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CT Behavioral Health Partnership Network Adequacy

CT Behavioral Health Partnership Network Adequacy. October 10, 2014. PRESENTATION OVERVIEW. Behavioral Health Services - Member Referrals CT BHP Provider Relations Department CMAP Network Inpatient MH and SA Intermediate (Partial Hospital and Intensive Outpatient) Outpatient Services

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CT Behavioral Health Partnership Network Adequacy

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  1. CT Behavioral Health Partnership Network Adequacy October 10, 2014

  2. PRESENTATION OVERVIEW • Behavioral Health Services - Member Referrals • CT BHP Provider Relations Department • CMAP Network • Inpatient MH and SA • Intermediate (Partial Hospital and Intensive Outpatient) • Outpatient Services • Provider Types and Specialties Accepting Referrals • Behavioral Health Geo-Access • Quality Improvement: • Enhanced Care Clinics • Impact of DSS policy shift on HUSKY C & D access • Next Steps

  3. Member Referrals OR Accesses Online Directory (ReferralConnect) Member receives list of referrals Member contacts provider for appointment Member calls VO for referrals ReferralConnect Provider Not Accepting Referrals? Member, Internal VO staff or Provider reports non-referral status VO outreaches to practice to verify referral status VO updates provider file referral status

  4. ReferralConnect

  5. ReferralConnect

  6. ReferralConnect

  7. Provider Relations – Network Operations

  8. Provider Relations/Network OperationsObjectives: We educate and empower the provider community to help them provide quality care to our members.

  9. Managing the CMAP Network HP sends weekly add/change files to VO VO builds or updates provider file Providers enroll in CMAP Network Connect Network Connect Then… Once returned, VO updates provider file Welcome Packet Sent* Provider Contacted * Account Request Form, Provider Data Verification Forms and CMAP Participation Made Simple

  10. Educating the Network NetOps and PR provide a variety of resources to help educate and inform providers User Manuals

  11. Educating the Network Training videos and webinars Email and Phone Consultations In house trainings and site visits

  12. Educating the Network Provider Alerts and Newsletters

  13. CMAP Network Components • Mental Health: MH • Substance Abuse: SA • Adults • Age: 18+ • Eligibility Categories: • HUSKY A, HUSKY C, HUSKY D • Dual Subcategories included for Inpatient & Intermediate services • Youth • Age: 0-17 • Adolescents: 14-17 for SA treatment • Eligibility Categories: • HUSKY A, HUSKY B, HUSKY C

  14. Network Counts: Inpatient Facilities

  15. Intermediate Care: Partial Hospital Programs (PHP) and Intensive Outpatient (IOP); Locations

  16. Outpatient Services: Enhanced Care Clinic (ECCs)Locations ECCs are reimbursed at a higher rate and held to higher standards • Timely Access to emergent (2 hours), urgent (2 days) and routine (2 weeks) appointments • Coordination of Care with Medical Providers • Substance Use Evaluation and Treatment/Referral • Mystery Shopper and Survey oversight

  17. Outpatient Services: Facilities FQHCs School Based Clinics Mental Health Clinics Hospital Outpatient MH Clinics

  18. Counts: Individual Practitioners and Group Practices

  19. Outpatient Facilities Accepting ReferralsAdults Facilities include: FQHCs, MH Clinics, Rehab Centers, Hospital Outpatient Clinics & State Outpatient Clinics

  20. Outpatient Facilities Accepting Referrals Youth

  21. Outpatient Practitioners & Groups Accepting Referrals

  22. Geo-Access Methodology • Standards: • Urban: 1 Within 15 miles • 46.8% of Medicaid population • Suburban: 1 Within 25 miles • 39.7% of Medicaid population • Rural: 1 Within 45 miles • 13.5% of Medicaid population • Eligibility Categories Included: • Adults and Youth: • All for Inpatient and Intermediate • Duals excluded for Outpatient Services • Providers Included: • Accepting Referrals • Authorized for at least two members in previous year (Outpatient)

  23. Regions in CT Considered to be Urban, Suburban and Rural Urban Membership >3000 per sq. mile Suburban Membership 1000-3000 per sq. mile Rural Membership <1000 per sq. mile

  24. Geo-Access: Adult MH Urban

  25. Geo-Access Adult MH Suburban

  26. Geo-Access: Adult MH Rural

  27. Geo-Access SA: Urban Adults

  28. Geo-Access SA: Suburban Adults

  29. Geo-Access SA: Rural Adults

  30. Geo-Access MH: Urban Youth

  31. Geo-Access MH: Suburban Youth

  32. Geo-Access MH: Rural Youth

  33. Geo-Access SA: Urban Adolescents

  34. Geo-Access SA: Suburban Adolescents

  35. Geo-Access SA: Rural Adolescents

  36. Enhanced Care Clinics (ECCs): Quality Improvement Activities Multiple Provider Bulletins (2007-2010) describe expectations of ECCs • Access Standards • Transportation Coordination • Family Engagement • Primary Care and BH Coordination of Care • Collaboration with PCPs and Pediatricians • GAIN (tool) to evaluate for SA issues • Provision of integrated MH and SA care for adults and adolescents with co-occurring diagnoses OR • Refer to appropriate provider

  37. Enhanced Care Clinics (ECCs): Quality Improvement Activities Cont’d • 2012: Oversight Assessment Tool developed collaboratively with DMHAS , DCF and Providers • Survey Team included DMHAS, DCF, DSS and VO staff • Consistency of scoring of elements was established • Surveys conducted at 34 ECCs: • 10 adult and 10 youth charts reviewed

  38. Enhanced Care Clinics (ECCs): Quality Improvement Activities Cont’d • Areas of Improvement Identified: • Coordination with PCPs • Evaluation of need for SA treatment (adolescents) • Transportation needs • Corrective Action Plans (CAPs) to address opportunities for improvement • Support by VO Regional Network Managers • 32 of 34 ECCs submitted CAPs • Follow-up Surveys: September 2013 - March 2014 • 28 of 32 demonstrated evidence of improvement

  39. Mystery Shopper: Enhanced Care Clinics (ECCs) • Program began in 2008 • 3 ECCs are “shopped” twice per quarter • Purpose: Assess for triage and timely response • Process: • Call ECC as a member/parent • Conduct call as if it was a request for a routine appointment • Disclosed call was for the CT BHP mystery shopper program before call ends • Call “fail” due to failure to triage or return call • If the ECC fails, ECC submits a Corrective Action Plan (CAP) and is on probationary status until a successful follow up shopper call is made.

  40. Improved Network Access: Impact of DSS Policy Change • As of July 1, 2014: HUSKY C and D adult members able to access Masters and Doctoral-level Individual Practitioners and Group Practices • Previously, were only able to access treatment with MDs and APRNs

  41. Next Steps • Increase MD/APRN Network Enrollment • Outreach to OPR* Providers to fully enroll • Targeted Outreach to DPH Licensed – Non Enrolled MD/APRN • Examine Suboxone Provider Network • 15 in Network • 6 Accepting Referrals *Ordering, Prescribing & Referring

  42. Future Network Enhancements for Consideration • ACCESS MH CT • Promote prescribing by PCP’s and pediatricians by education and consultation • TeleHealth • Improve access to services • Improve access to psychiatric/medication evaluation • Ambulatory Detox Program Availability • Limited availability of Suboxone

  43. QUESTIONS?

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