WRBHO BEST Meeting & Quarter Three Performance Report Presentation Erie, Niagara and Orleans Counties December 17, 2012

2 I. Introductions and Key Findings II. Q3 Performance Report Regional Overview of all domains III. Health Homes and the role of the WRBHO IV. Q3 Sub-Regional Performance Review Review of key metrics tied to the “Effective Linkages” domain for the sub-region Discuss the information to determine what it means to those in attendance (Are there opportunities for improvement?) V. Effective practices presentations Assistance in attending MH appointments: ECMC, Michael Zuber, Vice President of Behavioral Health Critical Time Intervention: Tara Karoleski, Coordinator, Adult Single Point of Access & Accountability, Erie County Intro to Consumer Centered Family Consultation and opportunity for technical assistance VI. Identify areas of focus for improving sub-region BH system of care VII. Next Steps WRBHO BEST Meeting Agenda

3 Presenters Adele Gorges, Executive Director, NYCCP Anne Wilder, President, CCSI John Lee, WRBHO Program Director, Beacon Christine Mangione, WRBHO Manager of Clinical Operations, Beacon

4 INTRODUCTION & KEY FINDINGS

5 Introduction Q3 Performance Report Organization: – Domains – Metrics within each domain (Data Sources: BHO data collection and OMH BHO Portal)

6 The 5 Performance Metric Domains Performance Domain 1: Coordination with the BHO Performance Domain 2: Person-Centered Care Coordination during the Inpatient Stay Performance Domain 3: Linkages to After Care Services Performance Domain 4: Continuity of Care Performance Domain 5: Engagement in Care

7 Highlights of WRBHO Findings Observed changes that support transformation : Improved provider performance within the WRBHO’s 19 county region – 6 out of 8 metrics within the Performance Domain: Linkage to After Care Services, reflect improvement: Q2 to Q3. – A number of OMH BHO Portal metrics reflect performance in WNY that exceeds the Statewide rates: outpatient visits, readmission rates. County MH Directors convening meetings to engage providers about the changes that need to take place to prepare for BH Managed Care. Facility COO expressing appreciation that the State is monitoring data to assess the ability of providers to work as a system of care. MH inpatient providers expressing interest in learning how to be more effective in linking patients with PH providers. Facility discharge planners requesting help from the WRBHO in securing housing for a patient, recognizing impact on avoidance of readmissions. Providers devoting a full day to listen to feedback from those with a inpatient psychiatric experience (The WRBHO forums)

8 REGIONAL & PROVIDER PROFILE PERFORMANCE REPORTS

9 Performance Domain 1 – Coordination with the RBHO Domain includes measures helpful in ensuring complete and timely data report and review practices Metrics: The number of Notices of Admission submitted by providers is consistent with established targets Notices of Admission are received within 24 hours of admission Initial Reviews are completed within 72 hours of admission

10 Performance Domain 1 – Coordination with the WRBHO Performance Metric 1(a): The number of Notices of Admission (NOAs) received is consistent with established targets Data Source: Data on NOAs provided through the eServices Portal / data gathered by WRBHO staff via telephone. Data on 2011 fee-for-service admissions provided by the NYS Office of Mental Health Metric Calculation:Total Admissions Noticed for Period / Total FFS Medicaid Admission Reported for Period Inpatient Admission Type # of Admissions Noticed to WRBHO: Q1 # of Admissions Noticed to WRBHO: Q2 # of Admissions Noticed to WRBHO: Q3 Total # of Admissions Noticed through Q3 Total Admissions through Quarter * % of Target (2011) Mental Health Adult Mental Health Youth Mental Health Total % Substance Use Detox Adult % Substance Use Inpatient Rehab Adult % Substance Use Total % TOTAL %

11 Performance Metric 1(b): Notices of Admission are Received within 24 Hours of Admission Data Source:Data gathered via phone by WRBHO clinician or e-portal entry Metric Calculation:# of NOAs received within 24 hours of admission/Total admissions noticed in reporting period Inpatient Admission Type Total admissions for current quarter NOAs within 24 hours for current quarter NOAs within 24 hours/admissions for current quarter Provider range for current quarter NOAs within 24 hours for previous quarter Variance: Current vs. Previous Quarter Mental Health Adult % %95%2% Mental Health Youth % %98%1% Substance Use Detox Adult645890% %98%-8% Substance Use Inpatient Rehab Adult % %89%5% Total % %94%2% Performance Domain 1 – Coordination with the WRBHO

12 Performance Metric 1(c): Initial Reviews are Completed within 72 Hours of Admission Data Source:Gathered via phone by WRBHO clinician Metric Calculation:Initial Reviews within 72 Hours of admission/Total admissions in reporting period Inpatient Admission Type Total Admissions: Current Quarter # of Initial Reviews w/in 72 hours: Current Quarter Initial Reviews w/in 72 hours / Total Admissions: Current Quarter Provider Range: Current quarter Initial Reviews w/in 72 hours / Total Admissions: Previous Quarter Variance: Current vs. Previous Quarter Mental Health Adult % %83%11% Mental Health Youth % %85%7% Substance Use Detox Adult645585% %94%-9% Substance Use Inpatient Rehab Adult % %67%11% Total % %80%10% Performance Domain 1 – Coordination with the WRBHO

13 Performance Domain 2 – Person-Centered Care Coordination During the Stay Domain includes metrics that describes the extent to which effective, person-centered care coordination practices during the inpatient stay are evident. Particular interest in efforts to ensure that the individual’s needs have been identified so that an effective discharge plan can be developed. Additional metrics will be added under this domain over time. Metric: Treatment history is shared with the inpatient provider during the Initial Review

14 Performance Metric 2(a): Treatment History is Shared with the Inpatient Provider during the Initial Review Data Source:Data recorded in FlexCare by WRBHO Clinician Metric Calculation:Discharges w/Treatment History Shared/Total Discharges in Reporting Period Inpatient Admission Type Total Discharges: Current Quarter # of Discharges w/Treatment History Shared: Current Quarter % of Discharges w/Treatment History Shared: Current Quarter Provider Range: Current Quarter % of Discharges w/Treatment History Shared: Previous Quarter Variance: Current vs. Previous Quarter Regional Year- To-Date Mental Health Adult % %80%5%83% Mental Health Youth % %80%9%86% Substance Use Detox Adult % %84%-3%82% Substance Use Inpatient Rehab Adult % %74%16%85% Total % %79%7%84% Performance Domain 2 – Person-Centered Care Coordination During the Stay

15 Performance Domain 3 – Linkages to After-Care Services Domain includes metrics that measures the extent to which steps were taken during the inpatient stay to establish linkages to needed outpatient services. Metrics: The current or prior mental health outpatient provider was contacted during stay An appointment for mental health outpatient treatment was scheduled as part of the discharge plan The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay A SPOA application was submitted for case management, housing and other services For youth with multi-system needs, the discharge plan includes referrals /linkages for the provision of basic needs For youth with multi-system needs, the discharge plan documents post discharge educational needs There is improvement in housing status for individuals who are homeless at admission

16 Performance Domain 3 – Linkages to After-Care Services Higher performing providers Fall in the top 25% for the performance metric 8 or more discharges during the quarter Data collection process for Q3 was viewed as an accurate reflection of the providers’ work by the WRBHO Utilization Review Clinician. Provider Profile Summaries

17 Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period Inpatient Admission Type Total Discharges: Current Quarter # Where Outpatient Provider was Contacted During the Stay: Current Quarter % Where Outpatient Provider was Contacted During the Stay: Current Quarter Provider Range: Current Quarter Where Outpatient Provider was Contacted During the Stay: Previous QuarterVariance Mental Health Adult % %64%14% Mental Health Youth % %84%8% Total % %68%13% Performance Domain 3 – Linkages to After-Care Services Regional Report

18 Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period Inpatient Admission TypeAdult Mental HealthYouth Mental Health Provider Average78%92% Provider range % % Higher Performing ProvidersD L P Performance Domain 3 – Linkages to After-Care Services Provider Profile Summary

19 Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay Performance Domain 3 – Linkages to After-Care Services Best Practices: Gathers collateral information from outpatient provider and is linked closely with other outpatient agencies. Attempts to keep MH clients within their system of care, which appears to help with continuity of care. Is protocol that the Discharge Planner notifies outpatient provider of individuals admitted (once identified) and shares appropriate collateral information. Has a “no wrong door” philosophy and offers co-existing treatment with mental and physical health providers in close proximity of each other. Encourages effective communication.

20 Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay Performance Domain 3 – Linkages to After-Care Services Barriers: Gaps in communication between UR clinicians and discharge planners. The practice is not built in to standard facility procedures. The treatment team does not reach out to current or active providers to collaborate and work together towards the recovery of patients.

21 Performance Metric 3(a): The current or prior mental health outpatient provider was contacted during stay Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: Clarified meaning of the indicator during one-on-one provider meetings through issuing a new review template and holding provider calls. WRBHO System of Care Transition Coordinator’s role redefined to include contacting outpatient providers when an active client has been admitted and encouraging follow-up. This outreach continues to encourage contact between inpatient and outpatient providers. Focused on the importance of the transition to outpatient treatment during the February and June BEST Meetings. Effective linkage to after care services was the theme during the September 27 BEST Meeting.

22 VIGNETTE: Linking with Past Supports to Avoid Future Readmissions Performance Domain 3 – Linkages to After-Care Services

23 Performance Metric 3(b): An appointment for mental health outpatient treatment was scheduled as part of the discharge plan Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges in Reporting Period Inpatient Admission Type Total Mental Health Discharges: Current Quarter An Appointment for MH Treatment was Part of the Discharge Plan: Current Quarter (#) An Appointment for MH Treatment was Part of the Discharge Plan: Current Quarter (%) Provider Range: Current Quarter An Appointment for MH Treatment was Part of the Discharge Plan: Previous Quarter Variance: Current vs. Previous Quarter Mental Health Adult % %81%-5% Mental Health Youth % %70%1% Total % %79%-4% Performance Domain 3 – Linkages to After-Care Services Regional Report

24 Performance Metric 3(b): An appointment for mental health outpatient treatment was made as part of the discharge plan Performance Domain 3 – Linkages to After-Care Services Best Practices: Strong ties to the system’s array of outpatient services facilitate effective communication and efficient scheduling. Follow a person-centered, thorough and comprehensive discharge planning process. Connecting with outpatient treatment is a standard practice for those individuals not transferring to another facility for inpatient rehabilitation (SUD). Standard operating practice to ensure linkage with a community- based provider prior to discharge. Intake coordinator assigned to client and follows him or her from inpatient to discharge. Outreach is performed if the aftercare appointment is missed.

25 Performance Metric 3(b): An appointment for mental health outpatient treatment was made as part of the discharge plan Performance Domain 3 – Linkages to After-Care Services Barriers: In instances where the individuals do not have an outpatient provider at the time of admission, this process is more difficult to accomplish during the inpatient stay. Lack of outpatient capacity is a barrier in some areas.

26 Performance Metric 3(b): An appointment for mental health outpatient treatment was scheduled as part of the discharge plan Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: During September 27 BEST Meeting, providers shown to be successful in scheduling outpatient appointments spoke about their practices. December BEST meeting will focus on sharing practices in place at providers having success with individuals leaving inpatient care with a outpatient mental health appointment scheduled. WRBHO staff will follow-up directly with providers with lower performance in this area to further define barriers and identify solutions.

27 Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period Inpatient Admission Type Total Discharges: Current Quarter Case Summary was Sent to the Outpatient Provider: Current Quarter (#) Case Summary was Sent to the Outpatient Provider: Current Quarter (%) Provider Range: Current Quarter Case Summary was Sent to the Outpatient Provider: Previous Quarter (%) Variance: Current vs. Previous Quarter Mental Health Adult % %65%0% Mental Health Youth % %52%8% Substance Use Detox Adult662842% %44%-2% Substance Use Inpatient Rehab Adult %9 - 83%35%8% Total % %56%3% Performance Domain 3 – Linkages to After-Care Services Regional Report

28 Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider Performance Domain 3 – Linkages to After-Care Services Best Practices: Standardized practice has been implemented to submit the discharge summary so the outpatient provider is aware of the discharge diagnosis, GAF, and medications/instructions. It is a standard operating practice that when a patient signs a release, case summaries are sent to the outpatient provider. If patient initially declines, staff will discuss with the patient the need to send the summary for good continuity of care. Provider has effective linkages to outpatient programs in their organization’s system of care.

29 Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: Confusion existed as to what constituted a “case summary.” WRBHO clarified definition: Discharge instructions which include dates of admission, discharge diagnosis, and medication list. Definition shared with providers and the WRBHO UR Clinicians are using this definition in their reviews. We anticipate that we will continue to see improvement on this important dimension.

30 Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO Metric Calculation:Discharges w/physical health appointment scheduled with an outpatient provider/discharges w/physical health need identified during inpatient stay for reporting period Inpatient Admission Type Total Discharges w/Physical Health Needs Identified: Current Quarter # w/Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Current Quarter % w/ Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Current Quarter Provider Range: Current Quarter % w/ Physical Health Appointment Scheduled w/ Outpatient Provider for those w/ Needs Identified: Prior Quarter Variance: Current vs. Previous Quarter Mental Health Adult % %21%18% Mental Health Youth12650% %25% Substance Use Detox Adult25535% %8%27% Substance Use Inpatient Rehab Adult % %14%41% Total % %19%21% Performance Domain 3 – Linkages to After-Care Services Regional Report

31 Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay Performance Domain 3 – Linkages to After-Care Services Best Practices: Facility goal is to ensure that all patients are well connected to all areas of health care - both mental and physical. Provider has a protocol requiring the case manager to link the patient with a Primary Care provider if the patient is admitted without one. The provider has developed relationships with two PCP practices to help expedite creating this very important link. Provider strives to connect clients to previous primary care providers, if none have been established, they refer clients to the county system. The County provides a list of accepting physicians.

32 Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay Performance Domain 3 – Linkages to After-Care Services Barriers: The responsibility is placed on the individual to follow up with their primary care physician after discharge. Some facilities have procedures that focus on SUD and mental health outpatient appointments only (not physical health). Many individuals admitted do not have a primary care provider and inpatient staff says that it is too hard to link the individuals with a PCP during the inpatient stay.

33 Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: Developed a template for inpatient providers that details the rationale and offers a definition of this (and other) metric(s). Template reviewed with inpatient providers via webinar. WRBHO Utilization Review Clinicians engaged in a thorough review of all questions contained in the review cycle to be better prepared to extract more accurate information from the providers during these reviews. WRBHO will continue to work to identify effective practices for integrating physical health engagement into the behavioral health admissions through surveying providers for effective practices and sharing strategies via BEST Meetings and other provider forums.

34 Performance Metric 3(e): A SPOA Application was Submitted During the Inpatient Stay Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool Faxed to the WRBHO Metric Calculation:# of SPOA Applications Submitted/# of Discharges in Reporting Period Inpatient Admission Type Total Discharges: Current Quarter # of Discharges w/SPOA Application Submitted: Current Quarter % of Discharges w/SPOA Application Submitted: Current Quarter Provider range for current quarter % of Discharges w/SPOA Application Submitted: Previous Quarter Variance: Current vs. Previous Quarter Mental Health Adult %0 - 66%9%3% Mental Health Youth % %19%0% Substance Use Detox Adult6614%0 - 33%2% Substance Use Inpatient Rehab Adult 26751%0 - 9%1%0% Total % %8%2% Performance Domain 3 – Linkages to After-Care Services Regional Report

35 Performance Metric 3(e): A SPOA Application was Submitted during the Inpatient Stay Provider Profile Summary Performance Domain 3 – Linkages to After-Care Services Best Practices: Overall, SPOA referrals are made for 12% of adults discharged from inpatient care and 19% of youth. However, the range varies considerably, with several providers reporting much higher referral rates. Based on interactions with providers, we have identified a few practices that appear to be proving successful: SPOA “consultant” from the county is placed on each unit to help identify and assist discharge planners with application process. Provider uses a team approach in working with the patient. That is, the discharge planner, the social worker/therapist and the MD/NPP all meet together with the patient to assist in determining needs for a successful transition.

36 Performance Metric 3(e): A SPOA Application was Submitted during the Inpatient Stay Performance Domain 3 – Linkages to After-Care Services Provider Profile Summary Barriers: Lack of SPOA services (care management) to support the needs of those with SU diagnosis. SPOA review processes occur on a monthly basis only in some counties. Inpatient facilities will start process if needed but rely on outpatient services to finish the referral. WRBHO Actions: The WRBHO has begun to work with county directors to assess the interest in developing greater consistency in SPOA processes. WRBHO UR Clinicians have been oriented to county specific SPOA processes so that they are in a better position to support the providers’ needs in each county. WRBHO UR Clinicians have been encouraged to support specific SPOA requests by helping with the application or even attending SPOA meetings to represent the needs of the individual and the provider.

37 Performance Metric 3(f): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic needs Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges with Indication that Basic Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period Inpatient Admission Type # of Youth w/Multi- Systems Needs Identified: Current Quarter # of Youth w/Indication that Basic Needs were Addressed: Current Quarter % of Youth w/Indication that Basic Needs were Addressed: Current Quarter Provider Range: Current Quarter % of Youth w/Indication that Basic Needs were Addressed: Previous Quarter Variance: Current vs. Previous Quarter Mental Health Youth % %98%0% Performance Domain 3 – Linkages to After-Care Services Regional Report

38 Performance Metric 3(f): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic needs Provider Profile Summary Performance Domain 3 – Linkages to After-Care Services Best Practices: Discharge planning is comprehensive and involved all outside agencies. Weekly team meetings are held for the interdisciplinary team and UR team. On-site team member meetings. Provider gathers collateral information from outpatient providers and is very knowledgeable about resources that are available in the community.

39 Performance Metric 3 (g): For youth with multi-systems needs, the discharge plan documents post-discharge educational needs Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges with Indication that Educational Needs Were Addressed/# of Discharges w/Multi-System Needs Identified for Reporting period Inpatient Admission Type # of Youth w/Multi- Systems Needs Identified: Current Quarter # of Youth w/Indication that Educational Needs were Addressed: Current Quarter % of Youth w/Indication that Educational Needs were Addressed: Current Quarter Provider Range: Current Quarter % of Youth w/Indication that Educational Needs were Addressed: Previous Quarter Variance: Current vs. Previous Quarter Mental Health Youth % %93%-5% Performance Domain 3 – Linkages to After-Care Services Regional Report

40 Performance Metric 3 (g): For youth with multi-systems needs, the discharge plan documents post-discharge educational needs Performance Domain 3 – Linkages to After-Care Services Provider Profile Summary Best Practices: Supporting the multi-system needs of children requires very comprehensive planning, involving a number of outside agencies in regular interdisciplinary team meetings. Higher performing providers have made school programming mandatory for children and youth.

41 Performance Metric 3(f) and (g): For youth with multi-systems needs, the discharge plan includes referrals / linkages for basic and educational needs Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: WRBHO staff will review these measures with providers following the release of the Q3 data to ensure that data collection and reporting accurately reflect current practice. A Clinical Grand Rounds scheduled for 2013 will focus on children’s services and will be presented by the WRBHO Child Psychiatrist, Mario Testani. Dr. Testani will spend a portion of his presentation discussing the importance of addressing educational needs.

42 Performance Metric 3(h): Improvement in housing status for individuals who are homeless at admission Data Source:Gathered by WRBHO clinician during review Metric Calculation:# of Discharges w/Improved Housing Status/# of Discharges that were Homeless at Admission for Reporting Period Inpatient Admission Type Total # Homeless at Admission: Current Quarter Improvement in Housing Status for Individuals Homeless at Admission: Current Quarter (#) Improvement in Housing Status for Individuals Homeless at Admission: Current Quarter (%) Provider Range: Current Quarter Improvement in Housing Status for Individuals Homeless at Admission: Previous Quarter (%)Variance Mental Health Adult632031% %20%11% Mental Health YouthNo Data 100%No Data Substance Use Detox Adult7133%0 - 50%No Data Substance Use Inpatient Rehab Adult % %68%-2% Total943739% %30%9% Performance Domain 3 – Linkages to After-Care Services Regional Report

43 Performance Metric 3(h): Improvement in housing status for individuals who are homeless at admission Performance Domain 3 – Linkages to After-Care Services WRBHO Actions: As access to stable housing is critical to achieving recovery this measure has been an area of focus in our review and discussion of both system and provider performance. WRBHO UR clinicians have been asked to encourage providers to work diligently to address this need for cases we review. WRBHO staff has also worked with county SPOAs to support an expedited review for inpatients, especially those in need of housing. Providers have been encouraged to begin the housing planning process for individuals admitted as homeless as soon as they are admitted.

44 Performance Domain 4 – Continuity of Care Domain includes metrics that look at the extent to which individuals are connected to outpatient mental health services following discharge from inpatient – as well the timeliness of that connection. Utilize data collected by WRBHO and data available through BHO Portal. Metrics: The percentage of scheduled Mental Health clinic outpatient appointments attended (WRBHO collected) The percentage of Mental Health Discharges followed by an outpatient visit for Mental Health treatment within 7 days (BHO Portal) The percentage of SUD Detox discharges with lower level SUD services with 14 days (BHO Portal) The percentage of SUD rehabilitation discharges with lower level SUD services within 14 days (BHO Portal)

45 Performance Metric 4(a): Percentage of scheduled Mental Health clinic outpatient appointments attended Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Outpatient Licensed Mental Health Clinic Appointments Attended Post-Discharge / # of Outpatient Mental Health Appointments Attended / Total # of Outpatient Mental Health Appointments Scheduled Inpatient Admission Type # of Outpatient Mental Health Appointments Scheduled: Current Quarter # of Outpatient Mental Health Appointments Attended: Current Quarter % of Outpatient Mental Health Appointments Attended: Current Quarter Provider Range: Current Quarter % of Outpatient Mental Health Appointments Attended: Previous Quarter Variance: Current vs. Previous Quarter Regional Year- To-Date Mental Health Adult %52-100%79%2%80% Mental Health Youth % %85%-4%84% Total % %80%1%80% Performance Domain 4 – Continuity of Care

46 Performance Metric 4(a): Percentage of scheduled Mental Health clinic outpatient appointments attended Performance Domain 4 – Continuity of Care WRBHO Actions: WRBHO clinicians gather these data through follow-up w/identified the outpatient mental health providers. WRBHO follow-up takes place for up to 60-days post discharge (or until there can be confirmation of either attendance or a “no show.”) Complements data available from the BHO Portal by providing a more timely way for staff to monitor the rate at which individuals are attending their outpatient mental health appointments. WRBHO focus will be on identifying barriers to after care attendance and strategies providers are finding effective in increasing attendance.

47 Performance Metric 4 (b):Percentage of MH Discharges Followed by an Outpatient Visit for MH Treatment within 7 Days Data Source:NYS OMH BHO Portal Metric Definition:Frequency with which individuals receive outpatient mental health treatment within 7 days of discharge from a mental health inpatient hospitalization. Inpatient Admission Type Western Region: Q Western Region: Q Variance: Current vs. Previous Quarter Statewide: Q Variance: Western Region vs. Statewide Mental Health Adult 44.8%45.9%1%34.7%10.1% Mental Health Youth 44.3%48.1%-4%38.6%5.6% Performance Domain 4 – Continuity of Care

48 Performance Metric 4 (c):Percentage of SUD Discharges Followed by a Lower Level SUD Service within 14 Days Data Source:NYS OMH BHO Portal Metric Definition:Frequency with which individuals receive a lower level, less intensive, substance use disorder service within 14 days following a discharge from an inpatient substance use treatment. Inpatient Admission Type Western Region: Q Western Region: Q Variance: Current vs. Previous Quarter Statewide: Q Variance: Western Region vs. Statewide Substance Use Detox Adult 58.1%50.5%7.5%33.1%25% Substance Use Inpatient Rehab Adult 47.7% 0%39.5%8.2 Performance Domain 4 – Continuity of Care

49 Performance Domain 5 – Engagement in Care Metrics % of Mental Health discharges followed by 2 or more MH outpatient visits within 30 days (BHO Portal) % of SUD Detox or Rehabilitation services followed by 2 or more SUD services within 14 days of discharge (BHO Portal)

50 Performance Metric 5(a):Percentage of MH Discharges Followed by Two or More MH Outpatient Visits within 30 Days Data Source:NYS OMH BHO Portal Metric Definition:Received two or more outpatient mental health visits within thirty days of discharge. Inpatient Admission Type Western Region: Q Western Region: Q Variance: Current vs. Previous Quarter Statewide: Q Variance: Western Region vs. Statewide Mental Health Adult 42.6%40.9%1.7%31.9%10.7% Mental Health Youth 48.9%49.6%-.7%43.3%5.6% Performance Domain 5 – Engagement in Care

51 Performance Metric 5 (b): Percentage of SUD Detox or Rehabilitation Discharges Followed by Two or More Lower Level SUD Services within 14 Days of Discharge Data Source:NYS OMH BHO Portal Metric Definition:Frequency with which individuals discharged from inpatient detoxification or chemical dependence inpatient rehabilitation engage in 2 or more lower level substance use disorder treatment services within fourteen days of discharge. Inpatient Admission Type Western Region: Q Western Region: Q Variance: Current vs. Previous Quarter Statewide: Q Variance: Western Region vs. Statewide Substance Use Adult 32.2%32.5%-.3%21.4%10.8% Performance Domain 5 – Engagement in Care

52 HEALTH HOMES Brief Overview Adele Gorges

53 WRBHO ROLE IN HEALTH HOMES Chris Mangione

54 Role of the WRBHO in Supporting Health Homes Notify inpatient providers when an admitted individual being reviewed by the WRBHO is enrolled in a Health Home or eligible for Health Home outreach Ensure the provider has contact information for the Health Home care coordinator. Contact Health Home care coordinators to review and assist with post-discharge follow-up as needed. Share past treatment history as found in PSYCKES and FlexCare Alert Health Home when Health Home member is admitted. Support community referrals to Health Homes

55 WRBHO Q3 SUB-REGIONAL PERFORMANCE REVIEW: Linkages to Aftercare Services

56 Sub-Regional View - Discharges Inpatient Admission Type County of Residence - Current Quarter Sub-Regional vs. Regional ErieNiagaraOrleans Sub- Regional Current Qtr Regional Current Qtr Sub- Regional vs. Regional Mental Health Adult % Mental Health Youth % Substance Use Detox % Substance Use Inpatient Rehab Adult % TOTALS %

57 Sub-Regional View Performance Metric 3 (a): The Current or Prior Mental Health Outpatient Provider was Contacted During the Stay Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation: # of Discharges where Mental Health Outpatient Provider was Contacted During the Stay/Total # of Discharges in Reporting Period Inpatient Admission Type By County of Residence - Current QuarterSub-Regional vs. Regional ErieNiagaraOrleans Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult 85%55%100%77%78%1% Mental Health Youth 80%100% 83%92%-9% TOTALS 84%56%100%78%80%-2%

58 Sub-Regional View Performance Metric 3 (b):An appointment for mental health outpatient treatment was made as part of the discharge plan Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation: # of Discharges w/Appointments Scheduled for a Mental Health Outpatient Provider/ Total Mental Health Discharges in Reporting Period Inpatient Admission Type By County of Residence - Current QuarterSub-Regional vs. Regional ErieNiagaraOrleans Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult 81%76%83%80% 76%4% Mental Health Youth 74%100% 78% 53%22% TOTALS 80%77%87%80% 72%8%

59 Sub-Regional View Performance Metric 3 (c): The case summary was sent to the outpatient mental health or substance use disorder (SUD) outpatient Provider Data Source: Gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool faxed to the WRBHO Metric Calculation:# of Discharges where Case Summary was Sent to Outpatient Provider / Total # of Discharges During Period Inpatient Admission Type By County of Residence - Current QuarterSub-Regional vs. Regional ErieNiagaraOrleans Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult 71%67%33%69%65%4% Mental Health Youth 67%100% 72% 60%12% Substance Use Detox 29%50%100%34%43%-11% Substance Use Inpatient Rehab 58%21%100%53%43%10% TOTALS 66%61%69%65%59%6%

60 Sub-Regional View Performance Metric 3 (d): A physical health appointment scheduled post-discharge if a physical health care need was identified during the stay Data Source: Data gathered by WRBHO clinician during review, provided via the e-services portal, or Discharge Review tool FAX'd to the WRBHO Metric Calculation: Discharges w/physical health appointment scheduled with an outpatient provider/Discharges w/physical health need identified during inpatient stay for reporting period Inpatient Admission Type By County of Residence - Current QuarterSub-Regional vs. Regional ErieNiagaraOrleans Sub-Regional Current Qtr Regional Current Qtr Sub-Regional vs. Regional Mental Health Adult 11%61%0%49%39%10% Mental Health Youth 0% 50%-50% Substance Use Detox 0% 42%-42% Substance Use Inpatient Rehab 20%0%100%40%55%-15% TOTALS 11%50%31%21%41%-20%

61 Initial sub-regional reports show performance within each sub-region by county of residence. While the number of cases within some counties is small, Q3 data do show some variation in performance within the sub-region when compared to the region as a whole. These reports will be followed with a report by county of fiscal responsibility that provides a view of provider-specific performance, which we believe will be helpful in better understanding patterns of care and identifying opportunities to strengthen effective linkages to after care services. Sub-Regional Analysis Summary

62 WRBHO EFFECTIVE PRACTICES PRESENTATIONS Assistance in attending MH appointments: Michael Zuber, Vice President of Behavioral Health, ECMC Critical Time Intervention: Tara Karoleski, Coordinator, Adult Single Point of Access & Accountability, Erie County Consumer Centered Family Consultation - Family Institute for Education, Practice and Research, U of R Medical Center

63 Assistance in attending MH appointments Michael Zuber, Vice President of Behavioral Health, ECMC

64 Critical Time Intervention Tara Karoleski, Coordinator, Adult Single Point of Access & Accountability, Erie County

65 The Family Institute for Education, Practice and Research (at URMC) & CCFC Has been funded by the NYS Office of Mental Health for over 10 years; has worked with over 200 agencies in a variety of settings Provides training and implementation support for agencies that are adopting evidence based family-involving approaches for people with severe mental illness Offers training and consultation related to evidence based practices as well as organizational changes related to the successful implementation of those practices One core offering is Consumer Centered Family Consultation (can also be called person centered family consultation) See 2012 article for additional detail and background

66 Consumer Centered Family Consultation Consumer Centered Family Consultation (CCFC) is a brief, education-based engagement and consultation service that is typically completed in one to three sessions It promotes collaboration among adult consumers of mental health services, members of their family or social network, and service providers to support each consumer’s recovery The focus of CCFC is the person/consumer with a behavioral health issue (the focus is not the family or family therapy) There are specific shared decision-making tools embedded in the process of engaging people and their natural supports CCFC provides an opportunity to help prevent avoidable hospitalizations and to help facilitate linkage with outpatient services by involving people’s natural supports in meaningful ways

67 Consumer Centered Family Consultation WRBHO CCFC Webinar: January 11 at 11:00 am Contact at the Family Institute: – Anne Smith, Executive Director – –

68 SUB-REGIONAL AREAS OF FOCUS

69 Top 4 reasons for admission for Individuals with Complex Needs Lack of engagement with outpatient provider Non-adherence to medication Drug & Alcohol Use Increased symptomology w/o Precipitant Noted Improve access to housing at discharge Address any gaps in the SPOA process and help county prepare for Health Homes Support the introduction of Consumer Centered Family Consultation across the sub-region Add more… Sub-Regional Areas of Focus

70 WRBHO PLANS WRBHO Report Summary

71 Post Q3 WRBHO Performance Report on NYCCP Website Distribute provider-specific reports Distribute county of origin reports to County Directors Survey to identify areas of focus for each region / begin to plan for Learning Collaborative Consumer Centered Family Consultation Webinar scheduled for January 11, 2013 Support Health Homes in our region Begin Grand Rounds Webinars WRBHO Plans

72 Q and A