Hudson River Region Provider Profiling

Community Care is expected to prepare quarterly Provider Profiling reports for the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services. These reports will contain profiling data on the inpatient and community providers with whom we have interacted. Community Care may use Medicaid claims data and may combine those data with our own provider-level performance data to profile providers. These profiles will include but not be limited to:

• The extent to which the inpatient provider contacted the BHO as required;
• The number of concurrent reviews completed and the findings of these reviews;
• The availability of hospital staff to provide information to the BHO;
• Characteristics and completeness of discharge plans
• The extent to which the discharge plans addressed key areas relevant to the client;
• Appropriateness of length of stay;
• Effectiveness of interactions between the inpatient provider, the outpatient provider and, if relevant, the case manager or health home to implement the discharge plan.
• Summaries and recommendations based on the information presented.

For behavioral health admissions which were readmissions to any hospital within 30 days of prior discharge for psychiatric and 45 days for substance abuse, Community Care's quarterly reports will contain a qualitative and quantitative summary of the reason(s) for readmission including an assessment of whether the readmission was attributable to:

• Action/inaction of the discharging hospital;
• Failure of the post discharge service providers to secure continuing engagement;
• Unstable post discharge living situation;
• Substance use;
• Discontinuation of psychotropic medication;
• Other clinical problems (including physical health) related to the individual's illness; and
• Other reasons

This information will be reported on a provider-specific basis and in total for the Hudson River Region. Data will be provided to The Offices quarterly on the number of referrals made by behavioral health inpatient units to traditional Medicaid Managed Care plans or network treatment providers for individuals whose physical health services are covered by these plans.