Report to the Operations

Sub-Committee

November 3, 2006

Network Operations

Web Registration

• Security Access/User ID Requests– 1,921 User Id’s generated as of 10/27/06

• 14 Requests currently in process

• Winfax – Non Web/Paper Registrations– 81 providers currently using paper registration– 34 providers transitioned from paper to web since 9/1/06

• Security Access – No Response– 498 EDS/Medicaid Providers– Provider Alerts sent to those 498 providers on 9/19/06– Response received from 213 providers

• Requesting Registration ID’s or Winfaxes

Web Registration – TotalsCompleted Web Registrations as of 10/23/06

Outpatient Services………….…..17,253

Methadone Maintenance…….…...1,143

Ambulatory Detoxification …………….58

Family Support Team………………..113 (Home Based Service)

Psychological Testing…………….…..12

Web Registration Continued

• 18,579 - Registrations completed as of October 23, 2006

• Registration timeline had been extended for an additional 61 days. – Providers were given until October 31, 2006 to enter Web-

Registrations for September 1, 2006 dates of service and ongoing.

– The 21 day registration time limit began November 1, 2006

• All fields for web registration are required effective November 1, 2006.– Provider Alerts 10/9 & 10/10– Updated User Manual will be posted to the week of November 6,

2006– Updated Winfax Forms were sent to non Web enabled providers

on 10/30/2006.

Provider Relations Phone Stats(September 10, 2006 - October 21, 2006)

• 1030 calls received Web Registration Inquiries General Provider Inquiries

PDV’S Received 1,230

PDV’S Keyed 1,230

# of new providers added from Add /Change Report

227

# of changes completed from Change Report

488

# of PDV’s mailed to date 2,956

Provider Data Verification Stats Aggregate since January 2006

Clinical Operations

Timeliness of Pre-cert and CCR Process

• Analysis of current forms/process- complete• Re-ordering/re-working of existing forms -

complete• Deletion of redundant information - complete• Result: more intuitive process, decrease burden• System to be reprogrammed mid-November• Clinician orientation and re-tooled forms on web

site week of November 13, 2006• Revised format implemented week of November

20, 2006

Residential Care TeamTransition

• IT infrastructure close to completion, currently in testing (tracking system and CANs tool)

• Training with John Lyons, PhD held October 23, 2006, 120 people trained

• Follow up training program under development

• Provider file information being updated• Anticipated transition 12/1/06

Members who Access 24 hour Care by LOCOctober 2006

Utilization Distribution

0

10

20

30

40

50

60

ADR/IPD GHA/GHC IPF PRTF RTC

Level of Care

%

ADR/IPD: Inpatient detox/rehabilitationGHA/GHC Group home 1.0/2.0IPF: Inpatient Psychiatric Facility

PRTF: Psychiatric Residential Tx FacilityRTC: Residential Treatment Facility

Authorization and Concurrent Review Update

October, 2006Level of Care October

(Total auths/CCRs)Denied Total YTD

(Total auths/CCRs)

RTC 443 2919

GH 2 80 387

GH 1 63 467

Inpatient Psych/Detox 1224 9 5789

Freestanding Detox/Rehab

107 637

OBS 4 41

PRTF 114 1 349

IOP/PHP 693 10 4303

EDT 251 9 1289

HBS 227 5 333

OTP 4716 18336

Total 7,992 34 34,850

• 10% of children in an Inpatient settings are defined as Discharge Delay this represents a decrease from 17% last month

53% are awaiting placement in Residential and/or PRTF 7% are awaiting Community Services 20% are awaiting Group Home placement 14% are awaiting Placement: other or unspecified Average length of stay in Delayed status is 47 days

• 11% of children in Residential Treatment Centers are defined as Discharge Delay

39% are awaiting Group Home placement 7% are awaiting Foster Care placement 54% are awaiting Placement: other or unspecified (primarily community

based services – training continues re. to code selection)

Inpatient/PRTF Discharge Delay Status October, 2006

ED Delay Tracking: October 2006Location /

ED# of

MembersAge

RangeDCF

IdentifiedAve. Days Stuck

Actual Disposition

NBGH 1 14 Y 5 Admitted to Inpatient

CCMC 10 1- 17 7 – DCF3 – Non-DCF

2 9 – Admitted to Inpatient1 – Returned to home/placement

Middlesex 3 16 – 17 2- DCF1 – Non-DCF

3.5 2 – Admitted to Inpatient1 – Returned to home/placement

Midstate 2 15 – 17 2 – DCF 2 2 – Admitted to Inpatient

ED Delayed Discharge Activity

• Overview:– May: 6 cases, average LOS 3.5 days– June: 5 cases, average LOS 7.2 days (1

outlier)– July: 10 cases, average LOS 2.9 days– August: 11 cases, average LOS 1.1 days– September: 26 cases, average LOS 2.0 days– October: 16 cases, average LOS 3.1 days

 

ICM TRACKING REFERRAL SOURCE MONTHLY REPORT

REFERRAL SOURCE JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

ED     0 1 8 10 2 7 26 16    

INPATIENT HOSPITAL     0 1 15 19 30 45 47 22    

MCO     2 3 1 1 6 44 36 40    

DCF     0 3 7 10 11 8 13 8    

SELF REFERRAL     0 0 1 1 4 2 1 5    

INTERNAL     1 29 27 41 22 1 6 6    

RESI/GROUP     0 0 0 0 2 11 11 5    

5 DAY DISCHARGE DELAY     0 0 0 0 34* 0 28 12    

COMMUNITY     0 0 0 0 0 9 15 11    

                         

                         

TOTAL RECEIVED     3 37 59 82 111 127 183 125    

                         

DISCHARGES               45 33 19    

Data source 10/1/06-10/24/06 YTD Referrals Recieved: 727

*

ICM Activity• All “delayed status” members currently in inpatient

settings are assigned (October 23, down from 30 in September)

• Coordinating Collateral meetings to determine barriers to appropriate disposition for acute levels of care

• Attending MSS mtg’s with System Managers• Identifying cases from daily census reports in MSS mtg’s

in order to facilitate appropriate treatment planning• Contacting ED’s and Area offices for updates on a daily

basis• Working with Systems Managers to coordinate meetings

with each Hospital ED in Connecticut • Monthly MCO meetings/trainings including reviews of co-

medically managed cases

Customer Service/Call Center Activity

2006 Call Volume YTD

Call Volume

01000200030004000500060007000

2006

Calls answered in < 30 seconds YTD

% Answered in < 30 Seconds

8486889092949698

100

% answered < 30 seconds

% answered < 30 seconds

CT BHP CALL MANAGEMENTIncoming Calls Totals:

September, 2006

Member Calls:203

5

Provider Calls:304

0

Crisis Calls: 145Total 5220

Types of InquiriesSeptember, 2006

43% - Provider Referrals for Members

27% - Member Eligibility Verification

21% - Provider Related/Authorization/Enrollment/Billing

9% - General Information

52% = Member Inquiries

Quality Management

Quality Initiatives

• Data analysis, Mercer prep, QI work, integrating work with all departments

• Satisfaction SurveysData collection began in early fall. Preliminary

Provider Survey has been received and will now be analyzed. Member Survey continues with interviews.

Reports complete and analyzed by January of 2007

Complaints

Total Number of Complaints Monthly 2006

0

1

2

3

4

5

6

7

8

9

10

Adult Member Complaints 2 2 6 0 0 3 2 0 0 3

Child member Complaints 2 1 3 0 2 1 1 1 0 1

Grand Total Complaints 4 3 9 0 2 4 3 1 0 4

January February March April May June July August Sept October

Total Number of Complaints Quarterly 2006

0

2

4

6

8

10

12

14

16

18

Adult Member Complaints 10 3 2 3

Child member Complaints 6 3 2 1

Grand Total Complaints 16 6 4 4

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Adult Complaints Quarterly 2006

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

CGA016 -Comlpaint Benefits 3 0 0 0

CGA017 - Complaint Claims 0 1 0 0

CGA063 - Coordination of Care 2 0 1 0

QUA010 - Quality of Care 1 1 1 1

QUA011 - Quality of Service 4 1 1 2

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Child Complaints Quarterly 2006

0

1

2

3

4

5

CGA016 - Complaint Benefits 4 0 0 0

CGA017 - Complaint Claims 1 0 0 0

CGA063 - Coordination of Care 0 0 1 0

QUA003 - Member Requested ProviderChange

0 1 0 0

QUA010 - Quality of Care 0 1 0 1

QUA011 - Quality of Service 1 1 1 0

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Adverse Incidents Quarterly 2006

0

1

2

3

4

5

6

Significant Events 3 2 3 5

Critical Incidents 1 1 2 0

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Grievances

• No Grievances filed in October of 2006

System’s Management

Three LADPs were approved by the Departments in September 2006

Six LADPs were approved by the Departments in October 2006

Six LADPS are due for review by the Departments on November 15th

Dissemination of the approved plans have begun and a process has been established to disseminate additional copies (Glenys Rios 860-263-2164 or glenys.rios@valueoptions.com)

System’s Management Update

Of the approved LADPs the following themes have been

highlighted: Increasing access to therapeutic support staff

and other services Increasing access to reliable transportation

services Enhancing the availability of cultural

competence/linguistic services Increasing specialized services (i.e. services for

children and youth with sexually acting out behavioral problems and eating disorders

Enhancing communication between families, schools and other systems/providers

Increasing family participation in the collaboratives

Increasing support for the development of community collaborative infrastructure

Themes continued….

Community Interaction:Peer/Family Services

Peer Support Unit

Peer and Family Peer Specialists worked with 90 CT BHP members and/or families in October.

Peer and Family Peer Specialists attended:

14 Community Outreach Meetings 11 Community Collaborative Meetings CT BHP Consumer and Family Advisory Sub-Committee

Meeting 2 School Meetings

Peer Support Unit, continued

5 Home visits with members1 Prospective placement visit with a family6 Treatment/Discharge Planning Meetings with

members/families1 Meeting with member and nurse to collaborate on

the co-management of a medically complicated case in order to be of support to member

1 Visit with member at the hospital57 Referrals were given for various agencies and

organizations

Referrals to FAVOR, its Family Organizationsand Support Groups

FAVOR Advocate Program: 5 families FAVOR Family–to-Family Program: 2 families AFCAMP: 3 families Families United for Children’s Mental Health: 7 families Tri State Support Network for Families

Raising Children with Bipolar-The Connecticut Group: 2 families North Star Support Group in Ansonia: 1 family

CT BHP Peer and Family Peer Specialists differ from the FAVOR Family Advocates in that we provide primarily community education, support and linkages rather than traditional advocacy

support

Examples of Other Referrals Given

Bereavement Support Group at Middlesex Hospital

The Connecticut Association for Children and Adults with Learning Disabilities

Connecticut Autism Spectrum Resource Center

Alanon Connecticut Employment and

Training Services Connecticut Family Support

Network Department of Mental Health and

Addiction Services (DMHAS) Dubois CenterThompson Ecumenical Empowerment Group

(TEEG)

Grandparents Raising Grandchildren Support Group

Groton Community Support Group Middletown Estuary Counsel of

Seniors Office of the Child Advocate Office of Protection and Advocacy Parent Leadership Training

Institute (PLTI) Positive Alternatives for Children

and Teens, Inc. (PACT) Special Education Resource

Center (SERC) Care Coordination with the

Systems of Care Youth Services Bureau

Outreach Activities for Peer and Family Peer Specialists

Meeting with the Clergy Association in Middletown Meeting with the Middlesex Coalition for Children Dialogue with parents and teens at two high schools in

Meriden Family Forum Presentation to Foster and Adoptive Parents

Program in Middletown Booth at NAMI-CT Annual Conference Co-sponsor with the Eastern CT Cooperative Workgroup to

host two workshops; one for parents on Educational Advocacy held in Putnam and one for parents and professionals on The CT Family to Family Health Information Project held in Norwich