children's mental health services - peach state presentation
TRANSCRIPT
11/2/2015
House Children’s Mental Health Study CommitteeJeff Luce, LPCClinical Director
2
Peach State Health Plan: Overview• Georgia based Care Management
Organization (CMO) since 2006
• 128 hospitals and related facilities state-wide
• 19,000 physicians and other types of providers in network
• Nearly 1,600 Behavioral Health-focused specialty providers in network
• Approximately 8% have primary mental health issues (60% of these are ADHD)
Over 300 Georgia-based employees deliver local services to almost 385,000
Georgia Families members
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• Right Service/Right Time– Behavioral Health services that
meet the unique needs of our Members
– 9,289 average number of Members per month accessing BH services (2015)
• Early Intervention– Identifying and intervening with
kids and families who face escalating Behavioral Health needs
• Solid Systems– Facilitate integration– Pharmacy checks and
balances
Top Priority: Caring for Members
• Strong Network– Behavioral Health continuum of care– Psychiatrists; Therapists; Community Support
Individuals
• Internal Staff– Georgia-licensed mental health professionals– Integrated care delivery teams
• Meaningful Outcomes– Are Members getting what they need?
Programmatic HEDIS measures—down to individual Members in Case Management meeting their treatment goals
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• Tele-health– Access the Georgia Tele-Health Network – Enhances the level of access to care for members in rural areas
• School-Based Mental Health – Highly supportive of school-based delivery (e.g. Georgia APEX project)
• Case Management– Ongoing emphasis on early intervention– Integrated Care Team – We make a difference by coordinating care and helping Members manage their
conditions
• Trauma-Informed Care– Since 2012, we have trained 813 people in trauma and behavioral health. This
includes 194 clinicians we trained in TF-CBT.
Innovation: Access & Quality
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2 Primary types: • Inpatient Psychiatric Utilization
– 13% utilization increase from 2010 to 2014
• Outpatient Behavioral Health Utilization– 130% increase from 2010 to
2014• What does that mean?
UtilizationOur Goal…• Deliver the right services at the
right time to our members– 2 real-life Member examples