Transcript WRBHO BEST - Care Coordination
WRBHO BEST Meeting & Quarter Three Performance Report Presentation Chautauqua & Cattaraugus Counties December 12, 2012
WRBHO BEST Meeting Agenda
I. Introductions and Key Findings
• •
II. Q3 Regional Overview
Regional Overview of all domains Role of the BHO in supporting Health Homes • •
III. Q3 Sub-Regional Review (compared to the region)
Review of key metrics tied to the “Effective Linkages” domain for the sub-region Discuss information to determine what it means to those in attendance (Are there opportunities for improvement?) • •
IV. Effective practices presentations
Trish McClennan, WCA Hospital : Peer and Family Supports Intro to Consumer Centered Family Consultation and opportunity for technical assistance
V. Identify areas of focus for improving sub-region BH system of care
•
VI. Next steps
Would a Learning Collaborative be helpful?
2
Presenters
• • • •
Adele Gorges, Executive Director, NYCCP Anne Wilder, President, CCSI John Lee, WRBHO Program Director, Beacon Christine Mangione, WRBHO Manager of Clinical Operations, Beacon
•
Elisabeth Hager, MD, Physician Advisor, Beacon
3
INTRODUCTION & KEY FINDINGS
4
Introduction
– – Q3 Performance Report Organization: Domains Metrics within each domain (Data Sources: BHO data collection and OMH BHO Portal) 5
The 5 Performance Metric Domains
Performance Domain 1: Coordination with the BHO Performance Domain 2: Person-Centered Care Coordination during the Inpatient Stay Performance Domain 3: Linkages to After Care Services Performance Domain 4: Continuity of Care Performance Domain 5: Engagement in Care
6
• • • • •
Highlights of WRBHO Findings
•
Observed changes that support transformation
:
Improved provider performance within the WRBHO’s 19 county region – 6 out of 8 metrics within the Performance Domain: Linkage to After Care Services, reflect improvement: Q2 to Q3. – A number of OMH BHO Portal metrics reflect performance in WNY that exceeds the Statewide rates: outpatient visits, readmission rates.
County MH Directors convening meetings to engage providers about the changes that need to take place to prepare for BH Managed Care.
Facility COO expressing appreciation that the State is monitoring data to assess the ability of providers to work as a system of care.
MH inpatient providers expressing interest in learning how to be more effective in linking patients with PH providers.
Facility discharge planners requesting help from the WRBHO in securing housing for a patient, recognizing impact on avoidance of readmissions.
Providers devoting a full day to listen to feedback from those with a inpatient psychiatric experience (The WRBHO forums) 7
REGIONAL & PROVIDER PROFILE PERFORMANCE REPORTS
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Performance Domain 1 – Coordination with the RBHO
Domain includes measures helpful in ensuring complete and timely data report and review practices • • •
Metrics:
The number of Notices of Admission submitted by providers is consistent with established targets Notices of Admission are received within 24 hours of admission Initial Reviews are completed within 72 hours of admission 9
Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(a):
Data Source: Metric Calculation:
The number of Notices of Admission (NOAs) received is consistent with established targets
Data on NOAs provided through the eServices Portal / data gathered by WRBHO staff via telephone. Data on 2011 fee-for-service admissions provided by the NYS Office of Mental Health Total Admissions Noticed for Period / Total FFS Medicaid Admission Reported for Period
Inpatient Admission Type
Mental Health Adult Mental Health Youth
Mental Health Total
Substance Use Detox Adult
# of Admissions Noticed to WRBHO: Q1
816
# of Admissions Noticed to WRBHO: Q2
828
# of Admissions Noticed to WRBHO: Q3
849
Total # of Admissions Noticed through Q3
2493
Total Admissions through Quarter 3 2011* % of Target (2011)
192
1008
128 164
992
72 157
1006
64 513
3006
264
4268
987
70.40%
26.70% Substance Use Inpatient Rehab Adult
Substance Use Total TOTAL
383
511 1519
264
336 1328
267
331 1337
914
1178 4184
2443
3430 7698
37.40%
34.30% 54.35%
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Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(b): Data Source: Metric Calculation: Notices of Admission are Received within 24 Hours of Admission
Data gathered via phone by WRBHO clinician or e-portal entry # of NOAs received within 24 hours of admission/Total admissions noticed in reporting period
Inpatient Admission Type Mental Health Adult Total admissions for current quarter
849
NOAs within 24 NOAs within 24 hours for current quarter hours/admissions for current quarter
829 97%
Provider range for current quarter
78 - 100%
NOAs within 24 hours for previous quarter
95%
Variance: Current vs. Previous Quarter
2%
Mental Health Youth Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total
157 64 267
1337
156 58 253
1296
99% 90% 94%
96%
93 - 100% 81 - 100% 87 - 100%
78 - 100%
98% 98% 89%
94%
1% -8% 5%
2%
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Performance Domain 1 – Coordination with the WRBHO
Performance Metric 1(c): Data Source: Metric Calculation: Initial Reviews are Completed within 72 Hours of Admission
Gathered via phone by WRBHO clinician Initial Reviews within 72 Hours of admission/Total admissions in reporting period
Inpatient Admission Type Mental Health Adult Mental Health Youth Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total Total Admissions: Current Quarter
849
# of Initial Reviews w/in 72 hours: Current Quarter Initial Reviews w/in 72 hours / Total Admissions: Current Quarter
805 94%
Provider Range: Current quarter
52 - 100%
Initial Reviews w/in 72 hours / Total Admissions: Previous Quarter
83%
Variance: Current vs. Previous Quarter
11% 157 64 267
1337
146 55 209
1215
92% 85% 78%
90%
77 - 100% 53 - 96% 38 - 100%
38 - 100%
85% 94% 67%
80%
7% -9% 11%
10%
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Performance Domain 2 – Person-Centered Care Coordination During the Stay
• • Domain includes metrics that describes the extent to which effective, person-centered care coordination practices during the inpatient stay are evident. Particular interest in efforts to ensure that the individual’s needs have been identified so that an effective discharge plan can be developed. Additional metrics will be added under this domain over time.
•
Metric:
Treatment history is shared with the inpatient provider during the Initial Review 13
Performance Domain 2 – Person-Centered Care Coordination During the Stay Performance Metric 2(a): Data Source: Metric Calculation: Treatment History is Shared with the Inpatient Provider during the Initial Review
Data recorded in FlexCare by WRBHO Clinician Discharges w/Treatment History Shared/Total Discharges in Reporting Period
Inpatient Admission Type Mental Health Adult Total Discharges: Current Quarter # of Discharges w/Treatment History Shared: Current Quarter
842 720
% of Discharges w/Treatment History Shared: Current Quarter
85%
Provider Range: Current Quarter % of Discharges w/Treatment History Shared: Previous Quarter Variance: Current vs. Previous Quarter
55 - 100% 80% 5%
Regional Year To-Date
83%
Mental Health Youth
152 136 89% 70 - 100% 80% 9% 86% 66 54 81% 80 - 100% 84% -3% 82%
Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total
267
1327
242
1152
90%
86%
81 - 100%
55 - 100%
74%
79%
16%
7%
85%
84%
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Performance Domain 2 – Person-Centered Care Coordination During the Stay Performance Metric 2(a): Treatment History is Shared with the Inpatient Provider during the Initial Review WRBHO Actions:
Staff supervision will continue to reinforce the expectation that treatment history be shared in every initial review, as going forward this will be the mechanism for identifying Complex vs. Non-Complex individuals in conjunction with the initial review.
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Performance Domain 3 – Linkages to After-Care Services
Domain includes metrics that measures the extent to which steps were taken during the inpatient stay to establish linkages to needed outpatient services.
• • • • • • • •
Metrics:
The current or prior mental health outpatient provider was contacted during stay An appointment for mental health outpatient treatment was scheduled as part of the discharge plan The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
A SPOA application was submitted for case management, housing and other services For youth with multi-system needs, the discharge plan includes referrals /linkages for the provision of basic needs For youth with multi-system needs, the discharge plan documents post discharge educational needs There is improvement in housing status for individuals who are homeless at admission
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Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summaries
• • • Higher performing providers Fall in the top 25% for the performance metric 8 or more discharges during the quarter Data collection process for Q3 was viewed as an accurate reflection of the providers’ work by the WRBHO Utilization Review Clinician.
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Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(a): Data Source: Metric Calculation: Inpatient Admission Type Mental Health Adult The current or prior mental health outpatient provider was contacted during stay
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period
Total Discharges: Current Quarter # Where Outpatient Provider was Contacted During the Stay: Current Quarter % Where Outpatient Provider was Contacted During the Stay: Current Quarter
842 662 78%
Provider Range: Current Quarter
49 - 100%
Where Outpatient Provider was Contacted During the Stay: Previous Quarter
64%
Variance
14%
Mental Health Youth Total
152
994
140
802
92%
81%
71 - 100%
49 - 100%
84%
68%
8%
13%
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Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(a): Data Source: Metric Calculation: The current or prior mental health outpatient provider was contacted during stay
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period
Inpatient Admission Type Provider Average Provider range Higher Performing Providers Adult Mental Health
78% 49 - 100% D L P
Youth Mental Health
92% 71 - 100% 19
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay
• • • •
Best Practices:
Gathers collateral information from outpatient provider and is linked closely with other outpatient agencies.
Attempts to keep MH clients within their system of care, which appears to help with continuity of care.
Is protocol that the Discharge Planner notifies outpatient provider of individuals admitted (once identified) and shares appropriate collateral information. Has a “no wrong door” philosophy and offers co-existing treatment with mental and physical health providers in close proximity of each other. Encourages effective communication . 20
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay
• • •
Barriers:
Gaps in communication between UR clinicians and discharge planners.
The practice is not built in to standard facility procedures.
The treatment team does not reach out to current or active providers to collaborate and work together towards the recovery of patients. 21
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay
• • • •
WRBHO Actions:
Clarified meaning of the indicator during one-on-one provider meetings through issuing a new review template and holding provider calls. WRBHO System of Care Transition Coordinator’s role redefined to include contacting outpatient providers when an active client has been admitted and encouraging follow-up. This outreach continues to encourage contact between inpatient and outpatient providers. Focused on the importance of the transition to outpatient treatment during the February and June BEST Meetings.
Effective linkage to after care services was the theme during the September 27 BEST Meeting. 22
Performance Domain 3 – Linkages to After-Care Services VIGNETTE:
Linking with Past Supports to Avoid Future Readmissions
On August 31, 2012 a 51 year-old man was mental hygiene arrested after he was found lying in the road with suicidal ideation. His diagnoses included: Psychosis Not Otherwise Specified and Paranoid Schizophrenia. The individual was observed as grandiose, paranoid, delusional and unkempt. The treatment history indicated that the individual had been discharged from the facility just three days earlier. It was also noted that the he had an apartment, but little to no supports. In addition, the individual had no current outpatient providers. Through use of PSYCKES the WRBHO Utilization Review Clinician (URC) learned that the individual had a history with the ACT team through the local psychiatric center. It also appeared likely that he was not taking his current medications. Due to his limited supports, the WRBHO URC recommended that the inpatient provider explore reestablishing the linkage with the ACT team. The provider accepted this recommendation. The individual was discharged home to his apartment and the ACT Team followed up within a very few days of the discharge. By reviewing the treatment history in PSYCKES, the WRBHO URC was able to identify a past support and encourage a linkage that will assist the beneficiary in living successfully and securely in his own apartment.
23
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(b): Data Source: Metric Calculation: An appointment for mental health outpatient treatment was scheduled as part of the discharge plan
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges in Reporting Period
Inpatient Admission Type Mental Health Adult Total Mental Health Discharges: Current Quarter An Appointment for MH Treatment was Part of the Discharge Plan: Current Quarter (#) An Appointment for MH Treatment was Part of the Discharge Plan: Current Quarter (%)
842 641 76%
Provider Range: Current Quarter
0 - 100%
An Appointment for MH Treatment was Part of the Discharge Plan: Previous Quarter
81%
Variance: Current vs. Previous Quarter
-5%
Mental Health Youth
152 108 71% 0 - 100% 70% 1%
Total 994 749 75% 0 - 100% 79% -4%
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Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(b): An appointment for mental health outpatient treatment was made as part of the discharge plan
• • • • • •
Best Practices:
Strong ties to the system’s array of outpatient services facilitate effective communication and efficient scheduling.
Follow a person-centered, thorough and comprehensive discharge planning process. Connecting with outpatient treatment is a standard practice for those individuals not transferring to another facility for inpatient rehabilitation (SUD).
Standard operating practice to ensure linkage with a community- based provider prior to discharge. Intake coordinator assigned to client and follows him or her from inpatient to discharge. Outreach is performed if the aftercare appointment is missed.
25
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(b): An appointment for mental health outpatient treatment was made as part of the discharge plan
• •
Barriers:
In instances where the individuals do not have an outpatient provider at the time of admission, this process is more difficult to accomplish during the inpatient stay.
Lack of outpatient capacity is a barrier in some areas. 26
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(b): An appointment for mental health outpatient treatment was scheduled as part of the discharge plan WRBHO Actions:
• During September 27 BEST Meeting, providers shown to be successful in scheduling outpatient appointments spoke about their practices. • December BEST meeting will focus on sharing practices in place at providers having success with individuals leaving inpatient care with a outpatient mental health appointment scheduled. • WRBHO staff will follow-up directly with providers with lower performance in this area to further define barriers and identify solutions.
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Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (c): Data Source: Metric Calculation: The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period
Inpatient Admission Type Mental Health Adult Mental Health Youth Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total Total Discharges: Current Quarter
842
Case Summary was Sent to the Outpatient Provider: Current Quarter (#) Case Summary was Sent to the Outpatient Provider: Current Quarter (%)
555 65%
Provider Range: Current Quarter
0 - 100%
Case Summary was Sent to the Outpatient Provider: Previous Quarter (%)
65%
Variance: Current vs. Previous Quarter
0% 152 66 267
1327
92 28 116
791
60% 42% 43%
59%
40 - 100% 22 - 61% 9 - 83%
0 - 100%
52% 44% 35%
56%
8% -2% 8%
3%
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Performance Domain 3 – Linkages to After-Care Services Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider
Best Practices:
• • • Standardized practice has been implemented to submit the discharge summary so the outpatient provider is aware of the discharge diagnosis, GAF, and medications/instructions.
It is a standard operating practice that when a patient signs a release, case summaries are sent to the outpatient provider. If patient initially declines, staff will discuss with the patient the need to send the summary for good continuity of care.
Provider has effective linkages to outpatient programs in their organization’s system of care. 29
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider
• • •
WRBHO Actions:
Confusion existed as to what constituted a “case summary.” WRBHO clarified definition: Discharge instructions which include dates of admission, discharge diagnosis, and medication list. Definition shared with providers and the WRBHO UR Clinicians are using this definition in their reviews. We anticipate that we will continue to see improvement on this important dimension.
30
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (d): Data Source: Metric Calculation: Inpatient Admission Type Mental Health Adult A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO Discharges w/physical health appointment scheduled with an outpatient provider/discharges w/physical health need identified during inpatient stay for reporting period
Total Discharges w/Physical Health Needs Identified: Current Quarter
279
# w/Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Current Quarter % w/ Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Current Quarter
110 39%
Provider Range: Current Quarter
0 - 100%
% w/ Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Prior Quarter
21%
Variance: Current vs. Previous Quarter
18%
Mental Health Youth
12 6 50% 0 - 100% 25% 25%
Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total
25 49
365
5 27
148
35% 55%
40%
0 - 100% 0 - 100%
0 - 100%
8% 14%
19%
27% 41%
21%
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Performance Domain 3 – Linkages to After-Care Services Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
• • •
Best Practices:
Facility goal is to ensure that all patients are well connected to all areas of health care - both mental and physical.
Provider has a protocol requiring the case manager to link the patient with a Primary Care provider if the patient is admitted without one. The provider has developed relationships with two PCP practices to help expedite creating this very important link.
Provider strives to connect clients to previous primary care providers, if none have been established, they refer clients to the county system. The County provides a list of accepting physicians.
32
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
• • •
Barriers:
The responsibility is placed on the individual to follow up with their primary care physician after discharge.
Some facilities have procedures that focus on SUD and mental health outpatient appointments only (not physical health). Many individuals admitted do not have a primary care provider and inpatient staff says that it is too hard to link the individuals with a PCP during the inpatient stay.
33
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
• • •
WRBHO Actions:
Developed a template for inpatient providers that details the rationale and offers a definition of this (and other) metric(s). Template reviewed with inpatient providers via webinar. WRBHO Utilization Review Clinicians engaged in a thorough review of all questions contained in the review cycle to be better prepared to extract more accurate information from the providers during these reviews. WRBHO will continue to work to identify effective practices for integrating physical health engagement into the behavioral health admissions through surveying providers for effective practices and sharing strategies via BEST Meetings and other provider forums.
34
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(e): Data Source: Metric Calculation: A SPOA Application was Submitted During the Inpatient Stay
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool Faxed to the WRBHO # of SPOA Applications Submitted/# of Discharges in Reporting Period
Inpatient Admission Type Mental Health Adult Mental Health Youth Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total Total Discharges: Current Quarter
842
# of Discharges w/SPOA Application Submitted: Current Quarter
104
% of Discharges w/SPOA Application Submitted: Current Quarter
12%
Provider range for current quarter
0 - 66%
% of Discharges w/SPOA Application Submitted: Previous Quarter
9% 152 66 267
1327
30 1 5
140
19% 4% 1%
10%
0 - 100% 0 - 33% 0 - 9%
0 - 100%
19% 2% 1%
8% Variance: Current vs. Previous Quarter
3% 0% 2% 0%
2%
35
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(e): A SPOA Application was Submitted during the Inpatient Stay
•
Best Practices:
Overall, SPOA referrals are made for 12% of adults discharged from inpatient care and 19% of youth. However, the range varies considerably, with several providers reporting much higher referral rates. Based on interactions with providers, we have identified a few practices that appear to be proving successful: • SPOA “consultant” from the county is placed on each unit to help identify and assist discharge planners with application process.
• Provider uses a team approach in working with the patient. That is, the discharge planner, the social worker/therapist and the MD/NPP all meet together with the patient to assist in determining needs for a successful transition.
36
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(e): A SPOA Application was Submitted during the Inpatient Stay Barriers:
• • • Lack of SPOA services (care management) to support the needs of those with SU diagnosis.
• • SPOA review processes occur on a monthly basis only in some counties.
• Inpatient facilities will start process if needed but rely on outpatient services to finish the referral.
WRBHO Actions: The WRBHO has begun to work with county directors to assess the interest in developing greater consistency in SPOA processes.
WRBHO UR Clinicians have been oriented to county specific SPOA processes so that they are in a better position to support the providers’ needs in each county.
WRBHO UR Clinicians have been encouraged to support specific SPOA requests by helping with the application or even attending SPOA meetings to represent the needs of the individual and the provider. 37
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(f): Data Source: Metric Calculation: For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic needs
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges with Indication that Basic Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period
Inpatient Admission Type Mental Health Youth # of Youth w/Multi Systems Needs Identified: Current Quarter # of Youth w/Indication that Basic Needs were Addressed: Current Quarter % of Youth w/Indication that Basic Needs were Addressed: Current Quarter
95 94 98%
Provider Range: Current Quarter
87 - 100%
% of Youth w/Indication that Basic Needs were Addressed: Previous Quarter
98%
Variance: Current vs. Previous Quarter
0% 38
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3(f): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic needs
• • • •
Best Practices:
Discharge planning is comprehensive and involved all outside agencies.
Weekly team meetings are held for the interdisciplinary team and UR team.
On-site team member meetings. Provider gathers collateral information from outpatient providers and is very knowledgeable about resources that are available in the community.
39
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3 (g): Data Source: Metric Calculation: For youth with multi-systems needs, the discharge plan documents post-discharge educational needs
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges with Indication that Educational Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period
Inpatient Admission Type Mental Health Youth # of Youth w/Multi Systems Needs Identified: Current Quarter
95
# of Youth w/Indication that Educational Needs were % of Youth w/Indication that Educational Needs Addressed: Current Quarter were Addressed: Current Quarter
84 88%
Provider Range: Current Quarter
0 - 100%
% of Youth w/Indication that Educational Needs were Addressed: Previous Quarter
93%
Variance: Current vs. Previous Quarter
-5% 40
Performance Domain 3 – Linkages to After-Care Services
Provider Profile Summary
Performance Metric 3 (g): For youth with multi-systems needs, the discharge plan documents post-discharge educational needs Best Practices:
Supporting the multi-system needs of children requires very comprehensive planning, involving a number of outside agencies in regular interdisciplinary team meetings. Higher performing providers have made school programming mandatory for children and youth.
41
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(f) and (g): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic and educational needs
•
WRBHO Actions:
WRBHO staff will review these measures with providers following the release of the Q3 data to ensure that data collection and reporting accurately reflect current practice. • A Clinical Grand Rounds scheduled for 2013 will focus on children’s services and will be presented by the WRBHO Child Psychiatrist, Mario Testani. Dr. Testani will spend a portion of his presentation discussing the importance of addressing educational needs.
42
Performance Domain 3 – Linkages to After-Care Services
Regional Report
Performance Metric 3(h): Data Source: Improvement in housing status for individuals who are homeless at admission
Gathered by WRBHO clinician during review
Metric Calculation:
# of Discharges w/Improved Housing Status/# of Discharges that were Homeless at Admission for Reporting Period
Inpatient Admission Type Mental Health Adult Total # Homeless at Admission: Current Quarter Improvement in Housing Status for Individuals Homeless at Admission: Current Quarter (#) Improvement in Housing Status for Individuals Homeless at Admission: Current Quarter (%)
63 20 31%
Provider Range: Current Quarter
0 - 100%
Improvement in Housing Status for Individuals Homeless at Admission: Previous Quarter (%)
20%
Mental Health Youth
No Data No Data No Data No Data 100%
Substance Use Detox Adult Substance Use Inpatient Rehab Adult Total
7 24
94
1 16
37
33% 66%
39%
0 - 50% 0 - 100%
20 - 100%
No Data 68%
30% Variance
11% No Data No Data -2%
9%
43
Performance Domain 3 – Linkages to After-Care Services Performance Metric 3(h): Improvement in housing status for individuals who are homeless at admission
• • • •
WRBHO Actions:
As access to stable housing is critical to achieving recovery this measure has been an area of focus in our review and discussion of both system and provider performance. WRBHO UR clinicians have been asked to encourage providers to work diligently to address this need for cases we review. WRBHO staff has also worked with county SPOAs to support an expedited review for inpatients, especially those in need of housing. Providers have been encouraged to begin the housing planning process for individuals admitted as homeless as soon as they are admitted. 44
Performance Domain 4 – Continuity of Care
• Domain includes metrics that look at the extent to which individuals are connected to outpatient mental health services following discharge from inpatient – as well the timeliness of that connection. Utilize data collected by WRBHO and data available through BHO Portal.
• • • •
Metrics:
The percentage of scheduled Mental Health clinic outpatient appointments attended (WRBHO collected) The percentage of Mental Health Discharges followed by an outpatient visit for Mental Health treatment within 7 days (BHO Portal) The percentage of SUD Detox discharges with lower level SUD services with 14 days (BHO Portal) The percentage of SUD rehabilitation discharges with lower level SUD services within 14 days (BHO Portal) 45
Performance Domain 4 – Continuity of Care Performance Metric 4(a): Data Source: Metric Calculation: Percentage of scheduled Mental Health clinic outpatient appointments attended
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Outpatient Licensed Mental Health Clinic Appointments Attended Post-Discharge / # of Outpatient Mental Health Appointments Attended / Total # of Outpatient Mental Health Appointments Scheduled
Inpatient Admission Type Mental Health Adult # of Outpatient Mental Health Appointments Scheduled: Current Quarter
286
# of Outpatient Mental Health Appointments Attended: Current Quarter
232
% of Outpatient Mental Health Appointments Attended: Current Quarter
81%
Provider Range: Current Quarter % of Outpatient Mental Health Appointments Attended: Previous Quarter Variance: Current vs. Previous Quarter
52-100% 79% 2%
Regional Year To-Date
80%
Mental Health Youth
37 30 81% 0 - 100% 85% -4% 84%
Total 320 262 81% 52 - 100% 80% 1% 80%
46
Performance Domain 4 – Continuity of Care Performance Metric 4(a): Percentage of scheduled Mental Health clinic outpatient appointments attended
• • •
WRBHO Actions:
WRBHO clinicians gather these data through follow-up w/identified the outpatient mental health providers. • WRBHO follow-up takes place for up to 60-days post discharge (or until there can be confirmation of either attendance or a “no show.”) Complements data available from the BHO Portal by providing a more timely way for staff to monitor the rate at which individuals are attending their outpatient mental health appointments. WRBHO focus will be on identifying barriers to after care attendance and strategies providers are finding effective in increasing attendance.
47
Performance Domain 4 – Continuity of Care Performance Metric 4 (b): Percentage of MH Discharges Followed by an Outpatient Visit for MH Treatment within 7 Days Data Source:
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals receive outpatient mental health treatment within 7 days of discharge from a mental health inpatient hospitalization.
Inpatient Admission Type Mental Health Adult Mental Health Youth Western Region: Q1 2012 Western Region: Q4 2011 Variance: Current vs. Previous Quarter Statewide: Q1 2012
44.8% 45.9% 1% 34.7%
Variance: Western Region vs. Statewide
10.1% 44.3% 48.1% -4% 38.6% 56% 48
Performance Domain 4 – Continuity of Care Performance Metric 4 (c): Data Source: Percentage of SUD Detox Discharges Followed by a Lower Level SUD Service within 14 Days
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals receive a lower level, less intensive, substance use disorder service within 14 days following a discharge from an inpatient substance use treatment.
Inpatient Admission Type Substance Use Detox Adult Substance Use Inpatient Rehab Adult Western Region: Q1 2012 Western Region: Q4 2011 Variance: Current vs. Previous Quarter Statewide: Q1 2012
58.1% 50.5% 7.5% 33.1%
Variance: Western Region vs. Statewide
25% 47.7% 47.7% 0% 39.5% 8.2
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Performance Domain 5 – Engagement in Care
• •
Metrics
% of Mental Health discharges followed by 2 or more MH outpatient visits within 30 days (BHO Portal) % of SUD Detox or Rehabilitation services followed by 2 or more SUD services within 14 days of discharge (BHO Portal) 50
Performance Domain 5 – Engagement in Care Performance Metric 5(a): Data Source: Metric Definition: Percentage of MH Discharges Followed by Two or More MH Outpatient Visits within 30 Days
NYS OMH BHO Portal Received two or more outpatient mental health visits within thirty days of discharge.
Inpatient Admission Type Mental Health Adult Mental Health Youth Western Region: Q1 2012 Western Region: Q4 2011 Variance: Current vs. Previous Quarter Statewide: Q1 2012
42.6% 40.9% 1.7% 31.9%
Variance: Western Region vs. Statewide
10.7% 48.9% 49.6% -.7% 43.3% 5.6% 51
Performance Domain 5 – Engagement in Care Performance Metric 5 (b): Data Source: Percentage of SUD Detox or Rehabilitation Discharges Followed by Two or More Lower Level SUD Services within 14 Days of Discharge
NYS OMH BHO Portal
Metric Definition:
Frequency with which individuals discharged from inpatient detoxification or chemical dependence inpatient rehabilitation engage in 2 or more lower level substance use disorder treatment services within fourteen days of discharge.
Inpatient Admission Type Substance Use Adult Western Region: Q1 2012 Western Region: Q4 2011 Variance: Current vs. Previous Quarter Statewide: Q1 2012
32.2% 32.5% -.3% 21.4%
Variance: Western Region vs. Statewide
10.8% 52
WRBHO ROLE IN HEALTH HOMES
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Role of the WRBHO in Supporting Health Homes
• Notify inpatient providers when an admitted individual being reviewed by the WRBHO is enrolled in a Health Home or eligible for Health Home outreach • Ensure the provider has contact information for the Health Home care coordinator.
• Contact Health Home care coordinators to review and assist with post-discharge follow-up as needed.
• Share past treatment history as found in PSYCKES and FlexCare • Alert Health Home when Health Home member is admitted.
• Support community referrals to Health Homes 54
SPECIAL /COMPLEX NEEDS POPULATION
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Admissions for Individuals with Complex Needs: Q3
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Complex Needs Population
• • • •
Special Study
Detox Clients who Leave Against Medical Advice:
NYS has identified an area of interest and concern related to improving care coordination for individuals admitted to SUD detox who leave against medical advice (AMA). These individuals do not complete treatment and often leave before discharge plans are in place, including coordinating the next level of care. o In addition to receiving incomplete care, these individuals are at risk for rapid readmission to detox. Understanding the needs of these individuals as well as the barriers to their treatment may help us provide better, patient-centered care, and improve overall outcomes . WRBHO is in a unique position to lead a process to better understand the characteristics of these individuals, system characteristics that may contribute to these discharges, to identify best practices that improve engagement / retention for this group. 57
Complex Needs Population
• • •
Detox Clients who Leave Against Medical Advice (cont’d):
Project will engage consumers and providers. Learning Community will be established with the ultimate plan to pilot best practices in at least two sites. Special emphasis is made to integrate knowledge and sensitivity of cultural issues that may impact an individual’s experience of detox services and the decision to leave AMA. 58
Complex Needs Population
•
Detox Clients who Leave Against Medical Advice (cont’d):
Claims data from Q 1-3, 2012 were evaluated. An evaluation of detox AMA discharges for the 19 county region shows the following: o 16% of all detox discharges were AMA o 84% male; 16% female o 50% white; 32 % black; 18% Hispanic o Opioids were the drug of choice (DOC) for white individuals leaving AMA (39%) o Alcohol was the DOC for black individuals leaving AMA (71%) Next steps include: o Developing background materials, o Establishing the Learning Community o Identifying pilot sites to develop and test models to improve care coordination of individuals leaving detox AMA. 59
WRBHO Q3 SUB-REGIONAL PERFORMANCE REVIEW: Linkages to Aftercare Services
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Sub-Regional View - Discharges
Inpatient Admission Type Mental Health Adult Mental Health Youth Substance Use Detox Substance Use Inpatient Rehab Adult TOTALS County of Residence Current Quarter Sub-Regional vs. Regional Cattaraugus Chautauqua Sub Regional Current Qtr Regional Current Qtr Sub Regional vs. Regional
30 11 63 12 93 23 842 152 11% 15% 0 4
45
0 10
85
0 14
130
66 267
1327
0% 5%
10%
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Sub-Regional View
Performance Metric 3(a): Data Source: Metric Calculation: The Current or Prior Mental Health Outpatient Provider was Contacted During the Stay
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period
By County of Residence - Current Quarter Sub-Regional vs. Regional Inpatient Admission Type Cattaraugus Chautauqua Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult Mental Health Youth TOTALS
66% 81%
70%
93% 100%
94%
84% 91%
85%
78% 92%
80%
6% -1%
5%
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Sub-Regional View
Performance Metric 3(b): Data Source: Metric Calculation: An appointment for mental health outpatient treatment was made as part of the discharge plan
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges in Reporting Period
By County of Residence - Current Quarter Sub-Regional vs. Regional Inpatient Admission Type Mental Health Adult Mental Health Youth TOTALS Cattaraugus
76% 72%
75% Chautauqua
55% 75%
58% Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional
62% 73%
64%
76% 53%
72%
-14% 20%
-8%
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Sub-Regional View
Performance Metric 3 (c): Data Source: Metric Calculation: The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider
Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO # of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period
Inpatient Admission Type Mental Health Adult Mental Health Youth Substance Use Inpatient Rehab TOTALS By County of Residence - Current Quarter Cattaraugus
76% 90% 66%
79% Chautauqua
71% 75% 80%
73% Sub-Regional vs. Regional Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional
73% 82% 76%
75%
65% 60% 43%
59%
8% 22% 33%
16%
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Sub-Regional View
Performance Metric 3 (d): Data Source: Metric Calculation: A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay
Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO Discharges w/physical health appointment scheduled with an outpatient provider/Discharges w/physical health need identified during inpatient stay for reporting period
By County of Residence - Current Quarter Sub-Regional vs. Regional Inpatient Admission Type Cattaraugus Chautauqua Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult Mental Health Youth Substance Use Inpatient Rehab TOTALS
45% 0% 0%
30%
50% 0% 0%
37%
46% 0% 0%
33%
39% 50% 55%
41%
7% -50% -55%
8%
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Sub-Regional Analysis Summary
• • • Initial sub-regional reports show performance within each sub-region by county of residence.
While the number of cases within some counties is small, Q3 data do show some variation in performance within the sub-region when compared to the region as a whole.
These reports will be followed with a report by county of fiscal responsibility that provides a view of provider-specific performance, which we believe will be helpful in better understanding patterns of care and identifying opportunities to strengthen effective linkages to after care services.
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• •
WRBHO EFFECTIVE PRACTICES PRESENTATIONS
Peer and Family Support: Trish McClennan, WCA Hospital
Consumer Centered Family Consultation - Family Institute
for Education, Practice and Research, U of R Medical Center 67
Peer and Family Support Trish McClennan, WCA Hospital
68
The Family Institute for Education, Practice and Research (at URMC) and The CCFC
• • • • • Has been funded by the NYS Office of Mental Health for over 10 years; has worked with over 200 agencies in a variety of settings Provides training and implementation support for agencies that are adopting evidence based family-involving approaches for people with severe mental illness Offers training and consultation related to evidence based practices as well as organizational changes related to the successful implementation of those practices One core offering is Consumer Centered Family
Consultation (can also be called person centered family
consultation) See 2012 article for additional detail and background 69
Consumer Centered Family Consultat
ion
• Consumer Centered Family Consultation (CCFC) is a brief, education-based engagement and consultation service that is typically completed in one to three sessions • It promotes collaboration among adult consumers of mental health services, members of their family or social network, and service providers to support each consumer’s recovery • The focus of CCFC is the person/consumer with a behavioral health issue (the focus is not the family or family therapy) • There are specific shared decision-making tools embedded in the process of engaging people and their natural supports • CCFC provides an opportunity to help prevent avoidable hospitalizations and to help facilitate linkage with outpatient services by involving people’s natural supports in meaningful ways 70
Consumer Centered Family Consultation
•
WRBHO CCFC Webinar: January 11 at 11:00 am
•
For Technical Assistance: Contact at the Family Institute:
– Anne Smith, Executive Director – 585-279-7903 –
[email protected]
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SUB-REGIONAL AREAS OF FOCUS
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Sub-Regional Areas of Focus
• Top 4 reasons for admission for
Individuals with Complex Needs
• • • • Lack of engagement with outpatient provider Non-adherence to medication Drug & Alcohol Use Increased symptomology w/o Precipitant Noted • Improve access to housing at discharge • Address any gaps in the SPOA process and help county prepare for Health Homes • Support the introduction of Consumer Centered Family Consultation across the sub-region • Add more… 73
WRBHO Report Summary
WRBHO PLANS
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•
WRBHO Plans
Post Q3 WRBHO Performance Report on NYCCP Website • Distribute provider-specific reports • Distribute county of origin reports to County Directors • Survey to identify areas of focus for each region / begin to plan for Learning Collaborative • Consumer Centered Family Consultation Webinar scheduled for January 11, 2013 • Support Regional Health Homes • Begin Grand Rounds Webinars 75
Q and A
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