1. Quarterly Meeting PMHP Collaborative PIP April 4, 2012 PMHP Analysis of Improvement

2. Overview  PMHPs’ assignment  PMHPs’ results  Next steps 2

3. PMHP Assignment 1.In the most recent measurement period, if your study indicator rate improved, what do you attribute the improvement to? 2.In the most recent measurement period, if your study indicator rate declined, why do you think there was a decline? 3.Have you evaluated interventions? If so, what did you do to evaluate interventions? 3

4. Access Behavioral Health  Demonstrated improvement for the most recent measurement period  Peer Transition Liaison intervention is credited for increases in follow-up appointment attendance  However, many of the appointments that are being kept are not within 7 days of discharge  Encounter data shows member did not attend the first weekly group therapy appointment  In some instances, the follow-up appointment the member attended was not within the 7 day period 4

5. Access Behavioral Health cont.  Plan to implement an additional intervention strategy  Subgroup analysis revealed that the rate of members discharged from one CSU far exceeded the rate of members discharged from other facilities  The Comprehensive Behavioral Health Provider operating that CSU also provides outpatient follow-up services to most members discharged from its CSU 5

6. Access Behavioral Health cont.  Asked that provider agency to present the provider-based intervention strategy they have applied during the ABH Quality Council (held last week during March)  To the degree that their strategy can be applied by other providers, ABH will promote the adoption of similar procedures 6

7. Community Based Care Partnership Child Welfare PMHP  Demonstrated improvement in the most recent measurement period  Attributed improvement to the interventions implemented during 2011 7

8. Community Based Care Partnership Child Welfare PMHP cont. The main interventions were:  Work plan to address barriers to improvement  Concurrent review teams  Three facilities fully participating in the “Bridge Program”  Outreach to Medicaid transportation services  Case managers conducting “Welcome home calls”  Updating and increasing the list or providers who can give appointments quickly 8

9. Community Based Care Partnership Child Welfare PMHP cont.  Developed and implemented Webinars  “Provider Focus” newsletter  Increase coordination between the follow-up specialists and the PMHP to improve follow-up and coordination of care for child welfare recipients discharged from inpatient facilities and crisis stabilization units 9

10. Community Based Care Partnership Child Welfare PMHP cont. Plan’s focus for 2012:  Continue Bridge Program  More evaluation to determine effectiveness of interventions 10

11. Community Based Care Partnership Child Welfare PMHP cont.  Interventions and barriers for improvement analyzed on an ongoing basis  Data analysts provide monthly reports  Can identify quickly if there are systematic barriers to follow-up appointments 11

12. Community Based Care Partnership Child Welfare PMHP cont. Mechanisms used to quickly identify issues are:  Care Managers and Follow-up Specialists’ observations and reports  Facility score cards  Monthly evaluations of performance 12

13. Community Based Care Partnership Child Welfare PMHP cont.  Evaluation of interventions to reach goals held in both local and national management meetings  Includes clinical operation and public sector “core performance indicators” review meetings 13

14. Florida Health Partners/North Florida Behavioral Health Partners  Did not demonstrate improvement for the most recent measurement period  One area’s result remained the same as the prior measurement period  The remaining areas had declines that were not statistically significant 14

15. Florida Health Partners/North Florida Behavioral Health Partners cont.  Identified through a number of critical incidents in 2011 that additional efforts have been made on behalf of Value Options to ensure continuity of care between inpatient and outpatient providers is occurring  Value Options terminated one Network Provider effective August 2011  Identified that appropriate discharge planning and follow- up care were not occurring  Specific scenarios have been agenda items in Quality Meetings with providers  Targeted reviews and conference calls with providers for discussion 15

16. Florida Health Partners/North Florida Behavioral Health Partners cont. Interventions that are used on an ongoing basis:  On-going discussion with network providers  Care coordination with Clinical Care Managers and Quality Department  Care coordination through monthly report to network providers  Referral to Value Options Medical Management/Intensive Care Management Program 16

17. Florida Health Partners/North Florida Behavioral Health Partners cont. Will continue to utilize the current interventions in addition to considering the following:  Outreach letter to non-partner/out-of-network facilities  Network provider survey/record review identifying those members with no follow-up care after discharge from a CSU 17

18. Florida Health Partners/North Florida Behavioral Health Partners cont.  Evaluated the pre-appointment reminder call intervention  Biggest barrier to a successful intervention is the inability to contact members 18

19. Magellan  All areas demonstrated improvement in the most recent measurement period  Attributed improvement to the interventions implemented during 2011 19

20. Magellan cont. The main interventions were:  Work plan to address barriers to improvement  Concurrent review teams  Three facilities fully participating in the “Bridge Program”  Outreach to Medicaid transportation services  Case managers conducting “Welcome home calls”  Updating and increasing the list or providers who can give appointments quickly 20

21. Magellan cont.  Developed and implemented Webinars  “Provider Focus” newsletter 21

22. Magellan cont.  Specific intervention for Area 2 was the commitment of Emerald Coast Hospital to participate in the Bridge Program  Barriers in Area 4 included difficulties reaching an agreement with the largest inpatient provider in the area  Planning specific intervention (on-site coordination activities) for Area 4 pending results of a pilot program in Area 9 22

23. Magellan cont. Specific intervention for Area 9:  Started in September 2011 with the collection of data on the Field Care Worker’s productivity and her interventions in the community 23

24. Magellan cont. Plan’s focus for 2012:  Continue Bridge Program and Peer Bridger Program  Peer Bridger Program utilizes peer specialist  Additional evaluation of areas will be conducted to determine the effectiveness of interventions 24

25. Magellan cont.  Interventions and barriers for improvement analyzed on an ongoing basis  Data analysts provide monthly reports  Can identify quickly if there are systematic barriers to follow-up appointments 25

26. Magellan cont. Mechanisms used to quickly identify issues are:  Care Managers and Follow-up Specialists’ observations and reports  Facility score cards  Monthly evaluations of performance 26

27. Magellan cont.  Evaluation of interventions to reach goals held in both local and national management meetings  Includes clinical operation and public sector “core performance indicators” review meetings 27

28. Public Health Trust  Demonstrated improvement in the most recent measurement period  Attributed improvement to the expansion of the fast-track “Opening Doors” program  Program available at three facilities  In addition, three providers are accessible to conduct in-home comprehensive post discharge assessments 28

29. Public Health Trust cont.  Improved working relationships with inpatient facilities  Improved aftercare coordination, more accuracy in analyzing and recording post discharge data  Increased emphasis on conducting welcome calls to members 29

30. Public Health Trust cont.  Major intervention-fast access to care program at a single hospital  Evaluated success of the intervention by calculating rates of compliance for only those individuals assigned to this intervention  The compliance rates for this group were 98 to 100 percent  Program was rolled out to the entire group 30

31. Next Steps  Next PMHP Collaborative PIP call is scheduled for April 25, 2012  Plans should be prepared to give an update on any progress related to their subgroup analysis  Will revisit the exclusion discussion 31