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Recommendations for Implementation
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a.
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Utilize
performance measures in budgeting, contracting, and managing mental health
services.
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Different stakeholders also have different uses for
performance measures. Payers, for instance, need performance indicators to make
purchasing decisions and to ensure that contract provisions are met. Consumers
may use information on performance to make enrollment decisions, choose
providers, and track quality and responsiveness of the different systems of
care available to them. Providers need performance measures for quality
management and improvement purposes. Accreditation agencies are incorporating
performance measures to monitor adherence to regulations and standards and to
guide accreditation and program-review decisions. Finally, governmental
entities need performance measures for policymaking, purchasing decisions,
budget formulation, and monitoring accountability.
Performance measures are one set of tools in the arsenal
of efforts intended to improve quality, management, and accountability. Often,
they are used as a key component of ongoing management functions such as
planning, quality improvement/management, contract management, and
accountability. The focus of management is to monitor and improve (or maintain)
levels of performance: performance measures are quantitative, measurable ways to
do so. Performance measures can be used effectively in planning/budget systems,
quality improvement/management systems, and in contracts management.
Example:
New York State Office of Mental Health Center for Performance Evaluation and
Outcomes Management
The New York State Office of Mental Health has
created the Center for Performance Evaluation and Outcomes Management to
develop performance measures and associated performance targets for each
priority initiative and major sector of the public mental health system and to
evaluate the outcomes associated with each initiative.
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b.
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Involve
consumers and families in mental health service evaluation.
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Evaluation of mental health services by those who use them
is an extremely valuable gauge of the system's effectiveness. One way to tap
the energy, commitment, and hard-earned knowledge of mental health consumers
and family members is to engage them in the independent evaluation of services.
Consumers and family members can help design surveys and "report cards"
on services. With consumer and family participation, it is more likely that
report cards will reflect real-life experiences of consumers: Did they get help
applying for benefits? Did they receive help in finding housing and/or
employment? Were they treated with respect?
Consumers and families generally respond to such surveys
if they feel the results will be made known to them and will lead to any
corrective measures indicated. In some places, consumers and family members
have gone beyond these efforts to form consumer satisfaction teams, which work
with the system to formally evaluate services through site visits, surveys, and
interviews with clients. When efforts of this nature are paired with a
commitment by providers to make improvements in services based on the team's
findings, significant progress can be made.
Example:
Consumer Surveys, Center for Mental Health Services
Under the auspices of the Center for Mental
Health Services and its Mental Health Statistics Improvement Program, consumers
and professionals have worked together to develop consumer surveys that are now
in use in a number of states. These surveys, which in some states have been
translated into Spanish, Cambodian, traditional Chinese, Portuguese, Russian,
and Vietnamese, among other languages, provide an opportunity for consumers to
indicate how well services do or do not work for them.
Example:
Consumer Satisfaction Team, Philadelphia (PA)
In 1990, a Consumer Satisfaction Team (CST) was
developed in Philadelphia. At the time, a state hospital was closing and
patients from the hospital were being transferred to community services. Family
members and consumers, skeptical of the system's commitment to provide adequate
services, coalesced to form the CST. The consumers and family members won
support of local authorities for incorporation of the CST's findings in the
overall evaluation of the system's ability to provide services in the
community. Relying primarily on multiple interviews with consumers at different
agencies, the CST was able to document consumer views on provided services. The
Philadelphia CST has served as a model for a number of state and local systems
wishing to formalize methods for obtaining consumer feedback.
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c.
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Attach funding to outcomes.
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States and other government entities responsible for
funding the public mental health system should employ budgeting and contracting
mechanisms that emphasize improved outcomes. Performance based budgeting and
other mechanisms that allow for costs in one system to be balanced against
offsets in another - spending in the mental health system versus
fewer costs in corrections, for example
- should be considered by
legislatures of states wishing to better understand the full implications of
the policies they establish.
Similarly, state mental health agencies that contract with
provider agencies for services in communities should attach funding to the
outcomes to be achieved. For example, contracts can include incentives for
lower rates of arrest among the population served by an agency, along with
safeguards that ensure the agency is not "creaming" or finding ways
to provide services only to clients at lower risk for involvement in the
criminal justice system.
By their nature, performance-based budgeting and
contracting mechanisms promote provision of a full spectrum of services that
meet all needs experienced by people with mental illness. Strategic placement
of both incentives and accountability can lead to development of a system that
stresses collaboration and outcomes and allows those making service decisions
to make specific spending decisions, as well.
Example:
Performance-based budgeting, Various states
Performance-based budgeting and contracting
initiatives are under way in many states across the country. While it is too
early in this wave of activity to identify states that are leading the field,
it is possible for states and counties to begin to learn lessons from the
experiences of their counterparts in other jurisdictions. Florida, Texas,
Virginia, Missouri, and South Carolina are among the states that have examined
or implemented performance-based budgeting in state government. In addition,
the federal government is developing methods to convert existing block grants,
such as the Mental Health Block Grant, to "performance partnership"
grants. Regulations for this effort will be issued some time in 2002.
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