mhp draft report - butte county

FY 16-17

Medi-Cal Specialty Mental Health

External Quality Review

MHP DRAFT Report

Prepared by:

Behavioral Health Concepts, Inc.

5901 Christie Avenue, Suite 502

Emeryville, CA 94608

www.caleqro.com

Butte Conducted on

August 17-18, 2016

http://www.caleqro.com/

TABLE OF CONTENTS

BUTTE MENTAL HEALTH PLAN SUMMARY FINDINGS ............................................................................................... 4

INTRODUCTION ..................................................................................................................................................................... 5

PRIOR YEAR REVIEW FINDINGS, FY15-16 ..................................................................................................................... 7

STATUS OF FY15-16 REVIEW RECOMMENDATIONS ................................................................................................................................ 7 Assignment of Ratings ............................................................................................................................................................................... 7 Key Recommendations from FY15-16 ................................................................................................................................................ 8

CHANGES IN THE MHP ENVIRONMENT AND WITHIN THE MHP—IMPACT AND IMPLICATIONS .................................................... 10

PERFORMANCE MEASUREMENT .................................................................................................................................... 12

TOTAL BENEFICIARIES SERVED................................................................................................................................................................... 12 PENETRATION RATES AND APPROVED CLAIM DOLLARS PER BENEFICIARY ....................................................................................... 13 HIGH-COST BENEFICIARIES ......................................................................................................................................................................... 17 TIMELY FOLLOW-UP AFTER PSYCHIATRIC INPATIENT DISCHARGE ...................................................................................................... 18 DIAGNOSTIC CATEGORIES ............................................................................................................................................................................ 19 PERFORMANCE MEASURES FINDINGS—IMPACT AND IMPLICATIONS .................................................................................................. 20

PERFORMANCE IMPROVEMENT PROJECT VALIDATION ....................................................................................... 22

BUTTE MHP PIPS IDENTIFIED FOR VALIDATION .................................................................................................................................... 22 CLINICAL PIP—OUTCOME MEASURES INFORMED CLINICAL PRACTICE ................................................................................................ 24 NON-CLINICAL PIP—BUTTE COUNTY CONSUMER WAIT TIME REDUCTION: METRICS ..................................................................... 25 PERFORMANCE IMPROVEMENT PROJECT FINDINGS—IMPACT AND IMPLICATIONS .......................................................................... 26

PERFORMANCE & QUALITY MANAGEMENT KEY COMPONENTS ......................................................................... 28

Access to Care .............................................................................................................................................................................................. 28 Timeliness of Services ............................................................................................................................................................................... 29 Quality of Care ............................................................................................................................................................................................. 31

KEY COMPONENTS FINDINGS—IMPACT AND IMPLICATIONS ................................................................................................................ 35

CONSUMER AND FAMILY MEMBER FOCUS GROUP(S) ............................................................................................ 37

CONSUMER/FAMILY MEMBER FOCUS GROUP 1 ...................................................................................................................................... 37 CONSUMER/FAMILY MEMBER FOCUS GROUP FINDINGS—IMPLICATIONS ......................................................................................... 38

INFORMATION SYSTEMS REVIEW ................................................................................................................................. 40

KEY ISCA INFORMATION PROVIDED BY THE MHP ................................................................................................................................. 40 CURRENT OPERATIONS ................................................................................................................................................................................. 41 PLANS FOR INFORMATION SYSTEMS CHANGE .......................................................................................................................................... 42 ELECTRONIC HEALTH RECORD STATUS ..................................................................................................................................................... 42 MAJOR CHANGES SINCE LAST YEAR ........................................................................................................................................................... 43 PRIORITIES FOR THE COMING YEAR ........................................................................................................................................................... 44 OTHER SIGNIFICANT ISSUES ........................................................................................................................................................................ 45 MEDI-CAL CLAIMS PROCESSING ................................................................................................................................................................... 45 INFORMATION SYSTEMS REVIEW FINDINGS—IMPLICATIONS ............................................................................................................... 46

SITE REVIEW PROCESS BARRIERS ................................................................................................................................ 47

CONCLUSIONS ...................................................................................................................................................................... 48

STRENGTHS AND OPPORTUNITIES .............................................................................................................................................................. 48

Access to Care .............................................................................................................................................................................................. 48 Timeliness of Services ............................................................................................................................................................................... 48 Quality of Care ............................................................................................................................................................................................. 49 Consumer Outcomes ................................................................................................................................................................................. 49

RECOMMENDATIONS ..................................................................................................................................................................................... 50

ATTACHMENTS ................................................................................................................................................................... 53

ATTACHMENT A—REVIEW AGENDA ......................................................................................................................................................... 54 ATTACHMENT B—REVIEW PARTICIPANTS .............................................................................................................................................. 55 ATTACHMENT C—APPROVED CLAIMS SOURCE DATA ........................................................................................................................... 58 ATTACHMENT D—PIP VALIDATION TOOL .............................................................................................................................................. 59

BUTTE MENTAL HEALTH PLAN SUMMARY FINDINGS

Summary Findings for CalEQRO FY16-17 review. This may serve as a stand-alone document that

provides only the overarching significant findings for each section of this MHP Report. MHP

Information as follows:

o Beneficiaries served in CY15—5,214

o MHP Threshold Language(s)—Spanish

o MHP Size—Medium

o MHP Region—Superior

o MHP Location— Chico

o MHP County Seat—Oroville

Introduction

Butte is a medium-sized, Superior region county that includes the city of Chico and county seat in

Oroville. The MHP headquarters are in Chico. Butte is located in the California Central Valley.

Agriculture is the number one industry, with a large rural workforce.

During the FY 16-17 review, CalEQRO found the following overall significant changes, efforts and

opportunities related to Access, Timeliness, Quality and Outcomes of MHP and its contractor

services. Further details and findings from EQRO mandated activities are provided in the rest of the

report.

Access

The Affordable Care Act (ACA) has had a positive impact by enrolling consumers not previously

eligible for the Medi-Cal program and resulting in additional Medi-Cal revenue. The MHP overall

penetration rate exceeds Medium size MHPs and statewide averages, as well as for age and

race/ethnicity categories. Staffing recruitment, retention and morale remain issues to be addressed

given the growing number of consumers requesting services.

Collaboration with managed care plans remains challenging for referring mild-to-moderate

consumers due to long wait times (up to 6 months), and accuracy of acuity determination which

leads to shuffling consumers back and forth.

Timeliness

The MHP continues to have issues in tracking timeliness. The “BCDBH Contact” form captures the

data difference between “Contact Date” and “First Actual Appointment Date” that serves as a

creative solution while the MHP works with the IS vendor for a permanent solution in MyAvatar.

The MHP is also not yet able to reliably track client no shows in the EHR MyAvatar.

Quality

The MHP signed an MOU with Social Services detailing internal steps and a joint management

structure for Katie A sub class members.

The MHP plans to adopt the American Society of Addiction Medicine (ASAM) criteria for training

Substance Use Disorder (SUD), Mental Health (MH) and contract provider staff and partners.

The recent opening of the 10-bed adult crisis residential facility is a significant enhancement to

continuum of care for adult services. Telepsychiatry services are robust, serving 1,141 consumers

at nine sites during the past year.

Outcomes

The MHP and consumers jointly created a short (7-question) consumer survey that is used at all

sites. Responses are reviewed and posted quarterly, with follow up by program managers and

supervisors.

INTRODUCTION

The United States Department of Health and Human Services (DHHS), Centers for Medicare and

Medicaid Services (CMS) requires an annual, independent external evaluation of State Medicaid

Managed Care programs by an External Quality Review Organization (EQRO). External Quality

Review (EQR) is the analysis and evaluation by an approved EQRO of aggregate information on

quality, timeliness, and access to health care services furnished by Prepaid Inpatient Health Plans

(PIHPs) and their contractors to recipients of Managed Care services. The CMS (42 CFR §438;

Medicaid Program, External Quality Review of Medicaid Managed Care Organizations) rules specify

the requirements for evaluation of Medicaid Managed Care programs. These rules require an on-

site review or a desk review of each Medi-Cal Mental Health Plan (MHP).

The State of California Department of Health Care Services (DHCS) contracts with fifty-six (56)

county Medi-Cal MHPs to provide Medi-Cal covered specialty mental health services to Medi-Cal

beneficiaries under the provisions of Title XIX of the federal Social Security Act.

This report presents the fiscal year 2016-2017 (FY 16-17) findings of an EQR of the Butte

MHP by the California External Quality Review Organization (CalEQRO), Behavioral Health

Concepts, Inc. (BHC).

The EQR technical report analyzes and aggregates data from the EQR activities as described below:

(1) VALIDATING PERFORMANCE MEASURES1

This report contains the results of the EQRO’s validation of eight (8) Mandatory Performance

Measures (PM) as defined by DHCS. The eight performance measures include:

Total Beneficiaries Served by each county MHP

1 Department of Health and Human Services. Centers for Medicare and Medicaid Services (2012). Validation

of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR),

Protocol 2, Version 2.0, September, 2012. Washington, DC: Author.

Total Costs per Beneficiary Served by each county MHP

Penetration Rates in each county MHP

Count of TBS Beneficiaries Served Compared to the four percent (4%) Emily Q.

Benchmark (not included in MHP reports; this information is included in the Annual

Statewide Report submitted to DHCS).

Total Psychiatric Inpatient Hospital Episodes, Costs, and Average Length of Stay

Psychiatric Inpatient Hospital 7-Day and 30-Day Rehospitalization Rates

Post-Psychiatric Inpatient Hospital 7-Day and 30-Day Specialty Mental Health

Services (SMHS) Follow-Up Service Rates

High Cost Beneficiaries ($30,000 or higher)

(2) VALIDATING PERFORMANCE IMPROVEMENT PROJECTS2

Each MHP is required to conduct two Performance Improvement Projects (PIPs) during the 12

months preceding the review; Butte MHP submitted two PIPs for validation through the EQRO

review. The PIP(s) are discussed in detail later in this report.

(3) MHP HEALTH INFORMATION SYSTEM CAPABILITIES3

Utilizing the Information Systems Capabilities Assessment (ISCA) protocol, the EQRO reviewed and

analyzed the extent to which the MHP meets federal data integrity requirement for Health

Information Systems (HIS), as identified in 42 CFR §438.242. This evaluation included review of

the MHP’s reporting systems and methodologies for calculating Performance Measures (PM).

(4) VALIDATION OF STATE AND COUNTY CONSUMER SATISFACTION SURVEYS

The EQRO examined available consumer satisfaction surveys conducted by DHCS, the MHP or its

subcontractors.

CalEQRO also conducted one 90-minute focus group with beneficiaries and family members to

obtain direct qualitative evidence from beneficiaries.

2 Department of Health and Human Services. Centers for Medicare and Medicaid Services (2012). Validating

Performance Improvement Projects: Mandatory Protocol for External Quality Review (EQR), Protocol 3,

Version 2.0, September 2012. Washington, DC: Author. 3 Department of Health and Human Services. Centers for Medicare and Medicaid Services (2012). EQR

Protocol 1: Assessment of Compliance with Medicaid Managed Care Regulations: A Mandatory Protocol for

External Quality Review (EQR), Protocol 1, Version 2.0, September 1, 2012. Washington, DC: Author.

(5) KEY COMPONENTS, SIGNIFICANT CHANGES, ASSESSMENT OF STRENGTHS,

OPPORTUNITIES FOR IMPROVEMENT, RECOMMENDATIONS

The CalEQRO review draws upon prior year’s findings, including sustained strengths, opportunities

for improvement, and actions in response to recommendations. Other findings in this report

include:

Changes, progress, or milestones in the MHP’s approach to performance

management—emphasizing utilization of data, specific reports, and activities

designed to manage and improve quality.

Ratings for Key Components associated with the following three domains: access,

timeliness, and quality. Submitted documentation as well as interviews with a

variety of key staff, contracted providers, advisory groups, beneficiaries, and other

stakeholders serve to inform the evaluation of MHP’s performance within these

domains. Detailed definitions for each of the review criteria can be found on the

CalEQRO Website www.caleqro.com.

PRIOR YEAR REVIEW FINDINGS, FY15-16

In this section we first discuss the status of last year’s (FY15-16) recommendations, as well as

changes within the MHP’s environment since its last review.

STATUS OF FY15-16 REVIEW RECOMMENDATIONS

In the FY15-16 site review report, the CalEQRO made a number of recommendations for

improvements in the MHP’s programmatic and/or operational areas. During the FY16-17 site visit,

CalEQRO and MHP staff discussed the status of those FY15-16 recommendations, which are

summarized below.

Assignment of Ratings

Fully addressed—

o resolved the identified issue

Partially addressed—Though not fully addressed, this rating reflects that the MHP

has either:

o made clear plans and is in the early stages of initiating activities to address the

recommendation

o addressed some but not all aspects of the recommendation or related issues

Not addressed—The MHP performed no meaningful activities to address the

recommendation or associated issues.

http://www.caleqro.com/

Key Recommendations from FY15-16

Recommendation #1: Demonstrate the values of the new leadership and engage in

activities addressing staff morale, leading to a renewed job commitment.

☐ Fully addressed ☒ Partially addressed ☐ Not addressed

o While the Board of Supervisors approved salary increases between 8-16% for

several key clinical, nursing and manager positions, compensation (salary and

benefits) is not perceived to be competitive with surrounding counties.

Psychiatrist salaries were raised by 16% and for contracted MDs the rate was

raised an additional $20/hour. Salary step increases where provided across the

board to all peer advocates/employees.

o Administrative staff has not received additional compensation, however

negotiations are in process with local labor unions.

o Staff report paying significantly more for benefits, while take-home pay has

decreased over the past several years.

o Recruitment and staff retention remain significant issues for the MHP, and the

vacancy rate remains significantly high.

o Currently the MHP is authorized 374 FTE positions of which 44 positions are

vacant and another 17 positions are back-filled. The IT unit has 33% of its

positions vacant. While adult clinics in Paradise, Chico, and Oroville have 20% or

so of their positions vacant.

o Staff reported that the productivity standard of 60% is now being enforced,

placing “tremendous pressure” on them and causing additional stress on an

already stretched workforce. While there is a productivity formula/wheel to

plug in staff activities (billable and non-billable), staff are required to do a lot of

not billable work which negatively impacts their productivity. When staff has

productivity under 60%, they receive a counseling memo for that quarter,

regardless of their performance during previous quarters. While the counseling

memo states that it is not punitive, staff receive it as such.

o Staff and supervisors report that it would help morale if there was recognition

and/or a reward system built into the productivity standard for staff that are

doing very good work and providing excellent care. Other suggestions included

changing the name from “productivity” to “billable time”.

o Consumer Satisfaction Surveys were conducted in November and May, and

comments received were overwhelmingly positive which resulted in building

staff morale.

Recommendation #2: Engage in two Performance Improvement Projects (PIPs),

Clinical and Non-Clinical, incorporating consumer outcomes or processes of care

directly affecting consumers.


o The MHP created two PIPs, one Clinical – “Outcome Measures Informed Clinical

Practices”, and one Non-Clinical – “Butte County Consumer Wait Time

Reduction, Metrics”.

o The Clinical PIP is designed with the goal of utilizing outcome measures of the

CANS and MORS to inform treatment decisions and service delivery which is

projected to improve client outcomes.

o The Non-Clinical PIP addresses a desire to improve timeliness of initial access

for consumers and hypothesizes that this will improve the benefit to the

consumer.

o Both PIPs began in July 2016 and are still “Concept Only” in that the

interventions have not begun and therefore no data nor analysis of results are

available at this time.

Recommendation #3: Implement the Avatar Schedule Tracker. Document the

methodology used to identify no show appointments, requests for urgent services,

initial requests for services and first appointments as soon as practical.


o During the course of implementing the Scheduler module it was determine that

MS-Outlook calendar items cannot automatically populate Avatar Scheduler.

Without this feature both clinical and clerical staff would be required to

maintain and manage two separate calendars.

o This issue has delayed deployment of Scheduler. The MHP is working with

Netsmart Technologies and has requested the vendor develop calendar syncing

capability into Scheduler.

o The MHP continues to have plans to use Scheduler to document and report on

no-show appointments.

Recommendation #4: Strategize ways to systematically analyze CANS, MORS and

FIT outcome data and disperse reports. Increase commitment to training all staff in

the use of tools and fidelity in scoring of the tools.

☒ Fully addressed ☐ Partially addressed ☐ Not addressed

o The MHP has narrowed the focus to the CANS and MORS to measure outcomes

and triage Level of Care (LOC) for youth and adults.

o While the MHP is working on ensuring that every consumer has at least one

outcome measure in their EHR record by October 2016, the tools are not

consistently being used to guide individual clinical care. The MHP is in the

process of creating a robust process and audit tool to use outcome measures to

guide individual treatment modalities.

o MORS training is conducted on a monthly basis with 51 staff completing the

training this fiscal year. CANS training is conducted on an “as needed” basis

when new staff is hired or recertification is required. In FY15-16, 30 staff have

been trained, and one recertified.

o Some outcome data reports are being dispersed at the monthly QIC, and the

MHP is working with CWS on standardizing CANS for screening all children.

o The MHP engaged in a PIP that focuses on the improved collection and informed

treatment of consumers by increasing the utilization of the CANS and MORS.

Recommendation #5: Implement the proposed navigator/ triage methodology and

consider employing consumers as appropriate.

☒ Fully addressed ☐ Partially addressed ☐ Not addressed

o The MHP implemented the Navigator Triage methodology and added three peer

advocates/employees to the team to engage clients in follow up outpatient

services. The peers assist with transportation, helping consumers navigate the

system, and handholding as needed. This has led to a decrease in the No Show

rate for post hospitalization consumers.

o Peer employees are benefitted if full time and salary step increases were

provided to all peer advocates/employees.

CHANGES IN THE MHP ENVIRONMENT AND WITHIN THE MHP—IMPACT AND IMPLICATIONS

Changes since the last CalEQRO review, identified as having a significant effect on service provision

or management of those services are discussed below. This section emphasizes systemic changes

that affect access, timeliness, and quality, including those changes that provide context to areas

discussed later in this report.

Access to Care

o The MHP experienced significant changes in clinical and administrative sites last

year, and is attempting to keep all services centralized to facilitated access.

Due to the fire that destroyed the adult clinic in Paradise, the clinic was

relocated to a temporary site provided by the owner of the burned

building. In the same complex is the adult wellness and recovery center

and children’s services.

In Chico, the Children’s clinic lost their lease and is moving into an

existing administration building on the same compound where crisis and

adult services are located, while the administration is moving to another

nearby building.

Additionally, IT, QM, and Systems Performance Research and

Evaluations (SPRE) have also been relocated.

o The MHP contracted with a crisis residential provider to open a 10-bed facility

in county, and with North Valley Behavioral Health (NVBH) to expand from 4 to

6 beds for Butte County consumers.

o The MHP began to work with managed care plans for the transition of clients

with mild to moderate diagnoses who no longer meet medical necessity for

specialty mental health services.

o Mental Health (MH) is the largest contributor of services to the homeless, which

is the justification for a new 14-bed housing unit for which construction has just

begun. The MHP is developing the selection process for tenants and for MH

teams to provide services there.

o MHP is collaborating with the County sheriff to provide expanded MH services

in the jail, and possibly designating the jail as a treatment facility for

Incompetent to Stand Trial (IST) cases.

o Educationally-related mental health services for local schools were phased-out

during FY15-16 and no longer being provided to the SELPA.

Timeliness of Services

o During the past year the MHP developed and implemented “BCDBH Contact”

form in Avatar. This captures the date difference between “Contact Date” and

“First Actual Appointment Date” that serves as the basis for wait-time data for

both adults, children and youth.

o The MHP has not yet been able to implement Avatar Scheduler module. It was

determined that MS-Outlook calendar items cannot automatically populate

Avatar Scheduler. Without this feature both clinical and clerical staff would be

required to maintain and manage two separate calendars.

o This issue has delayed deployment of Scheduler. The MHP is working with

Netsmart Technologies and has requested the vendor to develop calendar

syncing capability into Scheduler.

Quality of Care

o According to a County satisfaction survey of staff conducted last year, poor

compensation was the largest issue identified.

o Currently, the jail has no safety cells. However, funding has been secured to

build a new jail with expanded MH and Substance Use Disorder (SUD) service

capacity.

Consumer Outcomes

o Salary step increases where provided across the board to all peer

advocates/employees.

PERFORMANCE MEASUREMENT

CalEQRO is required to validate the following PMs as defined by DHCS:

Total Beneficiaries Served by each county MHP

Total Costs per Beneficiary Served by each county MHP

Penetration Rates in each county MHP

Count of TBS Beneficiaries Served Compared to the four percent (4%) Emily Q.

Benchmark (not included in MHP reports; this information is included in the Annual

Statewide Report submitted to DHCS)

Total Psychiatric Inpatient Hospital Episodes, Costs, and Average Length of Stay

Psychiatric Inpatient Hospital 7-Day and 30-Day Rehospitalization Rates

Post-Psychiatric Inpatient Hospital 7-Day and 30-Day SMHS Follow-Up Service

Rates

High Cost Beneficiaries ($30,000 or higher)

TOTAL BENEFICIARIES SERVED

Table 1 provides detail on beneficiaries served by race/ethnicity.

Table 1—Butte MHP Medi-Cal Enrollees and Beneficiaries Served in CY15 by Race/Ethnicity

Race/Ethnicity Average Monthly Unduplicated

Medi-Cal Enrollees* Unduplicated Annual Count of

Beneficiaries Served

White 36,686 3,500

Hispanic 11,492 605

African-American 1,543 184

Asian/Pacific Islander 4,311 199

Native American 1,182 90

Other 6,323 636

Total 61,534 5,214

*The total is not a direct sum of the averages above it. The averages are calculated separately.

PENETRATION RATES AND APPROVED CLAIM DOLLARS PER BENEFICIARY

The penetration rate is calculated by dividing the number of unduplicated beneficiaries served by

the monthly average enrollee count. The average approved claims per beneficiary served per year

is calculated by dividing the total annual dollar amount of Medi-Cal approved claims by the

unduplicated number of Medi-Cal beneficiaries served per year.

Regarding calculation of penetration rates, the Butte MHP:

☐ Uses the same method as used by the EQRO

☒ Uses a different method: Monthly average count of eligible derived from two

sources.

1. Monthly Medi-Cal Eligibility File (MMEF) that is downloaded into Avatar.

2. Medi-Cal Enrollment by Geographic Region from DHCS website.

☐ Does not calculate its penetration rate.

Figures 1A and 1B show 3-year trends of the MHP’s overall approved claims per beneficiary and

penetration rates, compared to both the statewide average and the average for Medium MHPs.

$4,400

$4,600

$4,800

$5,000

$5,200

$5,400

$5,600

$5,800

$6,000

$6,200

CY13 CY14 CY15

Figure 1A. Overall Average Approved Claims per Beneficiary

Butte Medium State

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

CY13 CY14 CY15

Figure 1B. Overall Penetration Rates

Butte Medium State

Figures 2A and 2B show 3-year trends of the MHP’s foster care (FC) approved claims per

beneficiary and penetration rates, compared to both the statewide average and the average for

Medium MHPs.

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

CY13 CY14 CY15

Figure 2A. FC Average Approved Claims per Beneficiary

Butte Medium State

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

CY13 CY14 CY15

Figure 2B. FC Penetration Rates

Butte Medium State

Figures 3A and 3B show 3-year trends of the MHP’s Hispanic approved claims per beneficiary and

penetration rates, compared to both the statewide average and the average for Medium MHPs.

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

CY13 CY14 CY15

Butte Medium State

Figure 3A. Hispanic Average Approved Claims per Beneficiary

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

CY13 CY14 CY15

Figure 3B. Hispanic Penetration Rates

Butte Medium State

HIGH-COST BENEFICIARIES

Table 2 compares the statewide data for high-cost beneficiaries (HCB) for CY15 with the MHP’s data

for CY15, as well as the prior two years. HCB in this table are identified as those with approved

claims of more than $30,000 in a year.

Table C1 (Attachment C) shows the penetration rate and approved claims per beneficiary for the

CY15 Medi-Cal Expansion (Affordable Care Act [ACA]) Penetration Rate and Approved Claims per

Beneficiary.

Table C2 (Attachment C) show the distribution of the MHP CY15 Distribution of Beneficiaries by

Approved Claims per Beneficiary Range for the various categories; under $20,000; $20,000 to

$30,000, and those above $30,000.

MHP Year

HCB

Count

Total

Beneficiary

Count

HCB %

by

Count

Average

Approved

Claims

per HCB

HCB Total

Claims

HCB % by

Approved

Claims

Statewide CY15 13,851 483,793 2.86% $51,635 $715,196,184 26.96%

CY15 114 5,214 2.19% $50,822 $5,793,698 22.06%

CY14 109 5,511 1.98% $51,914 $5,658,654 20.45%

CY13 158 5,511 2.87% $49,383 $7,802,442 25.74%

Table 2—High-Cost Beneficiaries

Butte

TIMELY FOLLOW-UP AFTER PSYCHIATRIC INPATIENT DISCHARGE

Figures 4A and 4B show the statewide and MHP 7-day and 30-day outpatient follow-up and

rehospitalization rates for CY14 and CY15.

0%

10%

20%

30%

40%

50%

60%

70%

Oupatient MHP Outpatient State RehospitalizationMHP

RehospitalizationState

Figure 4A. 7-Day Outpatient Follow-up and Rehospitalization Rates, Butte MHP and State

CY14 CY15

0%

10%

20%

30%

40%

50%

60%

70%

Oupatient MHP Outpatient State RehospitalizationMHP

RehospitalizationState

Figure 4B. 30-Day Outpatient Follow-up and Rehospitalization Rates, Butte MHP and State

CY14 CY15

DIAGNOSTIC CATEGORIES

Figures 5A and 5B compare the breakdown by diagnostic category of the statewide and MHP

number of beneficiaries served and total approved claims amount, respectively, for CY15.

MHP self-reported percent of consumers served with co-

occurring (substance abuse and mental health) diagnoses:

0%

5%

10%

15%

20%

25%

30%

35%

Depression Psychosis Disruptive Bipolar Anxiety Adjustment Other Deferred

Figure 5A. Diagnostic Categories, Beneficiaries Served

Butte CY15 State CY15

0%

5%

10%

15%

20%

25%

30%

35%

Depression Psychosis Disruptive Bipolar Anxiety Adjustment Other Deferred

Figure 5B. Diagnostic Categories, Total Approved

Butte CY15 State CY15

27%

PERFORMANCE MEASURES FINDINGS—IMPACT AND IMPLICATIONS

Access to Care

o While the MHP’s number of eligibles rose from 60,273 in CY14 to 61,534 in

CY15, the number of beneficiaries served dropped from 5,515 in CY14 to 5,214

in CY15. This correlates to a drop in penetration rate from 9.15% in CY14 to

8.47% in CY15, but still significantly higher than CY15 statewide rate of 4.82%.

o During CY15 the MHP served 1,629 Affordable Care Act (ACA) beneficiaries, of

the 14,491 eligibles for a penetration rate of 11.24% for this sub-group (see

Table C1 in Appendix C).

o While declining slightly each year from CY13 to CY15, the MHP’s CY15 Overall

penetration rate and exceeds medium and statewide averages.

o The MHP FC penetration rates declined slightly from CY13 to CY15, CY15 FC

penetration rate is slightly lower than medium and statewide averages.

o The MHP’s Hispanic penetration remains significantly greater than that of both

medium and statewide averages. Spanish is a threshold language for Butte.


o During CY15, the MHP’s 7 and 30 day outpatient follow-up rates after discharge

from a psychiatric inpatient episode decreased from corresponding CY14 rates,

but still exceed the statewide average.

o The MHP’s 7 and 30-day rehospitalization rates were slightly less than the

statewide averages for the two year period.

Quality of Care

o The MHP’s percentage of high-cost beneficiaries (HCBs) from CY13 to CY15

remain less than the statewide average. The percentage of total HCB claim

dollars also was slightly less than the statewide average in CY15 (22.06% vs.

26.96%).

o The MHP’s average Overall approved claims per beneficiary decreased each year

from CY13 to CY15, and was less than both medium and statewide averages for

the past two year period.

o While the MHP’s average FC approved claims per beneficiary increased from

CY14 to CY15, it remains less than both medium and statewide averages for the

past two year period.

o The MHP’s average Hispanic approved claims per beneficiary decreased each

year from CY13 to CY15, and was less than medium and statewide averages for

the past two year period.

o The MHP diagnosing patterns differ from statewide averages with higher

percentage of bipolar and anxiety disorder diagnoses. While lower percentage of

depression and disruptive disorder diagnoses than statewide averages.

o Varying from the statewide pattern, but correlating with the MHP’s diagnostic

pattern, the percentage of total approved claims for individuals with bipolar and

anxiety disorders was notably higher than that of most other diagnostic

categories.

Consumer Outcomes

o The MHP’s 7 day outpatient follow up rate declined from CY14 and remain

higher than the statewide average for the two year period.

PERFORMANCE IMPROVEMENT PROJECT VALIDATION

A PIP is defined by CMS as “a project designed to assess and improve processes, and outcomes of

care that is designed, conducted and reported in a methodologically sound manner.” The Validating

Performance Improvement Projects Protocol specifies that the EQRO validate two PIPs at each MHP

that have been initiated, are underway, were completed during the reporting year, or some

combination of these three stages. DHCS elected to examine projects that were underway during

the preceding calendar year 2015.

BUTTE MHP PIPS IDENTIFIED FOR VALIDATION

Each MHP is required to conduct two PIPs during the 12 months preceding the review. CalEQRO

reviewed and validated two MHP submitted PIPs as shown below.

Table 3A—PIPs Submitted

PIPs for Validation # of PIPs PIP Titles

Clinical PIP 1 Outcomes Measures Inform Clinical Practice

Non-Clinical PIP 1 Butte County Consumer Wait Time Reduction: Metrics

Table 3B lists the findings for each section of the evaluation of the PIPs, as required by the PIP

Protocols: Validation of Performance Improvement Projects.4

Table 3B—PIP Validation Review

Step PIP Section Validation Item

Item Rating*

Clinical PIP

Non-Clinical

PIP

1 Selected Study Topics

1.1 Stakeholder input/multi-functional team PM M

1.2 Analysis of comprehensive aspects of enrollee needs, care, and services

PM M

1.3 Broad spectrum of key aspects of enrollee care and services

M M

1.4 All enrolled populations M M

2 Study Question 2.1 Clearly stated PM PM

4 2012 Department of Health and Human Services, Centers for Medicare and Medicaid Service Protocol 3

Version 2.0, September 2012. EQR Protocol 3: Validating Performance Improvement Projects.



Item Rating*

Clinical PIP

Non-Clinical

PIP

3 Study Population 3.1 Clear definition of study population M M

3.2 Inclusion of the entire study population PM PM

4 Study Indicators

4.1 Objective, clearly defined, measurable indicators

M M

4.2 Changes in health status, functional status, enrollee satisfaction, or processes of care

PM PM

5 Sampling Methods

5.1 Sampling technique specified true frequency, confidence interval and margin of error

NA NA

5.2 Valid sampling techniques that protected against bias were employed

NA NA

5.3 Sample contained sufficient number of enrollees

NA NA

6 Data Collection Procedures

6.1 Clear specification of data M M

6.2 Clear specification of sources of data M M

6.3 Systematic collection of reliable and valid data for the study population

M M

6.4 Plan for consistent and accurate data collection

PM M

6.5 Prospective data analysis plan including contingencies

NM PM

6.6 Qualified data collection personnel M M

7 Assess Improvement Strategies

7.1 Reasonable interventions were undertaken to address causes/barriers

PM PM

8

Review Data Analysis and Interpretation of Study Results

8.1 Analysis of findings performed according to data analysis plan

UTD UTD

8.2 PIP results and findings presented clearly and accurately

UTD UTD

8.3 Threats to comparability, internal and

external validity UTD UTD

8.4 Interpretation of results indicating the success

of the PIP and follow-up UTD UTD

9 Validity of Improvement

9.1 Consistent methodology throughout the study UTD UTD

9.2 Documented, quantitative improvement in

processes or outcomes of care UTD UTD



Item Rating*

Clinical PIP

Non-Clinical

PIP

9.3 Improvement in performance linked to the

PIP UTD UTD

9.4 Statistical evidence of true improvement UTD UTD

9.5 Sustained improvement demonstrated

through repeated measures. UTD UTD

*M = Met; PM = Partially Met; NM = Not Met; NA = Not Applicable; UTD = Unable to Determine

Table 3C gives the overall rating for each PIP, based on the ratings given to the validation items.

Table 3C—PIP Validation Review Summary

Summary Totals for PIP Validation Clinical

PIP

Non-Clinical

PIP

Number Met 6 11

Number Partially Met 4 5

Number Not Met 1 0

Number Applicable (AP)

(Maximum = 28 with Sampling; 25 without Sampling) 13 16

Overall PIP Rating ((#Met*2)+(#Partially Met))/(AP*2) 62% 84%

CLINICAL PIP—OUTCOME MEASURES INFORMED CLINICAL PRACTICE

The MHP presented its study question for the Clinical PIP as follows:

“By utilizing consumer outcome measures, the CANS and MORS, will clinical staff be

better able to inform treatment decisions and service delivery to improve

beneficiary outcomes?”

Date PIP began: July, 2016

Status of PIP:

☐ Active and ongoing

☐ Complete

☐ Inactive, developed in a prior year

☒ Concept only, not yet active

☐ Submission determined not to be a PIP

☐ No PIP submitted

This PIP is designed for the purpose of increasing utilization of CANS and MORS outcomes data to

clinically inform treatment and directly affect beneficiary outcomes.

The fiscal year (FY) 2011-2012 CalEQRO review it was determined that “[BCDBH] has not selected,

developed or implemented use of a functional outcome measure to monitor consumer outcomes

across the system of care.” BCDBH spend the next year (FY12-13) identifying the outcome

measures that the MHP would utilize for adults (MORS) and children (CANS). FY13-14, BCDBH

began the process of implementing and training staff on the usage of the selected outcome

measures. In the FY14-15 final report it was noted that “The MHP has implemented CANS, and

MORS and FIT in MyAvatar. However, CalEQRO was provided no data from these tools. The MHP

has not yet implemented routine reporting to conduct a systematic evaluation of scores or changes

in scores.”

This feedback was the driving force that led BCDBH to determine that a performance improvement

project was imperative to be the impetus of change needed to shift the focus from the

implementation/utilization of the outcome measures to one of utilizing the data of the outcome

measures to clinically inform treatment and directly affect beneficiary outcomes.

Relevant details of these issues and recommendations are included within the comments found in

the PIP validation tool.

The technical assistance (TA) provided to the MHP by CalEQRO consisted of discussion with MHP

on how they will quantitatively and/or qualitatively measure “improve beneficiary outcomes”.

EQRO offered TA around discussion of how to develop a study question. Encouraged MHP to begin

interventions as soon as reasonably possible.

NON-CLINICAL PIP—BUTTE COUNTY CONSUMER WAIT TIME REDUCTION: METRICS

The MHP presented its study question for the non-clinical PIP as follows:

“Will improved timely access (metrics) to care, as determined by the Special Terms

and Conditions of the 1915b Waiver, improve BDCBH’s ability to serve

beneficiaries?

Date PIP began: July 2016

Status of PIP:

☐ Active and ongoing

☐ Completed

☐ Inactive, developed in a prior year

☒ Concept only, not yet active

☐ Submission determined not to be a PIP

☐ No PIP submitted

Timely access to services has been a focus of BCDBH for several years. This has included non-

urgent specialty mental health services (SMHS) after an initial request by consumer, follow up

outpatient SMHS following an inpatient psychiatric stay and the readmission following an inpatient

psychiatric stay. This PIP attempts to develop improve metrics to improve timeliness in service to

consumers.

Relevant details of these issues and recommendations are included within the comments found in

the PIP validation tool.

The technical assistance provided to the MHP by CalEQRO consisted of discussion of the issue of the

difficulty in measuring “ability to serve beneficiaries” in a quantitative or qualitative way. The MHP

reworked the study question to read “Will a standardization of processes increase the timeliness of

initial access or needed clinical services for beneficiaries, as defined by the timeliness measures in

the 1915b Special Terms and Conditions?” The EQRO has given further TA suggesting that the study

question state a specific increase in timeliness or a percentage of improvement instead of quoting

the 1915b Special Terms and Conditions. EQRO further recommended that interventions begin as

soon as reasonably possible. Further TA will be scheduled with EQRO on an as requested by the

MHP basis.

PERFORMANCE IMPROVEMENT PROJECT FINDINGS—IMPACT AND IMPLICATIONS

Access to Care

o The Non-Clinical PIP is designed with the hypothesis that access will improve to

clients requesting outpatient services if processes of metrics are standardized.


o The Non-Clinical PIP’s goal is to improve timeliness to service after initial

request of consumer for outpatient services as well as following an inpatient

psychiatric stay.

Quality of Care

o The Clinical PIP proposes that by using CANS or MORS scores to inform

treatment, more quality treatment and appropriate Level of Care (LOC) can be

obtained.

o Timely access to services is hypothesized in the non-clinical PIP to increase

quality of treatment.

Consumer Outcomes

o The Clinical PIP has as a goal to create positive outcomes of recovery for client

by using CANS or MORS scores (as appropriate) to inform treatment.

PERFORMANCE & QUALITY MANAGEMENT KEY COMPONENTS

CalEQRO emphasizes the MHP’s use of data to promote quality and improve performance.

Components widely recognized as critical to successful performance management include an

organizational culture with focused leadership and strong stakeholder involvement, effective use of

data to drive quality management, a comprehensive service delivery system, and workforce

development strategies that support system needs. These are discussed below.

Access to Care

As shown in Table 4, CalEQRO identifies the following components as representative of a broad

service delivery system that provides access to consumers and family members. An examination of

capacity, penetration rates, cultural competency, integration and collaboration of services with

other providers forms the foundation of access to and delivery of quality services.

Table 4—Access to Care

Component Compliant

(FC/PC/NC)* Comments

1A Service accessibility and availability are reflective of cultural competence principles and practices

FC

MHP has an Ethnic Services Manager who is currently updating the Cultural Competency Plan.

The Hmong Cultural Center received a SAMHSA grant of $200K per year for three years to reduce disparities.

Staff report that underserved populations include Hispanics, Hmong, African-American, LGBTQ youth, “mountain people” living in distant areas, the homeless, and the dually diagnosed elderly. Direct services are offered in Spanish, Hmong and sign language. When needed, the language line is used.

1B Manages and adapts its capacity to meet beneficiary service needs

PC

Staff and supervisors report staffing shortages and high caseloads for outpatient clinicians.

Newly embedded MH clinician and outreach/ engagement staff in the jail.

Consumers remain in the PHF beyond necessity as there are often no referral available to stepdown beds. However, they recently opened (July 2016) a 10-bed adult crisis residential facility located next to the crisis response unit which will address stepdown from PHF issue.

Children are sent out of county if on a hold as no long term beds are available in Butte.

The overall ACA impact on Butte is positive in that it largely increased Medi-Cal beneficiaries and is bringing in new Medi-Cal revenue.

All youth and adult outpatient clinics received new Ford Transit vans to assist with transportation needs.

Table 4—Access to Care

Component Compliant

(FC/PC/NC)* Comments The MHP plans to adopt the ASAM criteria and training SUD, MH and contract provider staff and partners.

1C Integration and/or collaboration with community based services to improve access

FC

Collaboration with County sheriff to provide expanded MH services in jail, and possibility of designating jail as a treatment facility for IST cases.

Success with the Butte County Medical Society jointly developing new school program for screening tools called Physicians Committed.

Collaboration remains challenging with the two managed care plans for referring mild-to-moderate consumers due to long wait times (6 months), and accuracy of acuity determination leading to shuffling consumers back and forth. From the MHP perspective, the MOU is very difficult if not impossible to enforce, particularly around data for units of service and where/by whom consumers are being seen.

The MHP contracts with Northern Valley Catholic Social Services for a confidential Peer to Peer Support toll free warm line called Northern Valley Talk Line which receives about 65 calls nightly from around the county. It is staffed daily from 4:30 – 9:30 PM.

*FC =Fully Compliant; PC = Partially Compliant; NC = Non-Compliant


As shown in Table 5, CalEQRO identifies the following components as necessary to support a full

service delivery system that provides timely access to mental health services. The ability to provide

timely services ensures successful engagement with consumers and family members and can

improve overall outcomes while moving beneficiaries throughout the system of care to full

recovery.

Table 5—Timeliness of Services

Component Compliant


2A Tracks and trends access data from initial contact to first appointment

FC Staff report wait times for new assessments ranges from one to two weeks for adults, and less for children.

The MHP set a standard of 15 days, with an overall average of 9 days, and meets it 88% of the time. The MHP also tracks this individually for both children/youth and adult services.

For children and youth they report an average of 16 days and meets it 76% of the time.

For adults they report an average of 6 days and meets it 94% of the time.


Component Compliant


The MHP develop and implemented “BCDBH Contact” form in Avatar which captures the date difference between “Contact Date” and “First Actual Appointment Date” that serves as the basis for wait-time data for both adults, children and youth.

2B Tracks and trends access data from initial contact to first psychiatric appointment

PC Clinical staff report wait times for new MD appointments ranges from three weeks to three months for adults and children.

The MHP set a standard of 21 days, with an overall average of 21 days, and meets it 92% of the time. The MHP also tracks this individually for both children/youth and adult services.



2C Tracks and trends access data for timely appointments for urgent conditions

PC The MHP has walk-in and same day appointments, as well as scheduled appointments.

They presented no data that reports the number of urgent conditions served for a 12 month period.

2D Tracks and trends timely access to follow up appointments after hospitalization

PC The MHP reports a standard of 7 days with the overall average length of time for follow-up appointments of 14 days and overall meets it 51% of the time.



2E Tracks and trends data on re-hospitalizations

FC The MHP set a standard of 10% hospital readmission rate within 30 days. Their overall readmission rate for CY2015 was 12%.

For adults they reported a 14% readmission rate.

For children and youth they reported no readmissions.

They have two monthly reports disseminated to senior management (“High Utilization Clients” and “Crisis Inpatient Activity”) which capture data on the frequency of hospitalization to monitor results.

2F Tracks and trends No Shows

PC The MHP tracks no-shows for both psychiatrist and clinicians/non-psychiatrist appointments. They have standard of 15% for both which it meets for both disciplines.

The MHP acknowledges the number of no shows are underreported. The MHP continues to implement the scheduling software that is integrated in the electronic health record (Avatar) which will capture the


Component Compliant

(FC/PC/NC)* Comments representation of the no show rate within one mechanism.

*FC = Fully Compliant; PC = Partially Compliant; NC = Non-Compliant

Quality of Care

As shown in Table 6, CalEQRO identifies the following components of an organization that is

dedicated to the overall quality of care. Effective quality improvement activities and data-driven

decision making require strong collaboration among staff (including consumer/family member

staff), working in information systems, data analysis, clinical care, executive management, and

program leadership. Technology infrastructure, effective business processes, and staff skills in

extracting and utilizing data for analysis must be present in order to demonstrate that analytic

findings are used to ensure overall quality of the service delivery system and organizational

operations.

Table 6—Quality of Care

Component Compliant


3A Quality management and performance improvement are organizational priorities

PC

A new Quality Improvement Coordinator was hired in April 2016 after a 2-3 month vacancy since the departure/retirement of the previous QI Coordinator. According to July 2016 Org Chart, the QI unit is allocated 9 FTE positions, with 3 positions vacant, but 2 positions are back-filled (staff working out of class).

The QIC is scheduled to meet monthly, during the last 12 months there were some months with no meetings. They have a standing agenda and most of the items reported on are compliance-focused. Program managers sit on QIC, but clinical supervisors report rarely attending.

CalEQRO was provided the FY16-17 QI Work Plan while onsite. The strategic plan core issues include: Accessibility of services; Service delivery capacity; Beneficiary satisfaction; Service delivery system and meaningful clinical issues.

3B Data are used to inform management and guide decisions

FC

Clinical supervisors find EHR reports very helpful for providing feedback to staff.

Systems Performance, Research and Evaluation (SPRE) has created about 50 reports during FY15-16 that were used to support data driven decision-making processes.

SPRE continues to produce Metrics Dashboards quarterly.


Component Compliant


3C Evidence of effective communication from MHP administration

PC

Supervisors hold weekly staff meetings and provide individual and group supervision with clinical staff.

MHP leadership identified increased compensation for some managers and clinicians, site visits, an open door policy, and regular meetings with staff and supervisors to improve communication, feedback, and to raise morale.

However, staff continues to feel unheard, unappreciated and undercompensated for their work, and that a culture of continuously changing staff, management, priorities, punitive measures, and a strong focus on data negatively affect staff morale.

Secondary trauma of staff is reported to be an issue as staff is told to call the EAP, but only get eight sessions which is often insufficient. Only the Chico Youth Center reportedly has initiated someone coming in to debrief staff.

The MHP signed an MOU with Social Services detailing internal steps and a joint management structure for Katie A sub class members. There are now two embedded clinicians in the Chico and Oroville clinics, and the next step will be to provide a full psych assessment for all FC youth. All out of county youth are tracked closely and visited monthly.

3D Evidence of stakeholder input and involvement in system planning and implementation

PC

Clinical staff were either unaware of the QIC, or did not know they could attend.

A recommendation was made that they be invited to QIC, CCC and other forums through continuous monthly communique.

3E Evidence of strong collaborative partnerships with other agencies and community based services

FC

The MHP is piloting a new program with law enforcement.

The MHP has a full time clinician in the jail who screens new inmates and continues services to those already receiving them. Assessments and referrals for MH and SUD are also completed for existing inmates not previously receiving services. MH provides injectables when not on formulary so jail medical providers can give them. Previously, medical providers were switching consumers to oral medications leading to decompensation, particularly after release.

They demonstrate a strong partnership with its main contract providers – Northern Valley Catholic Social Services, Victor Community Services, and Youth for Change.

The MHP collaborates with all four major health care systems in the county (one hospital each in Paradise,


Component Compliant

(FC/PC/NC)* Comments Oroville and Gridley, and a hospital and large medical center in Chico).

Success with the Butte County Medical Society jointly developing new school program called Athletes Committed where students agree not to use drugs, to stop bullying, and to engage in healthy activities.

3F Evidence of a systematic clinical Continuum of Care

PC The MHP is working towards being able to examine the relationship among levels of care, lengths of stay appropriateness, treatment goals, progress and outcomes. Collaboration with some managed care plans to timely serve beneficiaries with mild to moderate mental health diagnoses is a barrier.

The MHP uses several evidence based practices including Motivational Interviewing, Dialectical Behavioral Therapy and Trauma Informed Cognitive Behavioral Therapy.

The MHP tracks and trends data by consumer characteristics including demographics, diagnostic categories and social determinants, and uses information to improve clinical service delivery.

3G Evidence of individualized, client-driven treatment and recovery

PC

While the MHP has adopted a wellness and recovery model of care, staff is not yet trained or actively implementing it.

The MHP uses consumer and family education for engagement and improved outcomes.

The MHP does not measure or monitor consumer engagement in his/her own treatment planning and care.

Support groups are required and are part of the treatment planning process and therapy sessions.

3H Evidence of consumer and family member employment in key roles throughout the system

FC

The MHP has a career ladder and support for consumer employees, some of whom report to leadership.

Salary step increases where provided across the board to all peer advocates/employees.

All full time peer advocates/employees receive benefits.

3I Consumer run and/or consumer driven programs exist to enhance wellness and recovery

FC

The MHP opened a drop-in center in Paradise (The HUB) with peer supported counseling, a library, a full calendar of support groups, a computer center, employment resources, and links for Medi-Cal and Social Security. It is open M-TH from 11-4. The center is run by a staff member, with three consumer employees who assist him.

Iversen Wellness & Recovery Center and Medication Clinic operates in Chico and has both regular and drop in services. Most of the groups are facilitated by peers


Component Compliant

(FC/PC/NC)* Comments and the rest by staff who also provide WRAP services. 60-70 clients come through daily, and 80-90% of those are also BH Medi-Cal consumers. The wellness center also has a band that regularly performs in the community. A comprehensive activity calendar for August 2016 was provided during the site visit, support groups were observed and a consumer employee focus group was held during the review.

Consumers and peer advocates credit the wellness centers for much of their transformation and recovery. Peer job classifications include Peer Assistants, Lead Peer Assistants, Case Managers and Supervisors. There are five steps within each job classification, and positions working more than 20 hours/week for six months are benefitted.

All new MHP consumers are referred to the Passport to Wellness groups led by a peer advocate. Staff refers clients to wellness centers at routine appointments.

3J Measures clinical and/or functional outcomes of consumers served

FC

The MHP is focusing on CANS and MORS, and working on ensuring at least one outcome measure in the EHR for each consumer by October 2016. Tools are not consistently being used to guide individual clinical care. The MHP is in the process of creating a robust process and audit tool to use outcome measures to guide individual treatment modalities. MORS training is conducted monthly and CANS training as needed. Some outcome data reports are being dispersed at QIC, and the MHP is working with CWS on standardizing CANS for screening all children. The MHP is no longer focusing on the FIT. The MHP is engaged in a PIP on improved collection and informed treatment of consumers by increased utilization of CANS and MORS.

3K Utilizes information from Consumer Satisfaction Surveys

FC

Consumer Satisfaction Surveys were conducted November 2015 (418) and May 2016 (756). To reach a significant number of responses, new policies and procedures were put in place, staff was trained to use them, and follow up supervision was conducted.

Once surveys are received, comments are typed up and distributed to supervisors, clinicians and contract providers before being sent to DHCS. Program managers are provided with an action form where they report changes they’ve made based on survey results.

When data is received from DHCS, it is posted, circulated and presented to the MH board. Within the SOC, it is used to make system changes for overall outcomes.


Component Compliant

(FC/PC/NC)* Comments Consumer comments were overwhelmingly positive and significant in building staff morale.

Staff turnover was identified often as negatively impacting the continuity of care for clients and family members.

Jointly the MHP and consumers created a short 7-question consumer survey that is used continuously at all sites. Responses are reviewed and posted quarterly, with follow up by program managers and supervisors.

*FC = Fully Compliant; PC = Partially Compliant; NC = Non-Compliant

KEY COMPONENTS FINDINGS—IMPACT AND IMPLICATIONS

Access to Care

o The ongoing issue of clinical staff hiring and retention continues to present

challenges that impacts access to care. While the MHP has mostly dealt with the

challenge successfully, it results in pressures on staff and supervisors, and clinic

operations that normally would not be an issue if there were adequate level of

staff. Twenty percent or so clinical staff vacancy rate is currently common in

many outpatient clinics.

o Collaboration remains challenging with managed care plans for referring mild-

to-moderate consumers due to long wait times (6 months), and accuracy of

acuity determination leading to shuffling consumers back and forth.

o Overall, Affordable Care Act has impacted Butte County very positively by

enrolling consumers who were not previously eligible for Medi-Cal and bringing

in new Medi-Cal revenue.


o The MHP implemented “BCDBH Contact” form in Avatar which captures the date

difference between “Contact Date” and “First Actual Appointment Date” that

serves as the basis for wait-time data for both adults, children and youth.

Quality of Care

o The ongoing issue of higher than normal outpatient clinician’s caseload, in part

due to staff shortages and turnover, is difficult to measure other than anecdotal

comments from staff and supervisors. But was partially reinforce by CalEQRO

Butte Claims Summary CY15 data. That reports for outpatient mental health

service category the MHP approved claims per beneficiary served was $2,943,

while similar size (medium) MHP the average was $3,759. For Butte, outpatient

mental health services accounted for over 13 million dollars, of the total

approved claims of 26 million dollars for CY15. See Attachment C for details.

o The MHP signed an MOU with Social Services detailing internal steps and a joint

management structure for Katie A sub class members. There are now two

embedded clinicians in the Chico and Oroville clinics, and the next step will be to

provide a full psych assessment for all FC youth. All out of county youth are

tracked closely and visited monthly.

Consumer Outcomes

o Consumer Satisfaction Surveys were conducted November 2015 (418) and May

2016 (756), and results were overwhelmingly positive and significant in

building staff morale.

o Jointly the MHP and consumers created a short 7-question consumer survey that

is used continuously at all sites. Responses are reviewed and posted quarterly,

with follow up by program managers and supervisors.

o Lack of housing is one of the biggest issues facing incarcerated Seriously

Mentally Ill (SMI) individuals who are newly paroled into the community.

o Salary step increases where provided across the board to all peer

advocates/employees.

o Consumers and peer advocates reported that the system for appeals and

complaints does not work for them. The Patient’s Rights Advocate was

unresponsive to their repeated requests for assistance, and did not come to the

wellness center as scheduled weekly.

CONSUMER AND FAMILY MEMBER FOCUS GROUP(S)

CalEQRO conducted one 90-minute focus group with adult consumers during the site review of the

MHP. The second focus group (a culturally diverse group of parents/caregivers of child/youth

beneficiaries including a mix of existing and new clients who have initiated/utilized services within

the past 12 months) was cancelled due to very short notice being provided, and it was also the first

day of school so no participants attended. As part of the pre-site planning process, CalEQRO

requested two focus groups with 8 to 10 participants each. However, agenda planning was delayed

causing the short notice.

The Consumer/Family Member Focus Group is an important component of the CalEQRO Site

Review process. Obtaining feedback from those who are receiving services provides significant

information regarding quality, access, timeliness, and outcomes. The focus group questions specific

to the MHP reviewed and emphasized the availability of timely access to care, recovery, peer

support, cultural competence, improved outcomes, and consumer and family member involvement.

CalEQRO provided gift certificates to thank the consumers and family members for their

participation.

CONSUMER/FAMILY MEMBER FOCUS GROUP 1

The group consisted of a culturally diverse group of adult beneficiaries including a mix of existing

and new clients who have initiated/utilized services within the past 12 months. The focus group

was held at the Iverson Wellness and Recovery Center.

Number of participants – Eight

For the five participants who entered services within the past year, they described their experience

as the following:

Initial services were provided relatively quickly, from immediately upon walk-in to

one month.

Initial psychiatrist appointments took between one and three months.

Participants reported getting information about mental health services through the

internet, newspaper, from groups and word of mouth from other clients.

General comments regarding service delivery that were mentioned included the following:

Consumers are receiving individual and group therapy at “sufficient” intervals, from

weekly to as needed every few months.

Mixed responses were provided regarding how compassionate the staff was, from

“they don’t care about us” to “very caring and helpful”.

Nearly all participants complained about the lack of responsiveness of the Patient’s

Rights Advocate. Conversely, they all felt that the Wellness Center was a “safe

haven” that was extremely helpful for their individual recovery.

For the most part, transportation did not seem to be a problem, with many

participants receiving bus passes to use public transportation, or walking to

appointments.

Consumers felt that first MD assessments should be done in person for consumers

who are psychotic or severely mentally ill.

Recommendations for improving care included the following:

Behavioral Health should provide a survey to ask consumers for their feedback at

the wellness centers, and at annual reassessment appointments where treatment

plans are renewed.

More shelters, motels and other housing options for both short and long term are

needed. This is particularly important for the homeless SMI population who require

assistance navigating emergency housing.

Shelters and the Crisis Stabilization Unit (CSU) need to provide accommodations for

consumers with service/support animals.

More peer advocacy is needed, to attend appointments with consumers who need

support/advocates, to provide a voice when consumers feel theirs is not being

heard.

Psychiatrists need to be more responsive to consumers, and work with them on

their treatment plans, medication options and therapy.

Psychiatrist appointments in-person should be provided for those whose symptoms

make tele psychiatry prohibitive.

Interpreter used for focus group 1: ☒ No ☐ Yes Language(s): N/A

CONSUMER/FAMILY MEMBER FOCUS GROUP FINDINGS—IMPLICATIONS

Access to Care

o Consumers reported receiving individual therapy as often as needed.

o Participants reported having difficulty accessing services when they also had a

service animal accompanying them.

o Initial psychiatric assessments should be made available in-person for SMI

consumers whose symptoms make tele psychiatry prohibitive.

o Housing remains a significant challenge for a number of homeless consumers

with high acuity, who have difficulty navigating emergency, short and long term

housing.


o Consumers are receiving initial assessments ranging from immediately to one

month wait times, while initial MD appointments take between one and three

months.

Quality of Care

o Consumers get information on mental health services from a variety of media

and word of mouth.

o Nearly all participants complained about the lack of responsiveness of the

Patient’s Rights Advocate.

o Psychiatrists need to be more responsive to consumers, and work with them on

their treatment plans, medication options and therapy.

Consumer Outcomes

o The Wellness Center is considered a “safe haven” that is extremely helpful for

individual recovery.

o Peer advocacy opportunities need to be expanded and might include attending

appointments with consumers who need support/advocates to provide a voice

when they feel theirs is not being heard.

INFORMATION SYSTEMS REVIEW

Knowledge of the capabilities of an MHP’s information system is essential to evaluate the MHP’s

capacity to manage the health care of its beneficiaries. CalEQRO used the written response to

standard questions posed in the California-specific ISCA, additional documents submitted by the

MHP, and information gathered in interviews to complete the information systems evaluation.

KEY ISCA INFORMATION PROVIDED BY THE MHP

The following information is self-reported by the MHP in the ISCA and/or the site review.

Table 8 shows the percentage of services provided by type of service provider:

Table 8—Distribution of Services by Type of Provider

Type of Provider Distribution

County-operated/staffed clinics 68%

Contract providers 32%

Network providers <1%

Total 100%

Percentage of total annual MHP budget is dedicated to support information

technology operations: (includes hardware, network, software license, IT staff)

3.2%

Consumers have on-line access to their health records either through a Personal

Health Record (PHR) feature provided within EHR or a consumer portal or a third-

party PHR:

☐ Yes ☐ In Test/Pilot Phase ☒ No

MHP currently provide services to consumers using an tele-psychiatry application:

☒ Yes ☐ In Test/Pilot Phase ☐ No

o If yes, the number of remote sites currently operational:

9

o Tele-psychiatry services is available with English speaking practitioners.

MHP self-reported technology staff changes since the previous CalEQRO review (FTE):

Table 9 – Summary of Technology Staff Changes

Number IS

Staff

Number of New

Hires

Number of Staff Retired,

Transferred, Terminated

Current Number of

Unfilled Positions

9 2 5 3

MHP self-reported data analytical staff changes since the previous CalEQRO review

(FTE):

Table 10 – Summary of Data Analytical Staff Changes

Number

Data Analytical

Staff

Number of New

Hires

Number of Staff Retired,

Transferred, Terminated

Current Number of

Unfilled Positions

12 2 2 0

The following should be noted with regard to the above information:

The MHP reports serving 1,141 consumers via telepsychiatry during the past year.

IT staff did experience significant turnover during the past 18 month period or so.

Five of the nine FTE positions experienced some level of turnover which impacts

institutional knowledge until new staff are trained and understand the complexity

of operations.

The MHP did experience the loss of two knowledgeable staff members with

considerable MyAvatar expertise.

Systems Performance, Research and Evaluation, the data analytical unit, remains

fully staffed and contributes to quality improvement initiatives and the MHPs

overall data analytical capacity.

CURRENT OPERATIONS

The MHP continues to implement Netsmart Technologies Avatar system. They host

the system locally and maintains as close to 24/7 uptime availability to support

functional EHR environment.

The MHP has implemented Meaningful Use Incentive Program, Modified Stage 2, for

11 eligible professionals.

The MHP and other Butte County departments have contracted with XPIO Health to

provide HIPAA/HITECH 42 CFR Part 2 Act privacy and security gap analysis,

HIPAA/HITECH mandated training, analysis on specific department’s policy and

procedure development, and web-based training module.

Table 11 lists the primary systems and applications the MHP uses to conduct business and manage

operations. These systems support data collection and storage, provide EHR functionality, produce

Short-Doyle/Medi-Cal (SD/MC) and other third party claims, track revenue, perform managed care

activities, and provide information for analyses and reporting.

Table 11— Primary EHR Systems/Applications

System/Application Function Vendor/Supplier Years Used Operated By

MyAvatar – PM Practice Management

Netsmart Technologies 7 MHP

MyAvatar – CWS EHR Netsmart Technologies 7 MHP

MyAvatar – Order Connect e-prescribing Netsmart Technologies 3 MHP

MyAvatar - MSO Manage Care Netsmart Technologies <1 MHP

PLANS FOR INFORMATION SYSTEMS CHANGE

MyAvatar system implementation remains in progress.

Projected full system implementation currently is December 2018.

ELECTRONIC HEALTH RECORD STATUS

Table 12 summarizes the ratings given to the MHP for EHR functionality.

Table 12—Current EHR Functionality

Function System/Application

Rating

Present Partially Present

Not Present

Not Rated

Alerts MyAvatar/Order Connect X

Assessments MyAvatar/CWS X

Document imaging/storage MyAvatar X

Electronic signature—consumer MyAvatar/CWS X

Laboratory results (eLab) Quest/Millennium X

Level of Care/Level of Service MyAvatar/CWS X

Table 12—Current EHR Functionality

Function System/Application

Rating

Present Partially Present

Not Present

Not Rated

Outcomes CANS & MORS X

Prescriptions (eRx) MyAvatar/Order Connect X

Progress notes MyAvatar/CWS X

Treatment plans MyAvatar/CWS X

Summary Totals for EHR Functionality 9 1 0 0

Progress and issues associated with implementing an electronic health record over the past year

are discussed below:

Currently piloting Netsmart Technologies Perceptive document imaging application.

Tentative go-live date is October 2016.

Consumer’s Chart of Record for county-operated programs (self-reported by MHP):

☐ Paper ☐ Electronic ☒ Combination

MAJOR CHANGES SINCE LAST YEAR

Implementation and integration of VM (virtual machine) technology.

Transition Avatar Production environment Middleware, and ECP (reporting)

servers to VM environments.

Transition Avatar failover environment Middleware, and ECP (reporting) servers to

VM environments.

Integration of new SAN storage environment.

Establish high speed network connectivity at 995 Spruce Street, Gridley.

Establish high speed connectivity at 2131 & 2167 Montgomery Street, Oroville.

Completed RFP process for selection of a vendor to perform an in-depth audit and

review of department policies, procedures, and the EHR system.

Implement ICD-10 diagnoses.

Completed My Avatar Doctors Discharge Summary.

Completed My Avatar Nursing Care Plan.

Completed My Avatar Care Pathways Meaningful Use Component.

Completed My Avatar Request for Second Opinion form.

Completed My Avatar MH New Treatment Plan.

Completed My Avatar Discharge Disposition form.

Completed My Avatar CAN’s form change.

Completed My Avatar AOD/SUD Treatment Plan.

Completed My Avatar AOD Discharge Summary Modification.

Completed My Avatar AOD 30 Day Discharge Support Plan.

Completed My Avatar AOD Billing Override form.

Completed My Avatar AOD Contact/Referral Log.

Completed My Avatar AOD Signature Agreement form.

PRIORITIES FOR THE COMING YEAR

Network Risk Assessment documentation and remediation project.

Remediate recommendations from the recent XPIO Security Risk Assessment.

Encrypt 100% of department desktop computers.

Integration of two factor authentication Single Sign On application.

Install and configure new firewall appliances.

Purchase Netsmart Technologies Perceptive software to replace Point of Scan

software.

Complete integration of document scanning and routing into departments EHR.

Purchase Netsmart Technologies Provider Connect module.

Restart My Avatar MSO/Provider Connect integration.

Integration and implementation of My Avatar Scheduler component.

Implementation and integration of Netsmart Technologies My Health Point.

Implementation and integration of Netsmart Technologies Care Connect.

Integration of Netsmart Technologies Identity Manager MS Active Directory

password sign on capability.

Ensure compliance with federal, state and local regulations for computer and

electronic security and privacy.

OTHER SIGNIFICANT ISSUES

Most contract providers use direct data entry, by support staff, into MyAvatar daily.

Those with local EHRs are supporting data entry into two systems. Contract

provider clinicians do not have access to MyAvatar.

Some contract providers continue to submit paper documents monthly, which is

entered into MyAvatar by MHP staff.

Three large contract providers have local EHR systems, however electronic data

transfer (HIE) to MHP is not yet available.

MEDI-CAL CLAIMS PROCESSING

Normal cycle for submitting current fiscal year Medi-Cal claim files:

☐ Monthly ☒ More than 1x month ☐ Weekly ☐ More than 1x weekly

MHP performs end-to-end (837/835) claim transaction reconciliations:

☒ Yes ☐ No

If yes, product or application:

EMS EDI Reader

Method used to submit Medicare Part B claims:

☐ Clearinghouse ☒ Electronic ☐ Paper

Approximately 90% of billable services delivered are claim to Short-Doyle Medi-Cal.

INFORMATION SYSTEMS REVIEW FINDINGS—IMPLICATIONS

Access to Care

o Systems Performance, Research and Evaluation (SPRE) produces many

reports and analysis that is use to support data driven decision-making

processes.

o SPRE continues to produce Metrics Dashboards quarterly.


o The “BCDBH Contact” form in myAvatar captures the date difference

between “Contact Date” and “First Actual Appointment Date” that serves as

the basis for wait-time data for both adults, children and youth.

Quality of Care

o The MHP has sufficient data analytics staff to give QI and management the

regular data and special projects to fully engage in CQI activities.

Consumer Outcomes

o The MHP has not engaged with Level of Service/Level of Care tools to

provide secondary longitudinal analysis. This secondary data use could

assist management to objectively assess the efficacy of EBPs and treatment

protocols and provide broader perspectives on program utilization.

Number

Submitted

Gross Dollars

Billed

Dollars

Denied

Percent

Denied

Number

Denied

Gross Dollars

Adjudicated

Claim

Adjustments

Gross Dollars

Approved

143,435 $26,015,338 $334,652 1.29% 1,096 $25,680,686 $208,661 $25,472,025

Table 13 - Butte MHP Summary of CY15 Processed SDMC Claims

Note: Includes services provided during CY15 with the most recent DHCS processing date of May 19,2016

SITE REVIEW PROCESS BARRIERS

The following conditions significantly affected CalEQRO’s ability to prepare for and/or conduct a

comprehensive review:

No barriers were encountered during the preparation or implementation of this review.

CONCLUSIONS

During the FY16-17 annual review, CalEQRO found strengths in the MHP’s programs, practices, or

information systems that have a significant impact on the overall delivery system and its

supporting structure. In those same areas, CalEQRO also noted opportunities for quality

improvement. The findings presented below relate to the operation of an effective managed care

organization, reflecting the MHP’s processes for ensuring access to and timeliness of services and

improving the quality of care.

STRENGTHS AND OPPORTUNITIES

Access to Care

Strengths:

o The MHP overall penetration rate exceeds Medium size MHPs and statewide

averages, as well as for age and race/ethnicity categories.

o The recently opened 10-bed adult crisis residential facility enhances the MHP

continuum of care and provides the PHF the capability to refer patients to who

no longer have a medically necessary condition, but are not ready for discharge

to outpatient services.

o The Affordable Care Act (ACA) has had a positive impact by enrolling consumers

not previously eligible for the Medi-Cal program and resulting in additional

Medi-Cal revenue.

Opportunities:

o Staffing recruitment, retention and morale remain significant issues raised by all

participant groups during this review.

o Collaboration remains challenging with managed care plans for referring mild-

to-moderate consumers due to long wait times (6 months), and accuracy of

acuity determination leading to shuffling consumers back and forth.

o The MHP needs to continue working on graduating consumers to lower levels of

care, and working with community stakeholders to create referral sites.


Strengths:

o The “BCDBH Contact” form captures the date difference between “Contact Date”

and “First Actual Appointment Date” that serves as the basis for wait-time data.

It is a creative solution while the MHP works with IS vendor for more

permanent solution in MyAvatar.

Opportunities:

o The MHP is not yet able to reliably track client no-show appointments in

MyAvatar.

Quality of Care

Strengths:

o One success of the collaboration between MH and the jail has been the provision

of injectables by MH so jail medical providers can give them. Previously, since

injectables are not on the jail formulary, medical providers were switching

consumers to oral medications leading to decompensation, particularly after

release.

o The MHP signed an MOU with Social Services detailing internal steps and a joint

management structure for Katie A sub class members. There are now two

embedded clinicians in the Chico and Oroville clinics, and the next step will be to

provide a full psych assessment for all FC youth. All out of county youth are

tracked closely and visited monthly.

Opportunities:

o Staff continues to feel unheard, unappreciated and undercompensated for their

work, and that a culture of continuously changing staff, management, priorities,

punitive measures, high caseloads, and a strong focus on data negatively affect

staff morale.

o Secondary trauma of staff is reported to be an issue as staff is told to call the

EAP, but only get eight sessions which is often insufficient. Only the Chico Youth

Center reportedly has initiated someone coming in to debrief staff.

o The average overall approved claims per beneficiary decreased each year from

CY13 to CY15, and was less than both medium and statewide averages for the

past two year period.

o Health information exchange (HIE) is not yet established.

Consumer Outcomes

Strengths:

o The MHP and consumers jointly created a short (7-question) consumer survey

that is used at all sites. Responses are reviewed and posted quarterly, with

follow up by program managers and supervisors.

o The MHP has a career ladder and support for consumer employees, some of

whom report to leadership. Salary step increases where provided across the

board to all peer advocates/employees.

o Consumers and peer advocates credit the wellness centers for much of their

transformation and recovery.

Opportunities:

o Wellness center peer employees made the following suggestions:

It would be helpful for the MHP to do psychiatric assessments at the

wellness centers for new and returning clients who need this service;

The CSU should come to the wellness center when a client is in crisis

rather than the wellness center staff having to call the police;

Additional drug and alcohol services are needed, as are services for

dually diagnosed individuals; and

Improving communication and collaboration between wellness center

and MHP staff would be advantageous.

o Lack of housing is one of the biggest issues facing incarcerated SMI individuals

who are newly paroled into the community.

RECOMMENDATIONS

Continue to develop strategies and initiatives to address staff recruitment, retention

and morale to maintain an adequate levels of healthcare professionals. Seek subject

matter expertise from Butte County Human Resources and Chief Administrative

Office to support this critical initiative.

Investigate the multiple barriers to move consumers to lower levels of care due to

lack of coordination and integration to timely serve beneficiaries with mild to

moderate mental health diagnoses.

Engage local health care providers including the FQHC and Indian

Health.

Engage the two local Managed Care Plans (MCP).

Engage the local hospitals.

Establish regular meetings with primary care providers to address

operational and integration issues.

Establish processes and staff capacity to respond to individual

beneficiary treatment needs timely and efficiently.

Prioritize the implementation of network security and endpoint devices projects to

further support cyber security initiatives. The critical initiatives include:

Remediate XPIO Security Risk Assessment recommendations.

Encrypt all department desktop computers.

Integrate two factor authentication Single Sign On application.

Install and configure new firewall appliances.

Continue to implement MyAvatar Scheduler application. Work with Netsmart

Technologies to develop calendar syncing capability into Scheduler to track no-

show appointments. In order to measure system of care capacity to both timely and

efficiently serve consumers.

Investigate the feasibility to implement Netsmart Technologies Provider Connect

and Care Connect applications, sooner rather than later, to potentially eliminate

double data entry by support staff and to provide contract providers clinical staff

access to MyAvatar EHR.

ATTACHMENTS

Attachment A: Review Agenda

Attachment B: Review Participants

Attachment C: Approved Claims Source Data

Attachment D: CalEQRO PIP Validation Tools

ATTACHMENT A—REVIEW AGENDA Double click on the icon below to open the MHP On-Site Review Agenda:

ATTACHMENT B—REVIEW PARTICIPANTS

CALEQRO REVIEWERS

Della Dash, Senior Quality Reviewer

Bill Ullom, Chief Information Systems Reviewer

Luann Baldwin, Consumer/Family Member Consultant

Additional CalEQRO staff members were involved in the review process, assessments, and

recommendations. They provided significant contributions to the overall review by participating in

both the pre-site and the post-site meetings and, ultimately, in the recommendations within this

report.

SITES OF MHP REVIEW

MHP SITES

109 Parmac Road, Suite 5

Chico, CA 95926

592 Rio Lindo

Chico, CA 95926

3217 Cohasset Rd

Chico, CA 95926

Iverson Wellness & Recovery Center

492 Rio Linda Ave

Chico, CA 95926

PARTICIPANTS REPRESENTING THE MHP

Name Position Agency

Aaron Lyons Clinical Supervisor BCDBH – Chico Youth

Amanda Miller Behavioral Health Counselor BCBH – CAS

Amanda Thomas Admin Analyst, Senior BCDBH

Andrew Mondhan Behavioral Health Clinician III BCDBH

Andy Pilgram IT Supervisor Butte County Department of Behavioral Health

Brooke Chambers Medical Records/Quality Youth for Change

Carson Strauch Behavioral Health Clinician II BCDBH – CAS


Cathleen Onimet Program Manager Butte County

Cindy McDermott Clinical Supervisor BCDBH – Crisis

Dawn Rollins Program Manager Butte County

Deborah Fowler Behavioral Health Clinician BCDBH – CCCC

Don Taylor Assistant Director Butte County Behavioral Health

Dore Pena Supervisor, Admin Analyst, Billing Butte County Department of Behavioral Health

Dorian Kittrell Director, Behavioral Health BCDBH

Essence Davis Fiscal Manager Butte County Department of Behavioral Health

Essence Davis Fiscal Manager Butte County

George Siler Executive Director Youth for Change

Greg Shafer BHC I BCDBH – Paradise Youth

Hayley Hughes BHC II BCDBH – Paradise Adult

Helen Isaacs LVN/SPT Nursing Staff BCDBH – CAS

Holly Chrisope Clinician Victor

J Angel Calderon BHC II – BH Counselor BCDBH – Gridley

Jacqi Liddiard Supervisor, Admin. Analyst Butte County Department of Behavioral Health

James Crowder Janitorial Peer Assistant NVCSS

Jason Tate Program Manager NVCSS

Jenae Laws Katie A. Coordinator, NoCo BCDBH

Jennifer Lyon Contract Provider Counseling Solutions

Jeremy Wilson Program Manager Butte County

Jessica Baus Clinician BCDBH - Paradise Youth

Jessica Pederson Behavioral Health Clinician BCBH – OCCC

Jessica Wood Clinical Supervisor BCDBH – CAS

Jimmy Shirah Peer Assistant NVCSS

Joel Chain Assistant Director Butte County

Judy Beckert Behavioral Health Clinician II BCBH – CAS SEARCH North

Karen Elay Clinician Youth for Change

Kelly Kennelly Supervisor, Admin Analyst, Contracts

Butte County Department of Behavioral Health

LaTonya “T” Williams Behavioral Health Worker BCBH – PHF


Laura Williams Compliance Officer, Admin. Butte County Department of

Behavioral Health

Laura Williams Compliance/Admin BCDBH

Laurie Taylor Clinician Youth for Change

Leslie Glass Quality Assurance BCDBH

Linda Duncan Peer Assistant NVCSS

Martha Andrade Clinician Victor Community Support Services

Melodie Watkins Crisis Counselor Willow Glen Care Center

Michael Childers Peer Assistant NVCSS

Michael Larish IT Analyst Butte County Department of Behavioral Health

Michelle Berry Fiscal Manager Butte County Department of Behavioral Health

Nathan Hedlind BHC - Supervisor BCDBH – OOP SEARCH

Nicole Reimers Program Manager, Clinical Services

BCDBH

Pam Bjerke QA Coordinator BCDBH

Patrick Borel Clinical Supervisor BCDBH – Chico Youth

Pattie Pardini-Barrett Clinical Supervisor BCDBH – AB109

Rick Jackson Admin Analyst, Supervisor BCDBH

Russ Hansen, MFT Clinical Director Youth for Change

Sarah Feingold Behavioral Health Program Director

Youth for Change

Sarah Frohock Clinical Supervisor BCDBH – Paradise Adult

Sesha Zinn Research Manager BCDBH

Todd A. Harris Program Director WGCC – Iris House

Tony Stefanetti BHC - Supervisor BCDBH – Paradise Adult/The Hub

Trisha Oh Admin Analyst, Senior Butte County Department of Behavioral Health

Wayne Brandt Program Manager, IT Butte County Department of Behavioral Health

ATTACHMENT C—APPROVED CLAIMS SOURCE DATA These data are provided to the MHP in a HIPAA-compliant manner.

Two additional tables are provided below on Medi-Cal ACA Expansion beneficiaries and Medi-Cal

beneficiaries served by cost bands.

Table C1 (Attachment C) shows the penetration rate and approved claims per beneficiary for the

CY15 Medi-Cal ACA Expansion Penetration Rate and Approved Claims per Beneficiary.

Table C2 (Attachment C) shows the distribution of the MHP CY15 Distribution of Beneficiaries by

Approved Claims per Beneficiary (ACB) Range for the various categories; under $20,000; $20,000

to $30,000, and those above $30,000.

Entity

Average Monthly

ACA Enrollees

Number of

Beneficiaries

Served

Penetration

Rate

Total Approved

Claims

Approved Claims

per Beneficiary

Statwide 2,001,900 131,350 6.56% $533,318,886 $4,060

Medium 272,209 17,965 6.60% $79,457,048 $4,423

Butte 14,491 1,629 11.24% $4,611,672 $2,831

Table C1 - CY15 Medi-Cal Expansion (ACA) Penetration Rate and Approved Claims per Beneficiary

Range of ACB

MHP Count of

Beneficiaries

Served

MHP

Percentage

of

Beneficiaries

Statewide

Percentage

of

Beneficiaries

MHP Total

Approved

Claims

MHP

Approved

Claims per

Beneficiary

Statewide

Approved

Claims per

Beneficiary

MHP

Percentage

of Total

Approved

Claims

Statewide

Percentage

of Total

Approved

Claims

$0K - $20K 4,966 95.24% 94.46% $17,224,680 $3,469 $3,553 65.59% 61.20%

>$20K - $30K 134 2.57% 2.67% $3,243,116 $24,202 $24,306 12.35% 11.85%

>$30K 114 2.19% 2.86% $5,793,698 $50,822 $51,635 22.06% 26.96%

Table C2 - Butte MHP CY15 Distribution of Beneficiaries by ACB Range

ATTACHMENT D—PIP VALIDATION TOOL

Double click on the icons below to open the PIP Validation Tools:

Clinical PIP:

Non-Clinical PIP:

mhp draft report - butte county

Documents