Quarterly Meeting PMHP Collaborative PIP April 4, 2012

1. Quarterly MeetingPMHP Collaborative PIPApril 4, 2012 PMHP Analysis of Improvement

2. Overview • PMHPs’ assignment • PMHPs’ results • Next steps 2

3. PMHP Assignment • In the most recent measurement period, if your study indicator rate improved, what do you attribute the improvement to? • In the most recent measurement period, if your study indicator rate declined, why do you think there was a decline? • Have you evaluated interventions? If so, what did you do to evaluate interventions? 3

4. 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

5. 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

6. 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

7. Community Based Care PartnershipChild Welfare PMHP • Demonstrated improvement in the most recent measurement period • Attributed improvement to the interventions implemented during 2011 7

8. Community Based Care PartnershipChild 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

9. Community Based Care PartnershipChild 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

10. Community Based Care PartnershipChild Welfare PMHP cont. Plan’s focus for 2012: • Continue Bridge Program • More evaluation to determine effectiveness of interventions 10

11. Community Based Care PartnershipChild 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

12. Community Based Care PartnershipChild 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

13. Community Based Care PartnershipChild 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

14. 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 14

15. 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 follow-up care were not occurring • Specific scenarios have been agenda items in Quality Meetings with providers • Targeted reviews and conference calls with providers for discussion 15

16. 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

17. 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

18. 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

19. Magellan • All areas demonstrated improvement in the most recent measurement period • Attributed improvement to the interventions implemented during 2011 19

20. 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

21. Magellan cont. • Developed and implemented Webinars • “Provider Focus” newsletter 21

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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 30

31. 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 31