The document provides an overview of a quality improvement report and performance-based contracting for problem gambling treatment providers. It summarizes data on provider performance metrics like access, retention, completion and consumer satisfaction rates. It also outlines plans to introduce performance-based payments where providers can earn a 5% bonus each year for meeting metrics related to enrollment surveys, penetration rates, access times, reporting and spending on gambling treatment services. The document reviews the report and discusses future agenda items like co-occurring disorders and ideas for increasing enrollments.

1. Problem Gambling Treatment
Providers
Monthly Call/Webinar
Quality Improvement Report
Overview and Performance Based
Contracting
Greta Coe, Problem Gambling Services Manager
Thomas L. Moore, PhD, Herbert & Louis LLC
April 1, 2015

2. 2
Agenda
Time Topic
3:00pm-3:10pm Introductions/County Roll Call
3:10pm-3:15pm AMH Update/Announcements
•PG System Improvement 5 year Plan Update
•May PGS All Provider Webinar
3:15pm-3:45pm Presentation
•Statewide Quality Improvement Report Outcomes
•Performance Based Payments and Metrics for next Fiscal Year
3:45pm-4:00pm Discussion Topics
•PGS Treatment Provider Discussion-Updates from the field
Future agenda items:
•MH clinicians not knowing how to refer and screen
•Treating gambling addiction and co-occurring disorders
•Ideas for increasing enrollments

3. 3
AMH Updates
1. Community forums completed and next steps
2. May 14 All Provider Webinar
3. QIRs
4. Budget Notices
5. NARA Problem Gambling Treatment Specialist
Position

4. 4
Overview
1. Purpose of the Quality Improvement Reports
(QIR)
2. Data Collection Protocol
3. Report Contents

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Purpose
 Purpose of the Quality Improvement Report
(QIR) is to provide a data-driven platform for
system-wide, regional, and local agency
managers to track performance to contractual
and non-contractual goals with the goal of
improving system efficiencies and outcomes.

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Protocol
A. Monthly worksheets of the performance items are
distributed to key agency and regional personnel for
review and tracking.
B. Local agencies are expected to provide the opportunity
for active clients to participate in an anonymous
satisfaction survey at least once during each six-month
period.
C. Reports are prepared semiannually (July – December
and January – June), reviewed by PGS with Herbert &
Louis LLC staff, then distributed to local agency
directors, with comments.

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Protocol
D. Program strengths and success are normally addressed
in the comments that accompany the reports as well as
suggestions for possible technical assistance in areas that
are consistently below expected benchmarks.
E. In rare situations, PGS may delineate corrective action
– this will not come as a surprise.

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Criteria Above
Average
Average Below
Average
Contractually Required Performance Criteria
Access/Wait ◙
Retention ◙
Completion ◙
Satisfaction ◙
Reporting ◙
Informational Performance Criteria
Penetration ◙
Length of Stay ◙
Client Authorization ◙
Enrollment Survey
Reporting
◙
Performance Summary
Statewide
July 1, 2014 – December 31, 2014
(N=478)
Past Period
◙
Current
Period


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Contractually Required Performance Criteria
Table 1. Access Wait Time
(Percent Less Than 5 Days)
n = 461
Average wait times are calculated
by determining the number of
business days from the initial
contact to the first available
appointment opportunity.
Contractually, providers are
required to provide face-to-face
access for 90% of all clients within
five business days.

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The retention criteria is defined as
a minimum of 40% of gambling
clients that enter into treatment and
remain for a minimum of 10
contact sessions.
Table 2. Retention Rate
(In Percent)
n = 417

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Table 3. Successful Completion
Rate (Gamblers)
(In Percent)
n = 306
Successful program completion is
defined as the gambling client
having completed a minimum of
75% of the short-term treatment
goals, completion of a continued
wellness plan (relapse prevention
plan) for post treatment, and lack of
engagement in problem gambling
behaviors for a least 30 days prior
to discharge. This criteria has been
established as a minimum of 30%
successful discharge using the
adjusted discharge rate.

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Table 4. Consumer Satisfaction
(In Percent)
n = 184
The client satisfaction criterion is
based on gambling clients’
indicated willingness at discharge
to recommend the program to
others with similar problems. The
score is calculated by summing the
responses of always and often to
this question on the discharge
survey. This minimum cutoff is
85% positive rate.

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Contractual stipulations require that: (a) Client intake data (enrollment
forms) is submitted within 14 days of the first face to face contact. (b)
Discharge data (discharge forms) is submitted within 90 days of last
contact. (c) Encounter data is required to be submitted within 30 days
following the end of the billing month. The “reporting” criteria indicator
is calculated by averaging the percent of submitted data for each set of
data and arriving at an overall percent of data submitted within the
required time periods.
Table 5. Data Reporting Cycles
Enrollment, Termination, and
Encounter Data Reporting Cycles

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Non-benchmarked Performance Indicator Trends
The average number of gambler
and family client enrollments is
calculated by taking the total
number of enrollments and dividing
by the number of months in the
reporting window. There is no
minimum standard for this element.
Table 6. Average Number of
Enrollments per Month

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The average number of encounters per
gambling client is provided for
information. This is based on cases that
were closed during the period. This
information may understate actual services
hours provided if clients discharged during
the period had been enrolled prior to the
reporting of encounter data. There is no
minimum standard for action for this
element although 30% less than the
statewide average will require written
comments discussing potential causative
factors and steps that might improve the
number of encounters per client.
Table 7. Average Number of
Encounters (Gamblers)
n =

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Table 8. Average Number of
Open Cases per Month
The average number of open cases
per month during the period is
provided for information. There is
no minimum standard for this
element.

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Table 9. Percent of Cases Open
Over 12 Months With no Waiver
n = 115
The percent of cases that have been
open more than 12 months without
a waiver is provided for
information. As claims will be
automatically denied for clients
open more than 12 months without
a waiver, the expectation is that
there will be no such cases.

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The estimated penetration is provided for
informational purposes. It is a target of the number of
gamblers that would be expected to enroll in your
agency’s program during the report period. This
number is calculated by multiplying the estimated
population 18 years and older by the current estimated
prevalence rate (2.7%) of problem and pathological
gamblers in the state based on the most recent
population study and finally multiplied by 3.0% as a
target of the number of individuals that will seek
treatment during the period. These estimates are
conservative and somewhat coarse. There may be
regional variations in the prevalence of the disorder or
in the willingness of individuals to seek treatment.
Nonetheless, this should serve as a gauge of the
outreach efforts for your catchment area. The numbers
provided in Chart 11 are for the six month period.
Although there is no contractual minimum penetration
rate, situations where gambler enrollments are 30% or
more lower than the expected rate will require written
discussion regarding what steps might be taken to
increase enrollments.
Table 11. Estimated
Penetration
Gamblers Only
(For Six-Month Period)

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This data element is provided for
information purposes only as there is no
contractual minimum rate. This rate is
based on the number of gambling clients
who volunteer to participate in the system-
wide evaluation follow-up activities.
Clients may opt out of the follow-up as it
is voluntary and care must be exercised by
agency staff to ensure that accurate
information is provided to the client
regarding participation. Based on similar
follow-up studies, no fewer than 80% of
clients would normally be expected to
volunteer. Rates less than this comprise
quality improvement efforts. In situations
where the authorization rate is 50% or less
a written explanation will be required.
Table 12. Client Authorization for
Follow-up Rate
n = 478

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Table 13. Combined Enrollment
Survey Reporting Rate
n = 416
This data element tracks the
combine rate of gambler and family
enrollment surveys submitted
during the period. Data that was
previously required to be collected
on the record abstracting form was
transferred to the client self report
survey. This data is essential to
monitoring system performance.
The expected reporting rate is 95%.
This is not a contractual
requirement.

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Agencies that submit client satisfaction surveys will also
receive a detail report of how their clients responded to the
“most helpful,” “least helpful,” and suggestions for
improvement open-ended questions.

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Top Five Performing Agencies
Jefferson BestCare (75)
Addictions Recovery Center (60)
Yamhill County (60)
Emergence (50)
Josephine Options for Southern Oregon (50)
Maximum points possible:
80 with a 10 point bonus for exceeding enrollments

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Prepared By
Thomas L. Moore, PhD
Herbert & Louis, LLC
PO Box 304
Wilsonville, OR 97070-0304
(503) 685-6100
admin@herblou.com
LLC

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2015-16 Performance Based Contracting
Metrics
Moving to a Performance Based Contracting Model
starting July 1, 2015
Contractors (direct and Counties) will be eligible for a
5% performance payment each year if metric are met.
There will be five metrics and each represents 1 percent.
Data will be reviewed in mid-March 2016 for the
reporting period of July 1, 2015 through December 31,
2015.
Performance payments must be used for problem
gambling.

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Performance Based Contracting Metrics
1. 95% completion of enrollment surveys
2. 50% penetration rate reach for counties
3. 90% of clients seen within 5 business days (access/wait
time)
4. 90% of reporting submitted within contractual
requirement timeframe (3 data points- enrollment,
discharge and encounter data)
5. 50% or greater of yearly allocation spent on gambling
treatment services

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Future Agenda Items
MH clinicians not knowing how to refer and screen
Treating gambling addiction and co-occurring disorders
Ideas for increasing enrollments
Next meeting is May 6, 2015 at 3:00 pm.

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Questions

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