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2007 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 2007. These reports are generated by claims and are sent to high volume providers. The 2007 reports reviewed indicators for inpatient mental health, non-hospital rehabilitation, family based mental health services, and residential treatment facilities (RTF).

Specific indicators for the facility levels of care included 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 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 members who had a medication check within four months of the treatment start date. Indicators for the RTF level of care included the average length of stay, percentage of seven day follow up post discharge, and the percentage of members who had an inpatient admission during the RTF episode.

Additionally, the 2007 Provider Benchmarking reports included information regarding complaints and denials.

The 2007 Provider Benchmarking reports are based on claims from calendar year 2006, except for the North East where the claims are from July – December 2006.

Level of Care	Allegheny Mean	Berks Mean	Chester Mean	Northeast Mean	York/Adams Mean
Inpatient Mental Health
30 day readmission rate	17%	12%	14%	12%	9.6%
Percentage of 7 day follow up	54%	54%	55%	43%	49%
Percentage of 30 day follow up	69%	73%	75%	65%	70%
Average days to follow up within 30 days	5.7	6.1	6.3	7.5	6.8
Inpatient Mental Health (Primary Diagnosis of Schizophrenia)
Percentage of 7 day follow up	66%	58%	70%	44%	55%
Percentage of 30 day follow up	78%	76%	86%	61%	75%
Average days to follow up within 30 days	4.6	5.7	4.9	6.3	6.4
RTF
Average Length of Stay (ALOS)	181.4	189.1	214.1	79.3	225.4
Percentage of 7 day follow up	40.8%	25.9%	43.0%	42.4%	42.7%
% of Members with IPMH admission during treatment period	5.0%	5.4%	7.8%	8.7%	8.9%
Short-Term Rehab
Average Length of Stay (ALOS)	13.3	12.8	14.8	13.7	14.3
Percentage of 7 day follow up	42%	32%	31%	20%	31%
Percentage of 30 day follow up	57%	55%	41%	45%	48%
Average days to follow up within 30 days	5.8	8.5	6.5	10.7	8.3
Long-Term Rehab
Average Length of Stay (ALOS)	51.8	42.7	46.3	53.4	43.6
Percentage of 7 day follow up	28%	32%	18%	20%	15%
Percentage of 30 day follow up	48%	49%	30%	27%	30%
Average days to follow up within 30 days	8.5	7.5	8.1	6.6	8.1
Family Based Services
Average Units per Member	336.73	369.65	304.35	153.32	374.29
% of Members with Inpatient Stay	10.8%	11.2%	16.3%	5.5%	9.3%
% of Members with Med Check within 4 months of Service Start Date	68.5%	73.5%	69.5%	90.2%	54.0%

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. 

In addition to the above indicators, benchmarking was also completed on the targeted case management level of care in Chester County and the North East region.

	Chester Mean	North East Mean
ICM/RC
Contact rate during inpatient stay	94.3%	85.8%
Follow up within 7 days	61.2%	58.5%
Follow up within 14 days	72.1%	65.4%

If you have found other techniques that are effective in promoting the above indicators 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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