Ron Manderscheid convened the meeting and took a roll call. All states were represented.

It was determined that the indicator S2 needed to be added to the "indicators to be developed" section of the July 8 Next Steps Document. Eva Jacuba had requested the correction in a previous communication.

Ron requested that Vijay Ganju and John Whitbeck comment on the Risk Adjustment Conference that was held on August 17 in Spokane, WA. Vijay reported that approximately 80 people attended and that the organizer of the conference was Michael Hendricks of Washington State in Spokane. A number of experts including Steve Banks of New York and Susan Ettner from Harvard made presentations, and also workgroups met to grapple with current issues confronting the risk adjustment area. Some of the issues discussed included the need to explore methodologies, the need to consider standardization in risk adjustment, defining of best practices, and the need for developing of tool kits related to risk adjustment. Also discussed was the need to garner resources to sustain these activities. The implication of the conference was that risk adjustment needs to be included in the 16 State project. Mike Hendricks was to be providing summations of the conference, and Steve Davis had spoken to Mike about sending information to the MHSIP Website. Also discussed was the role of CMHS or MHSIP as a locus of activity to help develop standards or methodologies using the State Indicator Pilot as a model for concerns or to galvanize people around risk adjustment application. John Whitbeck agreed to talk to Mike about disseminating of conference notes to the 16 States. It was noted that other State Indicator Pilot PIs were present at the risk adjustment meeting: Eva Jakuba, John Pandiani, Denny Geertsen, and Steve Davis. It was decided that there would be continued updates on risk adjustment activities.

John Pandiani reported that he has collected one year of inpatient data from states with only a few gaps; he will repeat inpatient data collection again for FY ‘99'. He will also be addressing penetration rates for the community and already has South Carolina information with regional breakdowns. A future direction will be risk adjustment.

Ted Lutterman spoke for Mary Smith who could not be present. At present the sub-group (Ted, Jack, Vijay, and Randy) is working on identifying sites that are collecting information from more than one instrument on the same individuals to address crosswalking of instrumentation. Mary is working on a draft survey to identify these sites and to see if sites would be willing to work with the subgroup on crosswalking and comparability of instruments. The committee is also looking to convene technical assistance meetings on cross referencing of instruments-there would be separate meetings for children, adult functioning, and adult symptoms. The goal would be to have a meeting in the future with sponsorship from CMHS.

The group decided that the Recovery instruments were beyond their purview, and that Ruth Ralph should probably be contacted to lead any data collection effort.

A two page summary on the level of functioning/symptoms committee has been prepared and will be sent out to contacts. Specific instruments were identified that have been found to be most commonly used for adults and children. Ron will try to convene groups this fall once a list of names has been developed. Various states offered instruments used that are not mentioned on the list, and contacts were mentioned that could be added to the new technical group (i.e. B. Dickey, S. Eisen of McLean Hospital, Boston).

Consumer Surveys

Judy Hall reported on Consumer Surveys. She has sent out a memo to states to indicate the current status of information. A survey on state methodology is being developed, and is expected to go out to states in early October.

John McGrew was not available to report.

Marie Danforth reported that the planner group had met in July and decided to meet quarterly; a meeting is planned for November. A report of indicators used in the states in the state block grant process (culled from the state applications) will be sent out to planners soon.

Steve Davis of Oklahoma reported that of the seven states that responded to his inquiry, some can report data now and others can report within six months. The group will work through key operational definitions required for this indicator such as whether it should be person or episode based, what is a contact, what is a hospitalization, and whether it should cover state hospitals only or other inpatient settings. Ted Lutterman indicated that in the 5 state study, states looked at discharges and not persons, and that contact meant face to face contact. Also in the 5 state study, the indicator was limited to community centers. Steve indicated that ‘provider’ needs to be defined. Further discussion followed about use of a state hospital and expanded (more than the state hospital-private and cmhcs with community based inpatient) categories.

Dr. Linda Frisman from Connecticut was introduced by Eva Jakuba; Linda reported on the indicator, Proportion of Expenditures Accounted for by Administrative Cost. A key question for this indicator is what counts as administrative cost, and what doesn’t count as administrative cost. A proposed strategy suggested was to get a subgroup to define, measure, and test in subgroup member states with subsequent assessment of feasibility in other states. Colorado, Missouri, and Arizona are to be members of the committee. Vijay suggested first surveying of states to optimize commonality. Linda will look into finding common definitions such as the Medicaid Cost report and the NASMHPD report to identify common strategies. The subgroup will meet to discuss before the next conference call.

Al Volo of New York is the lead on this indicator. He reported that he will use the President’s Task Force definition rather than the ORYX definition. A spreadsheet will soon be sent out to the states requesting information. There was a discussion of use of time periods other than 30 days. Nancy Callahan stated that she had found interesting variations in a 5 year recidivism study when 6 month periods were used for analyses. She suggested using both time periods. Others suggested use of other time periods for analyses. Nancy will share her findings with members of the group if she can. Ted Lutterman said that he will have client level data from ORYX to examine return patterns using Life Table Analysis. Ron suggested that other time periods can be identified for data collection if they generate useful information.

Atypical Medications

Amy Elliott of Rhode Island reported on the atypical medication indicator. Amy has done preliminary work on how inpatient work will interface with ORYX, and the subgroup work will also be addressing use of atypicals in the community. The subgroup is preparing a survey of states to be ready for next month. There was a discussion of how many of the states were reporting this indicator under ORYX, and Ted will report on this at the next conference call.

Vijay Ganju reported on recovery instruments and some work on concept-mapping that was being tested in Texas. The group will invite Ruth Ralph of the Edmund S. Muskie School of Public Service, University of Southern Maine, Portland, to speak at the next conference call; she will present her work on a recovery model and developing of instrumentation.

Ted Lutterman discussed ORYX indicators. Most of the participating states are reporting 30 day readmission and seclusion and restraint indicators. Thirteen of the 16 States are participating in ORYX. He will report back next time on the specific indicators that are being reported by the 16 states.

Olinda reported that seven of the eight indicators that has been identified in the July 8 meeting as indicators to be implemented in year 2 now have leaders (most have subgroups). The 8^th indicator, Per Member Per Month Average Resources Spent for Mental Health was adopted by Nancy Callahan.

The next conference call will take place Thursday, October 7 from 3:00pm to 5:00pm Eastern Standard Time. We will have update reports on indicators from lead persons, Ted will have a report from Oryx, and Ruth Ralph will be invited to present her work on Recovery.