Brand New Day HMO: Assessment Evaluation for Brand New Day by Keith E. Torkelson

Title Page

Sharing and Agreement with Assessments

Brand New Day with Orange County Health Care Agency

Applying Lessons Learned from CIBHS Technology Conferences

By Keith E. Torkelson, M.Sci. – UC Davis Pathology

Paper Metadata

BND_0.0_Assessement_17062503_History

Classed as Foundations in Assessment

Initial: 20170625-SUN:

Updates: 20170701-SAT to 20170802-W (23 Incidences)

More Updates: 20170804-F: Publish Ready 20170805-SAT:

Plan Publish: 20170806-SUN: Begin Publish: 20170806-SUN:

Close Publish: 20170811-F:

BND_0.0.1

Assessment History & Inventory

Binder(s)

BND BLOG & ST4R

Content Elements

Summary of Findings - Recommendation Summary

Planned Distribution

Risk Summary – Risks Up Front

Purpose

20170714-F: Mentalation Solutions Group (MSG’s) Mission Statement

Brief on Assessment Conversion Factors (ACFs) - Sample Calculations

CMS Stars & Stars System Summaries

Community Partners

Scheduling

Quality Of Life

Inventory & Inventory Sharing

Member Satisfaction

Risk Management – Prevention & Early Intervention (PEI)

Low Transparency Assessments – Mental Status Exam (MSE) – Psych Mental Evaluation

A Brief Word on Data Management

Inventory - Planning Documents

Hot Off the Press – Last Minute – Capturing the Consumer Experience

Appendix Elements

Most Appendices Removed: BND_0.0_Assessement_17062503_History Appends

Appendices Retained

Appendix - Select Definitions

Appendix – Post Charter Information

Appendix – Attitude Of Gratitude

List of Appendices Removed

FYI – Bioses

Research – CMS Stars

CMS Stars in Depth

Links to Quality Of Life (QOL) Assessments

Searching For Friendly Data

RealAge Results

A Brief Word on Data Management

Metadata TorkBase & AVEYBase Query “star”

Table vs. Graph - Information Builders Spring 2008

Summary of Findings


Data Element	Recommendation	Reason

1-Scheduling	Adopt Master Appointment Card (MAC)
A Word on Data Management	Standardize and share Avoid Graphs
Centers for Medicare & Medicaid Services – Stars for BND	In BND’s Groups they might better “teach to the test”
Hot Off The Press Last Minute – Capturing the Consumer Experience	Pick a CMS Approved Assessment Provider
Inventory & Inventory Sharing	Encourage Brand New Day to know and interact with OCHCA
Low Transparency Assessments – MSE – Psych Mental Evaluation	Need to include a quantitative system for scoring
Member Advisory Board (MAB)	BND underutilizes its’ consumer resources – we suggest convening a MAB
Quality Of Life	Migrate to ProQOL
Risk Management	Share HRA with OCHCA Use HEDIS as a template
Satisfaction	All options investigated thus far are unsatisfactory

Last Update: 20170728-F: ItSaFriday! A Summary of Recommendations

Brief on Assessment Conversion Factors (ACFs) - Sample Calculations

55.0-GAFS * 0.95-SOFAS / GAFS = 52.3 SOFAS

65.0-QOLS * 0.87-ProQOLS / QOLs = 56.6 ProQOLS

77.0-WHOQOL-BREF * 0.80-ProQOLS / 1 WHOQOL-BREF = 61.6 ProQOLs

ACF Max

For all practical purposes Conversion Factors cannot exceed 1.0. The 0.95, 0.87 and 0.80 are the ACFs in the sample equations above. The QOL score was normalized to Percentage. Because GAF scores range from 0-100 they translate directly to Percentages.

Planned Distribution [E = Excerpts – W = Whole]


Recipient	Role	Target Date	Means

Doctor BS Lee (MD)	Current BH MD	20170801-TU	Hand – E
Doctor JA Nagel (PhD)	Friend and supporter in county	20170807-M	Email – W
Publish on Brand New Day Blog	Motivation & Reward	20170806-SUN	Blogger – W
The Kline Coalition	Family Involvement	20170807-M	Email – E
JMB	Family Therapist	20170809-W	Hand – E
Ali E	Friend in BND corporate	201709	USMail – W
K Murray (Boris)	Supervisor Volunteer Work	201709	Email – E
Technology Advisory	MHSA Technological Needs	201709	Email – E
Oswaldo Escalante		201710	Hand – E

Last Reviewed: 20170714-F: This table will be updated after the facts.

Risks In Front (RIF) - Risks Inventory (RI)

Yesterday, August 1 (TU), we were presenting excerpts from this paper to our Behavioral Health Doctor (BHD). At the last minute we determined that addressing our Risk Inventory (RI) was the most important. In particular we needed to know if he planned to retire soon. His answer was: Yes. To avoid either a gap in doctors or linking up with one that is not a good fit for us we are planning in advance for the smoothest transition possible. Below is a table of some of our current risks. Assessment type: Listing and Prioritization. We will discuss Brand New Day’s (BND’s) Risk Management style further on in the paper.

Consumer Risk Evaluation


Risk for Mitigation	Detail	Note

1-Behavioral Health Doctor	Retirement	20170801-TU Indicates “Yes”
2-Gap in Psychiatrists	Possibly due to retirement and/or lack of advanced planning

Blood Glucose Level	Is slightly elevated	Started Behavioral and Nutritional changes
COPD	Stage II (Moderate COPD) of IV
Having to Move	Landlord times out	Landlord suffered traumatic brain injury – health unpredictable
Interrupted Sleep	Protracted loud noises between 9pm-5am – Up to six (6) hours straight	Can balloon into serious panic
Retina Re-attached	Left eye blind to 20/25 Unforeseen complications	20170803: Surgeon indicates a Thing Greater Than Us intervened
Type-1 Gap in Medication	Historically detrimental and not cost effective Not in maintenance mode	Starting fresh leaves us with insufficient medication to maintain stability
Type-2 Gap in Medication	Clozapine cycle errors	2016-2017 several errors that we had to correct

Last Update: 20170804-F: Summary of Up-To-Date Risks for Keith E Torkelson.

20170801-TU: Action Item

If the face of our current doctor’s pending retirement begin referral process from current Behavioral Health Doctor (BHD) to preferred successor Network Doctor Rimal Bera. Doctor Bera looks to be a high performer. We have some documentation circa 2012 that indicates we were to link with Dr. Bera in the first place.

20170727-TH: Purpose (MSG)

The purpose of this report is to apply what we have learned from Lived Experience, including lessons learned by attending the 2015 California Institute for Behavioral Health Solutions (CIBHS) National Behavioral Health Information Conference (NBHIC), and the 2017 CIBHS NBHIC. We hope to relate our knowledge for solving Performance issues for Brand New Day (BND) a real Non-profit health service provider in need of help. In this paper we inventory and address some of BND’s measurement instruments. We use the Orange County Health Care Agency (OCHCA) as our model program. Here we discuss two conference presentations. We find the material as relevant about the subject under consideration.

Technology Conference 2015

“The 15th Annual National Behavioral Health Information – CIBHS (2015)

Reducing the tower of Babel: The beneﬁts and feasibility of standardizing a few Performance and outcome measures.”

“The increasing amount and diversity of required Performance and Outcome Measures threatens to overwhelm the capacity of behavioral health providers to respond. Presenters in this session will overview the dilemma nationally, particularly as it pertains to providers contracted to multiple payers across multiple counties. They will describe initiatives in a few states and in other countries to consolidate these requirements into a single set that can be incorporated into all EHR software systems. They will describe how this approach can streamline data collection and reduce administrative costs for providers, and preserve resources for Quality Improvement efforts. They will also illustrate how this approach can lead to enhance Benchmarking and Quality Improvement efforts.”

Bringing Down Babel (BND)

Back in 2015 we attended The 15th Annual National Behavioral Health Information Conference and Exposition hosted by CIBHS. On April 16^th we participated in a presentation: “Reducing the tower of Babel: The beneﬁts and feasibility of standardizing a few Performance and outcome measures.” We have worked both with the OCHCA and MHSOAC for standardizing a Library of Measures. Our primary interest Brand New Day (BND) is for helping to achieve superior Quality Assurance.

Top-Down Programming - National Quality Forum (NQF) Quality Measures

On April 27, 2017 we attended a presentation by David Pating MD and Vijay Ganju PhD. Doctor Pating MD discussed the rigorous process his team applies in vetting potential measurement instruments at the national level. Where possible an agency might best select nationally approved assessments. In the case of delivering about California’s Mental Health Services Act (MHSA) agencies such as California Department of Health Care Services (DHCS) and the Mental Health Services Oversight and Accountability Commission (MHSOAC) might best vet, wean, and approve assessment tools used in conjunction with the MHSA. Their agreements can also be shared outside the MHSA.

Endorsed Categorical Assessments

As a minimum there could be three categories of assessments. One category would be approved Commercial-Off-The-Shelf (COTS) assessments. The second category would be substantially modified and approved assessments. The third category would be derived and approved assessments. We here at MSG manage and apply assessments in all three categories.

FYI - National Quality Forum (NQF) Quality Measures

“How to decide on what measures of quality care to use: An overview of nationally vetted measures and how to select from them. David Pating, MD, Chief of Addiction Medicine, Kaiser Permanente Medical Center San Francisco and Member, National Quality Foundation’s Behavioral Health Standing Committee. Vijay Ganju, PhD, CEO, Behavioral Health Knowledge Management.”

Technology Conference 2017

“The 17th Annual National Behavioral Health Information – CIBHS (2017). Behavioral Health Measures - Phases I and II - National Quality Forum (NQF). This multi-phase project seeks to endorse measures for improving the delivery of behavioral health services, achieving better Behavioral Health Outcomes (BHO), and improving the behavioral health of the U.S. population, especially those with mental illness and substance abuse.”

FYI - National Quality Forum (NQF) - Steward List

Centers for Medicare & Medicaid Services (CMS)

AMA-convened Physician Consortium for Performance Improvement (PCPI)
National Committee for Quality Assurance (NCQA)
The Joint Commission

20170714-F: Mentalation Solution Group (MSG) Mission
To help develop a state-of the art mental health system in Orange County by not giving up until our program Brand New Day (BND) earns 4.5 of 5.0 the Centers for Medicare & Medicaid Services (CMS) Stars and that: Delivers on a model Housing Program that will be a foundation for improved Housing regulation and better Environmental outcomes. In addition, we wish to reduce the costs of inappropriate and/or ineffective health and human services. This mission will be modified as time progresses. We find there may be an unmet need for listening to the voices of BND’s contracted consumers. For overcoming this challenge we suggest a Member Advisory Board (MAB) that meets nine (9) months per year or roughly monthly. At this time we take advice from BND Garden Grove consumers in the smoking area at least once per month. More or less the regional smokers are eager to share what aspects of BND they are satisfied with. We would like to find online the results from BND’s latest consumer satisfaction survey run. BND lags a bit behind with Accountability and Transparency.

Metadata > MHSA_VMV_17070805_MSG

20170804-F: Quality Assurance Update – Clinical Quality Measure


AcroCode	Meaning

64-M	64 Measures
CQM	Clinical Quality Measure
MU	Meaningful Use
PQRI	Physician Quality Reporting Initiative (CMS)
PQRS	Physician Quality Reporting System
TRHCA	The 2006 Tax Relief and Health Care Act
	-

Last Reviewed: 20170804-F: Table Centered About Quality Reporting

Consumer Education – Quality Control
Physician Quality Reporting Initiative (PQRI) first appears in our database (TorkBase) on January 29, 2011. The Measures List describes two-hundred and sixteen (216) Measures. We find that Quality Control about Health & Human Services is a complex affair. Rather than peeling down to the core of the informant onion we seem to be traversing from the core outward. Do consumers really need to know Quality Control in excruciating detail? Who or what is responsible to educate the consumer such that they can evolve as us into a Prosumer (MSG). While updating our PQRI related knowledge we found up-to-date information describing the newer Physicians Quality Reporting System as having sixty-four (64) Measures. This distillation is worth looking in to [USAGE] because if indeed the PQRS reduced the number of measures down from 216 to 64 their process might be helpful in “Reducing the Tower of Babel”.

FYI – The CMS Stars System – Rate Program Quality

Brand New Day CMS Stars (2014-2017) - History - Objective

Stars Summary for Brand New Day (BND)


TimeStamp For Year	Overall Stars Score	Source	Trend

2014	3.0	MSG Database TorkBase
2015	3.5	Online - BND
2016	3.0	Online - BND	Flat
2017	3.0	Online - BND	Flat sustained

Last Update: 20170804-F: CMS Stars Score for Brand New Day

Mentalation Solutions Group (MSG) Impact (2012 – Present)

We have been helping Brand New Day (BND) by executing most everything prescribed to us. This year for our achievements we received a Kudos letter and care package from corporate. Yet across all contracted consumers our approaches to improve BND’s CMS Stars scores have been benign. At the Mental Health Service Act (MHSA) funded Wellness Center South we tested our Satisfaction Group Idea (SGI). The some even six (6) attendees seemed to enjoy it. At the close of the group the participants indicated for the most part they were “Satisfied” with our group.

Brand New Day – Dedication

Our designated day of the week to be at Brand New Day Garden Grove is Tuesday. Starting once a month in the afternoon on Tuesday we would be willing to provide for and teach our Global Satisfaction Training (GST). Of course it would be assessment driven. As you will see next Consumer Satisfaction about healthcare is of ever growing importance. Consumer Satisfaction contributes to the CMS Stars score. Progress Note: The day we dedicate to BND may change in the face of hooking up with Doctor Bera.

Do Centers for Medicare & Medicaid Services (CMS) Stars Matter?

MSG Finds - Yes Stars Do Matter

MSG concludes that CMS Stars do matter. For the consumer it helps explain poor quality and inappropriate service and support. The Stars system is underutilized. Last year (2016) only Kaiser declared on television their current Stars score. For the provider a high Stars Score is associated with earning them more incentive kickbacks. CMS spends a good deal of money collecting up HEDIS, CAHPS, and HOS data. The way they provide feedback is by awarding an appropriate Stars Score. Once again Brand New Day is a fixer upper with a sustained trend at 3.0 Stars. Results on CMS assessments such as HOS are not reported by to the “test taker”. While working with our Health Outcomes Survey (HOS) we discovered the concept of Survey Processing Burnout (SPB). More than ever clients might best code their own HOSs using one (1) or more onsite consumer “Kiosks”. A current CMS HOS contractor, SPH Analytics, still mails us some odd seven (7) pages to fill out. Then we return it to them postage paid. Since 2012 we have received any direct feedback for our effort(s). Again, a down side to the HOS process is that we have yet to receive any feedback through Symphony Performance Health, Inc. (SPH – HOS processing contractor) or Brand New Day.

FYI - [PDF] - CMS MA Star Ratings Overview (20 Slides)

https://www.nhpf.org/uploads/Handouts/Zavadil-slides_05-8-15.pdf

May 8, 2015 – “The Star ratings system began in 2007 as a way for CMS and Medicare beneficiaries to assess and compare MA (Medicare Advantage) health plans.” Each acronym (AcroCode) used below has a meaning yet just sharing the acronyms for now will suffice.

FYI - Measure Sources – For CMS Stars Ratings (Slide 10)


AcroCode	Description	2015-16 Weights	% SOS

HEDIS®	Developed and maintained by NCQA, largely focused on the processes and outcomes related to clinical quality; from claims data and chart review	13	27.1
CAHPS®	Developed and maintained by AHRQ, customer satisfaction surveys with health plan and health care	9	18.8
HOS	Survey of members oriented on health care processes and health status	4	8.3
PQA	Clinical pharmacy measures from PDE data	6	12.5
Others	[LISTED BELOW]	12	25.0

	Weight SUM =	48	100.0

Table Last Updated: 20170730-SUN:

SOS = Share Of Stars

HEDIS Gains

Obviously HEDIS improvements will generate the most impact. For BND services that impact their HEDIS is the yearly physical. We have participated in our yearly physical every year since becoming a member in 2012.

Others

Secret Shopper – CMS hires contractors to test plans’ customer service lines

Administrative – Disenrollment, complaints, appeals and plan audits
“Meta-measures” – Improvement

“*No measures are self-reported by health plan, all are rigorously audited”

FYI - [PDF] - Measures and Meta-Measures By J Pont-Tuset - ‎2013

http://www.cv-foundation.org/openaccess/content_cvpr_2013/papers/Pont-Tuset_Measures_and_Meta-Measures_2013_CVPR_paper.pdf

“Summary measures also play a role in performance comparison, thus the question that now arises is how to compare the goodness of an evaluation measure. In other words, we should define a Meta-measure to compare the evaluation measures.”

More Embedded Definitions in Context of Stars

NCQA

“The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.”

AHRQ

“The Agency for Healthcare Research and Quality (AHRQ) is a U.S. government agency that functions as a part of the Department of Health & Human Services (HHS) to support research to help improve the quality of health care.”

PDE Data

“Every time a beneficiary fills a prescription under Medicare Part D, a prescription drug plan sponsor must submit a summary record called the prescription drug event (PDE) data to CMS. The PDE data are not the same as individual drug claim transactions, but are summary extracts using CMS-defined standard fields.”

FYI - Medicare HOS Survey - Symphony Performance Health, Inc (SPH) Analytics

http://www.sphanalytics.com/medicare-hos/

“As a CMS-approved HOS survey provider, SPH Analytics has the experience and expertise you can rely on to conduct your HOS Surveys. SPH Analytics provides reliable survey management with up-to-date information and personalized assistance.”

[REMOVED] Links in Appendix – BND Stars – Findings and Data

The majority of the Appendix items were removed.

Metadata > BND_0.0_Assessement_17062503_History Appends

Stars Information & Data

Metadata - TorkBase & AVEYBase Query “star”

The next table is pretty much a ditto. It does demonstrate a higher level of precision or granularity. This format was initially used for our study comparing plans. Medicare’s Star System – Results for HMO Plan H0838 – Brand New Day.

FYI – “Granularity is the level of depth represented by the data in a fact or dimension table in a data warehouse. High granularity means a minute, sometimes atomic grade of detail, often at the level of the transaction. Low granularity zooms out into a summary view of data and transactions.”

Metadata > 07_Assess_GBDP_Stars_15012201_Narrative

Centers for Medicare & Medicaid Services (CMS) Stars Results from our Earlier Study

Results – Brand New Day (AKA GBDP)

20170725-TU Progress Note: Brief Compare CMS Stars 2017

BND (3.0) < CalOptima (4.0) < Kaiser (4.5)

Medicare’s (CMS) Star System – Results for HMO Plan H0838 – Brand New Day


Date	Plan	Description	Rating

20121020	H0838	2013 Medicare Ratings Overall Plan Rating	3.0-Stars
20111017	H0838	2011 Medicare Plan Ratings	3.0-Stars

20140301	H0838	2014 Overall Star Rating from Medicare	3.0-Stars
20140301	H0838	2014 – Health Plan Services	2.5-Stars
20140301	H0838	2014 – Drug Plan Services	3.0-Stars

20140301	H0838	2014 Medicare Star Ratings	Ӿ < 3.0-Stars

Last Update: 20170721-F: Legacy Table 2012 thru 2014 – Above for GBDP AKA BND

Ӿ = Average

Star Search 2017

Google - Query “kaiser stars 2017”

[PDF] - Kaiser Permanente - H1230 - 2017 Medicare Star Ratings = 4.5

[No LINK – PDF Glitch]

“Current members please call 800-805-2739 (toll-free) or 711 (TTY). Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next. 5 stars is excellent H1230_KPHI20161008 (H1230) accepted - Kaiser Permanente is an HMO plan with a Medicare contract.”

Google - Query “caloptima stars 2017”

[PDF] – CalOptima (OneCare) - (OneCare) – 2017 Stars Ratings = 4.0

View the 2017 Report to the Community - CalOptima

https://www.caloptima.org/~/media/Files/CalOptimaOrg/508/AboutUs/CalOptima_RTC_2017_508b.ashx

“Medicaid Health Insurance Plan Ratings 2016–2017: Straight line, going from 4.7 percent in FY 2007 to 4.1 percent in FY 2017 - OneCare receives 4-star.”

OCHCA-HCA Stars – Lived Experience (MSG-LiveX)
We were dependent on the Orange County Health Care Agency (OCHCA) Behavioral Health Service (BHS) division for services and supports from 2006-2008. We graduated twice (actually three times) first in 2007 and finally in 2008. In 2008 we were helped by the Health Insurance Counseling & Advocacy Program (HICAP) to choose and pick up HealthNet as our insurance provider. We fell out of HealthNet and were picked up by Brand New Day (BND) in 2012. For our services from 2007 to 2008 we award the Health Care Agency (OCHCA) 5.0 Stars. Our Doctor for Behavioral Health was doctor Andrew Inglis. Our Case Worker was Heather Rink. When we graduated our Global Assessment of Functioning (GAF) was not very good. Our GAF history has deep meaning for us. We will leave GAFs out until our study about Social and Occupational Functioning Assessment Scale (SOFAS). There are multiple Stars systems for rating individual doctors. Two of them are online are: Vitals and Healthgrades. Below are some rather up-to-date results about Dr. Andrew Inglis.

GAF Metadata > Assess_GAF_17060204_Results

FYI - Dr. Andrew Inglis, MD - Costa Mesa, CA - Psychiatrist - Vitals

http://www.vitals.com/doctors/Dr_Andrew_Inglis.html

20170725-TU: Rated 1.0 Stars of 5.0 Stars by patients - 3 Ratings (Votes).

FYI - Dr. Andrew Inglis, MD - Costa Mesa, CA – Psychiatry - Healthgrades

https://www.healthgrades.com/physician/dr-andrew-inglis-274mp

20170725-TU: Rating: 5.0 Stars of 5.0 Stars by patient(s) - ‎1 Rating (Vote).

LiveX (MSG) - Assessment

LiveX (Lived Experience) is MSG’s Lived Experience Approach (LEA). Since 2009 numerous health care professionals have indicated that our LiveX is important and valuable. Note that CMS Stars methodology is grander than the Vitals or Healthgrades Stars methodology. Vitals and Healthgrades consumer scoring might one day be included in the CMS Approach. Back in 2009 we were interviewed for positions within the OCHCA Mental Health Services Act (MHSA) Center of Excellence. We said it then and we say it again we have faith for standardization about Process and Outcome Measures collected longitudinally and reported back to the test taker. The general an innovation we discussed in our interview was assessment in health and human services might best mimic the K-12 standards’ for assessment.

Physician Quality Reporting Initiative (PQRI) first appears in our database (TorkBase) on January 29, 2011. The Measures List describes two-hundred and sixteen (216) Measures. We find that Quality Control about Health & Human Services is a complex affair. Rather than peeling down to the core of the informant onion we seem to be traversing from the core outward. Do consumers really need to know Quality Control in excruciating detail? Who or what is responsible to educate the consumer such that they can evolve as us into a Prosumer (MSG). While updating our PQRI related knowledge we found up-to-date information describing the newer Physicians Quality Reporting System as having sixty-four (64) Measures. This distillation is worth looking in to [USAGE] because if indeed the PQRS reduced the number of measures down from 216 to 64 their process might be helpful in “Reducing the Tower of Babel”.

FYI – The CMS Stars System – Rate Program Quality

Brand New Day CMS Stars (2014-2017) - History - Objective

Stars Summary for Brand New Day (BND)


TimeStamp For Year	Overall Stars Score	Source	Trend

2014	3.0	MSG Database TorkBase
2015	3.5	Online - BND
2016	3.0	Online - BND	Flat
2017	3.0	Online - BND	Flat sustained

Last Update: 20170804-F: CMS Stars Score for Brand New Day

Mentalation Solutions Group (MSG) Impact (2012 – Present)

Brand New Day – Dedication

Do Centers for Medicare & Medicaid Services (CMS) Stars Matter?

MSG Finds - Yes Stars Do Matter
MSG concludes that CMS Stars do matter. For the consumer it helps explain poor quality and inappropriate service and support. The Stars system is underutilized. Last year (2016) only Kaiser declared on television their current Stars score. For the provider a high Stars Score is associated with earning them more incentive kickbacks. CMS spends a good deal of money collecting up HEDIS, CAHPS, and HOS data. The way they provide feedback is by awarding an appropriate Stars Score. Once again Brand New Day is a fixer upper with a sustained trend at 3.0 Stars. Results on CMS assessments such as HOS are not reported by to the “test taker”. While working with our Health Outcomes Survey (HOS) we discovered the concept of Survey Processing Burnout (SPB). More than ever clients might best code their own HOSs using one (1) or more onsite consumer “Kiosks”. A current CMS HOS contractor, SPH Analytics, still mails us some odd seven (7) pages to fill out. Then we return it to them postage paid. Since 2012 we have received any direct feedback for our effort(s). Again, a down side to the HOS process is that we have yet to receive any feedback through Symphony Performance Health, Inc. (SPH – HOS processing contractor) or Brand New Day.

FYI - [PDF] - CMS MA Star Ratings Overview (20 Slides)

https://www.nhpf.org/uploads/Handouts/Zavadil-slides_05-8-15.pdf

FYI - Measure Sources – For CMS Stars Ratings (Slide 10)


AcroCode	Description	2015-16 Weights	% SOS

HEDIS®	Developed and maintained by NCQA, largely focused on the processes and outcomes related to clinical quality; from claims data and chart review	13	27.1
CAHPS®	Developed and maintained by AHRQ, customer satisfaction surveys with health plan and health care	9	18.8
HOS	Survey of members oriented on health care processes and health status	4	8.3
PQA	Clinical pharmacy measures from PDE data	6	12.5
Others	[LISTED BELOW]	12	25.0

	Weight SUM =	48	100.0

Table Last Updated: 20170730-SUN:

SOS = Share Of Stars

HEDIS Gains

Others

Secret Shopper – CMS hires contractors to test plans’ customer service lines

Administrative – Disenrollment, complaints, appeals and plan audits

“Meta-measures” – Improvement

“*No measures are self-reported by health plan, all are rigorously audited”

FYI - [PDF] - Measures and Meta-Measures By J Pont-Tuset - ‎2013

http://www.cv-foundation.org/openaccess/content_cvpr_2013/papers/Pont-Tuset_Measures_and_Meta-Measures_2013_CVPR_paper.pdf

“Summary measures also play a role in performance comparison, thus the question that now arises is how to compare the goodness of an evaluation measure. In other words, we should define a Meta-measure to compare the evaluation measures.”

More Embedded Definitions in Context of Stars

NCQA

AHRQ

PDE Data

http://www.sphanalytics.com/medicare-hos/

[REMOVED] Links in Appendix – BND Stars – Findings and Data

The majority of the Appendix items were removed.

Metadata > BND_0.0_Assessement_17062503_History Appends

Stars Information & Data

Metadata - TorkBase & AVEYBase Query “star”

Metadata > 07_Assess_GBDP_Stars_15012201_Narrative

Centers for Medicare & Medicaid Services (CMS) Stars Results from our Earlier Study

Results – Brand New Day (AKA GBDP)

20170725-TU Progress Note: Brief Compare CMS Stars 2017

BND (3.0) < CalOptima (4.0) < Kaiser (4.5)

Medicare’s (CMS) Star System – Results for HMO Plan H0838 – Brand New DaDay

Date	Plan	Description	Rating

20121020	H0838	2013 Medicare Ratings Overall Plan Rating	3.0-Stars
20111017	H0838	2011 Medicare Plan Ratings	3.0-Stars

20140301	H0838	2014 Overall Star Rating from Medicare	3.0-Stars
20140301	H0838	2014 – Health Plan Services	2.5-Stars
20140301	H0838	2014 – Drug Plan Services	3.0-Stars

20140301	H0838	2014 Medicare Star Ratings	Ӿ < 3.0-Stars

Last Update: 20170721-F: Legacy Table 2012 thru 2014 – Above for GBDP AKA BND

Ӿ = Average

Star Search 2017

Google - Query “kaiser stars 2017”

[PDF] - Kaiser Permanente - H1230 - 2017 Medicare Star Ratings = 4.5

[No LINK – PDF Glitch]

“Current members please call 800-805-2739 (toll-free) or 711 (TTY). Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next. 5 stars is excellent H1230_KPHI20161008 (H1230) accepted - Kaiser Permanente is an HMO plan with a Medicare contract.”

Google - Query “caloptima stars 2017”

[PDF] – CalOptima (OneCare) - (OneCare) – 2017 Stars Ratings = 4.0

View the 2017 Report to the Community - CalOptima

https://www.caloptima.org/~/media/Files/CalOptimaOrg/508/AboutUs/CalOptima_RTC_2017_508b.ashx

“Medicaid Health Insurance Plan Ratings 2016–2017: Straight line, going from 4.7 percent in FY 2007 to 4.1 percent in FY 2017 - OneCare receives 4-star.”

OCHCA-HCA Stars – Lived Experience (MSG-LiveX)

We were dependent on the Orange County Health Care Agency (OCHCA) Behavioral Health Service (BHS) division for services and supports from 2006-2008. We graduated twice (actually three times) first in 2007 and finally in 2008. In 2008 we were helped by the Health Insurance Counseling & Advocacy Program (HICAP) to choose and pick up HealthNet as our insurance provider. We fell out of HealthNet and were picked up by Brand New Day (BND) in 2012. For our services from 2007 to 2008 we award the Health Care Agency (OCHCA) 5.0 Stars. Our Doctor for Behavioral Health was doctor Andrew Inglis. Our Case Worker was Heather Rink. When we graduated our Global Assessment of Functioning (GAF) was not very good. Our GAF history has deep meaning for us. We will leave GAFs out until our study about Social and Occupational Functioning Assessment Scale (SOFAS). There are multiple Stars systems for rating individual doctors. Two of them are online are: Vitals and Healthgrades. Below are some rather up-to-date results about Dr. Andrew Inglis.

GAF Metadata > Assess_GAF_17060204_ReResults

FYI - Dr. Andrew Inglis, MD - Costa Mesa, CA - Psychiatrist - Vitals

http://www.vitals.com/doctors/Dr_Andrew_Inglis.html

20170725-TU: Rated 1.0 Stars of 5.0 Stars by patients - 3 Ratings (Votes).

FYI - Dr. Andrew Inglis, MD - Costa Mesa, CA – Psychiatry - Healthgrades

https://www.healthgrades.com/physician/dr-andrew-inglis-274mp

20170725-TU: Rating: 5.0 Stars of 5.0 Stars by patient(s) - ‎1 Rating (Vote).

LiveX (MSG) - Assessment
LiveX (Lived Experience) is MSG’s Lived Experience Approach (LEA). Since 2009 numerous health care professionals have indicated that our LiveX is important and valuable. Note that CMS Stars methodology is grander than the Vitals or Healthgrades Stars methodology. Vitals and Healthgrades consumer scoring might one day be included in the CMS Approach. Back in 2009 we were interviewed for positions within the OCHCA Mental Health Services Act (MHSA) Center of Excellence. We said it then and we say it again we have faith for standardization about Process and Outcome Measures collected longitudinally and reported back to the test taker. The general an innovation we discussed in our interview was assessment in health and human services might best mimic the K-12 standards’ for assessment.

Lived Experience - We Take Error Rates Seriously – Progress Report

After an incidence (mark #1) for which or error rate was too high we took action and sustained improvement.

Repeat AKA Ditto

Translating Legacy GAF Scores to SOFAS

Reviewing Assessment Conversion Factors (ACFs)

55.0-GAFS * 0.95-SOFAS / GAFS = 52.3 SOFAS

65.0-QOLS * 0.87-ProQOLS / QOLs = 56.6 ProQOLS

77.0-WHOQOL-BREF * 0.80-ProQOLS / 1 WHOQOL-BREF = 61.6 ProQOLs

CMS & Shopping for a Provider

As we see the CMS Stars system is in effect for both health insurance plans and individual practitioners. We still have yet to find any indications that the public health agencies participate in CMS’s Stars program. We have pondered this and reached a conclusion that Stars is a shopping system whereas one does not shop for public health services such as those provided by the Orange County Health Care Agency (OCHCA). In general an individual is at or near the bottom when they land (referred) in the Health Care Agency’s (HCA) lap. For example, tenure in Orange County Jail (OCJ) can land one (linkage) with the Orange County Health Care Agency (OCHCA).

Aside – Data Management - Graph Abuse (LiveX)

Back at UC Davis both as an undergraduate and as a graduate we wrote dozens of papers and reports using a typewriter. It took considerable effort to make perfect tables. Somewhere circa 1987 we found an on-campus resource that had Word Perfect installed. Ever since creating our first table with Word Perfect we fashion ourselves as “Tablizers”. Yet “tablization” is a pleasure while we find graph or color abuse annoying. If while presenting you need to use a graph concentrate on line graphs. In addition present more Metadata.

MSG 4 Brand New Day - Community Partners

Below are our Community Partners for this Study

Scheduling – Master Appointment Card (MAC)

Appointment Card(s) – Scheduler Implementation

20170706-TH - Sample BND Network Appointment Card

The Master Appointment Card (MAC) Idea

20170706-TH - Sample BND Network Appointment Card

The Master Appointment Card (MAC) Idea

The Master Appointment Card (MAC) Idea - Recommendation

We are participating in Health Related Engagements (HREs) including medical appointments at near capacity. Certain schedulers are better than others. For example, our Dermatology Team knows more often than not the best timeframe for appointments are Wednesday at 11am. Our Primary Care Physician (PCP) and Behavioral Health Doctor (BHD) are not only physically collocated they use the same Electronic Health Record (Central City Community Health Clinic – CCCHC).

MAC - Best Candidate

This makes the CCCHC E.H.R. the best candidate to house a consumer’s Master Appointment Card (MAC). As a minimum they might best have a record at any given moment all for our in Network Health Provider (NHP) appointments. Evidence for Interoperability – A comprehensive Master Schedule or Appointment Card would provide evidence for CCCHC’s level interoperability. As of July 2017 a CCCHC Appointment Card only includes on-site appointments. The sample Appointment Card above is text in nature. The Master Appointment Card might better have a character of a calendar. On a given day a single appointment should block out the whole day. Since being served by BND we have attended upwards to fifteen (15) Health Related Engagements (HRE-MSG) in one month.

Maintenance of MAC

Another candidate to maintain and manage the Master Appointment Card is the insurer. In this case that is Universal Care Brand New Day (BND) HMO-SNP.

Health Related Engagement (HRE) Investment

So what is a HRE? Since becoming a Brand New Day (BND) member in 2012, our BND Network Health Providers (NHPs) have invested substantial: Time, effort, and resources for bettering our health. BND care coordinators have some shortfalls. Thus for the most part we coordinate our own care. This is good because care coordination by the consumer is a promising practice. We describe our appointments and meetings associated with any aspect of consumer health a Health Related Engagement (HRE). We plan to publish a dedicated post about our HRE specification and requirement.

Health Information Exchange (HIE)

One of the promises about Electronic Health Records is that they achieve a high level of automation. We have been serviced twice for eye problems by BND network ophthalmologists. First Doctor Boyce performed cataract surgery in late 2016. Then Doctor Rol reattached our retina earlier this year. For both doctors we carried by hand hard copy summary health records to our PCP. For the incidence of Retina the record was concerning our diagnostic and surgical summary. We delivered it to our PCP’s Physician’s Assistant (PA). She said” Good! I will update your surgical history”. Eventually HIEs such as this might best be automated by scheduled daily deliveries. For our PCP’s office we now begin to see what the four (4) counter staffers are doing between making appointments. These four (4) are very likely updating and exercising the E.H.R. Each day they probably spend one (1) hour scheduling and six (6) hours updating and tweaking.

Client Gets Monitor - How is it that the client needs a monitor?

With our Dermatologist and Ophthalmologist the exam room monitor faces the client. At times we the clients are permitted to examine the information on a particular screen PRN. Our PCP makes it difficult to make out our records. As we have discussed in prior reports: Patient portals might best be Read Only Versions (ROVs) of the E.H.R. A question we will address again is: How is it we maximize common use of health records from two angles: The Client and the Provider. Yesterday, August 3, 2017 (TH) we had a post surgical appointment with our Retina Surgeon. When he was done examining us he handed us some five (5) pages of records pertaining to the appointment and we were permitted to examine them before handing them off to the counter person. This is incredible Transparency.

Brief – AOG Statement – Attitude Of Gratitude

Here is our Attitude Of Gratitude (AOG) section. For this publication we would like to thank The Kline Coalition (TKC) and Doctor Rol. We thank TKC for their tireless efforts to support us PRN. And Doctor Rol our BND Network Ophthalmologist for pretty much dropping everything to surgically insert a gas bubble in our left eye beginning the process of retinal reattachment. In other words we went blind in our left eye and now about one (1) month later our left eye sees 20/40. Make Note of Pain (MNP): It may not be the same for all gas bubble insertion (Step 3 of 3) surgeries yet for us we almost did not make it the thirty (30) seconds or so that he extracted our vitreous humor (Step 1 of 3). In other words you are awake and the Pain for us was incredible. 20170804 Update: We tested at 20/25 for our left eye. Doctor states that we must have a substantial entity on our side. We give the credit to TIME a Thing Greater Than Us (TGTU).

Getting One Right at a Time – Inter-changeability - Quality Of Life

Brand New Day’s Member – Quality Of Life (QOL) Evaluation

For more information – See Appendix – QOL [REMOVED]

Links to Quality Of Life (QOL) Assessments

Quality Of Life (QOL) – A Sample Inventory

This is a mixed inventory of assessments dedicated or partially dedicated for assessing a person’s Quality Of Life (QOL). Improving an individual’s QOL is a desirable indicator for any endeavor both service and worker alike. Brand New Day uses a version that appears to be derived in house (previous image). We recommend the Professional Quality Of Life or ProQOL because it offers common insight that life can be challenging regardless of if you don’t have a disability. In addition, we find the ProQOL to be Strengths-based and de-stigmatizing. Based on the ProQOL It would appear that professionals look forward to different and better states of health and wellbeing.


AcroCode	Meaning	Advantage	In Use By
	-
MHSIP	The Mental Health Statistics Improvement Program - Consumer Surveys Contains QOL Section	Scantron type scoring	DHCS
ProQOL	Professional Quality Of Life	Strengths Based & De-stigmatizing	“Professionals”
QOL	Quality of Life Assessment	15 Item Limit	BND
WHO-5	World Health Organization 5 (Item) Well-Being Index	15 Item Limit	OCHCA-BHS
WHOQOL BREF	World Health Organization Quality Of Life – BREF	Likely the full Monty	OCHCA-BHS
	-

Table Last Reviewed: 20170718-TU:

Brand New Day Version - Not available online

A Full Monty - Assessment

A Full Monty Assessment (FMA) is a test that would satisfy all the requirements necessary for publication and inclusion in a publication suitable for a professional refereed journal. Another feature for a FMA would be that it was vetted, approved and possibly purchased at the federal level by CMS or Substance Abuse and Mental Health Services (SAMHSA).

QOL - Application Hint

Brand New Day has just chartered a new effort. It is a six-week module to address High Utilizing Clients (HUC). In the orientation we did not receive any materials to capture Baseline (BL) Measures. For the next class we recommend as an indicator for progress using the BND Version of their Quality Of Life (QOL-15 Item) Assessment Tool. Better yet and less likely we would recommend they introduce the ProQOL for their next HUC class.

QOL - Matrix (Table)
The table we address next is our real data set about Brand New Day’s Quality Of Life assessment. Sample from our database (AVEYBase). The Quality Of Life (QOL) matrix before is taken from our AVEYBase because all or most of it was generated in the AVEYWindow 2015-2017.

QOL Screener Results

Quality Of Life (QOL-BND-15 Item) Assessment Results for Keith Torkelson, M.Sci.


	Date	Time	% Normalized (Items Scored)	Comment

01	20150623-TU	RT	71 (15)	Prep for Helper #4 – Jeff Gibbs
02	20151219-SA	RT	62 (15)
03	2015		62 (15)	Ӿ - Yearly - Retro
04	2015		67 (15)	Ӿ - Yearly - Calculated
05	20160309-W	RT	66 (15) - BL	Submitted with new service plan Another Baseline for Eye Crisis
06	20160612-SU	RT	70 (15)

07	201706	RT	79 (15)	1^st Half Retro Before retina issue
08	20170627-TU	RT		Date of detached retina diagnosis
09	20170702-SU	RT	52 (15)
10	201706	RT	79 (15)	Retroactive For 1^st half of June Baseline for Eye Crisis
11	20170702-SU	RT	52 (15) - BL	Retina Crisis Significant Baseline for CODP course

High Resolution Longitudinal Process Measures for Quality of Life (QOL-15) – Last Update: 20170802-W: QOL Reporting.

Ӿ = Average

RT = Real Time

BL = Baseline

Ledger or Longitudinal – Presentation

We are working towards a few data standard presentations. With data points that you expect to close out after three incidences or to obtain a trend data entered across is OK. Yet about most everything you will be sharing have more that three data points. The sample table above includes eleven (11) different data points. We now assume greater that three data points. We here at MSG are working on some standards for about three ledger form tables (matrices).

Actualization & Purpose Level (A&PL%)

At all times the name of the assessment will not indicate how to interpret it. So even if an assessment is called Quality Of Life we find that the Quality Of Life score is not as descriptive as say Actualization & Purpose Level (A&PL). We investigated dozens of assessments pertaining to the value of increased technology for Recovery. Our naming conventions for interpretation often do not include the name of the assessment.

Distraction - QOL - Introduced in Chapter-03B

The GB DEATH Program – Chapter-03B – Health and Profiling by TheDAG

http://ktork46.blogspot.com/2015/12/the-gb-death-program-chapter-03b-health.html#!/2015/12/the-gb-death-program-chapter-03b-health.html

DAG a Penname for Keith Torkelson

20170731-M Page Views = 252 Date Published - 12/23/15

If You Blog (IYB) Aside - It is serendipitous we went back to this post because Blogger did a hatchet job on our Chapter-03B post by inserting scripts.

-
Route	Appearance
-
Smartphone – Android	Normal
Google	Problematic
Chrome	20170802-W: Looks OK
Edge	Normal
-

Last Reviewed – 20170804-F: Blogger Post Evaluation

Real Time (RT) – Discovering Patterns and Trends
It is always nice to assess in Real Time (RT) yet if you wish to work on causation in efforts towards prevention retrograde and historical assessments are growing of importance.

Normalizing (NMLZD)
Basic numerical values (fields) for tables for single persons (individuals) might be: Date of assessment, time period for assessment, raw scores, number of items scored, value that the assessment delivers, and percentages. We here at MSG now normalize most all of our assessment scores to percentages. Assessments in Health & Human Services even lab values rarely report in percentages. When you look at various results they require reference ranges. We use two keys for percentages and interpreting percentages: Please see the table below for our recommended percentage keys.

-
Scale	A	B	C	D	F
	Super Average	Above Average	Average	Not Above Average	Super Not Above Average

Stringent (%)	100-91	90-81	80-71	70-61	60 or Less
Liberal (%)	100-81	80-61	60-41	40-21	21 or Less
-

Last Reviewed: 20170731-M: JS2TA = Just Something To Think About – More often that not for us high scores are favorable. For example with diagnostic assessment our scores yield a resolution percentage rather than problem percentage.

Prescribed Assessment Paradox (PAP)

The Prescribed Assessment Paradox describes a condition where an agency prescribes assessments for their members. An example would be the QOL that BND prescribed in its’ intake package. Once it was done and checked off BND really did not support any updated QOLs. The PAP is a condition: That if the agency does not prescribe or solicit an assessment they really are not motivated to help evaluate, interpret or leverage said assessment. We actually tested it a couple years back by trying to upgrade in our programmatic assessment portfolio the ProQOL. We had a care coordinator that was showing signs of burnout that might have shown up in their ProQOL. To better understand his condition we administered and promoted the ProQOL about ourselves. This idea didn’t take because of the PAP.

Alignment & Sharing

Assessment alignment and sharing differ a bit. Alignment could occur if some document specified a certain assessment and the various agencies used the information in the document to select common assessments. Sharing is a method by which various agencies would both share the results and share assessments that are not common generating a superset.

Migrating Baselines (BL)

An interesting feature of Human Health is that one really doesn’t know if an episode or crisis ends until something new and large supersedes. It is important to know when it is beneficial to take the time for gathering bit of baseline information. We recently suffered a detached retina! Our detached retina interfered with our mini, macro, endogenous and exogenous lives. The process to repair our vision generated significant subjective distress. Our detached retina crossed over into more than eight (8) domains of functioning. We could no longer see the laptop screen or we could drive comfortably. One of the most important before the eye injury was evaluation for a Baseline before the injury was using our DriveAbility Tool (DAT-MSG). The point is: Baselines scores migrated over time.

Inventory and Inventory Sharing

We have obtained several good inventories of assessments by various agencies. The first inventory we ran across was created by AstraZeneca (AZ) to help them sell medications marketted directly to the consumer. The AZ Inventory includes assessments that the consumer may take for themselves. For some reason AstraZeneca (of Seroquel fame) does not promote their AZ inventory anymore. Years ago we worked with the Mental Health Services Oversight and Accountability Commission (MHSOAC) to arrive at some three or so measures common to all MHSA Innovations (INN) Projects. These would in whole be called MHSOAC Approved Assessemnt Tool List or something similar. By now the more that one-hundred approved MHSA INN Projects have and are using more that one-hundred assessment tools. At present Brand New Day does not use many if not none of the OCHCA Innovations Project Assessment documented assessments.

Satisfaction – LiveX - Impact

Let us next consider the Health & Human Service dimension Satisfaction. Satisfaction with self and satisfaction with program are beginning to come of age. We first ran into the Satisfaction concept back in 2007 while receiving services from the OCHCA. The assessment was not promoted or used for Intel during your appointment. It was available as a FYI in the waiting area of the Costa Mesa Clinic. This survey impacted us by introducing two concepts: Degrees of Satisfaction can be ushered under consumer control and that life is orchestrated in Domains. The more Domains that you have co-occurring challenges about the more challenging is your case. Below is the OCHCA “Satisfaction With My Life” assessment as it was available at Costa Mesa Clinic back in 2006. We have addressed it several times with various OCHCA MHSA related teams. To get up to speed we will query using Google “OCHCA satisfaction survey”. On 20170731-M: We found the following hits.

FYI - Orange County, California - FAQs - OC Health Care Agency

http://www.ochealthinfo.com/about/admin/faq

What do “Operations” include?

“Operations are the activities needed to manage, maintain, and improve services. This would include patient Satisfaction Surveys, chart audits for quality control, handling grievances, mandated reports to the State, and activities to maintain accreditation and to measure provider and program effectiveness.”

FYI - Orange County, California - AQIS-CYBH Support

http://www.ochealthinfo.com/bhs/about/cys/support

Activities - Monitoring Beneficiary Satisfaction

OCHCA-BHS Department Support

“Authority & Quality Improvement Services (AQIS) is a Behavioral Health Services (BHS) Division that participates in a variety of quality improvement and compliance activities across all divisions (Adult Mental Health Services, Children and Youth Behavioral Health Services, Alcohol Drug Abuse Services) of BHS. One of AQIS's responsibilities is assisting with implementation of BHS Quality Improvement (QI) plan after its approval by the California Department of Mental Health Care Services (DHCS). DHCS expects BHS to engage in continuous QI activities. AQIS also has responsibility for implementing Performance Outcome Measures mandated by DHCS and coordination of the annual DHCS Medi-Cal audit. The AQIS staff are committed to assisting and supporting each program, department and clinic in its quality improvement and compliance activities.”

Assessments Not Found (ANF)

Really what we have hoped to find were one or two Satisfaction Assessments in PDF format. We actually have a few Satisfaction Assessments created by Resource Development Associates (RDA) for the OCHCA in hardcopy. We find that “continuous QI” is catchy because at this point we are beginning to suffer report fatigue. For Brand New Day (BND) we have and will continue to offer “Quality Improvement” and “External Quality Review” support. We realize now that BND has very little to offer the OCHCA.

Drop Everything Data - Performance Measures

In MSG’s opinion Performance Measures and their Outcomes are still too difficult to find online. By now we are looking for Data Matrices that make sense and have a tendency towards uniformity. We are looking for databases that you can access directly on the Web. For example searching for “program name data” or “location condition data”

Sample Searches – Friendly Data


Query	Nature	Timeframe	Graphs	Tables
-
BND Performance Data	Stars Only	2012-2017	3 per year	0
OCHCA Housing and Disability	No pertinent information found	2017
MHSOAC Innovations Project Data	Evaluation Inventory By CIBHS	2015	OK	Above AVG
OCHCA FSP Data	Good for Baselines	2010	8	0
OCHCA OC Depression Data	Brought up Profiles	2016 & 2017	2016 2017	2016 2017

Last Update: 20170805-SAT:

See Appendix – Searching For User Friendly Data

We decide to remove the majority of our appendix items including Searching For…Data.

Satisfaction – Metadata: 01_Assess_Satisfaction_15082002_OCHCA-2006

Consumer Rated Satisfaction Survey(s) – BND & OCHCA

Discover the Tools - These are process measures for consumer Satisfaction


Acronym	Assessment	Items	Note

ACSS	BND - 2013 - Annual Consumer Satisfaction Survey (Annual Kansas – 05/2013)	26 - Likert
ACSS	BND - 2015 – Annual Consumer Satisfaction Survey SNP 2015-1020	26 - Likert
SWML	HCA-BHS “Satisfaction With My Life”	9 Items Some odd 72 choices

Last Reviewed: 20170802-W: BND Satisfaction Surveys are received Direct From Corporate – BND measures Contributes to the CMS assigned annual Stars Score

BND Consumer Satisfaction with Program

Brand New Day (BND) Consumer Satisfaction Surveys are received directly via US Mail from the Corporate Office in Westminster. Remember when it comes to Satisfaction there are at least two types: Consumer Satisfaction with program (process) and Consumer Satisfaction with self.

BND Satisfaction - Notable Features (Limit to ten (10))

Corporate Rep identifies in cover letter as belonging to Quality Improvement
Huge change in format
Likely yet unknown if or how it contributes to BND’s CMS Stars Score
Not really annual
Quantitative results not returned to (consumer) test taker
Recurrent longitudinal scoring by consumer best done with a spreadsheet
Same corporate representative on the cover letter (2013 V 2015)
They get easier for the consumer to score with each repetition
We assume with changed order that at least the content is similar (2013 V 2015)

Processes - “How Satisfied Are You” Types

Consumer rates satisfaction with self

Consumer rate satisfaction with program (process)

Note: If the consumer is not satisfied with themselves it may bias their answers for Rate Your Satisfaction with Program.

Metadata > 07_UCMG_13082701_Satisfaction-Survey

Brand New Day and Network Providers

Note: Brand New Day has a separate quality control process than does it contracted network providers. Our PCP is associated with Universal Care Medical Group (UCMG) Central City Community Health Center (CCCHC). UCMG back in 2013 used to maintain a process for evaluating consumer Satisfaction separate from Brand New Day.

FYI - Universal Care Medical Group (UCMG) - Doctors - (Yelp, 2017)

https://www.yelp.com/biz/universal-care-medical-group-garden-grove

(714) 741-0330 – 12511 Brookhurst St Garden Grove, CA 92840.

Step Back
The UCMG Satisfaction Survey has been pulled from their website. In addition, the CCCHC does not support any service quality assessment from the consumer perspective.

Apply the Tools

Consumer Rated Satisfaction Survey(s) – Sample Results (26 Items)


Acronym	Assessment	Form	Our Score
	-
ACSS	BND - 2013 - Annual Consumer Satisfaction Survey (Annual Kansas – 05/2013)	Likert	20130706 63.2% Spreadsheet Created
ACSS	BND - Used 2013 Version		20150724 High 70.4%
ACSS	2015 – Annual Consumer Satisfaction Survey SNP 2015-1020	Likert	Spreadsheet Not Created Available Time Limited on Survey Monkey

Last Reviewed: 20170801-TU: Satisfaction Results – Assessment Received Direct From Corporate

Likert-Type Scale (LTS)

LTS “is the most widely used approach to scaling responses in survey research, such that the term (or more accurately the Likert-Type scale) is often used interchangeably with rating scale, although there are other types of rating scales. The scale is named after its inventor, psychologist Rensis Likert”.

Completing A Loop (CAL) [PET PEEVE]

Not completing the loop is something that MSG finds especially annoying. As we have stated several times the models for assessment management rarely include returning the results and interpretation to the test taker. Earlier we introduced that in the K-12 public school system and even with the university system test results are reported back to the test taker. Completing A Loop requires returning the assessment results (and interpretation) back to the test taker.

Completing A Loop – RealAge - Example

When it comes to standards for excellence in health assessment MSG continues to promote the ShareCare RealAge system. If you wish to explore the process using an online assessment we suggest creating an account and following through with the RealAge process yourself. We here at MSG are trying to figure out a relationship between RealAge and HEDIS. Here is a link for YaAll > https://www.sharecare.com/static/realage

RealAge Banter

“The first step to growing younger - Taken by more than 42 million people, the scientifically-based assessment shows you the true age of the body you’re living in – the first step towards improving your well-being - Headquarters: San Diego, CA - Founder: Michael Roizen - Founded: 1999.”

We decided to hold over our RealAge results. Our latest results indicate that we are improving. In addition we received back a strengths-based report.

Metadata > 11_GHlth_Prevent_14121911_Real-Age V2017 (RealAge)

Consumer Self Grade – Bringing Back Consumer Computers

There are many assessments that instruct the consumer to self-score. For the most part we get to self-score many of our (assigned) BND assessments. One instrument the Personal Health Questionnaire – 9 Item (PHQ-9) is easy to score right on the spot. We have mentioned that BND is in a good position to have their contracted consumers take the assessments on or more Kiosk type systems. In 2012 BND had two consumer computers. Somewhere around 2015 they were made not available anymore. Unfortunately this is a step back. In another study we are working for determining the impact of increased technology on consumer recovery.

Satisfaction - InterpretationAs the previous table indicates: In 2013 we scored 63.2% and in 2015 we scored 70.4% for our Satisfaction with BND. These scores are in par with Brand New Days CMS Stars 2012-2017 of 3.0 Stars or 60%. It would appear that our scores for Satisfaction have not been holding down BND’s CMS Stars Score (Step 2). We are due a 2017 survey for which we hope to award BND 75.0% or greater (Step 4). What’s up with no Step 1 or 3? It’s a holdover from writing computer programs.

Metadata – Satisfaction (TorkBase & AVEYBase)

This is just an example for another presentation about Metadata. These Excel files contain scoring algorithms.

In Algorithms We Trust

One of the reasons we would appreciate our scored assessments or just scores in themselves back is so we could compare the workings of BND’s scoring algorithm(s) with ours. We have written between 25 and 50 scoring algorithms this year (2017) using Excel. Our 2017 Excel file count as of 20170801-TU: is 85. With our Maturing The Algorithm (MTA) process many of our (*.xls) files for this year we brought forward from previous years. Our oldest assessment scorer evaluates Mania and dates back to 2001. At that time our Kaiser Behavioral Health Associate Joyce A. indicated that we write good assessments. She wished to replace the Mania Assement we created for the one that she was using at the time. This was the first time that we ran into the limitations of permissions.

See Appendix - A Brief Word on Data Management [REMOVED]

Return to Inventorying

When we set out on this study we collected up information to briefly inventory Brand New Days obvious assessments. The paper was reader friendly at about seven (7) pages long. Then in order to make some sense out of things we embellished. Now we have some odd fifty (50) pages. Our goal was to share our findings with the Technology Advisory Committee (TAC). For our upcoming meeting we probably will only share excerpts. Now let us examine planning and assessment.

Project Management As Direct Service (PMADS-MSG)

“We don’t know where we are going. Yet, we are sure getting there fast.” (Some mystery Project Manager) – The PMADS concept first appears in our database (TorkBase) on 20101206. We were trying to earn some value on our most costly computer program: Microsoft Office Project 2013 Professional. It looks like are target population for PMADS were those suffering from Substance Use Disorder. We stopped at the “Step” to obtain substantial funding for proving the idea. The basic theme of PMADS is the many consumers could move beyond stable if they had cash to spend on recovery. Back on 20110215 we presented to some county reps (data outcome advisory group) on consumer Empowerment. During our research we were surprised to see that consumers indicated the most Empowering gift would be cold hard cash. Graft the more the better.

Planning and Assessment

Inventory - Planning Documents

(By elimination these are all Process Measures)


AcroCode	Meaning	Note

CPRP	Collaborative Personal Recovery Plan	Submissions: 2012, 2013, & 2014
PSP	Personal Service Plan
TOP	Terms of Participation	Best used as a Checklist

Last Reviewed: 20170730-SUN: Brand New Day Planning Documents

Brand New Day - Planning Documents

We here at MSG were first introduced to the set of Brand New Day (BND) planning documents in 2012. The planning documents were part of their intake package. We tried both to use them directly as a scoring guide and to link our plans to separate As Measured By (AMB) tools. An example of an AMB tool is BND’s version of a Quality Of Life (QOL) instrument. Brand New Day intermediary Help such as care coordinators do not expect progress about consumer’s plans. It generates more work for them.

The Gary Zager Rule – Refer Away First – Think Later

BND care coordinators (case managers) do their best to avoid consumer-centered work by referring their charges away as much as possible. Our first care coordinator (circa 2012-2013) set the bar high. A friend Bruce R whose career was centered about Health & Human Services with Straight Talk Gerry House stated” It is difficult to get exceptional help for non-profits”. In addition, once you get “exceptional help it is very hard to retain them”. Makes sense because our best BND’s Helpers Diana Meier, AliE, and TheOE have moved on and up. For 2017 thus far we dropped formalizing and submitting our CPRP due to lack of collaboration. Hot-of-the-press: For BND TheOE has returned after earning his Certified Addictions Treatment Counselor or CAADE.

Epiphany – Just 4 Fun (J4F)

How it is that epiphany is here and now? It just jumped into our might (maybe it was thought insertion) yesterday. We never wrote the term epiphany before. The dictionary defines it as: A usually sudden manifestation or perception of the essential nature or meaning of something. An intuitive grasp of reality through something (such as an event) usually simple and striking. An illuminating discovery, realization or disclosure. Not epiphanies yet – patience may tell. We pick discovering something elegant.

Health Risk Assessments

Brand New Day’s Health Risk Assessments are administered by corporate and sent via US Mail. In general they are assigned once a year.

No OCHCA - BHS Risk Assessments Found

OCHCA Public Health has some risk assessment resources

None of these risk assessment are shared with OCHCA-BHS

Risk Management – General – All Administered by BND Corporate – Received by US Mail


Acronym	Meaning	Note

2012 HRA PQ	2012 Health Risk Assessment – Patient Questionnaire
2013 IHRAS	2013 Initial Health Risk Assessment Scale
2014 HRA	2014 Health Risk Assessment
2015 HRA	2015 Health Risk Assessment
2017 HRA	2017 Health Risk Assessment Promised Frequency Every 6 Months	Last Submitted 20170114 It’s Due

Last Reviewed: 20170714-F: Brand New Day’s Health Risk Assessment (HRA) Devolution.

Format Variation

For some reason Brand New Day (BND) varies its’ Health Risk Assessment from year to year. At first sight the questions appear comparable. Now that they have tried several versions they might best stick with the 2017 Version. If they need to amend it at all concatenate new questions on the end. Health Risk Assessments (HRAs) do not contribute directly to their CMS Stars score. Actually we would like to see a graphic of all there required assessments so we could see if our running blind conclusions are correct.

Closing A Loop – New Angle - Returning Results

Applying the K-12 Assessment Model (K-12AM). As you may know in K-12 education the teachers find or create quizzes and tests. A teacher administers (proctors) a test either at site or as take home. The consumer (student) tries their best in addressing the assessment. Assessments a turned in. The teacher or teacher’s aide grades the test. Finally to Close-A-Loop the teacher returns an interpretation and sometimes the marked up assessment itself to the test taker. The results tend to get quantified and a letter grade may be assigned. When we were a student teacher we were approved at final time to use the multiple choice Scantron method. The only assessment that Brand New Day uses that in easy to grade is their PHQ-9. Something asked (circa 2010) by a Phoenix House rep was who owns the assessment data and results? We here at BND believe assessment materials and findings are co-owned and split by share of effort about time-spent. The notion is: Is that if it takes the consumer longer that the therapeutic fifteen (15) minutes to complete an assessment the consumer is working for the entity that assigned the assessment.

Minimal Wage or Top Dollar (In Lunic) – Unreasonable Accommodations

We have been attending MHSA Steering Committee Meetings (SCM) since 2009. We are not nor have ever been a member and thus compensated. Each time as we sit listening we think about things. It occurred to us the over have of the attendees are on the clock. One or two earn top dollar. If the consumer (and family member) members were valued we think they should get a raise between the twenty dollar ($20.00) food card and top dollar. We have yet to see a Brand New Day rep that we know show yet. We did bring TheOE to an MHSA Technology Advisory Committee Meeting circa 2013.

Inventory - Risk Management - Condition Specific


Acronym	Meaning	Source

	Lipids	Unavailable
(CMP)	Diabetes	Unavailable
(CMP)	Dementia	Unavailable
CHF	Congestive Heart Failure	Unavailable
COPD (CMP)	NEW! Chronic Obstructive Pulmonary Disease Screener (Paper)	PCP
HIV-RT	Human Immunodeficiency Virus Risk Test [LiveX - Compliance issue]	PCP - RNR
PHQ-9	Personal Health Questionnaire 9 Items (Measures Depression)	PCP – RNR Easy to score
SAS	Substance Abuse Screener	Intake Package
SUA	Substance Use Assessment	Intake Package

Last Reviewed: 20170714-F:

CMP = Care Management Program

RNR = Results Not Returned

RND = Results Not Discussed

Risk Management

Two of the primary goals of Risk Management are to circumvent catastrophic loss and to save money. We encountered a document that indicated Risk Management is and will continue to be were the good money is. In the context of the Mental Health Services Act (MHSA) we thought that a measure of success would be migrating Community Services and Supports (CSS) monies over to Prevention & Early Intervention (PEI) programs. The PEI programs will apply lessons learned and promising practices proven in Innovations (INN) Projects. Think of how much money and suffering the Polio Series Vaccines have saved. We think that Salk’s vaccine work would qualify as something new and improve and thus one of Innovation. Brand New Day has never solicited from our Risk List. BND day is just happy when a member is stable and not a high utilizer. The Retina incident could have and could still escalate into an inpatient surgery. This would ruin our low utilizer record.

Completing the Inventory - Process Indicators


Acronym	Assessment	Measures	Nature
	-
AHH	Adult Health History	Causes	Prevention
QOL	Quality Of Life	Health & Welfare	Services & Supports
SHA	Staying Healthy Assessment	Behaviors	Early Intervention
SHA (OV)	Older version of SHA	Behaviors

Last Update: 20170721-F:

Process Measures & Indicators - Complaints and Grievances

Since 2012 we have submitted about five grievances to BND corporate. For the most part we were satisfied with the results. For more than one occasion a single complaint was ignored. Nature of the complaint: Well into the year we had not received our member materials package. We needed it to plan our dental work for the year. We finally escalated the issue to CMS. They solved it for us. This was minor while the BND process is ineffective with urgent matters such as an error in medication or scheduling associated with maintaining a reliable stream of medication.

Consumer Satisfaction - The Service Experience

We have been engaged with Customer Satisfaction for a very long time. Our mother was a successful small business owner. She took the majority of client complaint calls at home. We would listen in here and there. She didn’t lose many accounts. Over half the accounts she earned are still earning money for the family. Our mom passed away in 1998. At that time her yearly gross business earnings was just about $450,000.00 per year. $120,000.00 was profit. One off our early assignments (1981) for the business was to computerize the general ledger. We delivered using Fortran IV.

Online Assessment Tools

We have run across some superior Online Assessment Tools (OAT). We will only promote one at this time. ShareCares RealAge Fitness assessment is close to The Full Monty: Even though it exceeds our fifteen question limitation. Automated surveys do not have the fifteen question (item) constraint. RealAge is automatically graded. After you submit your assessment a utility grades about you. Next you automatically receive a grade report pointing out a balance of one’s strengths and shortcomings.

Health Related Engagement (HRE) – A Measure of Dosage

Metadata > 2016022801 HREs Step-03 V2017

We here at MSG have been refining our definition for a Health Related Engagement (HRE) since February 28, 2016. We have two classes of HREs: HRE within the Brand New Day (BND) network and HRE out of the BND network. “Like” 2016 our HRE Rate (dosage) was incredible. 42 days in network and 23 day out of network. One of the most important criteria for a HRE is preparing in advance. This document is an example of preparing for an out of network HRE our next Technology Advisory Committee Meeting.

Major Milestones & Key Event Tracking

We like the Milestone approach and Key Event Tracking (KET) method because it punctuates our progress. In addition it can help with understanding past losses with the intend to ameliorate future losses.

Low Transparency Assessments - Defined

Basically a low transparency assessment is one that is applied about the client yet is rarely or never shared. Sometimes the consumer can find them if they pay for a records request. Example: MSG, BSL, 2017) [SCAN BSL WITHHELD]. On February 14, 2017 our Behavioral Health Doctor (BHD) assessed us using his variant of the Mental Status Exam (MSE). He gave us no indication that we were being assessed. Due to a glitch with his clerk we were given a copy. The first thing that we noted was that it was not quantified. Make note that the typical BND member is not expected to get better or recover. So we scored his finding and we scored his MSE as a consumer. The following table describes MSE scores.

Assessments Not Apparent

Metadata > 11_Progress_Note_Summary_ 17021403_BSL

Brain-Mind-Behavior (BMB) Testing

Assessment: CACCHCAPP x BSL Format (25 Items)


TimeStamp	Assesse	Assessor	MPS Score

20170214-TU	KET	BSL – MD	70.0

20170214-TU	KET	KET – Scores Self	84.0
201708	KET Reassess	KET	We predict about the same

Last Reviewed 20170804-F: Yields A Mental Performance Score (MPS)

FYI - [PDF] - Mental Status Examination – Psychclerk (15 Item)

http://psychclerk.bsd.uchicago.edu/mse.pdf

By VII Mood - ‎The Components of the Mental Status Examination (MSE).

Observed / Inquired / Observed + Inquired

This is very important! Before you get critical of your psychiatrist (BHD) for not asking all the (MSE) questions that they are grading you a notation notes that the majority of the items require an observation only. Our biggest change since February 2017 would be with our Behavior.

Unawares

Again, we were completely unaware that on February 14, 2017 we were being rigorously (25 Items) evaluated about an MSE. How does the client know what to work on if one or more evaluations are not shared with the client? Our unawares with low transparency assessment goes back further than 2007. In 2007 our OCHCA doctor Doctor Inglis was grading us also. We discovered his MSE report cards (progress notes) when for a class we were taking at Santa Ana College we executed a formal record OCHCA Custodian of Records request.

Not Quantified

Back in 2007 Doctor Andrew Inglis working for the Orange County Health Care Agency Behavioral Health Service Division (OCHCA-BHS-Costa Mesa) did not quantify his Mental Status Exam (MSE) results. Hopefully for OCHCA-BHS) this has changed. Yet, again our current doctor, Doctor BSL, in 2017 did not quantify the MSE results.

Lived Experience (LiveX)

This is sort of a ditto but we like it. When we do these independent dittos we get to check the precision about our memory. Again, we ran into the MSE back in 2007 when we were seeing a county (HCA-BHS) psychiatrist. During the standard fifteen (15) minute appointment he had us step on the scale and asked us about ten (10) question. We really didn’t know what he was doing over there on his side of the computer monitor. In 2009 we took a class – Consumer Training of Paraprofessionals. After doing our case study we pursued retrieving some medical records. We went to the Orange County office Custodian of Records (COR) and requested everything the county had on us. In particular we wanted a progress note describing how we had excelled. For this one Progress Note the associated service chief would not release it. We obtained for a fee several of Doctor Andrew Inglis’ Mental Status Exam (MSE) results. MSE implementation is close but not in alignment. The versions the professionals use range from fifteen (15) to twenty-five (25) questions in length. Typically MSE results are not quantified.

FYI - Orange County, California - Custodian of Records

https://cms.ocgov.com/gov/health/about/admin/programs/records.asp

Phone: (714) 834-3536

Email: COR@ochca.com

Fax: (714) 835-9312

Mail: HCA / Custodian of Records P.O. Box 355. Santa Ana, CA 92702.

To Ponder

How is it that having your medical records promote your recovery?

How is it that having your medical records promise that you will live a more satisfying life?

Would you prefer a Patient Portal with glitches or a Read Only access to your whole Electronic Health Record?

Adding To The Inventory – Case Study

Segueing to Consumer Experience – Member Experience Evaluation (MEE)

20170721-F: LiveX Quandary – Energy – Lipids & Glucose

Doctor Chester Diokno Mojica (CDM) is our PCP. We have been working resolving our elevated Low-Density Lipoprotein (LDL) Cholesterol levels. We have a follow up appointment next week (20170725-TU). We have already received our LDL results via MyQuest’s online portal. MyQuest is a patient portal maintained by Quest Diagnostics Laboratory. MyQuest is a very high quality provisional records system. It looks like we have our LDL under control. Yet, now our Blood Glucose Level (BGL) is a bit high.

Blood Glucose Complication – Non-compliancy

We hope that CDM does not wish us to lower our BGL with medication. We would prefer the behavioral and dietary fixes we have chosen. Aside: Doctor CDM is the same doctor that stamped our paperwork with “Non-compliant” because we did not follow through on his VAPE prescription quick enough. Doctor CDM put us on Lipitor for the LDL yet Lipitor has a warning that it may elevate the consumer’s BGL. For us Doctor CDM demonstrates a poor history of Shared Decision Making. In the world of Shared Decision Making there is no Non-compliant in the dictionary. PCPs rarely take the time to know us consumers well enough to see why we are reserved about prescriptions: Pharmacological and other. Starting in July 2017 we are taking a class with James J. Krueger MD (BND Network Pulmonary Specialist). Doctor James J. Krueger does not approve of Doctor CDM’s VAPE fix. Since the VAPE cost around $80.00 for which CDM did not reimburse us it is as if we paid $80.00 to CDM to stay in Compliance.

CDM – Strengths Report

In keeping with the strengths-based approach we published the following strengths-based report.

Chester Diokno Mojica MD – Strengths By Keith Edward Torkelson, M.Sci. With MSG for - Brand New Day HMO

http://brandnewdayhmo.blogspot.com/2017/05/chester-diokno-mojica-md-strengths-by.html

May 29, 2017 - The material for this report was collected over the course of the last four to five years. This study focused on Doctor Chester Diokno Mojica MD.

20170725-TU: Actual

We had our lipid follow-up appointment. To our delight CDM was out for the day and we were assigned a Physician’s Assistant (CDM-PA). We didn’t catch her name and would have liked a business care. She deserves from us a Kudos. Our CDM-PA was strengths-based and fielded far more material than could Doctor CDM. Applying this latest beta assessment see below our table of comparative scores.

Metadata > Assess_MEE_17072603_MSG Beta (LiveX)

Hot Off The Press – Last Minute – Capturing the Consumer Experience

Source File: Email_17072101_SPHA CAHPS MIPS

Member Experience Evaluation (MEE-MSG 12 Derived Screener)

“The core survey includes 80 questions broken out by the following 12 Summary Survey Measures”

	-
##	Summary Survey Measure [Break Out]	2017 01-06 Baseline CDM	20170725-TU PAS Lipid Appt
	-
01	Getting Timely Care, Appointments, and Information	1.0	1.0
02	How Well Providers Communicate	0.5	1.0
03	Patient’s Rating of Provider	0.5	1.0
04	Access to Specialists	1.0	NA
05	Health Promotion and Education	0.5	1.0
06	Shared Decision Making	0.0	1.0
07	Health Status and Functional Status	0.75	1.0
08	Courteous and Helpful Office Staff	0.75	1.0
09	Care Coordination	0.5	1.0
10	Between Visit Communication	0.0	NA
11	Helping You to Take Medications as Directed	0.5	0.75
12	Stewardship of Patient Resources	0.0	NA
	-
	(Scored) Raw Total Sample Calculations	2.0 + 1.5 + 2.5 (12) 6.0	8.0 + 0.75 (9) 8.75
	Member Experience Grade (MEG)	50.0% 2.5 Stars	97.2% 4.9 Stars

Last Reviewed: 20170725-TU: Expect Little Improvement About Next Appointment – We were wrong because we were assigned a different practitioner (Physician Assistant Substitute (PAS)).

PAS = Physician’s Assistant Substitute

Quality Assurance Paradox

Basically, the Quality Assurance Paradox is “only the squeaky wheel gets the most grease”. Is it too much to ask for the quality of service that the PA demonstrated?

Appendix List (Items Held Back)

We have been trying to limit our reports to fifty (50) pages. This report went through two stages under the hatchet. The first was to remove much of the Technological Needs part. The second was to remove the majority of the appendices.

All of these will probably reorganized under Data Management and Stars Update for Brand New Day

Appendices Removed List

FYI – Bioses

Research – CMS Stars

CMS Stars in Depth

Links to Quality Of Life (QOL) Assessments

Searching For Friendly Data

RealAge Results

A Brief Word on Data Management

Metadata TorkBase & AVEYBase Query “star”

Table vs. Graph - Information Builders Spring 2008

Appendix – Legacy List & Metadata

Legacy Documents


Document	Primary Purpose	Secondary Purpose
-
BND_13062502_Doc-Accounting V2017	Get feedback	Encourage score reporting on our submissions
BND_CCCHC_Assess_14080201_Pod	Investigate Stars	Help improve Stars
BND_CPRP_15101302_Outcomes V2016	Report on progress	Closing out a plan
PM_EQRO_13081005_BND-Longitudinal	Introduce measuring longitudinally	Reporting and trends based on prescribed assessments
13_TAC_E-H-R_Assessments 2015 V2017	Share information	Apply learning from 2016 & 2017 TECK Conference

Last Update: 20170721-F:

New and/or Updated Documents

Document	Primary Purpose	Secondary Purpose

BND_7.1.1_Data_Management_17071901	Standardization	Apply CIBHS conference lessons learned
13_BND_TAC_HIT_17070806_CCCHC with Rol	Paper pushing in lieu	Share a strengths report
Email_17072101_SPHA CAHPS MIPS	Rate MDs
2016022801 HREs Step-03 V2017	Mature our HRE proprietary
11_Progress_Note_Summary_ 17021403_BSL	Ferreting about
Assess_GAF_17060204_Results	Simple Demo of the conversion issue
Assess_HEDIS_HDFA_16120801_Results V2017	Compare with RealAge

Last Update: 20170804-F:

Appendix – Definitions

Case Management System

Note Brand New Day is a non-profit health organization. They manage business matters rather than so much medical matters. Therefore the software they use is not an Electronic Health Record. BND uses a Case Management System. “Simply put, a Case Management System is a piece of computer software that allows you to make fewer trips to the filing cabinet by tracking a great deal of client information right on the computer, and then using that information to help you run your practice.” Feb 8, 2011

Collocation

Collocation in the context of Health & Human Services might be defined as delivering a full or partial spectrum of services at the same location or within walking distance apart. A sampling of a spectrum is: Primary Care services, Behavioral Health supports, and Substance Use Disorder (SUD) services and supports. Being collocated says little or nothing about the quality of services and supports. Collocation is “the action of placing things side by side or in position”.

Compatibility

Compatibility might be defined as when two or more things are associated and produce a synergy. In addition compatibility in general is “a state in which two things are able to exist or occur together without problems or conflict”. In Health and Human Services and Health TECK compatibility is “the ability of one computer, piece of software, etc., to work with another”.

Conversion Factors (CF)

Conversion factors are mathematical constructs with as minimums have values and units. In the context of measurement conversion factors may be required to achieve apple for apple when given apples and oranges. Conversion Factor might be defined as an arithmetical multiplier for converting a quantity expressed in one set of units into an equivalent expressed in another. To avoid having to use conversion factors we recommend normalizing assessment results to percentages. For example: How would you convert the legacy GAF scores to SOFAS scores? We would do it direct with potential with a fudge factor.

CF - Sample Calculation

55-GAFS * 1.05-SOFAS / GAFS = 57.8 SOFAS

Digitalization

Digitization is a process for taking written material, images, video, sound etc. and capturing it for conversion and banking in a digital form. We here at MSG participate in the Digital Preservation Movement (Network).

Health Information Exchange

“Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient's vital medical information electronically—improving the speed, quality, safety and cost of patient care.” May 12, 2014

Snow Flake Elements (9 Different Exchanges)

https://www.healthit.gov/sites/default/files/hie_snowflake.png

J4F - Jail

Jail might be defined as a place for the confinement of people accused or convicted of a crime. It is one of the ways to hook up with the Orange County Health Care Agency. We believe that the OCHCA provides medical services for the Orange County Jail System. The OCHCA has a rather good newsletter: What’s Up. We think we remember seeing and article or two about assignment of correctional administrators.

Interoperability (Dashboard)

Interoperability as it pertains to health technology is hardware and software bundle(s) (formatter) that permits one system’s information and data to be successfully, routinely, and correctly exchanged with one or more other system(s).

Meaningful Use

Google Query “define meaningful use”

“Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. Maintain privacy and security of patient health information. - Feb 6, 2015”

“The American Recovery and Reinvestment Act of 2009 authorizes the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals (EPs) and hospitals who adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology. - Apr 4, 2014”

Metadata

Metadata is "data [information] that provides information about other data". Three distinct types of metadata exist: Descriptive metadata, structural metadata, and administrative metadata. We primarily apply descriptive metadata. In some instances metadata about a data set may exceed the size of the data set itself. We find that about the presentations we are privy to metadata is underused. We have reached the point: Rather than be pummeled by graphs we would rather the slide address a metadata map of how to find the data. Actually better yet we want the presenter to access in real time the Base where the data is in silo.

Descriptive metadata describes a resource for purposes such as discovery and identification. It can include elements such as title, abstract, author, and keywords.

Structural metadata is metadata about containers of data and indicates how compound objects are put together, for example, how pages are ordered to form chapters. It describes the types, versions, relationships and other characteristics of digital materials.

Administrative metadata provides information to help manage a resource, such as when and how it was created, file type and other technical information, and who can access it.

Parity

Parity in the health technology is sharing apples for apples or oranges for oranges. I other words, sharing information derived from exactly the same assessment tool(s). For example the Global Assessment of Functioning (GAF) was used to perform this function. Parity might also be defined as being the state or condition of being equal, especially regarding status

Practical Assignment – Why? – Proof of Concept (Plus)

We have two practical assignments for Brand New Day (BND). First) Compile Master Appointment Card (MAC) across all members of their provider network. This is a huge request for us alone because we have schedules with: Dental, Optometry, Ophthalmology, and Dermatology. We may add a Chiropractor and an Acupuncturist. Second) we request BND retrieve our Blood Glucose Levels (BGL) from Kaiser circa 2000. We were seeing Doctor E. Gee our Primary Care Physician at the time. Dr. Everett M. Gee, MD - Family practice physician in Aliso Viejo, California - Address: 24502 Pacific Park Dr, Aliso Viejo, CA 92656 - Phone: (949) 425-3150 - https://healthy.kaiserpermanente.org/

Presentation

Information and data presentation might be describes as the many formats that the reporters choose to share their programs findings. We prefer a data table format to graphs. For tables we have tested presenting snapshots, three-point longitude, and a ledger approach. For several reasons we now are trying to standardize all of our in house data tables (AVEYBase) about a ledger format. We will discuss more in our paper on data management.

Sharing

A means for sharing performance and client data is the Health Information Exchange (HIE). A secondary means for sharing would be metadata. For example the agencies (sometime competing) need share their libraries and routes into their libraries of assessment tools as well as assessment results. We are almost done :o)

Size V Assessment Fatigue – Focus 15

We are privy to the SPH Analytics Blog. SPH owns and administers assessments for CMS. About a year or more ago the SPH Blog discussed the nature of survey fatigue. On the 2^nd of July this year (2017) we updated two of the assessments in our portfolio. We found that we had selected to score Quality Of Life (QOL) about the Brand New Day (BND) format. Our other choice contained too many items. The BND QOL instrument is a fifteen-item (15 Item) screener. We have yet to receive any interpretation back from BND. If at all possible keep the majority of your non-automated instruments to near fifteen items.

APD’s Prediction (Circa 1994)

Arnold P Deutsch MD predicted more than twenty (20) years ago that as long a psychiatrist overly relies on the medical model (namely pharmaceuticals) that Primary Care Physicians (PCP) would end up managing psychotropic medications. This would save money and very likely reduce errors. In our paper on data management we will address more about Health Information Exchange (HIE) snowflakes. 20170725-TU: This morning we executed a manual delivery of Health Information from our Ophthalmologist (surgeon) to our PCP’s stand in (younger) physician’s assistant. She used the information to immediately update the surgery section in our Electronic Health Record. Actually this may indicate the promise for the youth in maximizing the benefits for Health Technology.

Appendix - An Attitude Of Gratitude (AOG)

-
Gratitude	Persons - Things	Note
-
Community Partners	Numbers Seven
Dedicated To	Arnold P Deutsch MD & Gloria Shanks
Died Young In Memory	Lee Michael Pertroneo	Psychotropic Associated Kidney Failure
Driven By	Mary R Hale MS
Inspired By	Mark Refowitz & June Elizabeth Stoutenburg-Torkelson
Powered By	AVEY
Reviewed By	Bum Soo Lee MD & The Kline Coalition
Reward	Gifted to attend 2015 and 2017 TECK Conferences
-

Last Reviewed: 20170805-SAT:

A last straggler

Metadata > BND_0.0_Assessement_17062503_History Appends

Classed as Too Rigorous

Initial: 20170625-SU: Split Out: 20170802-W:

What follows is this report's for posting Charter Information

#StarSearch

Appendix – Post Charter Information

-
Aspect	Detail
-
Name of Post	Assessment Evaluation for Brand New Day by Keith E. Torkelson – M.Sci.
Date Chartered	20170806-SUN
Name of Blog	Brand New Day HMO
Blog Platform	Google - Blogger
Link to Post	http://brandnewdayhmo.blogspot.com/2017/08/assessment-evaluation-for-brand-new-day.html
Final Formatting Completed	Planned for 20170811-F
Google Plus Sharing Information	Sharing and Agreement with Assessments Brand New Day with Orange County Health Care Agency Applying Lessons Learned from CIBHS Technology Conferences
Page Equivalents in Post	About Fifty (50)
Number of Images	About Ten (10)
Image Prefix if Applicable	Duck_And_Cover_
Tag(s) Associated with Post	#StarSearch
Conflict of Interest Level	Low
-

Last Reviewed: 20170804-F

#StarSearch

Brand New Day HMO

Friday, August 4, 2017

Assessment Evaluation for Brand New Day by Keith E. Torkelson – M.Sci.

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