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Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System Review Project Advisory Committee 1

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Page 1: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Undertaken by the Office of Mental Health and Mental Retardation

In partnership with Allegheny HealthChoices, Inc.October 1, 2009

Washington CountySystem Review

Project Advisory Committee

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Page 2: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Agenda

Introductions Review of Meeting Notes Project Update Washington County Data Discussion Wrap up / Next Meeting

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Page 3: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Project Update

Letter to stakeholders

Meetings with County staff

Provider forum

Data collection and analysis

Interviews

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Page 4: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Project Update cont’d.

Interviews

Who– Providers– County committees and departments– Consumer and family support groups, advocates– Interface agencies

How– One-on-one interviews – Group interviews – Focus groups – Attending existing meetings

What– Focus on exploring key areas of project4

Page 5: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Project Update cont’d.

Data Collection and Analysis

Review available data– Information Systems survey

Data limitations:– Completeness of the data– Limited cost data for Base-funded services– Limited MR data

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Page 6: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data:

Purpose

Provide an example of the type of data available

Provide snapshots of Base and HealthChoices Data– Base:

County funded services for people not eligible for HealthChoices Services that are not funded by HealthChoices

– Residential services, administrative case management, social rehabilitation– HealthChoices:

Services available to those who are Medicaid eligible Paid for by the Managed Care Organization/Medicaid

Individuals can receive both Base and HealthChoices services

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Page 7: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

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BASE HC*1,446 Users 6,344 Users

GENDER Female 48% 53%Male 52% 47%

AGE GROUP

00 – 20 20% 42%21 – 65 + 80% 58%

RACE African-American 7% 10%Caucasian 90% 89%Other ** 3% 1%

Discussion of County Data cont’d.Demographics 2008 Base & HealthChoices (HC)

* *Includes Asian, Native American, Other, and Unknown

* Includes MH services only

A total of 666 users had services in both HC and Base for Washington during 2008 (MH type services only)

Page 8: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.

Where were people served in 2008?

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Concentrations in: City of Washington and Canonsburg (Washington

Community MH/MR) Mon Valley (SPHS)

Spread throughout southern section of county (Centerville Clinics)

Individuals are also served from other Counties

* HealthChoices Only

Page 9: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d. Users by Service Category: Base & HealthChoices in 2008

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Service Category Base HC

Outpatient MH 558 5,442Case Management/ICM 233 1,217BHRS 0 810Crisis 340 676Inpatient MH 0 657HC Supplemental Serv - MH 0 433Lab 0 306Partial Hosp MH 32 239Family Based Services 2 134CTT 20 38RTF 0 34

Service Category Base HC

Med Check 0 26LTSR / AOP 18 13Psych Rehab 38 1Administrative Management 546 0Community Residential 28 0Emergency Services 17 0Employment Related Services 23 0Facility Based Voc Rehab 10 0Housing Support 148 0RTF - Adult 31 0Social Rehab 146 0

•MH services only• Excludes service categories with less than 10 users

Page 10: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

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Discussion of County Data cont’d. Users by Diagnostic Category: Base & HealthChoices in 2008

Diagnostic Category (Age 00-20)

Base(297)

HC(2,710)

ADHD 54 930Adjustment D/O 35 774Neurotic D/O 68 496Major Depression 16 393Psychosis Ch Orig 15 368Conduct D/O 10 323Bipolar D/O 9 311Child-Adol Emot D/O 18 308Depressive D/O 52 270Schizophrenia 1 26

Diagnostic Category (Age 21-65+)

Base(1,153)

HC(3,673)

Major Depression 268 1,396Bipolar D/O 115 905Schizophrenia 189 603Neurotic D/O 174 507Depressive D/O 212 431Adjustment D/O 74 337Unspec Psychosis 11 65Conduct D/O 11 48Org Mental D/O 4 45ADHD 15 38

• Includes the top 10 MH diagnostic categories for both children and adults

Page 11: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.

HealthChoices Summary: 2008

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Age Group

Users Served

(MH – only)

Paid Amount

(MH – only)% of

Total MHAvg. cost per

user

00 - 20 2,710 $ 13,098,792 64% $4,834

21 - 65+ 3,673 $ 7,301,760 36% $1,988

Total 6,383 $20,400,552

Page 12: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.HealthChoices 2008: Age 00-20/MH Summary

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Top 3 service categories comprise 70% of total cost for this age groupUsers Avg. cost per user

BHRS 809 $8,349Family Based Services 134 $9,432

Outpatient MH 2,161 $550

Top 3 diagnostic categories comprise 59% of total cost for this age groupUsers Avg. cost per user

Psychosis Ch Orig 368 $10,429

ADHD 930 $2,463

Bipolar D/O 311 $4,932

Top 3 providers comprise 25% of total cost for this age groupUsers Avg. cost per user

Family Behavioral Resources 147 $7,755Southwest Behavioral Care 617 $1,718

Southwood Psychiatric Hospital 119 $8,867

Page 13: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

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Discussion of County Data cont’d.HealthChoices 2008: Age 21-65+/MH Summary

Top 3 service categories comprise 78% of total cost for this age groupUsers Avg. cost per user

Inpatient MH 494 $4,623Outpatient MH 3,316 $541

Case Management / ICM 672 $2,426

Top 3 diagnostic categories comprise 75% of total cost for this age groupUsers Avg. cost per user

Schizophrenia 603 $3,787

Major Depression 1,396 $1,374

Bipolar D/O 905 $1,436

Top 4 providers comprise 64% of total cost for this age groupUsers Avg. cost per user

Southwest Behavioral Care 1,002 $2,009Washington Hospital 386 $2,742

Centerville Clinics 429 $1,960Washington Communities MH/MR 723 $1,031

Page 14: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.Inpatient Utilization:Community IP-MH Admissions

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• Time frame spans the downsizing and closure of Mayview State Hospital• Admissions are trending downward

0

10

20

30

40

50

60

70

Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09

Admissions Linear (Admissions)

*

* Adult HealthChoices Only

Num

ber o

f Adm

its

Page 15: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

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Discussion of County Data cont’d.Inpatient Utilization:Community IP-MH Average LOS

• ALOS is trending very slightly upward, but it has been within one day the entire period.

* Adult HealthChoices Only

Day

s

Page 16: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.BHRS Utilization: Users and Amount Paid

16• Users and amount paid are trending upward over the

period 28% and 25%, respectively.

Dol

lars

Peop

le

Page 17: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

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Discussion of County Data cont’d.BHRS Utilization: Users and Amount Paid (re-scaled)

• Re-scaled chart with a trend line can provide a different way of viewing the same data

Dol

lars

Peop

le

Page 18: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Discussion of County Data cont’d.

What did you think of this data?

What more would you like to see?

Other areas we should consider?

Page 19: Undertaken by the Office of Mental Health and Mental Retardation In partnership with Allegheny HealthChoices, Inc. October 1, 2009 Washington County System

Wrap up / Next Meeting

Agenda items for the next meeting– Summary of themes from the interviews– Other ideas

Schedule next meeting

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