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Semi-Annual Behavioral Health Stakeholders Convening. Magellan in Louisiana: Transforming our System 04.17.13. Getting started – A year of transition. Before the Louisiana Behavioral Health Partnership. After the Louisiana Behavioral Health Partnership. Transformation Is Not Easy…. - PowerPoint PPT Presentation
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Semi-Annual Behavioral Health Stakeholders ConveningMagellan in Louisiana: Transforming our System
04.17.13
Getting started – A year of transition
2
Pre 3/1
• Build the infrastructure• Train and engage• Build the network
3/1
• Turn on the lights• Answer the phones• Ensure continuity of care (Priority No. 1)
3/1- Now
• Address challenges that come with large-scale change
• Refine the program• Learn the nuances; adjust as needed• Train and teach and train some more
Before the Louisiana Behavioral Health Partnership
3
IP CRISIS SERVICES ADULT SERVICES CHILDREN
SUBSTANCE ABUSE OUTPATIENT
General Hospital ER OBH/LGE CMHC services
OBH/LGE CMHC services
Medical Detoxification
Psychiatrist
LSU teaching Hospital
Medication Management/Nursing medication administration
Medication ManagementNursing medication administration
APRN
Psychiatric Hospitals
Psychological TestingMHR services-PSR/Community Support /Family child interaction
Some nursing and SW services
State Hospitals Psychological Testing
Medical and nonmedical psychologists
MST
After the Louisiana Behavioral Health Partnership
IP CRISISNEW &
EXPANDED SERVICES ADULT
NEW & EXPANDED SERVICES CHILDREN
CSOCCHILDREN
SUBSTANCE ABUSE OUTPATIENT
General Hospital Telephonic Crisis Triage ACT /FACT TGH TGH
Detox IPDetox RTCDetox OP
Outpatient CMHC/ FQHC
Free Standing Psychiatric Hospital
Mobile Services (Face to Face) PSR PSR PSR SA RTC MHR
LSU Teaching Hospital Crisis Residential CPST CPST CPST IOP Individual
State Hospital CI services CI CI CI OP Psychiatrist
Emergency Rm Telepsychiatry Case Conference Case Conference Suboxone Licensed and medical psychologist
FQHC NMGH NMGH LCSW
ECT TFC TFC LPC
ICM MST MST LMFT
Psychotherapy FFT FFT LAC
Psychological Testing PRTF PRTF
Psychotherapy Independent Living/Skills Building
Psychological TestingParent /Youth Support
and Training(FSO)
Wrap around Facilitation (WAA)
Crisis Respite
4
5
Transformation Is Not Easy…
… But it’s the END GAME that counts
Mission: Magellan will provide a platform to achieve the goals of the Louisiana Behavioral Health Partnership by improving the behavioral health care of children, adults, and families of Louisiana so that they may live long happy lives in their communities. Magellan will partner with our diverse stakeholders to create an innovative landscape so that resilient Louisianans may truly take control of their lives and achieve personal Recovery.
6
Vision: Magellan will transform the landscape of behavioral health care delivery in Louisiana by providing an infrastructure that paves the road to Recovery, Resiliency, good health and happiness. Louisiana’s behavioral health system will be first in its class.
Reshaping lives for generations
7
Meeting challenges head on
Meet people where they are: About 100,000 miles travelled across Louisiana
Ensure Continuity of Care: Priority No. 1
Address provider concerns• Adjusted Care Management
program to reduce wait times• Train staff constantly on nuances of
program• Focus on eligibility• More than 300 fixes or
enhancement to Clinical Advisor
Transforming Care in Louisiana
Clinical Outcomes
9
Shifting the Paradigm
April May June July Aug Sept Oct Nov0
5
10
15
20
25
30
35
Adult IP Bed Days Per 1,000
BD/K
April May June July Aug Sept Oct Nov0
1
2
3
4
5
6
7
Adult IP Admits/k and ALOS
10
Shifting the Paradigm
April May June July Aug Sept Oct Nov0
50
100
150
200
250
300
350
Adult Medicaid CPST (HCBS)
April May June July Aug Sept Oct Nov0
2
4
6
8
10
12
Adult Medicaid CPST (HCBS) Admits/k
11
Shifting the Paradigm
April May June July Aug Sept Oct Nov0
1
2
3
4
5
6
7
8
Child Psych IP ALOS and BD/k
April May June July Aug Sept Oct Nov0
0.2
0.4
0.6
0.8
1
1.2
1.4
Child Psych IP Admits/k
12
Shifting the Paradigm
April May June July Aug Sept Oct Nov0
50
100
150
200
250
300
350
400
Child Medicaid CPST (HCBS) Units/k
April May June July Aug Sept Oct Nov02468
101214161820
Child Medicaid CPST (HCBS) Admits/k
13
Examining access and recovery
March April May June July Aug Sept Oct Nov0%2%4%6%8%
10%12%14%16%18%20%
IP Readmits
14
Examining access and recovery
March April May June July Aug Sep Oct Nov0%
2%
4%
6%
8%
10%
12%
14%
Residential Readmits
Evidenced-Based Practices
Mar-12Apr-1
2
May-12
Jun-12Jul-1
2
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12Jan
-13
Feb-13
Mar-13
0
1
2
3
ACT (Adults)
Medicaid Adult
Mem
bers
/k re
ceiv
ing
ACT
Mar-12Apr-1
2
May-12
Jun-12Jul-1
2
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12Jan
-13
Feb-13
Mar-13
00.5
11.5
22.5
MSTHomebuildersFFT
Mem
bers
/k i
n se
rvic
e
Moving people toward Recovery
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 3102468
1012141618
Highest Utilizers
TOTAL READMITS BEFORE 09-01-12
TOTAL READMITS AFTER 09-01-12
Top 32 Highest Utilizing Members
Num
ber o
f Rea
dmits
Increasing Access to Care
Improving access through Network Development
18
Increasing Access: Building the Network
Feb 28 vs. October 24 network composition
Pre-implementation Adult Bed CapacityCurrent Adult Bed Capacity
-
500
1,000
1,500
2,000
2,500
1,204
2,247
Inpatient psych beds increased by 86% across Louisiana due to contracts with free standing psych units for adults
RFP Deliverables Strategy – Where are we now?
19
Network Comparison 11-May 12-Oct
Access Points 10-
12-2012 1-Mar
Access Points 3-
1-2013 OMPT-OTHER MASTER THERAPIST 183 222 216 274 APRN 25 35 39 69 SOCIAL WORKER 157 176 201 273 PSYCHOLOGIST 36 52 62 76 161 PSYCHIATRIST 213 104 168 134 372 SUB-TOTAL 635 521 663 666 1,149 Practitioner Roster Staff 12-Oct 1-Mar Behavioral Health Specialist 84 115 CERTIFIED ADDICTION CONSELOR 12 OTHER MASTER THERAPIST 72 APRN 157 194 SOCIAL WORKER 551 721 PSYCHOLOGIST 37 52 PSYCHIATRIST 257 472 SUB-TOTAL 1,098 1,154 TOTAL 635 1,619 663 1,820 1,149
20
Where we are now
86% increase in psychiatric bed capacity300 active provider locations using Clinical Advisor251 provider locations contracted for Crisis Intervention service183 new OMPTs brought in throughout the state all additional capacity
that added since 3/1First two Licensed PRTF beds (108) in placeOngoing dialogue with several hospitals engaged in dialogue about expansion of services array to include PRTFTGH 8 beds licensed in the state- ongoing conversations to encourage programs to obtain licensureTFC 248 bedsNon- medical group home 230 beds
Where we’re going: Network Plan
• Identify network gaps using the following details:– Readmission rates– LOS– Adverse Incidents
• Develop and Submit RFP for:– Crisis Continuum
• Crisis Receiving Centers• Crisis Stabilization• Crisis Residential
– Therapeutic Group Home– Therapeutic Foster Care– PRTF– EBP
21
Where we’re going: Network Plan
Complete the Crisis System Build out in all regions
• Mobile Crisis Services
• CART Teams
• 23-hour Observation/Crisis Receiving Centers
• Telehealth
• Peer-run warm lines
• Crisis Stabilization Services
• Crisis Residential Services
22
Where we’re going: Network Plan
• Current Strategies To Date– Identifying providers who
could transition existing facility to new levels of care
– Direct outreach– Direct support and direction
with licensing, certification and contracting process
• Strategies Under Consideration– Email blasts to assess interest
of current Network providers– Educational webinars– Regional Town Hall meetings
to engage regional leaders and stakeholders
– Identify licensing, programmatic or financial barriers to any LOC development
23
Complete the crisis system build out in all regions- Strategies
Where we’re going: Network Plan
Expand Evidence Based Practice (EBP) capacity through learning and technical assistance
• Partner with Medical Director to expand into EBP for 0-5 population
• Partner with System Transformation to assess the need to expand existing EBP
• MST (30 providers across the state)
• FFT (7 providers across the state)
• Homebuilders (10 providers across the state)
• ACT (11 teams across the state)
24
Provider Relations Plan
• Developing plan to include the three overarching goals– Enhanced Provider Communication
• Provider Relations Network team re-structure • Utilization of E-mail blast notification• Timely Provider Communications• Partnership Provider News• Provider Website/Increase Provider Self Service• Timely Telephonic Communication
– Enhanced Collaboration with Providers• Provider Meetings and Combined Stakeholder Meetings• Provider Satisfaction Surveys
– Enhanced Provider Education• Webinar Provider Forums• Provider Relations / On-Site Visits• New and Contracted Provider Orientation and Training
25
26
Provider Dashboard – Monthly Drill Down
What are they?Fully interactive online data management platform for providers, with drill down capabilityEasy to use, visual representation of dataThe same outcome measures which help to guide decisions on the evolution of the LBHP networkOn-line data management platform
Why do we offer them?Provider self-managementUse of data to inform qualityTransparencyPartnershipTool to aid in program improvement, benchmarking, and other QI management strategies
27
Provider Dashboard – Phase 2
Rolled out Phase 2 with training to providers on March 21
Providers included:Outpatient Mental HealthOutpatient Addictions TreatmentPsychiatric RehabilitationCommunity Psychiatric Supportive Treatment, including HomebuildersMultisystemic Therapy
Metrics include:Number servedNumber served by diagnostic categoryAverage number of services per member
28
Provider Quality Improvement Projects
PCP Coordination: The item with the lowest compliance is coordination of care with PCP. The current compliance rate across all levels of care is 31.2%. The QI department is currently working on a system wide Performance Improvement Project with PCP coordination. This project is still in its pilot phase and rollout is expected within the 2nd-3rd quarters.
Discharge Process/Planning: Discharge planning was also identified as an opportunity for improvement by UM to improve their 7 and 30 day follow-up hospitalization rates and items and QI to address deficiencies identified through the TRR process. The total discharge aggregate is currently 84.7%; however, outpatient facilities have an aggregate score of 51.5% and WAAs have an aggregate of 40%. QI will be collaborating with UM’s Follow-up Hospitalization QIP to improve the discharge process to ensure member’s receive adequate care following discharge. This QIP is in the analyze stage.
A new TRR audit tool under development will have a weighted component to support these two initiatives.
The numbers
Claims
30
Claims
1/21/2013 1/31/2013 2/3/2013 2/18/2013 2/24/2013 3/3/2013 3/10/2013 3/17/2013$5,100,000
$25,100,000
$45,100,000
$65,100,000
$85,100,000
$105,100,000
$125,100,000
$145,100,000
Claims Paid
ChildAdult
Looking ahead
Year 2 and refining the program
32
Strategy for Year 2
Fully implement 0-5 programsExpand crisis networkExpand children’s network (PRTF; therapeutic group homes)Use data to drive additional service opportunities through “in lieu of” agreementsOutreach to non-traditional referral sources, such as PCP community and law enforcementFocus on PCP, BAYOU HEALTH coordination of careWork toward Meaningful Use in CAImprove reach and focus of RCM program, emphasizing diagnostically-driven criteriaDrive improvements in discharge planningDrive change in crisis response away from ERs and PECs to better use of community programs