Report to the Transition

Sub-Committee

May 5, 2006

Operations Update

• Hiring– 100% of Key Positions

• Dr. John Swanson, Associate Medical Director

• Dr. Jeffery Gottlieb, Associate Medical Director

• Ann Phelan, MA, VP of Clinical Operations

– 88% Overall• 3 Peer/Family Specialists

• 2 IT/Reporting

• 1 Quality Management

Operations Update, con’d

Level of Care Total Auths/CCRs

RTC 1400

GH 2 37

GH 1 85

Inpatient Psych 635

Inpatient Detox 73

OBS 17

PRTF 66

IOP/PHP 366

Total 2679

Operations Update, con’d

• Pre-cert and Concurrent Call Volume– 1997 calls in April (increase of 70% from March)– Range of time on the phone: 17 seconds to 56 minutes– Average time on the phone: 28 minutes

• Riverview on line June 1, 2006• ED Interface

– Opportunities to improve notification/communication– Tracking of members– Drafting educational Alert

• Next Phase: EDT 6/1/2006• Home-Based Psychiatric Services: 7/1/2006• IVR/Web technology 8/2006

Call Management/Customer Service

CT BHP Call ManagementApril, 2006

Week Ending

Total Calls

Total %

Abandon

Day Staff Calls

# Abando

ns

Day Staff % Abando

n

After

Hours

Calls

# Abando

ns

After Hours

% Abandon

Member

Calls

Provider

Calls

Crisis

Calls

After Hour

s Member

After Hours Provider

4/1/2006 Partial Week 9 0.00% 0 0 0.00% 9 0 0.00% 0 0 0 0 9

4/8/2006 910 0.11% 848 1 0.12% 62 0 0.00% 401 418 29 2 60

4/15/2006 976 0.20% 930 2 0.22% 46 0 0.00% 383 515 32 3 43

4/22/2006 1023 0.29% 968 3 0.31% 55 0 0.00% 344 582 42 0 55

4/29/2006 950 0.21% 904 2 0.22% 46 0 0.00% 377 501 26 1 45

4/30/2006Partial Week  0

0.00%  0 0 0.00% 0  0 

 0.00%  0 0   0  0 0 

Total Monthly 3868 0.18%

3650 8 0.22% 218 0

0.00% 1505 2016 129 6 212

INCLUDES ALL CALLS WITH NO THRESHOLDS, <5% ABD IS TARGET

CT BHP CALL MANAGEMENTIncoming Calls Totals: April 2006

Total 3,868

(Total Call Volume in March: 2,852, a 36% increase in April)

Member Calls: 1511

Provider Calls: 2228

Crisis Calls: 129

Types of InquiriesApril, 2006

33% - Provider Referrals for Members

23% - Member Eligibility Verification

39% - Provider Related/Authorization/Enrollment/Billing

5% - General Information

38% = Member Inquiries

Note: .06% = Inquiries initiated due to provider status changing from in network at the MCO to out of network with new system

Note: Discrete MCO lines have been established and will be live and reportable for the June meeting

Note: Creation of a warm line transfer with the 211 Perinatal initiative

The Network

CT BHP Provider Network

(TYPE) - SERVICE DESCRIPTIONS

12/12/05 05/01/06

01/40 - (General Hospital) - Psychiatric Hospital – Under 21 5 5

01/42 - (General Hospital) - Psychiatric Hospital – Aged 2 3

01/49 - (General Hospital)- Psychiatric Hospital - Outpatient 2 3

01/78 - (General Hospital)- Inpatient 47 57

01/79 - (General Hospital) - Outpatient 47 47

06/40 - (State Institution) - Psychiatric – Under 21 5 5

06/42 - (State Institution) - Psychiatric - Aged 4 3

06/49 - (State Institution) - Psychiatric - Outpatient 2 2

06/50 - (State Institution) – Mental Health Clinic 4 3

12/3F - (Special Services) - Psychiatric Residential Treatment Facility       0 5

CT BHP Provider Network

(TYPE) - SERVICE DESCRIPTIONS12/12/05 05/01/06

12/3D - Residential Treatment Center 0 63

12/3I - Group Home - 1.0 0 33

12/3K - Group Home - 2.0 0 13

50/5B - (Community Clinic) - FQHC Medical Clinic 13 14

50/5C -(Community Clinic) -FQHC Mental Health Clinic 7 8

50/23 -(Community Clinic) - Methadone Maintenance Clinic * change due to merging of multiple vendor locations under one unique provider number 18 9

50/50 -(Community Clinic) - Mental Health Clinic * change due to merging of multiple vendor locations under one unique provider number

134 91

50/60 -(Community Clinic) -Medical Clinic * change due to merging of multiple vendor locations under one unique provider number

50 20

50/68 -(Community Clinic) -Rehabilitation Center 8 8

57/78 - (Alcohol and Drug Abuse Center) - Inpatient 10 11

57/79(Alcohol and Drug Abuse Center) - Outpatient    17 9

58/67 - (Home Health Agency) - Home Health Agency 88 89

CT BHP Provider Network(TYPE) - SERVICE DESCRIPTIONS

12/12/05 05/01/06

20/26 - (Physician, MD) - Psychiatry 281 316

21/26 - (Physician MD Group) - Psychiatry 22 26

23/26 - (Nurse Practitioner) - Psychiatry 95 107

24/26 - (Nurse Practitioner - Group) - Psychiatry 15 19

81/9A - (Behavioral Health Clinician) - License Clinical Social Worker (LCSW) 15 238

81/9B - (Behavioral Health Clinician) - License Marriage and Family Therapist   (LMFT) 6 94

81/9D - (Behavioral Health Clinician) - License/Certified Alcohol & Drug Abuse Counselor (LADC) 2 21

81/9E - (Behavioral Health Clinician) - License Professional Counselor (LPC) 2 56

81/92 - (Behavioral Health Clinician) - Psychologist 201 231

86/9A - (Behavioral Health Clinician Groups) - License Clin. Social Worker Group 1 30

86/9B - (Behavioral Health Clinician Groups) - License Marriage and Family Therapist Group   0 23

86/9D - (Behavioral Health Clinician Groups) - License/Cert Alcohol & Drug Abuse Counselor Group 1 5

86/9E - (Behavioral Health Clinician Groups) - License Professional Counselor Group     0 14

86/92 - (Behavioral Health Clinician Groups) - Psychologist Group 23 31

CT BHP Provider Network(TYPE) - SERVICE DESCRIPTIONS 12/12/05 05/01/06

12/3G - (Special Services) – Community Services 0 2

12/3L - (Special Services) – Group Home 1.5 0 1

20/37 – (Physician, MD) Osteopath 0 6

06/60 – (State Institution) 0 1

1127 1722

Network Status

CMAP providers: 1,722– Increase of 595 providers since 12/12/06– Addition of Rehab services within the SA continuum– Providers in process with EDS– Add/Change report 20-30 adds per week

10-20 changes per week

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

Inquires/Complaints/Grievances

Inquiries and Complaints and Grievances

January – April 2006

• 21 inquiries about providers no longer in network, 1 complaint filed, referrals given to the other 20

• 22 complaints - 20 closed provider enrollment appointment scheduling member choosing to continue care with OON provider referrals to MCO pharmacy - 2 open c/o access to MD within 10 miles who will provide therapy as well

as medication management c/o facility calling on weekend said our phone message said we

were closed. Provider has not called back to verify phone # called.

Inquiries and Complaints and Grievances

January – April 2006

• 4 Grievances

- 3 closed

- 1 open

* Open Case: Member is seeing OON provider and wants direct

payment to reimburse provider. Saw IN provider but language of

provider was a reported barrier

Community Outreach

Community Outreach

• April – Schools Meeting to occur in May with Cheryl Resha– Systems Managers

167 DCF, Provider, Collaborative and MSS meetings in April 289 Meetings year to date

– Peer/Family Meetings 30 Family forums, informational meetings, DCF and Collaborative meetings

– ICM cases: 60 mid-long term cases 65 short-term, high risk cases (some overlap)– Peer/Family Outreach/Coordination: 37 family/peer consultations

Questions?