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2005 Provider Benchmarking

Community Care publishes Provider Benchmarking reports to providers on an annual basis. The latest reports were sent to providers in October 2005. These reports are generated by claims and are sent to high volume providers. The 2005 reports looked at indicators for inpatient mental health, inpatient and non-hospital detoxification and rehabilitation, outpatient mental health and drug and alcohol and behavioral health rehabilitation services (BHRS), as did our 2004 reports. Additionally, for the 2005 reports, Community Care added family based mental health services as a level of care for Provider Benchmarking.

Specific indicators for the facility levels of care included average length of stay, readmission rates, rates of follow up within 7 and 30 days post hospital discharge and the average number of days to follow up visits after discharge. The outpatient reports included the average number of visits per member and frequencies of visits. Indicators for the BHRS reports were average hours of Behavior Specialist Consultant (BSC), Mobile Therapist (MT) and Therapeutic Staff Support (TSS) services per member, sorted by the diagnoses of attention deficit hyperactivity disorder (ADHD), autism and all other diagnoses. The family based reports included the average number of units per member, the number of children who had an inpatient admission during the family based episode and the percentage of team versus individual treatment delivery. The expectation is that at least 60% of treatment will be team delivered. Reports for all levels of care also included network means, benchmarks and performance goals where available.

Below are the calendar year 2004 means as published in the 2005 Provider Benchmarking Reports.

Level of Care	Allegheny 2004 Means	Berks 2004 Means	Chester 2004 Means	York/Adams 2004 Means
Inpatient Mental Health
Average Length of Stay (ALOS)	9.3	10.1	9.9	10.7
30 day readmission rate	16%	13%	15%	12%
Percentage of 7 day follow up	34%	34%	33%	31%
Percentage of 30 day follow up	55%	56%	51%	56%
Average days to follow up within 30 days	8.5	8.4	8.5	9.9
Inpatient Mental Health (Primary Diagnosis of Schizophrenia)
Average Length of Stay (ALOS)	15.2	15.3	12.8	17.0
Percentage of 7 day follow up	42%	29%	43%	28%
Percentage of 30 day follow up	65%	50%	61%	51%
Average days to follow up within 30 days	7.6	8.7	7.4	10.5
Detox
Average Length of Stay (ALOS)	2.8	3.4	3.4	3.4
30 day readmission rate	5.9%	8.1%	14%	5.4%
Percentage of 7 day follow up	50%	46%	56%	40%
Percentage of 30 day follow up	60%	59%	68%	50%
Average days to follow up within 30 days	3.6	5.4	3.3	5.4
Rehab
Average Length of Stay (ALOS)	22.1	15.6	16.3, 51.0*	16.5
30 day readmission rate	13%	12%	8.3%, 6.5%*	5.5%
Percentage of 7 day follow up	29%	26%	16%, 30%*	18%
Percentage of 30 day follow up	45%	42%	36%, 40%*	33%
Average days to follow up within 30 days	7.3	8.5	9.5, 6.4*	9.3
BHRS
Average BSC Hours/Episode
ADHD	48.6	52.3	81.7	38.6
Autism	95.6	65.2	125.3	60.7
Other	42.1	50.0	78.5	32.3
Average MT Hours/Episode
ADHD	42.1	44.7	42.2	21.9
Autism	18.0	17.2	24.6	12.6
Other	44.4	49.9	39.9	18.3
Average TSS Hours/Episode
ADHD	143.5	134.7	243.1	188.3
Autism	338.0	231.5	577.8	436.4
Other	131.0	125.1	266.9	142.0
Family Based Services
Average Units per Member	301.2	350.4	330.0	372.1
% of Team Delivered Services	41.8%	52.2%	41.8%	38.9%
% of Individual Delivered Services	58.2%	47.8%	58.2%	61.1%
% of Members with Inpatient Stay	9.7%	10.9%	8.4%	7.9%
Outpatient Drug and Alcohol
Average OP visits per member	8.0	9.3	8.1	6.8
Outpatient Mental Health
Average OP visits per member	8.9	7.9	8.8	6.8

*The first number is short-term rehab; the second number is long-term rehab. HIPAA codes took effect 1/1/04, which is when Community Care became the BHMCO for Chester County. Therefore we were able to break out short-term and long-term rehab for Chester only (the data for the other counties’ 2005 benchmarking reports was run from 10/1/03-9/30/04). For future benchmarking all counties will have short-term and long-term broken out.

Providers identified two main barriers to timely follow up appointments after discharge:

• Member resistance to aftercare.
• Rescheduling of aftercare appointments by both members and providers.

To combat these issues, providers will work more closely with members in scheduling aftercare appointments to ensure the member’s ability to keep the appointment and increase education about the importance of follow up. One provider is going to have members write a pro/con list for staying in treatment as part of their treatment plan.

If you have found other techniques that are effective in promoting follow up after inpatient stays or reducing the readmission rate, we would appreciate hearing from you. Please call us at 1-888-251-2224 with your ideas and comments.

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