Quarterly Meeting PMHP Collaborative PIP April 4, 2012 PMHP Analysis of Improvement.

Quarterly MeetingPMHP Collaborative PIP

April 4, 2012

PMHP Analysis of Improvement

Overview

PMHPs’ assignment

PMHPs’ results

Next steps

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PMHP Assignment

1. In the most recent measurement period, if your study indicator rate improved, what do you attribute the improvement to?

2. In the most recent measurement period, if your study indicator rate declined, why do you think there was a decline?

3. Have you evaluated interventions? If so, what did you do to evaluate interventions?

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Access Behavioral Health

Demonstrated improvement for the most recent measurement period

Peer Transition Liaison intervention is credited for increases in follow-up appointment attendance

However, many of the appointments that are being kept are not within 7 days of discharge

Encounter data shows member did not attend the first weekly group therapy appointment

In some instances, the follow-up appointment the member attended was not within the 7 day period

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Access Behavioral Health cont.

Plan to implement an additional intervention strategy

Subgroup analysis revealed that the rate of members discharged from one CSU far exceeded the rate of members discharged from other facilities

The Comprehensive Behavioral Health Provider operating that CSU also provides outpatient follow-up services to most members discharged from its CSU

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Access Behavioral Health cont.

Asked that provider agency to present the provider-based intervention strategy they have applied during the ABH Quality Council (held last week during March)

To the degree that their strategy can be applied by other providers, ABH will promote the adoption of similar procedures

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Community Based Care PartnershipChild Welfare PMHP

Demonstrated improvement in the most recent measurement period

Attributed improvement to the interventions implemented during 2011

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Community Based Care PartnershipChild Welfare PMHP cont.

The main interventions were: Work plan to address barriers to improvement Concurrent review teams Three facilities fully participating in the “Bridge

Program” Outreach to Medicaid transportation services Case managers conducting “Welcome home calls” Updating and increasing the list or providers who

can give appointments quickly

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Community Based Care PartnershipChild Welfare PMHP cont.

Developed and implemented Webinars

“Provider Focus” newsletter

Increase coordination between the follow-up specialists and the PMHP to improve follow-up and coordination of care for child welfare recipients discharged from inpatient facilities and crisis stabilization units

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Community Based Care PartnershipChild Welfare PMHP cont.

Plan’s focus for 2012:

Continue Bridge Program

More evaluation to determine effectiveness of interventions

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Community Based Care PartnershipChild Welfare PMHP cont.

Interventions and barriers for improvement analyzed on an ongoing basis

Data analysts provide monthly reports

Can identify quickly if there are systematic barriers to follow-up appointments

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Community Based Care PartnershipChild Welfare PMHP cont.

Mechanisms used to quickly identify issues are:

Care Managers and Follow-up Specialists’ observations and reports

Facility score cards

Monthly evaluations of performance

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Community Based Care PartnershipChild Welfare PMHP cont.

Evaluation of interventions to reach goals held in both local and national management meetings

Includes clinical operation and public sector “core performance indicators” review meetings

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Florida Health Partners/North Florida Behavioral Health Partners

Did not demonstrate improvement for the most recent measurement period

One area’s result remained the same as the prior measurement period

The remaining areas had declines that were not statistically significant

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Florida Health Partners/North Florida Behavioral Health Partners cont.

Identified through a number of critical incidents in 2011 that additional efforts have been made on behalf of Value Options to ensure continuity of care between inpatient and outpatient providers is occurring

Value Options terminated one Network Provider effective August 2011

Identified that appropriate discharge planning and follow-up care were not occurring

Specific scenarios have been agenda items in Quality Meetings with providers

Targeted reviews and conference calls with providers for discussion

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Florida Health Partners/North Florida Behavioral Health Partners cont.

Interventions that are used on an ongoing basis: On-going discussion with network providers Care coordination with Clinical Care Managers

and Quality Department Care coordination through monthly report to

network providers Referral to Value Options Medical

Management/Intensive Care Management Program

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Florida Health Partners/North Florida Behavioral Health Partners cont.

Will continue to utilize the current interventions in addition to considering the following:

Outreach letter to non-partner/out-of-network facilities

Network provider survey/record review identifying those members with no follow-up care after discharge from a CSU

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Florida Health Partners/North Florida Behavioral Health Partners cont.

Evaluated the pre-appointment reminder call intervention

Biggest barrier to a successful intervention is the inability to contact members

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Magellan

All areas demonstrated improvement in the most recent measurement period

Attributed improvement to the interventions implemented during 2011

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Magellan cont.

The main interventions were: Work plan to address barriers to improvement Concurrent review teams Three facilities fully participating in the “Bridge

Program” Outreach to Medicaid transportation services Case managers conducting “Welcome home calls” Updating and increasing the list or providers who

can give appointments quickly

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Magellan cont.

Developed and implemented Webinars

“Provider Focus” newsletter

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Magellan cont.

Specific intervention for Area 2 was the commitment of Emerald Coast Hospital to participate in the Bridge Program

Barriers in Area 4 included difficulties reaching an agreement with the largest inpatient provider in the area

Planning specific intervention (on-site coordination activities) for Area 4 pending results of a pilot program in Area 9

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Magellan cont.

Specific intervention for Area 9:

Started in September 2011 with the collection of data on the Field Care Worker’s productivity and her interventions in the community

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Magellan cont.

Plan’s focus for 2012:

Continue Bridge Program and Peer Bridger Program

Peer Bridger Program utilizes peer specialist

Additional evaluation of areas will be conducted to determine the effectiveness of interventions

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Magellan cont.

Interventions and barriers for improvement analyzed on an ongoing basis

Data analysts provide monthly reports

Can identify quickly if there are systematic barriers to follow-up appointments

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Magellan cont.

Mechanisms used to quickly identify issues are:

Care Managers and Follow-up Specialists’ observations and reports

Facility score cards

Monthly evaluations of performance

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Magellan cont.

Evaluation of interventions to reach goals held in both local and national management meetings

Includes clinical operation and public sector “core performance indicators” review meetings

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Public Health Trust

Demonstrated improvement in the most recent measurement period

Attributed improvement to the expansion of the fast-track “Opening Doors” program

Program available at three facilities In addition, three providers are accessible to

conduct in-home comprehensive post discharge assessments

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Public Health Trust cont.

Improved working relationships with inpatient facilities

Improved aftercare coordination, more accuracy in analyzing and recording post discharge data

Increased emphasis on conducting welcome calls to members

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Public Health Trust cont.

Major intervention-fast access to care program at a single hospital

Evaluated success of the intervention by calculating rates of compliance for only those individuals assigned to this intervention

The compliance rates for this group were 98 to 100 percent

Program was rolled out to the entire group

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Next Steps

Next PMHP Collaborative PIP call is scheduled for April 25, 2012

Plans should be prepared to give an update on any progress related to their subgroup analysis

Will revisit the exclusion discussion

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