Quality Management Program Annual Evaluation · Annual QM Program Evaluation. The Board is kept up to date on quality improvement initiatives, at least annually, through reported

QUALITY MANAGEMENT PROGRAM ANNUAL EVALUATION

PARTNERS HEALTH MANAGEMENT

QM Director Review: 8/18/20 QIC/Chief Medical Officer Approval: 10/6/20 Board Review: Regulatory Reference: URAC Core v. 3.0 Standard 20(i); NCQA QI 1.B; DHB Contract Section 7.1.2; DMH Contract Section 15

Fiscal Year (FY) 2020 (July 2019-June 2020)

FY 2020 QM Program Evaluation 1 | P a g e Completed By: Marsha Johnson, QM Analyst

I. Introduction Partners Health Management (Partners) oversees and manages member-centered local services for behavioral issues or illness, intellectual and developmental disabilities, and substance use. The objective of the Quality Management (QM) Program is to systematically use performance information and data to drive improved member outcomes, training and support. The functional structure of the program not only guides and supports business decisions but creates a system of continual integrity and readiness for external review agents such as the Department of Health and Human Services (DHHS), Intra-departmental Monitoring Team (IMT), External Quality Review (EQR), national accrediting bodies and other agents. This annual report presents an evaluative summary of the QM Program activities accomplished, discovered, mediated, or improved during the Fiscal Year (FY) of 2020 (July 1, 2019-June 30, 2020).

II. Overview The Quality Management Program of Partners is designed to ensure that Partners’ core functions are delivered in a manner consistent with the State Plan, the Division of Mental Health/Intellectual Developmental Disabilities/Substance Use Services (DMH) and Division of Health Benefits (DHB), formerly the Division of Medical Assistance (DMA), contracts, national accreditation standards, and Partners’ mission, philosophy, values and working principles.

Table 1a. Medicaid Population for Partners’ Catchment Area

FY 2020 Unduplicated Count of Medicaid Members in Catchment Area 155,106

% Members Receiving MH Services 7.4% % Receiving SU Services 1.1% % Members Receiving IDD Services 1.7%

*Data from LME/MCO Monthly Monitoring Report

Table 1b. Uninsured Population for Partners’ Catchment Area FY 2020 Estimated Number of Uninsured** in Catchment Area 102,790

% Uninsured Receiving MH Services 1.8% % Uninsured Receiving SU Services 1.4% % Uninsured Receiving IDD Services 0.4%

*Data from LME/MCO Monthly Monitoring Report **The terms “Uninsured” and “Non-Medicaid” are used interchangeably


A. PROGRAM STRUCTURE The overarching function of the Quality Management Program is to ensure the following objectives: • Members are free from abuse, neglect, and exploitation, and care is provided in a safe and

therapeutic manner. • Members have access to quality services to meet their clinical needs. • Members benefit from the services they receive. • Public resources are used appropriately, effectively, and efficiently. • Members in the service system are empowered to improve their individual outcomes. • Providers in the network are encouraged to focus on quality measures and are held accountable

for their actions. • Comprehensive, open stakeholder involvement is welcomed. • Reasonable and accurate feedback is shared with the provider network. • A universal quality culture for respect, collaboration, and focused improvement is widespread

across the network to meet cultural and linguistic needs. The ultimate authority for the QM Program is Partners’ Board of Directors. The Board of Directors delegates this authority to the Quality Improvement Committee (QIC) through the Chief Executive Officer (CEO), and the CEO assigns clinical oversight to the Chief Medical Officer (CMO), who is a board-certified M.D.

Quality Management Program Staff Partners employs staff and uses other resources to provide the necessary support in the day-to-day operations of the QM Program. At Partners, all employees, contractors, and providers are “quality-driven” and take part in the implementation of the QM Program. Key personnel positions crucial to the QM oversight process are consistently evaluated for sufficiency and reviewed with Human Resources as indicated. Key QM Personnel Roles Include:

• Quality Assurance and Quality Improvement Teams: The Quality Improvement and Quality

Assurance Teams are responsible for quality improvement projects, facilitation and analysis of applicable satisfaction surveys, internal monitoring of accreditation standards, and various other tasks.

• QM Monitoring Team: The QM Monitoring Team includes Consumer Rights Officers and QM

Monitoring Specialists. The Consumer Rights Officers monitor incident reports, sentinel events, and safety issues which may arise in the provision of care. QM Monitoring Specialists conduct routine provider monitoring that may include customer service issues such as quality of practitioner office space and other identified areas including, but not limited to, “for cause” audits and other audits as requested or required for services delivered in the Provider Network.

• QM Data Team: The QM Data Team is responsible for data analysis and data management, which

includes measuring outlined performance indicators in the core functional areas to assure compliance with DMH and DHB contract requirements, as well as accreditation standards. The data unit generates reports, analyzes data, and identifies significant trends and patterns for


various internal quality measures. When applicable, data reports are submitted to the Executive Leadership Team (ELT), Cross Functional Teams, and/or the QIC. Organizational decisions and recommendations are made by these groups based on the data provided.

• Chief Medical Officer: The Chief Medical Officer (CMO) is the senior clinical staff person

responsible for providing guidance to the clinical operational aspects of Partners and to provide oversight to all QIC activities. This individual is responsible for the oversight of the clinical decision-making aspects of the program and has periodic consultation with practitioners in the field. The CMO is also responsible for ensuring the organization utilizes qualified clinicians who are accountable to the organization for decisions affecting members. He/she provides regular supervision and clinical support to clinical departments of Partners. The CMO oversees peer review activities as well as provides quality review and quality assurance oversight for Partners clinical actions.

Goal: Ensure that the QM Program has adequate staffing and infrastructure in place. (NCQA Standard:

QI 1A.1)

Table 2. QM Program Staffing Position Credentials/#

Chief Medical Officer 1 (MD, MBA, DFAPA, FASAM)

Chief Performance & Compliance Officer 1 (MHA) QM Director 1(LCMHC) Assistant QM Director 1 (BS) QM Manager 1 (MBA) External Review Coordinator (PRN) 1 (MS) QM Analyst 2(BS)

2 (AAS) Grants Monitoring Specialist 1 (LCMHC) QM Data Manager 1 (BA) QM Data Analysts 2 (BA) QM Monitoring Administrative Assistant 1 (AAS) QM Monitoring Manager 1 (CCS, CSAC) QM Monitoring Specialists 1 (BA)

3 (BS) 1 (LCSWA) 1 (LMFT)

Consumer Rights Officers 1 (LCSW) 1 (LCSW, LCAS)

*Data from Partners Organizational Chart

Status/Evaluation: • Partners went through reorganization that affected QM July 2019-September 2019. The full-time

External Review Coordinator position was eliminated, and job duties were distributed to other QM staff.

• Currently the QM department has adequate staffing and infrastructure to complete functions. Identified Issue(s)/Barrier(s): • No issues or barriers were identified.


Interventions: • No interventions were required as goal was met.

Goal(s) to Continue for Next Fiscal Year: Yes

QM Plan and Program Description Partners is required to maintain a written description of the quality management program that is reviewed, updated and approved by QIC at least annually. The program description: • Defines the scope, objectives, activities and structure of the program • Defines the roles and responsibilities of the Quality Improvement Committee (QIC); • Designates a member of senior management with the authority and responsibility for the overall

operation of the quality management program and who serves on the Quality Management Committee.

Goal: The QM Plan and Program Description is approved by the Quality Improvement Committee (QIC)

annually. (NCQA Standard: AI 1A.5)

Status/Evaluation: • The FY 2020 QM Plan and Program Description was completed on time and approved by QIC June

2019.

Identified Issue(s)/Barrier(s): • No issues or barriers to timely completion of QM Plan and Program Description were identified.

Interventions: • No interventions required as goal was met.



QM Work Plan NCQA requires that the QM program maintain an annual work plan detailing specific goals to be monitored throughout the fiscal year. The plan is to included outcomes, barrier analysis and development of interventions to address any identified issues or barriers. The QM Work Plan is approved annually by the QIC along with updates to be presented at least quarterly. Goal: The QM Work Plan is reviewed and approved by the Quality Improvement Committee (QIC)

annually. (NCQA Standard: QI 1B)

Status/Evaluation: • The FY 2020 QM Work Plan was completed on time and approved by QIC June 2020.

Identified Issue(s)/Barrier(s): • No issues or barrier to completing the QM evaluation on time were identified.

Interventions: • No interventions required as goal was met.


B. PROGRAM OPERATIONS

Quality Improvement Committee The Quality Improvement Committee (QIC) is responsible for guiding the QM Program, including the annual review and approval of the QM Program Plan and Program Description and the Annual QM Program Evaluation. The Board is kept up to date on quality improvement initiatives, at least annually, through reported updates and Board review of the Annual Quality Management (QM) Program Evaluation.

The QIC Membership is composed of a cross-functional team of representatives from various units within Partners, the Provider community, and the Consumer and Family Advisory Committee (CFAC). All members are voting members unless identified as non-voting or designee.

The QIC’s responsibilities include: • Recommends policy decisions. • Analyzes and evaluates the results of QM activities. • Ensures practitioner participation in the QM program through planning, design, implementation

or review. • Identifies needed actions. • Ensures follow-up, as appropriate.


Table 3. QIC Committee Members

Member Position Bill Rankin Quality Management Director (Committee Chair) Selenna Moss Chief Performance and Compliance Officer Elizabeth Stanton Chief Medical Officer Jane Harris Chief Clinical Officer Jackie Copeland Waiver Contract Manager Deborah Sprinkle Assistant QM Director Beth Lackey Provider Network Director Rhonda Colvard Claims Manager Shirley Moore Consumer Specialist, CFAC Liaison Lynne Grey MHSU Clinical Director Christy Edwards IDD Program Support Specialist Melissa Cline Access to Care Director Charity Bridges Utilization Management Director CFAC Members (3) CFAC Members to Represent Age & Disability Provider Network Representation (3) Network Providers to Represent Age & Disability Global CQI Representation (2) Network Providers to Represent Global CQI

*Data from Partners QIC Charter

The QIC also utilizes sub-committees and workgroups to fulfill its role. Each committee or workgroup is identified on the committee organizational chart. In addition, each committee or workgroup is chaired by a Partners staff person and has an associated charter. The charter provides additional detailed information related to the committee including its purpose, structure, meeting schedule, membership, and responsibilities. The QIC sub-committees include: • Quality of Care Committee (QOCC)- Also Reports to NMC Committee • Network Management Committee (NMC)- Also Reports to Credentialing Committee • Credentialing Committee (CC)- Includes Provider Representation • Regulatory Compliance Committee (RCC) • Clinical Advisory Committee (CAC)- Includes CFAC and Provider Representation • Utilization Management/Utilization Review Committee (UMUR)- Includes Provider Representation • Quality Improvement Projects (QIP) Committee • Network Development Cross Function Team (Reports to NMC)- Includes CFAC Representation

Each of these committees report their activities to QIC at least quarterly so that feedback and input is possible.

Goal(s): Assess the effectiveness of the Quality Improvement Committee (QIC) at least annually to

ensure committee responsibilities are fulfilled. (NCQA Standard: QI 2A):

Status/Evaluation: • Review of QIC minutes from July 2019-June 2020 indicated that QIC fulfilled its responsibilities

effectively and appropriately.


Identified Issue(s)/Barrier(s):

• No issues or barriers were identified.

Interventions: • As no issues or barriers were identified, no interventions were required.

Goal(s) to Continue for Next Fiscal Year: Yes Goal(s): Submit NCQA specific policies and procedures to QIC for annual review/approval. (NCQA

Standard: QI 2A.1)

Status/Evaluation: • Review of QIC minutes from July 2019-June 2020 indicated that NCQA specific policies were

submitted to the committee on time. • In addition, the QM department implemented a quarterly reporting process to update QIC on

policies, plans and program description that have gone through annual review and if they need approval by QIC to satisfy accreditation standards.


• No issues or barriers were identified.

Interventions: • As no issues or barriers were identified, no interventions were required.


Policy and Procedure Audit To ensure that policy and procedure review is completed annually, Partners’ QM department completes an audit of QIC and Board review dates at least annually to ensure that Partners’ policy and accreditation standards are met. • Goal(s): Achieve a 95% or higher score on the annual audit. (URAC Standard: CORE 3(c); NCQA

Standard: QI 2A.1; Policy 1.09.II.B)

Table 4. Policy and Procedure Audit Results Goal FY 2019 FY 2020

Director/QIC review and approval completed within 1-year timeframe

95% 100% 100%

Board of Directors review/ approval completed within 1-year timeframe

95% 100% 100%

*Data from Policy and Procedure Audit Report


Status/Evaluation: • Partners achieved 100% compliance on the annual audit.

Identified Issue(s)/Barrier(s): • No issues or barriers identified.

Interventions:

• No interventions required as goal was met


URAC Accreditation: One of the qualifications for being an LME/MCO in North Carolina is to obtain and maintain accreditation with a nationally recognized accrediting organization. Partners chose accreditation with URAC. Partners has maintained accreditation with URAC since 2012 with the most recent reaccreditation cycle 2018-2021.

Goal: Will achieve a 95% or higher compliance score for all accreditation areas. (Internal Goal)

Table 5. URAC Review Results Goal FY 2018 FY 2020

CORE 95% 100% 100% Health Call Center 95% 100% 100% Health Network 95% 100% 100% Health Utilization Management 95% 100% 100%

*Data from URAC Accreditation Report

Status/Evaluation: • A URAC monitoring review was completed November 2019 with 100% scores across all accredited

areas.


Interventions: • No interventions required.

Goal(s) to Continue for Next Fiscal Year: Partners is currently in the process of obtaining National Committee for Quality Assurance (NCQA) accreditation, which is required to become a NC Tailored Plan. Accreditation review is expected to be completed July 2020. Once NCQA is achieved, Partners will not apply for reaccreditation with URAC.


LME/MCO Systems Review and Block Grant Audit The LME/MCO Systems Review is completed annually by DHHS and consists of a Block Grant Review and Clinical Services Review which includes the Community Mental Health Services Block Grant (CMHSBG), the Substance Abuse Prevention and Treatment Block Grant (SAPTBG), the Social Services Block Grant (SSBG), the Planning Grant for Expansion of Comprehensive Mental Health Services for Children and their Families (System of Care Planning Grant) and State-funded services. Partners’ most recent audit was completed July 2019. Goal: Score at least 85% in all areas of audit. (Internal Goal)

Table 6. LME/MCO Systems Review Audit Results

Goal FY 2019 FY 2020 Adult MH and SU Clinical Monitoring

Overall Score 85% 52.6% 71.4% MH Adult Score 85% 36% 83% SUD Adult Score 85% 39% 64% SAIOP 85% 100% N/A

Child MH and SU Clinical Monitoring Overall Score 85% N/A 100% MH Child Score 85% N/A 100%

I/DD Clinical Monitoring Overall Score 85% 78.8% 95.7% Supported Employment- Continuation 85% N/A 93% Developmental Day- Initial 85% N/A 100% Developmental Day- Continuation 85% N/A 75% Day Activity- Initial 85% N/A 100% Day Activity- Continuation 85% N/A 94% Day Supports- Continuation 85% N/A 100%

LME/MCO Block Grant Program Monitoring Overall Score 85% 92.3% 93.7% SAPTBG- Individual 85% 91% 95% SAPTBG-Women’s Set-Aside Funding Program Monitoring 85% 85% 100% SAPTBG-Women’s Set-Aside Funding Record Review 85% 85% 80% SAPTBG- Work First Program Monitoring 85% 100% 100% SAPTBG- Work First Record Review 85% 95% 100% JJSAMHP- Program Review 85% 100% 100% JJSAMHP- Record Review 85% 100% 91% CMHSBG- Program Monitoring 85% 75% 100% CMHSBG- Record Review 85% 96% 96%

*Data from DHHS LME/MCO Systems Review Report Red Font= Goal not met

Status/Evaluation: • Adult MH and SU Clinical Monitoring: Although the overall score for the 2019 audit was below

85% it showed an 18.8 percentage point increase from the 2018 audit results.


• Child MH and SU Clinical Monitoring: Overall score for 2019 audit was 100%. No additional action required.

• IDD Clinical Monitoring: Overall score for the 2019 audit showed a 16.9 percentage point increase from the 2018 results. Although the overall score was above 85%, Partners scored 75% for Developmental Day- Continuation, therefore a plan of correction was required.

• LME/MCO Block Grant Program Monitoring: Overall score for the 2019 audit showed a 1.4 increase from the 2018 results. Although the overall score was above 85% Partners scored 80% for SAPTBG-Women’s Set-Aside Funding Record Review. A plan of correction was required.

Identified Issue(s)/Barrier(s): • Adult MH and SU Clinical Monitoring: There was no current disposition of the case within 30-days post discharge for 3 of 12 records. The LME-MCO did not provide any care coordination DURING state psychiatric hospital, ADATC,

community psychiatric hospital, facility-based crisis, or non-hospital medical detox services utilization for 12 of 20 records reviewed.

The LME-MCO Care coordinator did not attempt to contact the individual within 5 calendar days of the missed appointment for 2 of 4 records reviewed.

The LME-MCO did not provide any care coordination AFTER state psychiatric hospital, ADATC, community psychiatric hospital, facility-based crisis, or non-hospital medical detox services utilization for 7 of 20 records reviewed.

• IDD Clinical Monitoring: IDD Supported Employment Continuation Authorization -- 1 of 5 records did not have evidence

that the individual meets benefit plan eligibility. IDD Day Activity Continuation Authorization -- 1 of 4 records showed a lack of evidence to

support that the individual meets benefit plan eligibility.

• LME/MCO Block Grant Program Monitoring: The LME-MCO did not follow NC TOPPS requirements in 16 of 41 records reviewed. The LME-MCO did not show evidence the individual met the requirements of the designated

benefit plan in 7 of 15 records reviewed. The LME-MCO did not show Gender Specific Treatment being offered in 9 of 15 records

reviewed. The LME-MCO did not show evidence of a TB screening in 8 of 8 records reviewed.

Interventions: The following interventions were submitted to DHHS on 10/24/19 and approved. DHHS completed a follow-up review January 2020 resulting in closure of the case.

• Adult MH and SU Clinical Monitoring: MHSU Care Coordination Supervisors completed a post-audit review of the records cited in the

2019 State/Federal Block Grant Audit. This review was completed to determine which specific care coordinators needed additional training/supervision as well as general training/supervision needed for all care coordination staff.

Partners will implement a new case management platform (True Care) November 15, 2019. MHSU Care Coordination to develop a process for supervisor and/or peer review of

documentation.


Partners’ Quality Management (QM) department will continue internal audit of MHSU Care Coordination records.

• IDD Clinical Monitoring: Utilization Management completed a post-audit review of the cited records to determine root

cause of this issue. Utilization Management submitted documentation to NC DMHDDSAS to support inclusion of

both members under the Legacy criteria (receiving services prior to 7/1/2012) as specified in Joint Communication Bulletin J325.

Will communicate with Partners’ Health Information Management (HIM) Director to ensure HIM staff are available to access legacy records during the Clinical Monitoring Reviews conducted by NC DMHDDSAS.

Utilization Management will continue to work with DHHS’ IDD Monitoring Team to clarify acceptable documentation of eligibility. Once this is clarified, information will be shared with UM IDD Care Managers and providers.

• LME/MCO Block Grant Program Monitoring: Partners will have NC-TOPPS super-user present at next audit to check for NC-TOPPS

assessments if not in record provider brings to the audit. Partners will request providers whose records were cited submit a copy of their current

process/policy/procedure for NC-TOPPS submission, action taken to improve the process and evidence of staff training on action items within 30 days of being informed of compliance issues.

Partners will audit a random sample of NC-TOPPS submissions in the NC_TOPPS database for the provider who had records cited during the July 2019 audit at least quarterly. A plan of correction will be requested from the provider if requirements are not met.

Eligibility & Enrollment staff have been informed as of 10/15/19 if a request for ASWOM to be added to a member’s funding source and the enrollment/CUR does not indicate the member fully met the ASWOM criteria (i.e. are female with primary SA but are not pregnant, have dependent child/children under 18 or seeking custody of child/children under 18) the enrollment/CUR is returned and request provider indicate which criteria justifies the member receiving ASWOM funding. This information will also be reviewed again in Eligibility & Enrollment’s departmental staff meeting on 10/22/19.

Partners has contacted each of the providers who had consumer records that did not meet eligibility for ASWOM. These providers are researching their records to determine if there is evidence of ASWOM eligibility. Corrective action may be requested by Partners depending on the results of the providers’ research.

One provider has already completed review and determined that an error occurred and ASWOM designation was not end dated as it should have been. The provider has implemented an internal corrective action plan and are in the process of reversing the claims for the members indicated in the audit report. The reversal process is expected to be completed by 10/31/19.

Partners has requested a POC from the second provider to outline the steps they are going to implement to correct the issue.

Webinar on Women’s Set Aside funding requirements by Starleen Scott Robbins of DMH on was scheduled for 10/15/19 and attended by Partners staff and one Women’s Set-Aside service provider.


Partners will continue with monitoring of SU Block Grant providers that was implemented November 2018. Monitoring of providers with Women’s Set-Aside will include a focus on benefit plan eligibility. Scores below 80% may result in corrective action for the provider.

Goal(s) to Continue for Next Fiscal Year: Yes.

C. AVAILABILITY OF PRACTITIONERS AND PROVIDERS

Network Composition Partners is contracted with the North Carolina Department of Health and Human Services (DHHS) to operate a Prepaid Inpatient Hospital Plan (PIHP) and LME to administer both Medicaid and indigent healthcare benefits to citizens of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry and Yadkin counties in North Carolina who need mental health, intellectual/developmental disability, and/or substance use services. Criteria for network participation focus on: • Member needs, • Ensuring quality of care; • Ensuring quality of service; and • Meeting the business needs of the organization.

Table 7a. Network Composition- Practitioner Types

FY 2020 Psychiatrist 425 Clinical Psychologist 203 Licensed Clinical Social Worker 800 Licensed Professional Counselor 826

*Data from Partners Network Adequacy and Accessibility Analysis Report

Table 7b. Network Composition- Facility Types

FY 2020 Inpatient Hospitals 11 Residential 144 Ambulatory Services 913

*Data from Partners Network Adequacy and Accessibility Analysis


Provider Network Access and Availability Partners ensures that the provider network consists of enough practitioners/providers to provide adequate access to cover community capacity. Partners annually evaluates the location of practitioners/providers and types of services in its capacity study and determines the need for additional Providers.

GEO Access Mapping Goal(s): 95% of members have access to at least two (2) outpatient service providers within 30

minutes/miles for urban counties and within 45 minutes/miles for rural counties from their home. (NCQA Standard: QI 4B.3)

Table 8a. Outpatient Service Accessibility

Goal FY 2019 FY 2020 Urban Counties 95%

Medicaid 100% 100% Non-Medicaid 100% 100%

Rural Counties 95% Medicaid 100% 100% Non-Medicaid 100% 100%


Status/Evaluation: • Partners exceeded goal of 95% compliance with outpatient services accessibility standard with

100% compliance for both urban and rural counties.


Interventions: • As no issues or barriers were identified, no interventions required.


Goal(s): • 95% of Medicaid and Non-Medicaid members have access to at least two (2) location-based

service providers within 30/45 minutes/miles/45 travel from their home. (NCQA Standard: QI 4B.3)

• 95% of Medicaid and Non-Medicaid members have access to at least one (1) location-based service providers within 30/45 minutes/miles/45 travel from their home for the following services: SA Non-Medical Community Residential Treatment and SA Medically Monitored Community Residential Treatment. (NCQA Standard: QI 4B.3)


Table 8b. Location-Based Service Accessibility Service Type Goal FY 2019 FY 2020

Services with 2 Provider Standard Psychosocial Rehabilitation (PSR) Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100% Child/Adolescent Day Tx Medicaid 95% 100% 100% Non-Medicaid 95% 100% 90% Partial Hospitalization Medicaid 95% N/A 59% Non-Medicaid 95% N/A 54% Substance Abuse Intensive Outpatient Program (SAIOP) Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100% Substance Abuse Comprehensive Outpatient Treatment Program (SACOT)

Medicaid 95% 99% 100% Non-Medicaid 95% 90% 88% Opioid Tx Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Services with 1 Provider Standard SA Non-Medical Residential Tx Medicaid 95% N/A 100% Non-Medicaid 95% N/A 100% SA Medically Monitored Residential Treatment Medicaid 95% N/A 100% Non-Medicaid 95% N/A 100%

*Data from Partners Network Adequacy and Accessibility Analysis N/A= Percentages not included in 2019 Analysis Red Font= Goal Not Met

Status/Evaluation: • Partners exceed the 95% goal of two (2) providers within 30/45 minutes/miles/45 travel from a

member’s home for five (5) of six (6) Medicaid services. • Partners exceed the 95% goal of one (1) providers within 30/45 minutes/miles/45 travel from a

member’s home for two (2) of two (2) Medicaid services. • Partners exceed the 95% goal of two (2) providers within 30/45 minutes/miles/45 travel from a

member’s home for three (3) of six (6) Non-Medicaid services.

Identified Issue(s)/Barrier(s): • Partners did not meet the 95% goal for the following services/funding type:

Child/Adolescent Day Treatment (Non-Medicaid: 90%) Partial Hospitalization (Medicaid: 59%; Non-Medicaid: 54%) SACOT (Non-Medicaid: 88%)

• A contributing factor for the lower scores for Child/Adolescent Day Treatment and SACOT was the change in the Non-Medicaid standard from access to one (1) provider for FY 2019 to two (2) providers for FY 2020.


Interventions: • Partners’ Provider Network department received the Geo Access Mapping data at the end of July

2020 and is still in the process of completing the annual network adequacy and accessibility analysis, due to DHHS October 2020. Interventions will be developed based on the results of this analysis.


Goal(s): 95% of Medicaid and Non-Medicaid members have access to at least two (2) community/ mobile service providers within the Partners’ catchment area. (NCQA Standard: QI 4B.3)

Table 8c. Community/Mobile Services Accessibility

Service Type Goal FY 2019 FY 2020 Assertive Community Treatment Team (ACTT)

Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Community Support Team (CST) Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Intensive In-Home (IIH) Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Multi-systemic Therapy (MST) Medicaid 95% 100% 100% Non-Medicaid 95% 100% 0%

(b)(3) MH Supported Employment Services Medicaid 95% 100% 100% Non-Medicaid 95% Not a Non-Medicaid

Service (b)(3) I/DD Supported Employment Services

Medicaid 95% 100% 100% Non-Medicaid 95% Not a Non-Medicaid

Service (b)(3) Waiver Community Guide


Service (b)(3) Waiver Individual Support (Personal Care)


Service (b)(3) Waiver Peer Support


Service (b)(3) Waiver Respite


Service


I/DD Supported Employment Services Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100% Long-term Vocational Supports

Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

MH/SA Supported Employment Services (IPS-SE) Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

I/DD Non-Medicaid-funded Personal Care Services Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

Day Supports Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

Peer Support Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

Transition Management Service Medicaid 95% Not a Medicaid Service Non-Medicaid 95% 100% 100%

*Data from Partners Network Adequacy and Accessibility Analysis Red Font= Goal Not Met

Status/Evaluation: • Partners exceed the 95% goal of at least two (2) providers within the Partners’ catchment area for

ten (10) of ten (10) Medicaid services. • Partners exceed the 95% goal of at least two (2) providers within the Partners’ catchment area for

ten (10) of eleven (11) Non-Medicaid services.


Multi-Systemic Therapy (Non-Medicaid: 0%) • A contributing factor for the lower score was the change in the Non-Medicaid standard from

access to one (1) provider for FY 2019 to two (2) providers for FY 2020.





Goal(s): • 95% of Medicaid and Non-Medicaid members have access to at least one (1) crisis services

provider within Partners’ catchment area for: Ambulatory Detox, Facility-Based Crisis- Child, Facility-Based Respite, and Mobile Crisis Management. (NCQA Standard: QI 4B.3)

• 95% of Medicaid and Non-Medicaid members have access to at least two (2) crisis services provider within Partners’ catchment area for: Facility-Based Crisis-Adult and Non-Hospital Detoxification. (NCQA Standard: QI 4B.3)

Table 8d. Crisis Services Accessibility

Service Type Goal FY 2019 FY 2020 Services with 1 Provider Standard

Ambulatory Detox Medicaid 95% N/A 100% Non-Medicaid 95% N/A 100%

Facility-Based Crisis – Child Medicaid 95% 0% 0% Non-Medicaid 95% 0% 0%

Facility-Based Respite Medicaid 95% Not a Medicaid service Non-Medicaid 95% 100% 100%

Mobile Crisis Management Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Services with 2 Provider Standard Facility- Based Crisis- Adult

Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Non-Hospital Detoxification Medicaid 95% 100% 0% Non-Medicaid 95% 100% 0%

*Data from Partners Network Adequacy and Accessibility Analysis N/A= Percentages not included in 2019 Analysis Red Font= Goal Not Met

Status/Evaluation: • Partners exceeded the 95% goal of at least one (1) provider within Partners’ catchment are for

three (3) of four (4) Medicaid services. • Partners exceeded the 95% goal of at least one (1) provider within Partners’ catchment are for

three (3) of four (4) Non-Medicaid services. • Partners exceeded the 95% goal of at least two (2) providers within Partners’ catchment are for

one (1) of two (2) Medicaid services. • Partners exceeded the 95% goal of at least two (2) providers within Partners’ catchment are for

one (1) of two (2) Non-Medicaid services.


Facility-Based Crisis- Child (Medicaid= 0%; Non-Medicaid= 0%) Non-Hospital Detoxification (Non-Medicaid= 0%)


• Partners contracts with four (4) providers that provide facility-base crisis for children, but they are all outside Partners’ catchment area.

• Currently Partners uses the Rapid Response service for children in crisis. • Partners contracts with a Non-Hospital detoxification provider but it is outside Partners’

catchment area. • A contributing factor for the lower scores for detox was the change in the standard from access to

one (1) provider for FY 2019 to two (2) providers for FY 2020.



Goal(s) to Continue for Next Fiscal Year: Yes Goal(s): 95% of members have access to at least 1 inpatient service provider within the Partners’

catchment area. (NCQA Standard: QI 4B.3)

Table 8e. Inpatient Services Accessibility Service Type Goal FY 2019 FY 2020

Inpatient Hospital- Adult Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%

Inpatient Hospital- Child Medicaid 95% 100% 100% Non-Medicaid 95% 100% 100%


Status/Evaluation: • Partners exceeded the inpatient services goal with 100% compliance with the accessibility

standard.

Identified Issue(s)/Barrier(s): • No issues or barriers were identified.

Interventions: • As no issues or barriers were identified no interventions required.



Goal(s):

• 95% of members have access to at least 2 Innovations Waiver providers within the Partners’ catchment area for the services indicated below. (NCQA Standard: QI 4B.3)

• 95% of members have access to at least 1 Innovations Waiver provider within the Partners’ catchment area for the following services: Day Supports, Out of Home Crisis, Respite Care- Community Facility, Financial Supports, Specialized Consultative. (NCQA Standard: QI 4B.3)

Table 8f. Innovation Waiver Services Accessibility

Goal FY 2019 FY 2020 Services with 2 Provider Standard

Community Living and Supports 95% 100% 100% Community Navigator 95% 100% 100% Community Navigator Training for Employer of Record 95% 100% 100% Community Networking 95% 100% 100% Crisis Behavioral Consultation 95% 100% 100% In Home Intensive 95% 100% 100% In Home Skill Building 95% 100% 100% Personal Care 95% 100% 100% Crisis Consultation 95% 100% 100% Crisis Intervention & Stabilization Supports 95% 100% 100% Residential Supports 1 95% 100% 100% Residential Supports 2 95% 100% 100% Residential Supports 3 95% 100% 100% Residential Supports 4 95% 100% 100% Respite Care - Community 95% 100% 100% Respite Care Nursing – LPN & RN 95% 100% 100% Supported Employment 95% 100% 100% Supported Employment – Long Term Follow-up 95% 100% 100% Supported Living 95% 100% 100%

Services with 1 Provider Standard Day Supports 95% 100% 100% Out of Home Crisis 95% 100% 100% Respite Care - Community Facility 95% 100% 100% Financial Supports 95% 100% 100% Specialized Consultative 95% 100% 100%


Status/Evaluation: • Partners exceeded both Innovations services accessibility goals for FY 2020 with 100% compliance

with the accessibility standards.


Interventions: • As no issues or barriers were identified no interventions required.



Practitioner to Member Ratios: Goal(s): • Maintain a provider network with at least one (1) Psychiatrist for every 2,000 members. (NCQA

Standard: QI 4B.3) • Maintain a provider network with at least one (1) Clinical Psychologist for every 10,000 members.

(NCQA Standard: QI 4B.3) • Maintain at least one (1) Licensed Clinical Social Worker for every 1,000 members. (NCQA

Standard: QI 4B.3) • Maintain at least one (1) Licensed Professional Counselor for every 1,000 members. (NCQA

Standard: QI 4B.3)

Table 9a. Practitioner Ratios Practitioner Type Goal FY 2019 FY 2020

Psychiatrist 1:2000 1:472 1:542 Clinical Psychologist 1:10,000 1:1986 1:1,134 Licensed Clinical Social Worker 1:1000 1:354 1:288 Licensed Professional Counselor 1:1000 1:304 1:279

*Data from Partners Network Adequacy and Accessibility Analysis Note: Total Ratio data used in table

Status/Evaluation: • Partners met all practitioner to member ratios for FY 2020.


Interventions: • As no issues or barrier were identified, no interventions required.


Facility to Member Ratios: Goal(s): • Maintain network of at least one (1) Inpatient Hospital for every 10,000 members. (NCQA

Standard: QI 4B.3) • Maintain a network of at least one (1) Residential Facility for every 7,500 members. (NCQA

Standard: QI 4B.3) • Maintain a network of one at least one (1) Ambulatory/Crisis facility for every 750 members.

(NCQA Standard: QI 4B.3)


Table 9b. Facility Ratios

Facility Type Goal FY 2019 FY 2020 Inpatient Hospitals 1:10,000 1:24,938 1:20,925 Residential 1:7500 1:1592 1:1,598 Ambulatory/Crisis Services 1:750 1:257 1:252

*Data from Partners Network Adequacy and Accessibility Analysis Note: Total Ratio data used in table Red Font= Goal Not Met

Status/Evaluation: • Partners met the facility to member ratio goal for two (2) of three (3) facility types.

Identified Issue(s)/Barrier(s): • For FY 2020, Partners had a ratio of one (1) inpatient hospital provider for every 20,925 members

which is higher than the one (1) in 10,000 member standard.

Interventions: • Partners’ Provider Network department received the facility to member ratio data at the end of

July 2020 and is still in the process of completing the annual network adequacy and accessibility analysis, due to DHHS October 2020. Interventions will be developed based on the results of this analysis.


D. ACCESSIBILITY OF SERVICES

Provider Appointment Availability Partners has the responsibility of offering individuals who live in Partners’ catchment area 24/7/365 access to services. Partners fulfills these responsibilities through the Access to Care Call Center. The call center fields various calls and performs screening, triage and referral. Access to Care does not perform health education, except in the context of screening, triage and referral when personnel are assisting the member with provider choice. Partners strives to provide timely access to routine, urgent and emergent behavioral healthcare for its members. URAC Health Call Center guidelines, NCQA standards, and the Division of Health and Human Services (DHHS) contract provide specific requirements for ensuring that timely appointments are provided to members. Emergent Appointments: Goal(s): 95% of Emergent calls are scheduled to be seen by a provider within two (2) hours of initial

call. (URAC Standard: HCC 16; NCQA QI 5A.1)


Table 10a. Appointments Scheduled- Emergent Calls

*Data from Access to Care Department

Status/Evaluation: • Partners scheduled Emergent appointments with providers within two (2) hours 100% of the time

for all four (4) quarters of FY 2020.


Interventions: • As no compliance issues or barriers were identified, no interventions were required.


Urgent Appointments: Goal(s): 85% of Urgent calls are scheduled to be seen by a provider within forty-eight (48) hours of

initial call. (URAC Standard: HCC 16; NCQA Standard: QI 5A.1)

Table 10b. Appointments Scheduled- Urgent Calls

*Data from Partners QM Program Work Plan

Status/Evaluation: • Partners exceeded the goal of scheduling Urgent appointments within 48 hours 85% of the time

all four (4) quarters for FY 2020. Identified Issue(s)/Barrier(s):

100% 100% 100% 100%

92%

94%

96%

98%

100%

102%

Q1 Q2 Q3 Q4

% Calls Scheduled Goal (95%)

97% 98.2% 97.8% 95.8%

75%

80%

85%

90%

95%

100%

Q1 Q2 Q3 Q4



• No issues or barriers were identified. Interventions: • As no compliance issues or barriers were identified, no interventions were required.


Routine Appointments: Goal(s): 85% of Routine calls are scheduled to be seen by a provider within fourteen (14) calendar days

of initial. (URAC Standard: HCC 16; NCQA Standard: QI 5A.1)

Table 10c. Appointments Scheduled- Routine Calls

*Data from Partners QM Program Work Plan Status/Evaluation: • Partners exceeded the goal of scheduling Routine appointments within 14 calendar days 85% of

the time all four (4) quarters for FY 2020. Identified Issue(s)/Barrier(s): • No issues or barriers were identified.

Interventions: • As no compliance issues or barriers were identified, no interventions were required.


Triage Process Audit Screening, Triage and Referral (STR) is the primary purpose of the Access to Care Department and those functions are defined as:

1. Screening: A preliminary determination of member eligibility for services under the State’s Medicaid or State Benefit Plan.

2. Triage: A clinical determination of the member’s level of acuity. 3. Referral: Identification of and linkage to the member’s provider of choice who can meet the

member’s unique behavioral healthcare needs and is available within the required timeframe.

99.0% 99.4% 99% 97.3%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

Q1 Q2 Q3 Q4



To ensure that the triage function is implemented within contractual and accreditation requirements, Partners’ QM Department completes audits of the Access to Care call center at least annually.

Goal(s): Achieve a score of 95% or greater on the annual audit. (URAC Standard: HCC 4(d), HCC 5, HCC

20, HCC 21; NCQA Standard: QI 5A.1; Policy 10.04, Policy 10.04)

Table 11. Triage Process Audit Results Goal FY 2019 FY 2020 Overall Audit Score 95% 95% 100% Non-Clinical staff appropriately transferred caller 95% 100% 100% Clinical Decisions/Activities performed by licensed clinician 95% 100% 100% Appointment Scheduled within timeframe 95% 98% 100% Documentation indicates that appropriate follow-up communication was attempted to ensure consumer attended appointment

95% 100% 100%

Documentation indicates caller was asked if consumer wants information from call shared with the consumer's Primary Care Physician (PCP)

95% 90% 100%

*Data from Call Center Audit Report

Status/Evaluation: • Partners exceeded goal with a 100% score on annual audit.


Interventions: • No corrective action or interventions were required.


Enrollment and Eligibility Audit The Enrollment and Eligibility Audit was developed as part of Partners’ 2019 Block Grant Audit plan of correction to ensure that members being enrolled into a benefit plan meet the eligibility requirements for the plan and enrollment into the plan is discontinued once member no longer meets eligibility. This audit focuses specifically on eligibility for the AWSOM benefit plan. Benefit Plan enrollment is completed through the Access to Care department.

Goal(s): Achieve a score of 95% or greater on the annual audit. (Policy 10.08.I.A.1)


Table 12. Enrollment and Eligibility Audit Results Goal FY 2019 FY 2020 Overall Audit Score 95% N/A 96% End Date for ASWOM Benefit Plan is one (1) year from Effective Date

95% N/A 95%

Adult woman 18 and over 95% N/A 100% Has Primary Substance Use Disorder diagnosis 95% N/A 100% Meets at least one of the following criteria:

• Currently pregnant OR • Have dependent children under 18 OR • Is seeking custody of a child under 18

95% N/A 87%

*Data from Enrollment and Eligibility Audit Report

Status/Evaluation: • The first ASWOM Enrollment and Eligibility Audit was completed December 2019 with an overall

score of 96%. Identified Issue(s)/Barrier(s): • Partners scored below the 95% goal on the following item:

Meets at least one of the following criteria: currently pregnant OR have dependent children under 18 OR is seeking custody of a child under 18. (87%)

Interventions: • The Enrollment and Eligibility department has implemented interventions to address this issue,

including requesting additional information from the provider to verify eligibility at the time of enrollment request and end dating ASWOM target pop 1 year from the date of enrollment request.

• Focused audit was completed March 2020 focusing on the area of out of compliance identified in December 2019. Scored 95%. 95% score was due to a computer glitch that would not allow E&E to revise the target pop end date. Issue now resolved.


Telephone Accessibility Average Speed to Answer: Average Speed to Answer (ASA) is the average delay in minutes and seconds that inbound telephone calls encounter waiting in the telephone queue before being answered by a live staff person. Goal: 95% of calls to Access to Care line will be answered within 30 seconds or less. (URAC Standard:

HCC 11b; DHHS Contract; NCQA Standard: QI 5.B1)


Table 13. Average Speed to Answer

*Data from LME/MCO Monthly Report

Status/Evaluation: • Partners exceeded the 95% goal rate for four (4) of four (4) quarters for FY 2020.


Interventions: • As Partners exceeded the goal and no issues or barriers were identified, no interventions were

required. Goal(s) to Continue for Next Fiscal Year: Yes

Abandonment Rate: Abandonment Rate (AR) is the percentage of calls offered to the automatic call distribution (ACD) system, that are terminated by the caller prior to being answered by a live staff person.

Goal(s): Partners will maintain an abandonment rate of 5% or less. (URAC Standard: HCC 11c; NCQA

Standard: QI 5B.2; DHHS Contract) Table 14. Abandonment Rate

*Data from LME/MCO Monthly Report

98.4%99.6%

98.8% 99.1%

92.0%93.0%94.0%95.0%96.0%97.0%98.0%99.0%

100.0%

Q1 Q2 Q3 Q4

ASA % Goal (95%)

0.2% 0.3% 0.2% 0.25%0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Q1 Q2 Q3 Q4

AR Goal (< 5%)


Status/Evaluation: • Partners exceeded the 5% or less goal for four (4) of four (4) quarters of FY 2020.




E. MEMBER EXPERIENCE

Complaints/Grievances Grievances (also called complaints) are defined as “an expression of dissatisfaction about matters involving the MCO or MCO Provider Network”. Grievances are expressions of dissatisfaction about any matters other than an “action” (summarized as UM decisions to deny, reduce, suspend or terminate any requested services). Grievances or complaints can be received by any staff member at Partners. Grievances may be received via telephone, mail, email, Access to Care web address, or in person. All Grievances and complaints are entered into the AlphaMCS System by the staff receiving the grievance or complaint. The Legal Department of Partners is responsible for assignment of complaints to appropriate staff/departments for resolution, tracking, monitoring, and ensuring completion of all complaints received.

Complaint/Grievance Categories & Examples:

• Quality of Care: A member has filed a complaint that a condition was misdiagnosed. • Access: A member filed a complaint that participating practitioners lacked available

appointments. • Attitude/Service: A Member complained that a practitioner was rude and used abusive

language. • Billing/Financial: Out of Network services where members are balanced billed or

disputes of deductibles and copayments. • Quality of Practitioner Office Site: A member sought out-of-network care because the

participating practitioner’s offices lacked wheelchair accessibility. The organization identified other practitioners with wheelchair access, but the member appealed to go out of network.


Table 15. Complaint/Grievance Totals FY 2020 % of Total Total Grievances Received 95

Quality of Care 60 63.2% Access 23 24.2% Billing/Financial 8 8.4% Attitude/Service 4 4.2% Quality of Practitioner Office Site 0 0%

*Data from Annual Grievance Report

Complaint/Grievance Rate Goal(s): Maintain a quarterly complaint/grievance rate below 10 per 1000 active members for FY 2020. (QI 6A.1)

Table 16. Complaints/Grievances per 1000 by Category

*Data from Annual Grievance Report

Status/Evaluation: • The grievance rate remained below 10 grievances per 1000 active members for all four (4) quarters

of FY 2020.




1.83

1.16

0.28

0.22

0.17

0

1.72

0.94

0.67

0.11

0 0

0.83

0.55

0.22

0.06

0 0

0.89

0.67

0.11

0.06

0.06

0

0

2

4

6

8

10

12

Total Rate Quality of Care Access Billing/Financial Attitude/Service Quality ofPractitioner Office

Site

Per 1

000

Q1 (Jul-Sep) Q2 (Oct-Dec) Q3 (Jan-Mar) Q4 (Apr-Jun) Goal (10)


Timely Grievance Resolution Goal(s): At least 90% of all grievances are resolved within 30 calendar days of receipt. (URAC Standard:

Core 35d; NCQA Standard: QI 6A.1; State Performance Measure)

Table 17. Grievance Resolution Timeframes

*Data from LME/MCO Monthly Monitoring Report

Status/Evaluation: • Partners exceeded the 90% goal four (4) of four (4) quarters of FY 2020




100% 100% 100% 100%100% 100% 100% 100%

84%

86%

88%

90%

92%

94%

96%

98%

100%

102%

Q1 (Jul-Sep) Q2 (Oct-Dec) Q3 (Jan-Mar) Q4 (Apr-Jun)

Mediciad Non-Medicaid Goal (90%)


Grievance Audit Partners’ QM Department completes audits of complaints/grievances at least annually to ensure that policies, contractual requirements and accreditation standards are being met.

Goal: Achieve score of 95% or higher on the annual audit. (URAC Standard: CORE 35(b-d); NCQA

Standard: RR 2A.1-4, EQR: VI.A.1.3; Policy 6.00.III.J.1)

Table 18. Grievance Audit Results Goal FY 2019 FY 2020 Overall Audit Score 95% 99% 98% Acknowledgement letter is dated within 5 business days of grievance receipt

95% 98% 100%

The summary of actions taken to follow-up and/or investigate the grievance and the final disposition are documented in the Follow Up tile in Alpha

95% 100% 100%

Grievance was resolved within 30 calendar days of receipt. 95% 98% 100% Resolution letter includes a description of the action taken to resolve the grievance and steps for filing an appeal if not satisfied with the grievance resolution

95% 100% 95%

Resolution letter dated within 30 calendar days of receipt. 95% 100% 95% *Data from Grievance Audit Report

Status/Evaluation: • Partners met goal for FY 2020.


Interventions: • No corrective action or interventions required.


Member Experience Survey Partners monitors performance areas affecting member satisfaction on an annual basis. One of the ways this monitoring is completed is through the administration of the Partners’ Member Experience Survey. The objectives of this survey are to: • Evaluate member satisfaction with Partners • Identify opportunities to improve member satisfaction • Develop and implement solutions to improve member satisfaction

The baseline survey was administered on behalf of Partners by The Mihalik Group (TMG), LLC during March 2019. A second survey was completed June 2019 with the preliminary results being received during Q1 of FY 2020.


Goal(s): Achieve at least 80% score on the Member Experience Survey. (NCQA Standard: QI 6A.2) Table 19. Member Experience Survey Results

Survey Item Goal Baseline Survey Results

2nd Survey Results

1. Call to Partners was answered timely 80 % 80.85% 92.45% 2. Benefits and coverage limits were explained clearly 80 % 83.67% 90.20% 3. Special/cultural needs or choices were considered when getting

services/treatment 80% 89.13% 90.20%

4. Ease of getting an appointment 80% 86.27% 90.57% 5. Happiness with getting into treatment 80% 72.22% 70.91% 6. Provider’s location is easy to get to. 80% 98.28% 86.21% 7. Provider was able to schedule the first appointment as soon as

wanted 80% 85.96% 84.48%

8. Provider was able to schedule a follow-up appointment as soon as wanted

80% 92.98% 86.21%

9. Provider responded to phone calls in a timely manner 80% 96.36% 92.86% 10. Privacy and dignity were maintained while receiving services or

treatment. 80% 93.33% 94.92%

11. Provider was able to meet any special/cultural needs or choices 80% 98.15% 92.31% 12. Provider worked with you to develop treatment goals and a plan of

action 80% 94.83% 93.22%

13. Fees and payments were explained 80% 92.16% 92.16% 14. Privacy of information was explained clearly 80% 94.83% 93.10% 15. The office staff was helpful 80% 94.92% 94.83% 16. Wait time for first appointment within 2 weeks 80% 73.58% 82.69% 17. Rating of your Provider 80% 79.66% 82.46% 18. The services or treatment I received helped me perform better at

work or school 80% 91.84% 89.36%

19. The services or treatment I received helped me function better at home

80% 86.21% 84.91%

20. Overall, the problems or symptoms that I had before receiving services or treatment have improved

80% 82.14% 88.68%

21. It was easy to get approval for services or treatment that you or your Provider felt were necessary.

80% 85.96% 86.79%

22. My Provider and Primary Care Physician worked together to coordinate my care.

80% 81.82% 86.00%

23. On a scale of 1 to 10, with 10 being the best and 1 being the worst, how pleased are you with the services or treatment you received?

80% 84.48% 92.59%

*Data from Partners’ Member Experience Survey Report Red Font= Goal not met

Status/Evaluation: • Eleven (11) measures showed an increase in performance from the Baseline Survey to 2nd Survey. • The measure that showed the highest increase in performance was question #1, “Call to Partners

was answered timely”


Identified Issue(s)/Barrier(s): • Partners scored below 80% for the following:

Happiness with getting into treatment. (Survey 1: 72.22%; Survey 2: 70.91%) Wait time for first appointment within 2 weeks. (Survey 1: 73.58%) Rating of your Provider. (79.66%)

• Partners identified the following barriers that may have affected survey scores: Some provider locations are not located on bus routes, if the county has public

transportation. Members lack of money to pay for alternative transportation when they don’t qualify for

Medicaid transportation and may not have natural supports to assist. Providers may not have alternative hours of operation from Monday-Friday 8-5pm. Lack of childcare options. Members unable to engage in treatment because employment prevents them from keeping

appointments during normal business hours. Lack of communication and scheduling conflict with parents who have joint custody of

children/adolescents. No transportation available at times treatment facilities are in operation.

Interventions: • The Provider Network Department continues to expand the practitioner panel to improve access

for members. This will reduce strain on the current provider/practitioner network and ensure Partners will have an enough open appointment slots for its growing membership.

• Explore ways to address transportation cost and availability (e.g. voucher system, local DSS) • Explore way to encourage providers to expand hours of operation, to include evenings and

potential weekend hours to accommodate members who work, have childcare and transportation issues.

• Explore development of specialized appointment timeliness standards for Provider Network • Review data related to initial access, compliance and availability of first appointments



ECHO Survey The Experience of Care and Health Outcomes (ECHO) for North Carolina Medicaid enrollees is a tool for assessing members’ experiences with their health care. DataStat, Inc. conducted the survey on behalf of the State of North Carolina Division of Health Benefits (DHB) and the Carolinas Center for Medical Excellence (CCME). The FY 2020 survey was administered between August 8, 2019 and October 9, 2019. Goal(s): Achieve at least 80% score on the ECHO Survey. (NCQA Standard: QI 6A.2; EQR Standard:

IV.A.4)

Table 20. ECHO Survey Results Survey Composites Goal FY 2019 FY 2020

Adult Child Adult Child Overall Rating 80% 68.9% 63.5% 75.6% 71.2% Getting Treatment Quickly 80% 53.1% 62.5% 61.5% 68.1% How Well Clinicians Communicate 80% 91.8% 84.1% 89.5% 86.1% Getting Treatment/Information from the Plan 80% 61.2% 31.4% 37.2% 26.8% Perceived Improvement 80% 66% 65.5% 51.2% 63.9% Information About Treatment Plan 80% 50.5% N/A 61.3% N/A

*Data from CCME Adult ECHO Survey Report N/A= Domain not included in survey indicated Red Font= Goal not met

Status/Evaluation: • How Well Clinicians Communicate was the highest scoring composite for both the Adult Survey

and the Child Survey. • Partners’ overall all score for the Adult Survey showed a 6.7 percentage point improvement

compared to the FY 2019 survey results. The overall score for the Child Survey showed a 7.1 percentage point improvement.

Identified Issue(s)/Barrier(s): • Partners scored below 80% for the following survey composites:

Getting Treatment Quickly (Adult Survey and Child Survey) Getting Treatment and Information from the Plan (Adult Survey and Child Survey) Perceived Improvement (Adult Survey and Child Survey) Information About Treatment Plan (Adult Survey only)

Interventions: • Partners is in the process of reviewing 3 years trends and developing interventions.



Perception of Care Survey The North Carolina Mental Health and Substance Abuse Consumer Perception of Care Survey is administered by the North Carolina Department of Health and Human Services (DHHS), in partnership with the Local Management Entities/Managed Care Organizations (LME/MCO) on an annual basis. The survey provides information on the quality of care in each LME/MCO catchment area, based on the perceptions of individuals and families who have received Medicaid or State-funded mental health and/or substance use services. The FY 2020 survey was administered between May 6,2019 and June 4, 2019. Goal(s): Achieve at least 80% score on the Perception of Care Survey. (NCQA Standard: QI 6A.2; EQR

Standard: IV.A.4)

Table 21. Perception of Care Survey Results Survey Domains Goal FY 2019 FY 2020

Adult Youth Family Adult Youth Family

Access 80% 93% 73% 95% 93% 76% 92% Treatment Planning 80% 88.2% 68.1% 96.2% 88% 78% 91% Quality & Appropriateness 80% 95.9% N/A N/A 95% N/A N/A Cultural Sensitivity 80% N/A 87% 96.8% N/A 88% 98% Outcomes 80% 75% 69.2% 73.6% 76% 64% 65% Functioning 80% 76.2% N/A 74.4% 77% N/A 67% Social Connectedness 80% 73.9% N/A 85% 76% N/A 87% General Satisfaction 80% 93.9% 76.4% 95.4% 94% 84% 91%

*Data from DHHS Perception of Care Survey Report N/A= Domain not included in survey indicated Red Font= Goal not met

Status/Evaluation: • The highest scoring domain for the Adult Survey was Quality & Appropriateness. • For both the Youth Survey and Family Survey, the highest scoring domain was Cultural Sensitivity.

Identified Issue(s)/Barrier(s): • Partners scored below 80% for the following domains:

Outcomes (Adult/Youth/Family) Functioning (Adult and Family) Access (Youth only) Treatment Planning (Youth only) Social Connectedness (Adult only)

Interventions: • As the final results for the survey were not received from DHHS until the end of June 2019,

Partners is still in the process of analyzing the data for the domains scoring below 80%. Partners will complete the analysis and developed appropriate interventions during FY 2021.



Provider Satisfaction Survey The DHHS Provider Satisfaction Survey is administered on behalf of the North Carolina Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) by the Carolinas Center for Medical Excellence (CCME) on an annual basis. The purpose of the survey is to assess perceptions of the LME/MCOs in North Carolina by service providers participating in the 1915(b) (c) Medicaid Waiver program. The FY 2020 survey was administered between October 7, 2019 and November 22, 2019. Goal(s): Achieve at least 80% score on the Provider Satisfaction Survey. (NCQA Standard: QI 6A.2; EQR Standard: IV.A.4)

Table 22. Provider Satisfaction Survey Results Survey Domains Goal FY 2019

Results FY 2020 Results

Overall Satisfaction with Partners 80% 90.5% 91.3% Satisfaction with LME/MCO Staff 80% 84.5% 84.9% Satisfaction with Claims Processing 80% 89.9% 92.1% Satisfaction with Information Technology 80% 89.0% 90.9% Satisfaction with Authorization & Appeals Process 80% 91.2% 92.3% Satisfaction with Provider Network 80% 88.7% 89.2% Satisfaction with Provider Monitoring 80% 89.9% 89.0% Satisfaction with Training Provided by LME/MCO 80% 90.7% 93.4%

*Data from NC Medicaid Provider Satisfaction Survey Report *Data from Partners Provider Satisfaction QM Analysis Report

Status/Evaluation: • Partners’ score for Overall Satisfaction increased by 0.8 percentage points compared to the FY

2019 results. • Partners scored 90% or above for four (4) out of seven (7) survey domains.

Identified Issue(s)/Barrier(s): • Although Partners did not score below 80% for any of the survey domains, Partners did score

below 80% for one (1) survey question: Q6. LME/MCO staff referring consumers whose clinical needs match the services of the

provider. (Satisfaction with LME/MCO Staff: 75.4%) Interventions: • Partners is in the process of developing interventions. These will be monitored during FY 2021

Goal(s) to Continue for Next Fiscal Year (Yes/No): Yes


F. CARE MANAGEMENT

Mental Health and Substance Use (MHSU) Care Management Care Management is an administrative function of Partners. The goal of Care Management is to oversee the individual’s continuum of care by coordinating and linking the individual to behavioral health services and supports. Partners’ QM Department completes audits of the MHSU Care Management function at least annually to ensure that Care Management functions are being completed within the requirements of Partners’ policies, contractual requirements and accreditation standards. Goal(s): Achieve a score of 95% or above for the annual audit. (NCQA Standard: QI 9G, EQR Standard:

EQR Standard: V.C; Policy 9.11; Policy 9.01(E)(F))

Table 23. MHSU Care Management Audit Results Goal FY 2019 FY 2020 Overall Audit Score 95% 95% 91% Care coordination provided during inpatient stay 95% 98% 95% Care Manager monitored follow-up appointment 95% 95% 89% Care coordination was provided during 30 day post discharge period 95% 90% 89%

*Data from MHSU Care Management Audit Report Red Font= Goal not met

Status/Evaluation: • Annual audit was completed November 2019. Overall score was 91%. • A follow-up audit was completed May 2019 concentrating on the items that were below 95% in

the November 2019 audit. Overall score was 98%. Identified Issue(s)/Barrier(s): • MHSU Care Management scored below 95% for the following:

Care Manager monitored follow-up appointment. (89%) Care coordination was provided during the 30 day post discharge period. (89%)

Interventions: • MHSU Care Management has been realigned to include a specialized team of care managers to

follow a member from inpatient stay to the community to improve continuity of care and communication between inpatient provider, MCO and outpatient providers.

• MHSU Care Coordination is to develop a process for supervisor and/or peer review of documentation to monitor and improve the quality of care coordination notes.

• Care Coordinators will contact members who are scheduling their own appointments to verify this has occurred and document contact in member’s record.



Intellectual/Developmental Disabilities (I/DD) Care Management Intellectual and Developmental Disabilities (I/DD) Care Management is a managed care function that together, with an individual and his or her support system, makes sure that the individual is cared for in the best possible manner. Care Managers work with the member and his or her natural supports to help monitor services, make sure that assessments and Person-Centered Plans are completed, and private provider agencies deliver needed services. Partners’ QM Department completes audits of the IDD Care Management function at least annually to ensure that Care Management functions are being completed within the requirements of Partners’ policies, contractual requirements and accreditation standards. Goal(s): Achieve a score of 95% or higher for annual Audit. (EQR Standard: V.C.2, III.B.1.5)

Table 24. I/DD Care Management Audit Results

Goal FY 2019 FY 2020 Overall Audit Score 95% 85% 91% The ISP is updated/revised at least annually and effective the first day of the month following member's birth month

95% 100% 100%

Beneficiary/Participant Responsibilities form is reviewed/ signed annually

95% 83% 65%

There is documentation of Care Manager assessing needs, addressing issues/concerns and/or linking to services/supports if needed

95% 100% 100%

Care Manager monitors services at least quarterly 95% 94% 100% *Data from I/DD Care Management Audit Report

Red Font= Goal not met

Status/Evaluation: • The I/DD Care Management department scored 91% in annual audit. • Follow-up audit was completed May 2019 with an overall score of 99%.

Identified Issue(s)/Barrier(s): • IDD Care Management scored below 95% for the following:

Beneficiary/Participant Responsibilities form is reviewed/ signed annually. (65%)

Interventions: • IDD Supervisors will review the member files that are missing the Beneficiary/Participant

Responsibilities forms with the applicable Care Managers to ensure the form is updated.



Transition to Community Living Initiative (TCLI) The State of North Carolina entered into an agreement with the United States Department of Justice in 2012. The purpose was to ensure that persons with mental health issues are able to live in their communities in the least restrictive settings of their choice. Partners joined with the NC Department of Health and Human Services in implementing the agreement through the Transition to Community Living Initiative (TCLI). The Transition to Community Living Initiative has six primary components: • Providing and arranging frequent education efforts and discharge planning for individuals in adult

care homes and state psychiatric hospitals • Diverting individuals from adult care homes • Providing community-based supportive housing with assistance maintaining tenancy • Supporting employment for individuals through evidence-based services focused on preparing for,

identifying, and maintaining integrated, paid, competitive employment • Offering intensive, customized community-based services for people with mental health problems

through an evidence-based treatment and support model of services called Assertive Community Treatment

• Using data to evaluate progress and outcomes

Partners’ QM Department completes audits at least annually to ensure that Partners’ TCLI program staff are upholding the initiative’s standards within the parameters of Partners’ policies, contractual requirements and accreditation standards.

Goal(s): Achieve a score of 95% or higher for annual Audit. (EQR Standard: V.D.2)

Table 25. Transition to Community Living Initiative Audit Results Goal FY 2019 FY 2020 Overall Audit Score 95% 98% 100% There is documentation present in Alpha indicating that transition activities were completed and/or attempted (i.e. looking for housing, linking with DSS regarding Medicaid, Social Security, etc..)

95% 98% 100%

There is documentation in Alpha that member was linked or linking was attempted by Care Coordination and/or TCL Staff, with community behavioral health services if not already engaged

95% 100% 100%

If consumer has transitioned into the community, there is documentation in Alpha indicating that follow-up by Care Coordination and/or TCL Staff occurred/was attempted during the first 90 days their move

95% 100% 100%

*Data from TCLI Audit Report

Status/Evaluation: • TCLI staff scored 100% on the FY 2020 audit.


Interventions:


• As no issues or barriers were identified, no interventions were required.


H. CLINICAL PRACTICE GUIDELINES Clinical Practice Guidelines Partners uses clinical practice guidelines to help practitioners and members make decisions about appropriate health care for specific clinical circumstances. Partners Behavioral Health Management adopted the following Clinical Practice Guidelines in November 2019. The monitoring results for each aspect for each guideline is monitored monthly. The monitoring results are reported to QIC and the Clinical Advisory Committee (CAC) quarterly. Clinical Practice Guideline (CPG) 1: AACAP: Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Aspects to Track: 1. Frequency of Periodic assessment, Initial within 30 days (recommendation #12 under treatment

section, presence of a follow-up visit during the 30-day initiation phase for 6-12-year-old prescribed ADHD medication).

2. Frequency of Periodic assessment, at least two follow-up visits within 9 months after initial (recommendation #12 under treatment section, presence of at least two follow-up visits 9 months after IPSD for 6-12-year-old prescribed ADHD medication).

Table 26. Results for CPG #1

Aspects to Track Monitoring Period 1

Monitoring Period 2

Monitoring Period 3

Monitoring Period 4

Monitoring Period 5

1. Follow up visit within 30 days

39.3% 39.9% 39.4%

2. Two follow up visits within 9 months

30.3% 30.8% 32.9%

1Data from Relias Report 933 2Data from Relias Report 907 Status/Evaluation: • Aspect 1: Monitoring Period 2 (April 2020) results showed an increase of 0.6 percentage points

compared to Monitoring Period 1 (March 2020). Monitoring Period 3 (May 2020) results showed a 0.5 percentage point decrease compare to Monitoring Period 2.

• Aspect 2: Monitoring Period 2 results showed an increase of 0.5 percentage points compared to Monitoring Period 1. Monitoring Period 3 results showed an increase of 2.1 percentage points compared to Monitoring Period 2.

• Monitoring Period 1 data was presented by Partners’ Chief Medical Officer to the Quality Improvement Committee on 5/5/20. No questions or concerns voiced by the committee.


• Monitoring Periods 2 & 3 (April & May 2020) data were presented by Partners’ Chief Medical Officer to the Quality Improvement Committee on 8/4/20. No questions or concerns voiced by the committee.

Clinical Practice Guideline (CPG) 2: CDC: Guidelines for Prescribing Opioids for Chronic Pain (2016)

Aspects to Track: 1. History of Substance Use Disorder 2. Use of State Prescription Drug Monitoring Program. 3. Use of State Prescription Drug Monitoring Program



Monitoring Period 2

Monitoring Period 3

Monitoring Period 4

Monitoring Period 5

1. Use of Opioids for 60+ days w/ SUD in past year

19.8% 21.9% 22.9%

2. Use of 4 or more pharmacies for opioid prescriptions

0% 0% 0%

3. Multiple Prescribers of opioids w/o malignant cancer diagnosis

1.2% 1.1% .9%

1Data from Relias Report 883 2Data from Relias Report 853 3Data from Relias Report 886

Status/Evaluation: • Aspect 1: Monitoring Period 2 (April 2020) showed a 2.1 percentage point increase compared to

Monitoring Period 1(March 2020). Monitoring Period 3 (May 2020) showed a 1 percentage point increase compared to Monitoring Period 2.

• Aspect 2: No change in results for monitoring periods 1-3. • Aspect 3: Monitoring Period 2 showed a 0.1 percentage point decrease compared to Monitoring

Period 1. Monitoring Period 3 showed a 0.2 percentage point decrease compared to Monitoring Period 2.


• Monitoring Periods 2 & 3 (April & May 2020) data were presented by Partners’ Chief Medical

Officer to the Quality Improvement Committee on 8/4/20. No questions or concerns voiced by the committee.


Clinical Practice Guideline (CPG) 3: APA: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition (2010)

Aspects to Track: 1. Presence or absence of treatment (Depression Care Quality: Patient with a diagnosis of depression

who is not receiving treatment) 2. Quantity of treatment if receiving psychotherapy (recommendation under depression treatment,

acute phase – choice of an initial treatment modality plus detailed review and evaluation in treatment planning phase)



Monitoring Period 2

Monitoring Period 3

Monitoring Period 4

Monitoring Period 5

1. Patient with diagnosis of depression not receiving treatment

42.5% 42.9% 43.6%

2. Fewer psychotherapy sessions than recommended

48.8% 50.2% 48.6%

1Data from Relias Report 171 2Data from Relias Report 117

Status/Evaluation: • Aspect 1: Monitoring Period 2 (April 2020) results showed a 0.4 percentage point increase

compared to Monitoring Period 1 (March 2020). Monitoring Period 3 (May 2020) showed a 0.7 percentage point increase compared to Monitoring Period 2.

• Aspect 2: Monitoring Period 2 results showed a 1.4 percentage point increase compared to Monitoring Period 1. Monitoring Period 3 results showed a 1.6 decrease compared to Monitoring Period 2.


• Monitoring Periods 2 & 3 (April & May 2020) data were presented by Partners’ Chief Medical Officer to the Quality Improvement Committee on 8/4/20. No questions or concerns voiced by the committee.

I. CLINICAL MEASUREMENT ACTIVITIES Quality Improvement Projects Contractual and accreditation standards required that Partners develop and maintain Quality Improvement Projects (QIPs). These are developed and prioritized to meet the clinical and non-clinical project requirements in the DHB contract, along with current accreditation standards. Each QIP is carried out under the guidance and oversight of the MCO Chief Medical Officer (CMO). The QIP Committee is responsible for tracking QIP performance and reporting results to the Quality Improvement Committee (QIC) at least quarterly. (DHHS Contract; URAC Standard: CORE 22; NCQA Standard: QI 11B)


QIP005: Increase Opioid-Initiated Engagement of Members with Opioid Use Disorders in Services within 1-34 Days after an Assessment/Evaluation is Completed

Goal(s): • 74.5% of Non-Medicaid Individuals with opioid abuse/dependence diagnosis who initiated

treatment by evaluation/assessment had 2 or more additional services (excluding crisis services) within 1-34 days after the initial assessment or evaluation. (Target End Date: June 2020)

• 71.2% of Medicaid Individuals with opioid abuse/dependence diagnosis who initiated treatment by evaluation/assessment had 2 or more additional services (excluding crisis services) within 1-34 days after the initial assessment or evaluation. (Target End Date: June 2020)

Table 29a. Opioid Engagement QIP Measurement- Non-Medicaid

*Data from Partners Quality Improvement Project (QIP) Form *Data from QIP Reporting Form

Table 29b. Opioid Engagement QIP Measurement- Medicaid

*Data from Partners Quality Improvement Project (QIP) Form *Data from QIP Reporting Form

Status/Evaluation: • Non-Medicaid Results: There was an increase of 3 percentage points from the Jul-Sep 2019

measure to the Oct-Dec 2019 measure (most recent validated measure) but still below the 74.5% goal.

• Medicaid Results: There was an increase of 1.2 percentage points from the Jul-Sep 2019 measure to the Oct-Dec 2019 measure (most recent validated measure). 71.2% goal met for Oct-Dec 2019 measure period.


69.5%

70.0%

73.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

Quality Management Program Annual Evaluation · Annual QM Program Evaluation. The Board is kept up to date on quality improvement initiatives, at least annually, through reported

Documents