Report to the Transition

Sub-Committee

June 2, 2006

Operations Update

• Hiring– 100% of Key Positions– Developed new Clinical Support Position to support

improved efficiency in the Clinical Dept.– 94% Overall

• Peer Specialists• Clinicians• Clinical Support Staff• 1 IT Analyst

Level of Care 4/24 – 5/28(Total auths/CCRs)

Total To Date(Total auths/CCRs)

RTC 381 1781

GH 2 30 67

GH 1 48 133

Inpatient Psych/Detox

1341 1976

Freestanding Detox/Rehab

107 180

OBS 16 33

PRTF 73 139

IOP/PHP 946 1312

EDT 113 113

Total 3,055 5,734

Authorization and Concurrent Review Update

Operations Update, con’d

• Riverview: effective 6/1/06 prior auth by ASO now required for all admissions (exception, court ordered admissions)

• EDT authorizations went “live” 6/1/2006• Home-Based Psychiatric Services: 7/2006• Inpatient Auth to Claims: projected 7/1/2006• IVR/Web technology 8/2006-9/2006

– Web technology likely in August 2006– Interim plan (possibly winfax) as temporary alternative

to IVR– IVR tentatively September 2006

Operations Update, con’d

• Pre-cert and Concurrent Call Volume:– 2854 calls in May (increase of 30% from April)

• We continue to work to improve efficiency• Under reported as clinicians have been giving out their direct extensions

• ICM Cases:– 79 mid-long term cases, 72 short-term, high risk (some overlap)

• ED Interface– Alert sent to CHA 5/11/2006

• Delay in Discharge (Inpatient, PRTF, Residential): – We continue to “Scrub” the census report– 22%: Family requesting add’t care – 21%: Awaiting PRTF– 8%: Awaiting Group Home

ED M/F Age DCF Diagnosis Days Stuck

Identified Disposition needed

ActualDisposition

St.Francis

M 12 Yes PTSDMajor Depression, recurrent

4 PRTF  Review due 6/1

HartfordHospital

F 9 Yes PTSDDepressiveDisorder

3 Inpatient IOL

Backus M 13 No Bipolar,Manic

1 Inpatient Boarded at Backus, stabilized, d/c home

St.Raphael’s

F 13 Yes ODD 4 Inpatient St. Raphaels

Day Kimball

M 14 No PsychoticDisorder Asperger’s

6 PRTF Left AMA w/ outpt. appointment

St. Mary’s M 7 Yes Bipolar, ADHD

3 PRTF Boys and Girls Village, Safe Home

Stuck ED Volume, May 2006

Call Management/Customer Service

CT BHP Call ManagementMay, 2006

*Please note: Enclosed data includes reporting period 5/1/2006 – 5/27/2006

Week Ending

Total

Calls

Total % Abando

n

Day Staff Calls

# Abandons

Day Staff

% Abandon

After Hour

s Calls

# Abandons

After Hours %

Abandon

Member

Calls

Provider

CallsCrisis Calls

After Hour

s Member

After Hour

s Provider

MCO Calls

211 Perinatal Depressio

n

5/6/2006 Partial Week

1121

0.18% 1066 2

0.19% 55 0

0.00% 383 658 25 2 53 1 0

5/13/2006

1101

0.18% 1059 1

0.09% 42 1

2.38% 447 584 28 2 40 3 0

5/20/2006

1238

0.40% 1195 5

0.42% 43 0

0.00% 483 680 32 0 43 2 0

5/27/2006

1210

0.25% 1136 1

0.09% 74 2

2.70% 423 691 22 1 73 1 0

Total Monthly

4677

0.26% 4456 9

0.20% 214 3

1.40% 1736 2613 107 5 209 7 0

Types of InquiriesMay, 2006

• 37% - Provider Referrals for Member• 20% - Member Eligibility Verification• 34% - Provider Related/Authorization/Enrollment/Billing• 9% - General Information

46% = Member Inquiries(Increase from April - 38%of total calls)

Note:0.06% = Inquiries initiated due to provider status change from

IN to OON7 MCO calls, 211 Initiative not yet live, but discrete phone line

operational

CT BHP CALL MANAGEMENTIncoming Calls Totals

May 2006

Total 4677

Note: Increase of 17% since April

Member Calls: 1741

Provider Calls: 2822

Crisis Calls: 112

The Network

Network Status

– CMAP Network– Increase of 628 providers since 12/12/05 (increase of 33

providers since April report)• MD and MD Groups: 40 • LCSW: 260• LMFT: 104• LPC: 70

– Add/Change report: 20-30 adds per week, 10-20 changes

–DCF Network- 110 RTC and Group Home providers (increase of 24 providers since 11/2005)

Rapid Response Team Findings

• Cycle Date 042106 we have identified the following (2) issues:

– 90 Claims denied for Prior Authorization Number Invalid

• All 90 claims were prior to CTBHP authorizing services;

– Outreach calls were provided to the high level denial providers

• Cycle date 051906 we have identified the following issues:

– 16 inpatient providers put data in auth line

– 7 IOP/PHP providers submitted claims without prior authorization

• Outreach calls were provided to the high level denial providers

Provider Handbook

• May 16th – Draft resubmitted to the state, incorporating

edits from May 2nd.

• May 25th – State approved draft with one final edit

• Incorporate the 4/11/06 LOC Guidelines for Children and Adolescents

• Present– Formatting final version for website posting

Quality Management

Quality Initiatives

• Clinical Studies – one focused on adults and another focused on children – both proposals are with the State for review

• Reporting – coordination occurring with the State re. priority reports, time frames for production, analysis

• Quality Control of documentation for clinicians and provider relations staff, examples include:– Authorization letters– Daily Census Report

Quality Initiatives, con’d

• Satisfaction Surveys– Member, Member with Complex Needs and

Provider Surveys– Data collection will begin in June and July and

conclude in late summer, early Fall – completed via phone interviews

– Report complete Fall of 2006

Complaints and GrievancesJanuary – May 2006

• Complaints: 4 in May (25 year to date)– 2 Providers (length of auth process)– 2 Member (OON providers)

• Grievances: 0 in May (3 year to date)– 2 related to OON status, 1 related to slow processing

of credentialing packet and subsequent payment concerns

All Complaints and Grievances were resolved within

standard timeframes

Community Outreach

Community Outreach

• May, 2006 – Systems Managers

177 DCF, Provider, Collaborative and MSS meetings in May 462 Meetings year to date

– Peer/Family Meetings

51 Family forums, informational meetings, DCF and Collaborative meetings (an increase of 85% from April)

– Peer/Family Outreach/Coordination: 28 Open family/peer consultations in May 17 Family/peer consults completed in May

Example: * Peer assisted a member post discharge with arranging mtg with DCF for services and the housing authority to stabilize living situation

Provider Trainings• May 22nd & May 30th

– Overview and Q&A following EDS Provider Forums • May 25th

– Provider Training – Hill Health, New Haven• June 5th

– Clinical Director’s Overview, CCPA, Rocky Hill• June 17th

– Provider Training - New Britain General Hospital • June 21st

– Provider Training – Family Care/VNA, Stratford • In process

– Scheduling 5 Provider Forums for July & August– Follow up meeting with State Dept. of Ed for joint training in the

Fall (next meeting June 23 w/ Cheryl Resha)

Questions?