1. Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System Review Project Advisory Committee 1

2. Agenda Introductions Review of Meeting Notes Project Update Washington County Data Discussion Wrap up / Next Meeting 2

3. Project Update Letter to stakeholders Meetings with County staff Provider forum Data collection and analysis Interviews 3

4. Project Update cont’d. Interviews Who – Providers – County committees and departments – Consumer and family support groups, advocates – Interface agencies How – One-on-one interviews – Group interviews – Focus groups – Attending existing meetings What – Focus on exploring key areas of project 4

5. Project Update cont’d. Data Collection and Analysis Review available data – Information Systems survey Data limitations: – Completeness of the data – Limited cost data for Base-funded services – Limited MR data 5

6. Discussion of County Data: Purpose Provide an example of the type of data available Provide snapshots of Base and HealthChoices Data – Base: County funded services for people not eligible for HealthChoices Services that are not funded by HealthChoices – Residential services, administrative case management, social rehabilitation – HealthChoices: Services available to those who are Medicaid eligible Paid for by the Managed Care Organization/Medicaid Individuals can receive both Base and HealthChoices services 6

7. 7 BASEHC* 1,446 Users6,344 Users GENDERFemale48%53% Male52%47% AGE GROUP 00 – 2020%42% 21 – 65 +80%58% RACEAfrican-American7%10% Caucasian90%89% Other **3%1% Discussion of County Data cont’d. Demographics 2008 Base & HealthChoices (HC) * *Includes Asian, Native American, Other, and Unknown * Includes MH services only A total of 666 users had services in both HC and Base for Washington during 2008 (MH type services only)

8. Discussion of County Data cont’d. Where were people served in 2008? 8 Concentrations in: City of Washington and Canonsburg (Washington Community MH/MR) Mon Valley (SPHS) Spread throughout southern section of county (Centerville Clinics) Individuals are also served from other Counties * HealthChoices Only

9. Discussion of County Data cont’d. Users by Service Category: Base & HealthChoices in 2008 9 Service CategoryBaseHC Outpatient MH5585,442 Case Management/ICM2331,217 BHRS0810 Crisis340676 Inpatient MH0657 HC Supplemental Serv - MH0433 Lab0306 Partial Hosp MH32239 Family Based Services2134 CTT2038 RTF034 Service CategoryBaseHC Med Check026 LTSR / AOP1813 Psych Rehab381 Administrative Management5460 Community Residential280 Emergency Services170 Employment Related Services230 Facility Based Voc Rehab100 Housing Support1480 RTF - Adult310 Social Rehab1460 MH services only Excludes service categories with less than 10 users

10. 10 Discussion of County Data cont’d. Users by Diagnostic Category: Base & HealthChoices in 2008 Diagnostic Category (Age 00-20) Base (297) HC (2,710) ADHD54930 Adjustment D/O35774 Neurotic D/O68496 Major Depression16393 Psychosis Ch Orig15368 Conduct D/O10323 Bipolar D/O9311 Child-Adol Emot D/O18308 Depressive D/O52270 Schizophrenia126 Diagnostic Category (Age 21-65+) Base (1,153) HC (3,673) Major Depression2681,396 Bipolar D/O115905 Schizophrenia189603 Neurotic D/O174507 Depressive D/O212431 Adjustment D/O74337 Unspec Psychosis1165 Conduct D/O1148 Org Mental D/O445 ADHD1538 Includes the top 10 MH diagnostic categories for both children and adults

11. Discussion of County Data cont’d. HealthChoices Summary: 2008 11 Age Group Users Served (MH – only) Paid Amount (MH – only) % of Total MH Avg. cost per user 00 - 202,710$ 13,098,79264%$4,834 21 - 65+3,673$ 7,301,76036%$1,988 Total6,383$20,400,552

12. Discussion of County Data cont’d. HealthChoices 2008: Age 00-20/MH Summary 12 Top 3 service categories comprise 70% of total cost for this age group UsersAvg. cost per user BHRS809$8,349 Family Based Services134$9,432 Outpatient MH2,161$550 Top 3 diagnostic categories comprise 59% of total cost for this age group UsersAvg. cost per user Psychosis Ch Orig368$10,429 ADHD930$2,463 Bipolar D/O311$4,932 Top 3 providers comprise 25% of total cost for this age group UsersAvg. cost per user Family Behavioral Resources147$7,755 Southwest Behavioral Care617$1,718 Southwood Psychiatric Hospital119$8,867

13. 13 Discussion of County Data cont’d. HealthChoices 2008: Age 21-65+/MH Summary Top 3 service categories comprise 78% of total cost for this age group UsersAvg. cost per user Inpatient MH494$4,623 Outpatient MH3,316$541 Case Management / ICM672$2,426 Top 3 diagnostic categories comprise 75% of total cost for this age group UsersAvg. cost per user Schizophrenia603$3,787 Major Depression1,396$1,374 Bipolar D/O905$1,436 Top 4 providers comprise 64% of total cost for this age group UsersAvg. cost per user Southwest Behavioral Care1,002$2,009 Washington Hospital386$2,742 Centerville Clinics429$1,960 Washington Communities MH/MR723$1,031

14. Discussion of County Data cont’d. Inpatient Utilization: Community IP-MH Admissions 14 Time frame spans the downsizing and closure of Mayview State Hospital Admissions are trending downward * Adult HealthChoices Only Number of Admits

15. 15 Discussion of County Data cont’d. Inpatient Utilization: Community IP-MH Average LOS ALOS is trending very slightly upward, but it has been within one day the entire period. * Adult HealthChoices Only Days

16. Discussion of County Data cont’d. BHRS Utilization: Users and Amount Paid 16 Users and amount paid are trending upward over the period 28% and 25%, respectively. DollarsPeople

17. 17 Discussion of County Data cont’d. BHRS Utilization: Users and Amount Paid (re-scaled) Re-scaled chart with a trend line can provide a different way of viewing the same data Dollars People

18. Discussion of County Data cont’d. What did you think of this data? What more would you like to see? Other areas we should consider?

19. Wrap up / Next Meeting Agenda items for the next meeting – Summary of themes from the interviews – Other ideas Schedule next meeting 19