Design of a Payment Decision–Support Tool for Coordinated Specialty Care for Early Psychosis

Bao, Yuhua; Li, Yan; Jeng, Philip J.; Scodes, Jennifer; Papp, Michelle Alexandra; Humensky, Jennifer; Wall, Melanie M.; Lee, Rufina; Ancker, Jessica S.; Pincus, Harold Alan; Smith, Thomas E.; Dixon, Lisa B.

doi:10.1176/appi.ps.202000129

Cited by 10 publications

(3 citation statements)

References 11 publications

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“…Moreover, what services are to be bundled and how much the case rate should be will need to be determined locally. We are currently developing a decision-support tool to assist CSC stakeholders in making such decisions (17).…”

Section: Discussionmentioning

confidence: 99%

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Bao

Papp

Lee

et al. 2021

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The authors aimed to identify prominent financing approaches for coordinated specialty care (CSC) of patients with first-episode psychosis, alignment or misalignment of such approaches with sustained CSC implementation, and CSC provider perspectives on ideal payment models.Methods: Semistructured interviews were conducted with informants from CSC provider organizations. Purposeful sampling of CSC program directors, team leaders, and other administrators from a national e-mail Listserv was supplemented by snowball sampling via participant recommendations. Interview data from 19 CSC programs in 14 states were analyzed by using an integrated (inductive and deductive) approach to derive themes. Results:The results indicated that financing approaches to CSC were patchwork and highly varied. Three major sources of funding were cited: insurance billing (largely fee for service [FFS] to Medicaid and private insurance), set-aside funding from the federal Mental Health Block Grant (MHBG) program, and state funding. The findings revealed limited coverage and restrictive rules associated with FFS insurance billing that were misaligned with CSC implementation. The grant nature of MHBG and other public funding was seen as a threat to long-term CSC sustainability and deployment. CSC stakeholders endorsed a bundled-payment approach by public and private payers and supported tying payment to client outcomes to reflect CSC's recovery orientation.Conclusions: Reliance on FFS insurance billing and public funding is likely to be unsustainable. Additionally, FFS billing is misaligned with CSC goals. Because of the diversity in CSC programs, populations, and existing funding mechanisms and rules, payer-provider collaboration will be essential in designing a bundled-payment model that meets local needs.

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Section: Discussionmentioning

confidence: 99%

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Bao

Papp

Lee

et al. 2021

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“…One obstacle to adopting new THD practices is uncertainty by the senior leadership of OTPs regarding the financial viability of any change that deviates from established billing practices [60]. As part of this project, we will use State administrative data to develop a revenue projection tool for OTPs; this decision-support tool will be provided to OTP leadership and allows for revenue projections conditional on target THD practices and optimal billing [83,84].…”

Section: Introductionmentioning

confidence: 99%

“…The tool and guidance will walk through number of clients with different THD schedules and projections for revenue based on optimal billing. Leadership would be able to conduct 'what-if' analyses under varying assumptions of THD practices[83,84]. research as well as from findings from qualitative studies conducted during phase 1, provide training on clinical best practices for THD.…”

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confidence: 99%

Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes

Choi¹,

O’Grady²,

Cleland³

et al. 2023

PLoS ONE

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Introduction Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. Methods and analysis We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases—Medicaid, treatment registry, THD reporting—with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. Discussion This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE—particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.

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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis

Aguey-Zinsou

Scanlan

Cusick

2022

Community Ment Health J

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Design of a Payment Decision–Support Tool for Coordinated Specialty Care for Early Psychosis

Cited by 10 publications

References 11 publications

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Financing Early Psychosis Intervention Programs: Provider Organization Perspectives

Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes

A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis

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