report to the transition sub-committee june 2, 2006
TRANSCRIPT
Report to the Transition
Sub-Committee
June 2, 2006
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
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
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
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
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
Call Management/Customer Service
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
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
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
The Network
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)
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
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
Quality Management
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
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
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
Community Outreach
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
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)
Questions?