Transcript AHCA Conference Call

Quarterly Meeting
PMHP Collaborative PIP
PMHP Analysis of Improvement
April 4, 2012
Overview
 PMHPs’ assignment
 PMHPs’ results
 Next steps
2
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?
3
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
4
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
5
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
6
Community Based Care Partnership
Child Welfare PMHP
 Demonstrated improvement in the most recent
measurement period
 Attributed improvement to the interventions
implemented during 2011
7
Community Based Care Partnership
Child 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
8
Community Based Care Partnership
Child 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
9
Community Based Care Partnership
Child Welfare PMHP cont.
Plan’s focus for 2012:
 Continue Bridge Program
 More evaluation to determine effectiveness of
interventions
10
Community Based Care Partnership
Child 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
11
Community Based Care Partnership
Child 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
12
Community Based Care Partnership
Child 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
13
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
1
4
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 followup care were not occurring
 Specific scenarios have been agenda items in Quality
Meetings with providers
 Targeted reviews and conference calls with providers for
discussion
1
5
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
16
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
17
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
18
Magellan
 All areas demonstrated improvement in the most
recent measurement period
 Attributed improvement to the interventions
implemented during 2011
19
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
20
Magellan cont.
 Developed and implemented Webinars
 “Provider Focus” newsletter
21
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
22
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
23
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
24
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
25
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
26
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
27
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
28
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
29
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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