ValueAdded This is the 207 th issue of our VBH-PA information update. These updates will be emailed to network providers monthly. Please feel free to share our newsletter with others, and be sure your appropriate clinical and financial staffs receive copies. Inside this issue Provider Policy Clarificaon Update ........................................ 2 Partners for Performance Improvement ................................ 3 Save the Date! Best Pracce Forum for Inpaent Providers .................. 4 Naonal Recovery Month ............. 5 Naonal Suicide Awareness Month ........................................... 5 Adherence to Anpsychoc Medicaons for Individuals with Schizophrenia ................................ 6 Save the Date! “Acknowledging The Journey” ................................. 7 Updated Services Webpage ......... 7 VBH-PA Receives NAMI Walks Award ........................................... 7 Join Us! 10th Annual Family Forum ................................ 8 2016 CAMP “T.A.A.G.” Picnic ........ 10 Vol. 18 Issue 9 September 2016 Notification of Change in Access to Services Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA) by calling their Provider Field Coordinator or through notification in writing by mail, email or facsimile to 1-855-541-5211 (attention Provider Relations Department) upon the occurrence of any of the following: 1. Inability to provide emergent care within one hour, urgent care within 24 hours, or routine care within seven days. 2. Usage of alternative provider coverage in any situation when unable to treat VBH-PA members in active treatment, e.g. vacation. 3. When reaching full (100%) capacity. Full capacity is considered the point at which the provider is unable to meet the access standards noted above or is unable to accept referrals for a particular level of care. Notices for full (100%) capacity should contain the reason for reaching capacity, the effective date, and the steps the provider will take to resume functioning at normal capacity. 4. The inability to provide any portion of a prescribed service, e.g. BHRS. Network providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for- service if the provider serves only Medicaid members. You may find this information in our online Provider Manual: http://www.vbh-pa.com/provider/info/prvmanual/4_PartPrvResp/ notification_change_access_svcs.htm
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ValueAdded - Beacon Health OptionsTable 1 shows the average of the 2015 and 2016 chart reviews conducted at the four inpatient facilities (30 charts per facility). Chart Review Results
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ValueAdded
This is the 207th issue of our VBH-PA information update. These updates will be
emailed to network providers monthly. Please feel free to share our newsletter
with others, and be sure your appropriate clinical and financial staffs receive
copies.
Inside this issue
Provider Policy Clarification Update ........................................ 2 Partners for Performance Improvement ................................ 3 Save the Date! Best Practice Forum for Inpatient Providers .................. 4 National Recovery Month ............. 5 National Suicide Awareness Month ........................................... 5 Adherence to Antipsychotic Medications for Individuals with Schizophrenia ................................ 6 Save the Date! “Acknowledging The Journey” ................................. 7 Updated Services Webpage ......... 7 VBH-PA Receives NAMI Walks Award ........................................... 7 Join Us! 10th Annual Family Forum ................................ 8 2016 CAMP “T.A.A.G.” Picnic ........ 10
Vol. 18 Issue 9 September 2016
Notification of Change in Access
to Services
Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA)
by calling their Provider Field Coordinator or through notification in writing by
mail, email or facsimile to 1-855-541-5211 (attention Provider Relations
Department) upon the occurrence of any of the following:
1. Inability to provide emergent care within one hour, urgent care within 24
hours, or routine care within seven days.
2. Usage of alternative provider coverage in any situation when unable to
treat VBH-PA members in active treatment, e.g. vacation.
3. When reaching full (100%) capacity. Full capacity is considered the point
at which the provider is unable to meet the access standards noted above
or is unable to accept referrals for a particular level of care. Notices for full
(100%) capacity should contain the reason for reaching capacity, the
effective date, and the steps the provider will take to resume functioning at
normal capacity.
4. The inability to provide any portion of a prescribed service, e.g. BHRS.
Network providers must offer hours of operation that are no less than the hours
of operation offered to commercial members or comparable to Medicaid fee-for-
service if the provider serves only Medicaid members. You may find this
Adherence to Antipsychotic Medications for Individuals with
Schizophrenia: Goals Met Within First Year of Study
Gateway HealthSM and VBH-PA are collaborating on an initiative to increase medication adherence for our shared members
with schizophrenia who are prescribed antipsychotic medications. An article published in the World Journal of Psychiatry in
2012 estimated that non-adherence rates in schizophrenia are about 50%, and of the over $10 billion annual cost of
schizophrenia, 40% was observed to be attributed to non-adherence. (Acosta FJ, et al. Medication Adherence in
Schizophrenia. World J Psych. 2012; 2(5):74-82 [NCBI]).
Upon review of prescription and refill history, members are identified for an educational mailing who may be less than 80%
adherent based on the proportion of days covered for their antipsychotic medications. The reasons for non-compliance are
varied and can depend on the many factors which influence the strategies for improving adherence. We have developed a list
of tips for your reference to address non-adherence with your patients (Table 1).
Reason for Poor Medication Adherence Possible Tools and Strategies for Addressing
Adherence Barriers
Cognitive factors (such as poor memory, difficulty understanding, etc.)
Encourage patients to sign up for automatic refills at their pharmacy
Set up an alarm; place post-it notes around the house
Use a pill box
Internal beliefs about medicine Provide simple, patient-friendly education about the disease state and why the medication is important to take
Consider cultural, spiritual, and religious beliefs that may impact treatment plans
External system and health barriers Adverse event—education on best ways to take medication to avoid unnecessary adverse events/side effects or change to a medication that is better tolerated
Complicated regimens—look for ways to simplify or use pill boxes
Table 1
Please consider using this information to reach out to your members if they have not been into the office recently to see you
or to initiate a conversation with them at their next visit about the importance of taking their medications. Please also
explore the potential cause of their non-adherence and develop a plan together to address the main causes.
Did You Know?
Many retail pharmacies offer automatic refills. Remind your patients to take advantage of this service.
If patients have trouble getting to the pharmacy there are sometimes free delivery programs available. Refer your
patients to their retail pharmacist.
Open communication with your patients’ other providers can help with medication reconciliation. If you are not a
particular patient’s PCP, consider reviewing the medical chart together with the PCP.
As part of the statewide improvement project, one of the measures to be analyzed included adherence to antipsychotic
medication for individuals with schizophrenia. The network-wide average, set back in 2014, indicated that only 57% of our
members had an 80% or higher compliance rate (Figure 1).
Article continued on page 9.
7 ValueAdded—September 2016
VBH-PA Receives NAMI Walks Award for
Being in the Top Ten Fundraisers
Upcoming BHRS Summits
(Your choice of two
locations per month.)
September 9 —
Hampton Inn & Suites
Mercer, PA
September 16 —
Courtyard by Marriott
Greensburg, PA
December 2 —
Courtyard by Marriott
Greensburg, PA
December 9 —
Hampton Inn & Suites
Mercer, PA
Upcoming RTF Summits
Friday, October 7th
9:00 a.m.—11:00
a.m.
Location:
Doubletree by Hil-
ton
910 Sheraton Drive,
Mars, PA 16046
View all of our
upcoming trainings
on the Provider
Trainings webpage:
http://www.vbh-
pa.com/provider/
prv_trn.htm
At the NAMI Walks kick-off luncheon on August 24th, VBH-PA
was awarded a special certificate for their hard work and dedication
in support of NAMI Walks. Specifically, we were in the Top Ten
Team Fundraisers for the first time in our history! Go Team VBH-
PA! We are looking for a similarly successful Walk this year on
Sunday, October 2nd at the Waterfront in Homestead. Sue Klaus,
PE&O Manager and our team leader, accepted the award and will be
organizing our team this year. This is NAMI SWPA’s 10th
anniversary. Support NAMI’s mission by walking and raising funds
for this great organization. Visit their website at: http://
www.namiwalks.org.
All are welcome—adult members, family members, County staff, provider staff and anyone
interested in learning more about how people with mental illness recover!
Save the Date!
Thursday, November 10, 2016
Registration begins at 8:00 a.m.
9:00 a.m. — Child Services Sessions
Noon — Exceptional Individual and Parent Awards Luncheon
1:45 p.m. — Adult Services Sessions
More information and registration coming soon!
Please consider nominating an Exceptional Individual (Adult) and/or an Exceptional Parent/
Caregiver for the Annual Awards Ceremony. Contact Shelley Thomas with any questions you
may have regarding nominations. Nomination forms will be available soon! If you are
interesting in exhibiting at this year’s forum, please email Shelley Thomas at