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2004 Provider BenchmarkingFor the past five years, Community Care has been publishing its Provider Benchmarking Reports annually to providers. The most recent reports were sent in September 2004 to HealthChoices providers in Allegheny, York, Adams and Berks Counties as well as to Community Care’s Commercial providers. Providers in Chester County will receive their first reports in Spring 2005. The reports are generated from claims and are sent to “High Volume” providers. The 2004 reports looked at indicators for Inpatient Mental Health, Inpatient and Nonhospital Detoxification and Rehabilitation, Outpatient Mental Health and Drug and Alcohol, and Behavioral Health Rehabilitation Services (BHRS). Specifically, indicators for the facility levels of care included average length of stay, readmission rates, rates of follow up at 7 and 30 days post-hospital discharge and the average days to follow up visits after discharge. The outpatient reports included average visits per member and frequencies of visits. BHRS indicators included average hours of Behavior Specialist Consultant (BSC), Mobile Therapy (MT), and Therapeutic Staff Support (TSS) services per member, sorted by the diagnoses of attention deficit hyperactivity disorder, autism, and other diagnoses. The reports also included network means, benchmarks, and performance goals where available. Internal clinical workgroups identified “outliers” for many of the indicators. Providers were requested to submit their analysis of all indicators identified as “outliers”. This activity included identification of factors affecting their rates, areas where improvements could be made and plans for future interventions to address these areas. Providers identified several barriers to timely follow up appointments after discharge including shortage of providers in rural areas, lack of available appointments for some urban providers, difficulty obtaining psychiatrist appointments for medication monitoring, and waiting lists for some services such as halfway house, bilingual and bicultural services, and certain children’s services. Discharges Against Medical Advice (AMA) or on weekends or holidays were also identified as barriers as well as member preferences for particular clinicians, programs or appointment times and cancelled, failed or rescheduled appointments. Providers responded with a number of interventions to address these barriers. Providers are increasing the number of discharge planning groups on their units and starting the discharge planning process earlier in members’ stays. Others are dedicating specific staff to aftercare planning. One provider is training its staff in Motivational Interviewing. The provider also developed an interactive video to introduce follow up to members. Another facility provider met with its county’s outpatient providers and members to brainstorm about possible methods to improve timeliness of follow up visits. Other facility providers are attempting to work more closely with outpatient providers to improve the prompt exchange of information and introduce members to their outpatient therapist prior to discharge. Providers are also contacting members at various points after discharge to remind them of appointment times and intervene if necessary. Another provider enlists case managers to contact members on weekends if the members are discharged from an inpatient stay on a Thursday or Friday. The case managers inquire about medication compliance and symptoms. Finally, providers are developing interim plans for treatment when a member is not able to enter the desired level of care promptly. Providers also identified barriers related to readmission rates. Some barriers that they identified include lack of timely aftercare, lack of engagement with the aftercare provider, noncompliance with discharge instructions, noncompliance with medications, and psychosocial factors such as homelessness, substance abuse, and lack of supports. Other providers identified lack of access to “wet” shelters, drug and alcohol care managers and rehabilitation programs as factors. Providers also mention that the nature of addiction includes periodic relapses for some members with associated failure in follow-up visits. In order to address these barriers affecting readmission, providers have begun implementing a number of interventions. Providers are placing more emphasis on thorough aftercare and medication teaching. Family meetings are being held prior to discharge specifically to address issues and triggers that may lead to relapse and readmission. Several providers conduct ongoing reviews of readmissions through peer reviews or monitoring of readmissions data with their Service Coordination Unit (SCU). One provider monitors the appropriateness of 24-hour admissions and the utilization of resources in the Emergency Department to divert the admission. Another provider has developed a community transitions group to assist in connecting members to outpatient treatment and is currently exploring a transition group for members with co-occurring substance abuse disorders. Inpatient mental health providers are making prevention plans a part of the treatment process. Another provider is developing “red flags” for each age group that will identify factors that may impact recidivism to help treatments teams be more proactive. Non-hospital drug and alcohol providers are developing new policies to begin to engage members and families prior to admission and encourage flexibility during the initial days of treatment. Members in drug and alcohol facilities are asked to sign 72-hour notices of their intent to leave treatment to allow more time for intervention by staff and time to arrange aftercare and transportation. Another provider’s counselors follow the member through the entire treatment process through all successive levels of care to ensure smooth transitions in care. Community Care’s goal in publishing the Provider Benchmarking Reports is to prompt discussion among providers about important standards of care. It is our hope that sharing some of these interventions that have worked for others will spark that discussion and ultimately lead to improved quality of care for all our members. Below are the 2003 means for each product as published in the 2004 Provider Benchmarking Reports.
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