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Report to the Behavioral Health Oversight Council April 12, 2006

Report to the Behavioral Health Oversight Council April 12, 2006. Implementation Update. Hiring 97% of Key Positions filled 91% Over (5 ICMs, .75 CCM, 1 IT, 1 QM) Residential Authorizations 2/1/06 581 authorizations 53 concurrent reviews 70 approved awaiting placement

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Report to the Behavioral Health Oversight Council April 12, 2006

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  1. Report to the Behavioral Health Oversight Council April 12, 2006

  2. Implementation Update • Hiring • 97% of Key Positions filled • 91% Over (5 ICMs, .75 CCM, 1 IT, 1 QM) • Residential Authorizations 2/1/06 • 581 authorizations • 53 concurrent reviews • 70 approved awaiting placement • Inpatient/Detox/Obs. Authorizations 4/1/06 • 115 authorizations • 12 concurrent reviews • 50 plus winfax forms data entered • 27 discharges

  3. Call Management/Customer Service

  4. CT BHP Call ManagementMarch, 2006

  5. CT BHP CALL MANAGEMENTIncoming Calls Totals March 2006 Total 2852

  6. Types of InquiriesMarch, 2006 58% - Provider Referrals for Members 25% - Member Eligibility Verification 8% - Provider Related/Enrollment/Billing Inquiries 9% - General Information67% = Member Inquiries 0.40% = Inquiries initiated due to provider status change from IN to OON

  7. Rapid Response Team • EDS, DSS and CT BHP • Bi-weekly meetings • Jointly developing protocols for problem resolution • Reviewing live claims data and determining follow up actions

  8. The Network

  9. Network Status • The Network • Referral Sites per Referral Connect: 2,271 • Numerous providers in process with EDS • DCF Network • 86 RTC and Group Home providers • Disruption Analysis • Over 1,500 calls made • Multiple searches • 302 unknown providers down to 55 • Who are the 247 (aka “the found”?)

  10. The Found

  11. The Found, con’t

  12. Inquires/Complaints/Grievances

  13. Inquiries and Complaints and GrievancesJanuary – March 2006 • 20 inquiries about providers no longer in network, 1 complaint filed, referrals given to the other 19 • 20 complaints - 17 closed provider enrollment appointment scheduling member choosing to continue care with OON provider referral to MCO pharmacy - 3 open gastric by-pass evaluation appointment with 10 miles, has list of places will not go MD changed meds and 2nd opinion supported change

  14. Inquiries and Complaints and GrievancesJanuary – March 2006 • 3 Grievances - 1 closed - 2 open provider was previously in network when referral was given in Dec 2005, now provider is balance billing member member requesting MD referral, several referrals given want member to have medication management and therapist at the same place, member is satisfied with own therapist and does not want to change

  15. Community Outreach

  16. Community Outreach • March • Systems Managers 75 DCF, Provider, Collaborative and MSS meetings • Peer/Family Meetings 37 Family forums, informational meetings, DCF and Collaborative meetings • ICM cases: 28 mid-long term cases 34 short-term, high risk cases • Peer/Family Outreach/Coordination: 46 cases (increase 72% over February)

  17. Questions?

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