Presentation is loading. Please wait.

Presentation is loading. Please wait.

CT Behavioral Health Partnership Network Adequacy October 10, 2014.

Similar presentations

Presentation on theme: "CT Behavioral Health Partnership Network Adequacy October 10, 2014."— Presentation transcript:

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 2

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

4 ReferralConnect 4

5 5

6 6

7 Provider Relations – Network Operations 7

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

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

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

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

12 Educating the Network 12 Provider Alerts and Newsletters

13 CMAP Network Components 13  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 14

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

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 16

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

18 Counts: Individual Practitioners and Group Practices 18

19 Outpatient Facilities Accepting Referrals Adults 19 AdultsCMAP Accepting Referrals % Accepting Referrals Facilities Providing MH Treatment22722599% FQHCs40 100% MH Clinics12312198% Rehabilitation Centers66100% Hospital Outpatient Clinics43 100% State Institution Outpatient Clinics11 100% Facilities Providing SA Treatment121 100% FQHC18 100% MH Clinics78 100% Rehabilitation Centers11100% Hospital Outpatient Clinics17 100% State Institution Outpatient Clinics55100% Facilities include: FQHCs, MH Clinics, Rehab Centers, Hospital Outpatient Clinics & State Outpatient Clinics

20 Outpatient Facilities Accepting Referrals Youth YouthCMAP Accepting Referrals % Accepting Referrals Facilities Providing MH Treatment18818799.47% FQHCs53 100.00% Medical Clinic36 100.00% MH Clinics75 100.00% Rehabilitation Centers33100.00% Hospital Outpatient Clinics201995.00% Facilities Providing SA Treatment36 100% FQHCs99100% Medical Clinic11100% MH Clinics24 100% Hospital Outpatient Clinics22100% 20

21 Outpatient Practitioners & Groups Accepting Referrals 21 AdultsCMAPAccepting Referrals% Accepting Referrals Total1501138992.54% BH Clinician95092096.84% BH Clinician Group33932696.17% Nurse Practitioner585086.21% Nurse Practitioner Group523771.15% Physician351131.43% Physician Group674567.16% YouthCMAPAccepting Referrals% Accepting Referrals Total1051100495.53% BH Clinician68266196.92% BH Clinician Group27126698.15% Nurse Practitioner211780.95% Nurse Practitioner Group272592.59% Physician14750.00% Physician Group362877.78%

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) 22

23 Regions in CT Considered to be Urban, Suburban and Rural 23 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 24

25 Geo-Access Adult MH Suburban 25

26 Geo-Access: Adult MH Rural 26

27 Geo-Access SA: Urban Adults 27

28 Geo-Access SA: Suburban Adults 28

29 Geo-Access SA: Rural Adults 29

30 Geo-Access MH: Urban Youth 30

31 Geo-Access MH: Suburban Youth 31

32 Geo-Access MH: Rural Youth 32

33 Geo-Access SA: Urban Adolescents 33

34 Geo-Access SA: Suburban Adolescents 34

35 Geo-Access SA: Rural Adolescents 35

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 36

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 37

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 38

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. 39

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 40

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 41 *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 42


Download ppt "CT Behavioral Health Partnership Network Adequacy October 10, 2014."

Similar presentations

Ads by Google