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Monitoring Follow-Up After Behavioral Health Hospitalization

UPMC Health Plan Behavioral Health Services, together with UPMC for Life, monitors the rate at which members receive follow-up 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 for the UPMC for Life HMO (Medicare) population are as follows:

Calendar Year	7-Day Rate	30-Day Rate
2003	44.12%	67.65%
2004	63.83%	76.60%

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.
• Providers not adequately assessing specific barriers keeping a member from following up, such as transportation needs.
• The costs of behavioral health care in addition to other health care costs.
• Difficulty managing a large number of appointments if physical health treatment is also needed.

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

• Outreach to members and their aftercare provider to ensure that the appointment was kept and problem solving with members if appointments are not kept.
• Annual distribution of Provider Benchmarking reports to high volume inpatient providers to inform them of their follow up rates as compared to the network average.
• Conducting inpatient record reviews to assess whether members are being educated about 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 for Life 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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