The Los Angeles County Department of Public Health’s Bureau of Substance Abuse Prevention and Control (SAPC) designed an Incentive payment structure to begin to move the specialty SUD system to a
more outcomes- and value-based reimbursement structure for specialty substance use disorder (SUD) systems.
This will require defining performance metrics that are designed to incentivize outcome-focused services that translate to value-based and better care.
Metrics are outlined for Workforce Development, Reaching the 95% (R95), Medications for Addiction Treatment (MAT), Optimizing Care Coordination, and Enhancing Data Reporting.
1.Workforce Development
- 1a. SUD Counselors Certified
Metric: 40% of all SUD Counselors providing direct services according to NACT employed agency-wide by June 2024
- 1b. LPHA-to-SUD Counselor Ratio
Metric: 1 Full Time (F/T) LPHA for every 15 SUD Counselors agency-wide ratio by June 30, 2024
2. Reaching the 95% Champion Criteria
- 2a. Access to Care
Metric: Implement 2C-1, 2C-2, 2D-1, and 2D-2 + one other FULL R95 Capacity Building Criteria in the Capacity Building Category (example: all items (2) under 2F-Bidirectional referrals).
Include proof of completion of above with invoice.
3. Medications for Addiction Treatment (MAT)
- 3a.
Metric: At least 50% of clients agency-wide with opioid (OUD) and/or alcohol (AUD) use disorder within the fiscal year either receive MAT education and/or Medication Services that include MAT*.
NOTE: OTP settings must ensure at least 50% AUD either receive MAT for AUD Education and/or Medication Services that include MAT for AUD.*
*See Applicable Service Codes, pg. 2
- 3b.
Metric: At least 50% of clients agency-wide receive naloxone
4. Optimizing Care Coordination
- 4a.
Metric: At least 75% of clients served agency-wide have a signed Release of Information (ROI) form to share information with internal (other SUD) or external entities (e.g., physical or mental health entities)
- 4b.
Metric: At least 30% of clients within a given agency are referred and admitted to another level of SUD care within 30 days at discharge
5A. Enhancing Data Reporting
-
Metric: At least 30% of CalOMS admission and discharge records agency-wide within the fiscal year are submitted timely and are 100% complete as reported to DHCS.