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Monitoring Follow Up After Behavioral Health Hospitalization

UPMC Health Plan Behavioral Health Services, together with UPMC Health Plan, monitors the rate at which members receive timely follow-up outpatient treatment after discharge from psychiatric hospitalizations. We monitor the percentage of members who attend an outpatient appointment within 7 and 30 days after discharge.

To monitor these rates, UPMC Health Plan Behavioral Health Services uses a standard national methodology contained in the Health Plan Employer Data and Information Set (HEDIS). Rates for these measures include:

Our ambulatory 7-day follow-up rate for calendar year 2004 surpasses the national HEDIS average of 55.63% and is just below the 90th national percentile of 70.18%. Similarly, our ambulatory 30-day rate exceeds the national average of 76.17% and is just slightly below the 90th national percentile of 86.22%.

Barriers to members keeping their follow-up appointments may include the following:

• Members seeing their primary care physician instead of a behavioral health professional for follow-up after discharge
• Members not being aware of the importance of aftercare
• Practitioners not adequately assessing a member's specific barriers to follow-up, such as transportation or child care

UPMC Health Plan Behavioral Health Services has implemented many interventions in an attempt to overcome the barriers to members keeping their follow-up appointments. Interventions include:

• Outreach to members and their aftercare practitioner to ensure that the appointment was kept and problem solving with members if appointments are not kept
• Annual distribution of reports to high-volume inpatient providers to inform them of their follow-up rates as compared to the network's average
• Reviewing inpatient records for documentation of member education on the importance of follow-up care
• Publication of articles related to the importance of follow-up care
• Encouraging providers to contact Care Managers for assistance in the event a barrier arises in discharge planning

UPMC Health Plan Behavioral Health Services and UPMC Health Plan will continue to monitor the follow-up rate after behavioral health hospitalizations and will develop additional interventions, as needed, to improve these rates.

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