June 2006

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Report to the Operations

Sub
-
Committee

July 7, 2006

Operations Update


Hiring


95% of Key Positions


UM Director position currently open



98% Overall


3 Peer Specialists


1 ICM clinician



Level of Care

6/1/06
-

6/25/06

(Total auths/CCRs)

Total To Date

(Total auths/CCRs)

RTC

452

1640

GH 2

92

137

GH 1

81

168

Inpatient
Psych/Detox

1119

2592

Freestanding
Detox/Rehab

97

261

OBS

5

28

PRTF

65

135

IOP/PHP

858

1743

EDT

398

407

Total

3,167

7,111

Authorization and Concurrent Review
Update

*duplicates cleaned in June

Operations Update, con’d


Inpatient Auth to Claims:
7/1/2006




Care Coordination and Crisis Stabilization
new auth process pended


need to finalize
level of care criteria



Home based Services:
8/2006


MST, IICAPs, MDFT, FFT for dates of service 8/1/06
and after will be auth’ed via clinician. Winfax process
will capture members currently in care


FST will register via web registration in August and
back date start date to capture individuals in care
from August 1, 2006 and forward as a registered
service vs auth’ed service



Operations Update, con’d


Outpatient Services via web registration:



9/2006
for services provided for dates of service 9/1/06 and forward


IVR/Web technology:
8/2006
-
9/2006


Provider Trainings to be held in July and August


Web technology available August 2006, mandated to ensure
payment effective September 1, 2006


Providers will begin registering care in the system in August, will
provide an additional 30 day window through September


Interim plan (possibly winfax) as alternative to web registration


Modified IVR/winfax technology October 2006



Operations Update, con’d


Pre
-
Certification Call Duration


Reviewed Avaya phone system to test capability


More focused reporting has been programmed


Average call length: 16:53 min:sec


Maximum call length: 21:33 min:sec


ICM Activity


186 total cases


58 referred in June, 55 accepted


19% of total referrals from inpatient psychiatric units


34% of total referrals from internal source


Other referral sources include: MCO’s, DCF, self referral, Residential
and EDs


Referrals from EDs decreased by approximately 65% since March

Operations Update, con’d


ED Interface


Decrease in call volume from EDs. Instituting daily
outreach calls effective July 1, 2006



Delay in Discharge
(Inpt., PRTF, Resi)


6% of all clients in 24 hour LOC have discharge
delays


20% of the 6% represent delays from inpatient care


20% of the 6% represent delays from PRTF


60% of the 6% represent delays from residential


Majority indicate the family is requesting additional treatment



ED

M/F

Age

DCF

Diagnosis

Days
Stuck

Identified
Disposition
needed

Actual

Disposition

CCMC

F

15

Yes

Intermittent
Explosive D/O,
Schizo
-

Affective D/O,
MR

18

Inpatient

Riverview

CCMC

M

15

Yes

PTSD, ADHD

1

Inpatient

Riverview

New
Britain

M

15

Yes

Mood disorder,
Reactive D/O

9

Inpatient

PRTF

Charl,

Hungers

M

15

Yes

Conduct D/O

3

CCP

CCP

Middle
-
sex

M

15

Yes

ODD, PTSD

5

Inpatient

Natchaug

Medical

Unit/

Boarding

M/F

Age

DCF

Diagnosis

Days

Stuck

Identified

Disposition

Needed

Actual
Disposition

**CCMC

? Primary
psych or
med.
Coordinati
on of care

M

15

Yes

Oppositional

Defiant D/O

Significant
medical co
-

morbids

24

Inpatient

Cumberland


Stuck ED Volume


June 2006

Call Management/Customer Service

CT BHP Call Management

June, 2006

*Please note: MCO and 211 totals are calculated in “member” total monthly calculation.


Week
Ending

Tota
l
Calls

Total
%
Aban
don

Day
Staff
Calls

#
Aband
ons

Day
Staff
%
Aband
on

After
Hours
Calls

#
Aband
ons

After
Hours
%
Aband
on

Memb
er
Calls

Provid
er
Calls

Crisis
Calls

After
Hours
Memb
er

After
Hours
Provid
er

MCO
Calls

211
Perinata
l
Depress
ion

6/3/2006
Partial
Week

500

0.40%

473

2

0.42%

27

0

0.00%

151

306

16

1

26






1






11

6/10/2006

1219

0.33%

1152

4

0.35%

67

0

0.00%

417

708

27

1

66





0





0

6/17/2006

956

0.10%

911

1

0.11%

45

0

0.00%

399

487

25

1

44



6



0

6/24/2006

1048

0.29%

996

2

0.20%

52

1

1.92%

377

591

28

2

50



3





0

6/30/2006

1169

0.26%

1136

3

0.26%

33

0

0.00%

415

699

22

1

32



8



3

Total
Monthly

4892

0.31%

4668

12

0.30%

224

1

0.45%

1759

2791

118

6

218




18




14

Types of Inquiries

June, 2006



38%
-

Provider Referrals for Members



18%
-

Member Eligibility Verification



39%
-

Provider Related/Authorization/Enrollment/Billing



5%
-

General Information




43% = Member Inquiries


0.01% = Inquiries initiated due to provider status change from IN to OON


Type and percentage of calls remains relatively the same as May, 2006

CT BHP CALL MANAGEMENT

Incoming Calls Totals: June 2006



Total



4892


Increase of 215 calls over May, 2006

Member Calls:

1765

Provider Calls:

3009

Crisis Calls:


118


Network Operations

Network Operations/Status



Provider Handbook


Posted to the website June 14 2006


Feedback appreciated


CMAP Network as of June 26, 2006


1,435 Total Providers



519 Facilities


Individual Providers


MD and MD Groups: 381


LCSW: 308


LMFT: 122


LPC: 82


Add/Change report: 0
-
5 adds per week, 5
-
10 changes


DCF Network


122 RTC and Group Home providers


(Increase of 36 providers since 11/2005)


Rapid Response Team Findings



Cycle date 051906 we have
identified the following
issues:


16 inpatient providers put
data in auth line


7 IOP/PHP providers
submitted claims without
prior authorization



Outreach calls were provided
to the high level denial
providers




Cycle date 060906 we have
identified the following issues:


343 Claims were submitted
without authorization;


51 Claims were submitted
outside the effective
authorization dates;


43 Claims were submitted with
the incorrect authorization
number;


31 Claims were submitted with
an invalid provider number;


17 Claims were submitted by
Out
-
of
-
State providers without
receiving prior authorization;


14 Claims were submitted after
the effective authorization
dates;

Rapid Response Team Process


The Rapid Response Team is composed of
representatives from CTBHP, DSS and EDS:


The RRT meets bi
-
weekly to review any denial issues;


CTBHP produces a detailed report of provider claims that
directly correlate with the reports forwarded by EDS;


CTBHP works in concert with EDS to resolve claims issues.


Providers are contacted and the denial(s) are reviewed for
resolution;


CTBHP’s outreach contributes to building the
relationship with the Network and providing cohesion
across the departments;

Rapid Response Team Process Cont’d


Reviewed claims issues for 26 providers, follow up
included:


16 Outreach Calls to providers;


Claim information was faxed and issues were
resolved for 4 providers;


3 Providers pending response from EDS Provider
Assistance Center follow
-
up;


1 Provider presently remains in review with RRT;


Quality Management

Quality Initiatives, con’d


Satisfaction Surveys


Member, Member with Complex Needs and Provider
Surveys


Data collection will begin in June and July for the
provider survey and conclude in late summer, early
Fall


completed via phone interviews


Provider report complete Fall of 2006


Member Survey presented to Quality Sub
-
Committee,
feedback to be incorporated


Member Survey roll
-
out Fall of 2006


Complaints and Grievances

January


June 2006


Complaints: 30 from January to June 23rd.




5 member complaints in June:



2 Quality of Service,



2 Quality of Care,



1 concerning member wanting to use an Out of Network


provider



Grievances: 3 from January to June 23rd.






None in June.




All Complaints and Grievances were resolved within standard timeframes






Community Outreach

Community Outreach


June, 2006


Systems Managers


91
DCF, Provider, Collaborative and MSS meetings in June


551
Meetings year to date


Peer/Family Meetings



49
Family forums, informational meetings, DCF and


Collaborative meetings,



2
Staff attended NAMI conference in Washington DC


Peer/Family Outreach/Coordination
:


41
Open family/peer consultations in June


(68% increase from May)


19
Family/peer consults completed in June


Local Area Development Plans


Preliminary plans submitted to the Departments
on June 30, 2006


Departments will review over the next 30 days


Final submission due September, 2006


Statewide themes and regional variation


Sample of general issues:


Recognized commitment for continued change/reform


Determination to expand community
-
based services, while
strengthening local service system development


System gridlock, lack of coordinated system infrastructure and
accountability, lack of integration of resources, knowledge and
strategies across advisory groups


Questions?