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Report to the Transition
Sub-Committee
June 2, 2006
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Operations Update
• Hiring– 100% of Key Positions– Developed new Clinical Support Position to support
improved efficiency in the Clinical Dept.– 94% Overall
• Peer Specialists• Clinicians• Clinical Support Staff• 1 IT Analyst
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Level of Care 4/24 – 5/28(Total auths/CCRs)
Total To Date(Total auths/CCRs)
RTC 381 1781
GH 2 30 67
GH 1 48 133
Inpatient Psych/Detox
1341 1976
Freestanding Detox/Rehab
107 180
OBS 16 33
PRTF 73 139
IOP/PHP 946 1312
EDT 113 113
Total 3,055 5,734
Authorization and Concurrent Review Update
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Operations Update, con’d
• Riverview: effective 6/1/06 prior auth by ASO now required for all admissions (exception, court ordered admissions)
• EDT authorizations went “live” 6/1/2006• Home-Based Psychiatric Services: 7/2006• Inpatient Auth to Claims: projected 7/1/2006• IVR/Web technology 8/2006-9/2006
– Web technology likely in August 2006– Interim plan (possibly winfax) as temporary alternative
to IVR– IVR tentatively September 2006
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Operations Update, con’d
• Pre-cert and Concurrent Call Volume:– 2854 calls in May (increase of 30% from April)
• We continue to work to improve efficiency• Under reported as clinicians have been giving out their direct extensions
• ICM Cases:– 79 mid-long term cases, 72 short-term, high risk (some overlap)
• ED Interface– Alert sent to CHA 5/11/2006
• Delay in Discharge (Inpatient, PRTF, Residential): – We continue to “Scrub” the census report– 22%: Family requesting add’t care – 21%: Awaiting PRTF– 8%: Awaiting Group Home
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ED M/F Age DCF Diagnosis Days Stuck
Identified Disposition needed
ActualDisposition
St.Francis
M 12 Yes PTSDMajor Depression, recurrent
4 PRTF Review due 6/1
HartfordHospital
F 9 Yes PTSDDepressiveDisorder
3 Inpatient IOL
Backus M 13 No Bipolar,Manic
1 Inpatient Boarded at Backus, stabilized, d/c home
St.Raphael’s
F 13 Yes ODD 4 Inpatient St. Raphaels
Day Kimball
M 14 No PsychoticDisorder Asperger’s
6 PRTF Left AMA w/ outpt. appointment
St. Mary’s M 7 Yes Bipolar, ADHD
3 PRTF Boys and Girls Village, Safe Home
Stuck ED Volume, May 2006
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Call Management/Customer Service
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CT BHP Call ManagementMay, 2006
*Please note: Enclosed data includes reporting period 5/1/2006 – 5/27/2006
Week Ending
Total
Calls
Total % Abando
n
Day Staff Calls
# Abandons
Day Staff
% Abandon
After Hour
s Calls
# Abandons
After Hours %
Abandon
Member
Calls
Provider
CallsCrisis Calls
After Hour
s Member
After Hour
s Provider
MCO Calls
211 Perinatal Depressio
n
5/6/2006 Partial Week
1121
0.18% 1066 2
0.19% 55 0
0.00% 383 658 25 2 53 1 0
5/13/2006
1101
0.18% 1059 1
0.09% 42 1
2.38% 447 584 28 2 40 3 0
5/20/2006
1238
0.40% 1195 5
0.42% 43 0
0.00% 483 680 32 0 43 2 0
5/27/2006
1210
0.25% 1136 1
0.09% 74 2
2.70% 423 691 22 1 73 1 0
Total Monthly
4677
0.26% 4456 9
0.20% 214 3
1.40% 1736 2613 107 5 209 7 0
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Types of InquiriesMay, 2006
• 37% - Provider Referrals for Member• 20% - Member Eligibility Verification• 34% - Provider Related/Authorization/Enrollment/Billing• 9% - General Information
46% = Member Inquiries(Increase from April - 38%of total calls)
Note:0.06% = Inquiries initiated due to provider status change from
IN to OON7 MCO calls, 211 Initiative not yet live, but discrete phone line
operational
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CT BHP CALL MANAGEMENTIncoming Calls Totals
May 2006
Total 4677
Note: Increase of 17% since April
Member Calls: 1741
Provider Calls: 2822
Crisis Calls: 112
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The Network
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Network Status
– CMAP Network– Increase of 628 providers since 12/12/05 (increase of 33
providers since April report)• MD and MD Groups: 40 • LCSW: 260• LMFT: 104• LPC: 70
– Add/Change report: 20-30 adds per week, 10-20 changes
–DCF Network- 110 RTC and Group Home providers (increase of 24 providers since 11/2005)
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Rapid Response Team Findings
• Cycle Date 042106 we have identified the following (2) issues:
– 90 Claims denied for Prior Authorization Number Invalid
• All 90 claims were prior to CTBHP authorizing services;
– Outreach calls were provided to the high level denial providers
• Cycle date 051906 we have identified the following issues:
– 16 inpatient providers put data in auth line
– 7 IOP/PHP providers submitted claims without prior authorization
• Outreach calls were provided to the high level denial providers
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Provider Handbook
• May 16th – Draft resubmitted to the state, incorporating
edits from May 2nd.
• May 25th – State approved draft with one final edit
• Incorporate the 4/11/06 LOC Guidelines for Children and Adolescents
• Present– Formatting final version for website posting
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Quality Management
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Quality Initiatives
• Clinical Studies – one focused on adults and another focused on children – both proposals are with the State for review
• Reporting – coordination occurring with the State re. priority reports, time frames for production, analysis
• Quality Control of documentation for clinicians and provider relations staff, examples include:– Authorization letters– Daily Census Report
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Quality Initiatives, con’d
• Satisfaction Surveys– Member, Member with Complex Needs and
Provider Surveys– Data collection will begin in June and July and
conclude in late summer, early Fall – completed via phone interviews
– Report complete Fall of 2006
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Complaints and GrievancesJanuary – May 2006
• Complaints: 4 in May (25 year to date)– 2 Providers (length of auth process)– 2 Member (OON providers)
• Grievances: 0 in May (3 year to date)– 2 related to OON status, 1 related to slow processing
of credentialing packet and subsequent payment concerns
All Complaints and Grievances were resolved within
standard timeframes
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Community Outreach
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Community Outreach
• May, 2006 – Systems Managers
177 DCF, Provider, Collaborative and MSS meetings in May 462 Meetings year to date
– Peer/Family Meetings
51 Family forums, informational meetings, DCF and Collaborative meetings (an increase of 85% from April)
– Peer/Family Outreach/Coordination: 28 Open family/peer consultations in May 17 Family/peer consults completed in May
Example: * Peer assisted a member post discharge with arranging mtg with DCF for services and the housing authority to stabilize living situation
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Provider Trainings• May 22nd & May 30th
– Overview and Q&A following EDS Provider Forums • May 25th
– Provider Training – Hill Health, New Haven• June 5th
– Clinical Director’s Overview, CCPA, Rocky Hill• June 17th
– Provider Training - New Britain General Hospital • June 21st
– Provider Training – Family Care/VNA, Stratford • In process
– Scheduling 5 Provider Forums for July & August– Follow up meeting with State Dept. of Ed for joint training in the
Fall (next meeting June 23 w/ Cheryl Resha)
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Questions?