report to the operations sub-committee december 8, 2006
TRANSCRIPT
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Report to the Operations
Sub-Committee
December 8, 2006
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Network Operations
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Web Registration
• Security Access/User ID Requests• 2,034 User Id’s generated as of 12/4/2006
• 27 Requests currently in process
• Winfax – Non Web/Paper Registrations• 104 Providers currently using paper
registration
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Web Registration – TotalsCompleted Web Registrations as of 12/4/06
Outpatient Services………….…..21,963
Methadone Maintenance…….…...1,230
Ambulatory Detoxification …………….77
Family Support Team………………..128 (Home Based Service)
Psychological Testing…………….…..32
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Web Registration Continued
• 23,430 - Registrations completed as of December 4, 2006
• Registration 21 day timely limit began November 6, 2006 – Providers have 21 days from the initial visit to
register CT BHP clients for Registered Services
• All fields for web registration required as of November 1, 2006– Race & Ethnicity (Optional)
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Provider Relations Phone Stats October 2006 - November 2006
1646 Calls
Web Registration InquiriesGeneral Provider Inquiries
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PDV’S Received 1259
PDV’S Keyed 1259
# of new providers added from Add /Change Report
270
# of changes completed from Change Report
574
# of PDV’s mailed to date 3132
Provider Data Verification Stats Aggregate since January 2005
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Rapid Response Team Findings
• Reviewed authorization related claims issues for 30 providers
• Provider outreach letters sent to providers to offer assistance in the authorization process
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Rapid Response Team
Provider Outreach Correspondences
• 15 – PH.D. level
• 9 – MD level
• 6 – APRN level
Provider Site Visits
• 1 Group Practice
• 3 Facilities
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Clinical Operations
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Authorizations per LOC for '06
0
200
400
600
800
1000
1200
IPF 0 0 511 779 874 682 731 755 1141 1090
ADR/IPD 0 0 70 99 125 137 120 105 132 154
GHA/GHC 8 30 23 25 74 151 180 162 141 168
PRTF 0 10 13 9 24 42 59 53 84 130
RTC 34 395 281 147 207 241 566 476 422 371
Intermediate (IOP, PHP, EDT) 0 0 0 850 1148 820 958 794 981 1054
HBS(FFT,FST,MDF,HBS,MST) 0 0 0 0 0 0 23 396 239 362
Feb March April May June July Aug Sept Oct Nov
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Average Length of Inpatient Stay
not including Riverview (not including discharge delays)
26
64
6
27
11
22
8 6
14 12
60
1
121611
0
20
40
60
Local Area
Days
Current LOS
CT AVG
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Percent Per Facility of Discharge Delays
15.6%
3.1%
9.4%
59.4%
6.3%6.3%
Hall Brooke Behavioral Health
Hampstead Hospital
Hartford Hospital
Riverview Hospital for Children
St. Francis Hospital
Yale New Haven Hospital
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Discharge Delay Reason Codes
3.1%6.3%
12.5%
3.1%
15.6%
6.3%
12.5%
3.1%
37.5%
Await Com Svc: Home Hlth
Await Com Svc: IICAPS
Awaiting place Grp Hm 2.0
Awaiting place: Ther FC
Awaiting placement: PRTF
Awaiting placement: RTF
Fam Req TX before Return
Other
Pending Abuse/Neglect inv
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• 10% of children in an Inpatient setting are defined as Discharge Delay - represents a decrease from 17% last month
37.5% are awaiting placement in Residential and/or PRTF
9.4% are awaiting Community Services12.5% are awaiting Group Home placement12.5% are awaiting Placement: other or unspecified
Inpatient Discharge Delay Status November, 2006
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Number of Members in ED Delay Tracking Status per Month
5
1012
26
16
10
0
5
10
15
20
25
30
June July Aug Sept Oct Nov
# of
Mem
bers
JUNE - '06
JULY - '06
AUG - '06
SEPT - '06
OCT - '06
NOV - '06
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Average Days Stuck in ED Delay Tracking Status per Month
7.20
2.90
1.581.99 2.47
6.60
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
June July Aug Sept Oct Nov
# of
Day
s
JUNE - '06
JULY - '06
AUG - '06
SEPT - '06
OCT - '06
NOV - '06
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Number of DCF vs. Non DCF Identified Members in ED Delay Tracking Status per Month
5
910
1210
01
2
9
4
0
17
02468
1012141618
JUNE -'06
JULY -'06
AUG -'06
SEPT -'06
OCT -'06
NOV -'06
# of
Mem
bers
DCF
Non DCF
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Actual Dispostion for Members in ED Delay Tracking Status per Month
0
5
10
15
20
JUNE -'06
JULY -'06
AUG -'06
SEPT -'06
OCT -'06
NOV -'06
# of
Mem
bers
Admitted toInpatientUnitReturnhome/prevplacementTemporaryFosterCareAdmittedResidentialRemanded to JuvDetention
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ED Delayed Discharge Activity
• Started trending ED cases, source, length of stay, and disposition
• Despite increased numbers of members presenting to EDs, overall lengths of stay are trending down (3 outliers in November negatively impacted LOS)
• Members presenting to EDs are more likely to be DCF involved than not
• Members presenting to the ED are more likely to be discharged to an Inpatient level of Care than any other option
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ICM TRACKING REFERRAL SOURCE MONTHLY REPORT November 2006
REFERRAL SOURCE JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC
ED 0 1 8 10 2 7 26 16 11INPATIENT HOSPITAL 0 1 15 19 30 45 47 21 23MCO 2 3 1 1 6 44 36 40 18DCF 0 3 7 10 11 8 13 8 18SELF REFERRAL 0 0 1 1 4 2 1 5 0INTERNAL 1 29 27 41 22 1 6 6 3RIVERVIEW HOSPITAL 0 0 0 0 34 0 0 1 2RESI/GROUP 0 0 0 0 2 11 11 5 175 DAY DISCHARGE DELAY 0 0 0 0 0 0 28 12 2COMMUNITY 0 0 0 0 0 9 15 11 13
TOTAL RECEIVED 3 37 59 82 111 127 183 125 107
DISCHARGES 45 33 19 48
Data source 11/1/06 -11/29/06 YTD Referrals Recieved: 834 YTD ICM Cases: 793
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Timeliness of Pre-cert and CCR Process
• Analysis of current forms/process- complete• Re-ordering/re-working of existing forms -
complete• Deletion of redundant information - complete• System was reprogrammed mid-November• Clinician orientation and re-tooled forms on web
site week of November 13, 2006• Revised format implemented week of November
20, 2006
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Residential Care TeamTransition
• IT infrastructure complete (tracking system/CANs)
• Follow up training occurring via web
• John Lyons training CSSD
• Final revisions to provider information
• Census reporting has improved to better support matching
• Transition occurred 12/1/06
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Customer Service/Call Center Activity
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2006 Call Volume YTD
Call Volume
01000200030004000500060007000
2006
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Calls answered in < 30 seconds YTD
% Answered in < 30 Seconds
8486889092949698
100
% answered < 30 seconds
% answered < 30 seconds
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Types of Service Connect InquiriesNovember, 2006
41% - Provider Referrals for Members
15% - Member Eligibility Verification
36% - Provider Related/Authorization/Enrollment/Billing
8% - General Information
49% = Member Inquiries
No Inquiries initiated due to provider status change from IN to OON
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CT BHP CALL MANAGEMENTIncoming Calls Totals: November, 2006
Total 5813
Member Calls: 2550
Provider Calls: 3241
Crisis Calls: 22
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Quality Management
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Quality Initiatives
• Adult and Child Studies underway
• Final analysis of Provider Satisfaction survey underway
• Member Satisfaction close to completion
• Mercer Post-Implementation evaluation scheduled for January 3-5, 2007
• Continues to support all departments at the CT BHP
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Total Number of Complaints Monthly 2006
2 2
6
0 0
3
2
0 0
3
1
2
1
3
0
2
1 1 1
0
1 1
3
0
2
4
3
1
0
4
2
4
9
0
1
2
3
4
5
6
7
8
9
10
Adult Member Complaints 2 2 6 0 0 3 2 0 0 3 1
Child member Complaints 2 1 3 0 2 1 1 1 0 1 1
Grand Total Complaints 4 3 9 0 2 4 3 1 0 4 2
Jan Feb March April May June July August Sept Oct Nov
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Complaints
• The complaint categories identified do not have enough volume to suggest a trend at this time
• All complaints will continue to be monitored• Complaints documented at VO’s Helpdesk
related to Web Registration will be transferred to CT BHP data base
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Percent of Denials- Administrative and Medical Necessity
66.67%
91.67% 90.24% 91.67%
33.33%
8.33% 9.76% 8.33%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
% Administrative 66.67% 91.67% 90.24% 91.67%
% Medical Necessity 33.33% 8.33% 9.76% 8.33%
Aug Sept Oct Nov
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Appeals
• Overall appeal rate is less than 1% of authorizations
• A typical denial (>90%) is generated by failure to adhere to administrative process rather than Medical Necessity determination
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Grievances
• No Grievances filed in November of 2006
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System’s Management
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System Management Update
• System Managers held numerous community meetings to finalize assigned LADPs for submission in November
• The final Six LADPs were submitted and approved by the Departments in November
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System Management Update con’d
• System Managers have established local oversight bodies for the implementation and monitoring of the LADPs
• System Managers whose plans were approved in October began the implementation process in November and have convened and facilitated meetings with their respective oversight bodies
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System Management Update con’d
• Statewide themes and regional variations across all 15 plans are being compiled for future presentations and strategic planning purposes
• All System Managers were trained and began the initial phase of utilizing project management to monitor, track and prepare for reporting on the status of each plan
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System Management Update con’d• System Managers presented approved LADPs
to local Community Collaboratives, Local Department of Children Area Advisory Councils and Managed Service System members
• System Managers continue to actively participate in community meetings and initiatives across the state
• Requests for LADPs are currently being tracked
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Community Interaction:Peer/Family Services
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Peer Support Unit
The Peer and Family Peer Specialists worked with 68 CT BHP members and/or families in November.
Peer and Family Peer Specialists attended:
9 Community Collaborative Meetings16 Community Outreach Meetings 1 CT BHP Consumer and Family Advisory Sub-Committee Meeting 2 Home visits with members 1 Visit at ED with member 1 Child Specific Team Meeting 3 Treatment/Discharge Planning Meetings with members/families17 Referrals were given to various agencies and organizations
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Outreach Activities for Peer Unit Help Me Grow Breakfast in Waterbury In-Service Training to the Middletown Adult Education
Teachers Presentation to the Even Start Program Meeting with the Middlesex Coalition for Children Attended Provider Presentation on Respite Services in South
Central Region Co-Hosted Provider Fair for School District and DCF Personnel
with the NE Collaborative Members Eastern Connecticut Cooperative Workgroup Meeting to Plan
Spring Workshops Attended the Families United Support Group in Plainville
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Examples of Referrals Given by Peer Unit
Worked with MCO to resolve a transportation issue for member Department of Mental Health and Addiction Services (DMHAS) Connecticut Autism Spectrum Resource Center Access Agency Office of Protection and Advocacy DCF Ombudsman Children’s Law Center Legal Aid Statewide Legal Services North Star Support Group Tri-State Support Network for Families Raising Children with
Bipolar- The Connecticut Group AFCAMP, Families United, PAP, NAMI-CT FAVOR Advocate