitative and quantitative data that accurately reflects the four groups and shall be collected and interpreted in a culturally competent manner at national, state, and local levels. Findings from these data shall be used in a culturally competent manner to continually assess, improve, and inform strategic planning for services to racial/ethnic group consumers and families.
- For purposes of accountability, the Health Plan shall report to the governing entity, in a regular and timely manner, performance and outcome data specific to consumers and families from the four groups.
- Aggregated data linkages by ethnicity with primary care plan, public health, substance abuse, developmental disability, education, courts, corrections, and juvenile justice shall be established to provide cross-system utilization information on the mental health status of the four groups at the federal, state, and local levels.
- Data shall be current, accurate, and include gender, age, ethnicity, socioeconomic status, linguistic proficiency, geographic area, sexual orientation (at the consumer’s option), and health insurance status.
- Each of the four groups shall be broad and inclusive, including a capacity to code all and multiple subgroups and those of mixed race/ethnicity. Each of the four categories shall be distinct and monitored separately even when consistent with U.S. Census Bureau practice.
- The Health Plan shall collect and track (independently from billing data) aggregated diagnostic and assessment information, service utilization trends and costs, drop-outs, and utilization patterns, and behavioral and functional outcomes. Each category shall be computed across modalities, using standardized units of measurement across modalities.
- Individual consumer data shall be kept confidential with data sets coded in such a manner that client cannot be readily identified.
- The Health Plan shall seek formal input from the consumers' communities on adequacy of proportional mix of culturally competent mental health professional staff, including adequacy of culturally competent staff from their own racial/ethnic group.
Recommended Performance Indicators
- Presence of a data system inclusive of the above mentioned elements.
- Use of a unified clinical record across all levels of care that legally allow for sharing of information to facilitate data collection and tracking.
- Regular reporting to the governing entity of performance and outcome indicators.
- Timely and accurate consumer data which provides for tracking across age and race ethnicity.
- Timely transition of data to enhance continuity of care.
Benchmark: Real time authorizations for services.
- Focused preventive and service planning for consumers.
Benchmark: Increased specialized and preventive services to at-risk consumers.