Transcript Slide 1

New York State
Behavioral Health Organizations
Summary Report, January 2012 – June 2013
NYS Offices of Mental Health and
Alcoholism and Substance Abuse Services
Phase I BHOs were Administrative Services Organizations
Charge to BHOs: conduct advisory concurrent review of
inpatient behavioral health services and facilitate treatment
and discharge planning for Medicaid FFS beneficiaries.
 New York City Region:
OptumHealth
 Hudson River Region:
Community Care Behavioral
Health
 Long Island:
Long Island Behavioral Health
Management (North Shore/Long
Island Jewish & ValueOptions)
 Central Region:
Magellan Behavioral Health
 Western Region:
New York Care Coordination
Program (with Beacon Health
Strategies)
66,719 fee-for-service admissions were reported
to BHOs between January 2012—June 2013
30000
SUD Rehab
SUD Detox
Child Mental Health
Adult Mental Health
25000
20000
15000
10000
5000
0
NYC (Optum)
HRR (Community Care)
Western (NYCCP)
Central (Magellan)
LI (LIBHM)
Data submitted by BHO
BHO Phase I Admissions
Of the 66,719 FFS admissions reported to BHOs over 18 months,
23% belonged to one or more of the following Complex Needs
populations:
1. AOT: Individuals with active Assisted Outpatient Treatment orders (involuntary outpatient
2.
3.
4.
5.
6.
7.
treatment)
Adult MH Readmissions: Adults admitted to a mental health inpatient unit who had a
previous mental health admission in the prior 30 days
Youth MH Readmissions: Youth admitted to a mental health inpatient unit who had a
previous mental health admission in the prior 90 days
SUD Readmissions: Individuals (all ages) admitted to a substance use disorder (SUD)
inpatient unit who had a previous SUD admission in the prior 90 days
Multiple Detox Admissions: High Need Inpatient Detoxification: individuals with ≥3
inpatient detox admissions in the prior 12 months
High Need Ineffectively Engaged: ≥3 inpatient/ER visits in prior 12 months OR forensic
mental health services in prior 5 years OR expired AOT order in prior 5 years, AND no
claims indicating recent community-based services
Provider-nominated
16000
Complex Needs and Non-Complex Needs Admissions
January 2012—June 2013
14000
SUD
SUDNon-Complex
Non-ComplexNeeds
Needs
SUD
SUDComplex
ComplexNeeds
Needs
12000
MH Non-Complex Needs
MH Complex Needs
10000
8000
6000
4000
2000
0
MH
SUD
NYC (Oputm)
MH
SUD
Hudson River
(Community Care)
MH
SUD
Central (Magellan)
MH
SUD
Western (NYCCP)
MH
SUD
Long Island (LIBHM)
Data submitted by BHO
Rates of admissions of individuals
who were homeless (shelter or street)
Statewide, by service type
Regional, all service types, January 2012—June 2013
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Long Island (LIBHM) NOAs: 4,873
Western (NYCCP) NOAs: 7,158
Central (Magellan) NOAs: 7,253
NYC (Optum) NOAs: 27,835
Hudson River (Community Care) NOAs: 19,602
2012 Q1
2012 Q2
2012 Q3 2012 Q4
SUD Detox
SUD Rehab
Adult MH
Child MH
All Service Types
2013 Q1
2013 Q2
Data submitted
by BHO
Individuals discharged from detox units who had
multiple prior detox admissions, April 2012—June 2013
10000
Fewer than 3 prior Detox admissions
3 or more prior Detox admissions
9000
8000
7000
6000
34% of all individuals discharged from NYC detox units
had at least 3 other detox stays in the prior 12 months
5000
4000
3000
2000
3+
3+prior
prior
admissions
admissions
1000
N=18
3+ prior
admissions
N=14
3+ prior
admissions
N=1
Central (Magellan)
Western (NYCCP)
0
NYC (Optum)
Hudson River
(Community Care)
Long Island (LIBHM)
Data submitted by BHO
Rates of hospital providers scheduling appointments with outpatient MH providers (for MH
discharges) or SUD providers (for SUD discharges) for individuals discharged to the community
Regional, all service types, January 2012—June 2013
Statewide, by service type
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
0%
Western (NYCCP) Community Discharges: 6,115
Central (Magellan) Community Discharges: 6,431
Long Island (LIBHM) Community Discharges: 4,087
Hudson River(Community Care) Community Discharges: 16,311
NYC (Optum) Community Discharges: 23,223
10%
0%
2012 Q1
2012 Q2
2012 Q3
2012 Q4
SUD Detox
SUD Rehab
Adult MH
Child MH
All Service Types
2013 Q1
2013 Q2
Data submitted
by BHO
Rates of referrals for case management/housing support
services (for individuals discharged to the community)
Regional, all service types, January 2012—June 2013
Statewide, by service type
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Western (NYCCP) Community Discharges: 6,115
Central (Magellan) Community Discharges: 6,431
Long Island (LIBHM) Community Discharges: 4,087
Hudson River (Community Care) Community Discharges: 16,311
NYC (Optum) Community Discharges: 23,223
2012 Q1
2012 Q2
2012 Q3
2012 Q4
Detox
Rehab
Adult MH
Child MH
All Service Types
2013 Q1
2013 Q2
Data submitted
by BHO
Integrated care: How often did behavioral health inpatient providers
identify general medical conditions requiring follow-up, and did
they arrange aftercare appointments?
No physical
health
condition
identified:
64%
Physical
health
condition
identified:
36%
No physical
health
appointment
made: 82%
Physical health
appointment
made: 18%
Based upon 56,167 behavioral health community discharges (all service types), January 2012—June 2013
Data submitted by BHO
Rates of inpatient providers sending case summaries to
aftercare providers (for individuals discharged to the community)
Regional, all service types, January 2012—June 2013
Statewide, by service type
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Central (Magellan) Community Discharges: 6,431
Western (NYCCP) Community Discharges: 6,115
Hudson River (Community Care) Community Discharges: 16,311
2012 Q1
2012 Q2
2012 Q3
2012 Q4
2013 Q1
2013 Q2
SUD Detox
SUD Rehab
Adult MH
Long Island (LIBHM) Community Discharges: 4,087
Child MH
NYC (Optum) Community Discharges: 23,223
All Service Types
Data submitted
by BHO
100%
90%
Post-discharge outcomes for Adult Mental Health
fee for service discharges, 2012 YTD
30-day readmission rate (32,242 CY 2012 Statewide Discharges)
Outpatient MH or SUD treatment within 7 days of discharge
(29,661 CY 2012 Statewide Discharges)
80%
Two or more MH outpatient visits within 30 days of discharge
(29,361 CY 2012 Statewide Discharges)
70%
60%
50%
40%
30%
20%
10%
0%
Western (NYCCP) Central (Magellan)
Hudson River
(Community Care)
Long Island
(LIBHM)
NYC (Optum)
Statewide
Medicaid claims data
Post-discharge outcomes for SUD
fee for service discharges, 2012 YTD
100%
90%
45-day readmission rate (34,827 CY 2012 Statewide Discharges)
80%
Lower level of SUD service or MH outpatient care
within 14 days of discharge (25,389 CY 2012 Statewide Detox Discharges)
Lower level of SUD service or MH outpatient care
within 14 days of discharge (16,101 CY 2012 Statewide Rehab Discharges)
70%
Three or more SUD lower level services within 30 days of discharge
(36,197 CY 2012 Statewide Discharges)
60%
50%
40%
30%
20%
10%
0%
Western (NYCCP)
Central (Magellan)
Hudson River
(Community Care)
Long Island (LIBHM)
NYC (Optum)
Statewide
Medicaid claims data
How do hospitals compare in rates of connection with outpatient services for
adults discharged from their inpatient mental health units?
(CY 2012 Medicaid claims data for NYC hospitals that made the most referrals)
250
100%
Number seen within 7 days
Number seen within 30 days
Number of discharges referred to clinics
Percent seen within 7 days
Percent seen within 30 days
200
90%
80%
70%
150
60%
50%
100
40%
30%
50
20%
10%
0
0%
Hospital A
Hospital B
Hospital C
Hospital D
Hospital E
Hospital F
Hospital G
Hospital H
Hospital I
Hospital J
How do outpatient clinics compare in rates of connection to outpatient
services for adults discharged from inpatient mental health units?
250
200
(CY 2012 Medicaid claims data for NYC clinics that received the most referrals)
Number seen within 7 days
Number seen within 30 days
Number of referrals received
Percent seen within 7 days
Percent seen within 30 days
100%
90%
80%
70%
150
60%
50%
100
40%
30%
50
20%
10%
0
0%
Outpatient Outpatient Outpatient Outpatient Outpatient Outpatient Outpatient Outpatient Outpatient Outpatient
Clinic A
Clinic B
Clinic C
Clinic D
Clinic E
Clinic F
Clinic G
Clinic H
Clinic I
Clinic J
BHO Phase I Summary
1. The FFS population includes many individuals with multiple treatment
and care coordination needs.
2. Rates of hospital providers communicating with outpatient providers,
scheduling aftercare appointments, and sending discharge summaries
to aftercare providers are highly variable.
3. Many admitted individuals have physical health conditions requiring
follow-up, but rates of scheduled aftercare appointments with a
physical health provider for these individuals are low.
4. This population has high rates of inpatient readmission and low rates of
continuity and engagement in post-discharge outpatient services.
5. Some of the highest volume providers have low rates of individuals
successfully transitioning to outpatient services.