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2006 Provider Benchmarking at Community Care

Community Care publishes Provider Benchmarking reports to providers on an annual basis.  The latest reports were sent to providers in September 2006.  These reports are generated by claims and are sent to high volume providers.  The 2006 reports reviewed indicators for inpatient mental health, inpatient and non-hospital detoxification and rehabilitation, outpatient mental health and drug and alcohol and family based mental health services.

Specific indicators for the facility levels of care included average length of stay, readmission rates, rates of follow up within seven 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.  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.

The 2006 Provider Benchmarking reports are based on claims from October 1, 2004 through September 30, 2005. 

Level of Care	Allegheny Mean	Berks Mean	Chester Mean	York/Adams Mean
Inpatient Mental Health
Average Length of Stay (ALOS)	9.6	10.3	9.9	11
30 day readmission rate	16%	14%	11%	8.6%
Percentage of 7 day follow up	44%	45%	52%	38%
Percentage of 30 day follow up	61%	63%	66%	58%
Average days to follow up within 30 days	6.8	6.8	5.8	7.5
Inpatient Mental Health (Primary Diagnosis of Schizophrenia)
Average Length of Stay (ALOS)	16.5	13.5	13.3	19.5
30 day readmission rate	13%	9.3%	9.5%	9.1%
Percentage of 7 day follow up	60%	45%	60%	34%
Percentage of 30 day follow up	76%	64%	75%	51%
Average days to follow up within 30 days	5.5	6.8	5.3	7.3
Detox
Average Length of Stay (ALOS)	3.0	3.7	3.6	3.4
30 day readmission rate	6.7%	9.7%	3.7%	5.8%
Percentage of 7 day follow up	61%	54%	69%	46%
Percentage of 30 day follow up	70%	73%	76%	53%
Average days to follow up within 30 days	3.2	5.1	2.8	3.5
Short-Term Rehab
Average Length of Stay (ALOS)	11.5	12.8	14.9	13.9
30 day readmission rate	6.4%	10%	8.4%	6.3%
Percentage of 7 day follow up	50%	37%	45%	37%
Percentage of 30 day follow up	64%	56%	66%	56%
Average days to follow up within 30 days	4.9	7.3	6.9	7.3
Long-Term Rehab
Average Length of Stay (ALOS)	52.4	43.5	52.1	41.9
30 day readmission rate	19%	13%	10%	10%
Percentage of 7 day follow up	23%	42%	30%	29%
Percentage of 30 day follow up	40%	57%	47%	40%
Average days to follow up within 30 days	8.6	5.7	6.4	6.8
Family Based Services
Average Units per Member	320.1	386.0	305.8	343.3
% of Team Delivered Services	39.8%	50.9%	46.8%	47.3%
% of Individual Delivered Services	60.2%	49.1%	53.2%	52.7%
% of Members with Inpatient Stay	11.1%	9.6%	9.6%	8.3%
Outpatient Drug and Alcohol
Average OP visits per member	6.5	8.3	8.0	6.9
Outpatient Mental Health
Average OP visits per member	9.5	8.6	9.3	7.7

Providers identified the following barriers to timely follow up appointments after discharge and readmissions:

• Members choosing not to attend aftercare appointment.
• Members choosing to not take prescribed medications.
• Members returning to previous living arrangement, which may not promote positive mental health.

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 medication education groups and groups about the importance of follow up.  One provider plans to develop a recovery tool for each member admitted to inpatient.  This recovery tool will be shared with the member and include action steps to promote and maintain recovery. 

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 and ask to speak to a Quality representative. 

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