UTILIZATION MANAGEMENT FOR YOUTH MEMBERS · UTILIZATION MANAGEMENT FOR YOUTH MEMBERS Executive Summary & Analysis by Level of Care Calendar Year 2016: Januar\-December 2016 - Submitted

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UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of Care

Calendar Year 2016: January-December 2016 - Submitted March 1, 2017

By Robert Plant, PhD, with Ann Phelan, Bonni Hopkins, PhD,Laurie Van Der Heide, PhD, Sherrie Sharp, MD,Lynne Ringer, Heidi Pugliese, Carrie Bourdon,Jennfier Krom, Joe Bernardi, Stella Ntate,

Stephanie Shorey-Roca, Wallace Farrell, and Lindsay Betzendahl,as well as the entire Reporting, Clinical, and Quality Departments.

For any inquiries, comments, or questions related to the use of Tableau, or the interactive features within this report,please contact Lindsay Betzendahl at [email protected].

This report was created by Beacon Health Options on behalf of the CT Behavioral Health Partnership. However the opinions, conclusions, and recommendations contained herein aresolely those of Beacon Health Options, and may not represent those of DSS, DMHAS, and DCF.

UTILIZATION REPORT FOR YOUTH MEMBERSCalendar Year 2016: January-December 2016

MethodologyThe data contained in this report are based on authorization admissions and are refreshed for each subsequent set of updates during the year. Due to changes ineligibility, the results for each quarter or year may change from the previously reported values. The reports and analyses for all levels of care are affected by thischange. Please note that utilization metrics may change with the refresh of the data. Therefore, the reader should be cautious when interpreting the latest quarterof data. The contractor will monitor the post-refresh changes closely. If warranted, methodology will be revisited.

The methodology for membership totals remains unchanged. For the Total Membership counts, each member is only counted once per quarter, even if he/shechanges eligibility groups or experiences gaps in eligibility. For instance, if a member changes benefit groups within the quarter, that member is included in thetotals for each benefit group, but only once for the total membership. This methodology is referred to in the graphs as “Unique Membership". For the benefitgroups, members are counted in each group in which they were eligible during the time period (quarter or year). This means that the individual benefit groupmembership counts cannot be added to obtain an overall total since members can shift between benefit groups.

The methodology for calculating age has changed, resulting in a slight shift in adult and youth membership totals. Previous to this report, counts for adults andyouth were based on if a member met that age criteria during the time period. This meant that youth who were both 17 and 18 years old in a quarter were countedin both the adult and youth totals. In order to allow for the drill-down of demographic and age information, it was required that members be counted in only onegroup during a time period. Age group is now based on the age that a member was for the majority of the time period (quarter or year). Other demographics suchas gender and race/ethnicity are based on the most recently updated eligibility. These demographics will update as needed as we want to report on the mostaccurate gender or race/ethnicity that a member identifies with.

Additionally, while unchanged from previous reporting periods, it is worth noting that the per 1,000 measures compare the utilization rates of the population to thepopulation’s “member months”. This means that when viewing the Admits/1,000 of HUSKY D members the rate is based on the number of admissions within theHUSKY D population, not the entire adult population. This helps to analyze which populations are potentially more chronic, acute, or in need.

General OverviewOn at least a semiannual basis, the reports mutually agreed upon in Exhibit E of the CT BHP contract are submitted to the State for review. The shift to semiannualreports was designed to minimize noise created by quarter-to-quarter fluctuations that do not reflect a true trend in the data. The March deliverable serves as theannual report and covers four consecutive years of utilization data. The September deliverable covers 10 consecutive quarters with a focused analysis on the mostrecent two quarters, but may include the past four if there is information necessary to review that had not been analyzed previously.

This report focuses on the utilization management portion of these reports, evidenced in the 4A series, which reviews utilization statistics such as admissions per1,000 members (Admits/1,000), days per 1,000 members (Days/1,000), and average length of stay (ALOS).

Within this interactive report, all utilization data is available via drop-down filters, but the narrative highlights the areas of interest related to certain utilization trends.In some cases, demographic breakouts are available to enhance the understanding of utilization. Additionally, the narrative identifies the underlying factors, whichdrive the trends and associated programmatic responses taken by Beacon Health Options to impact/mitigate or support the trend. Beacon also presentsrecommendations to address remaining challenges and reports progress related to these planned recommendations. The areas of focus for this deliverable arelisted on the following page.

UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of Care

Calendar Year 2016: January-December 2016 - Submitted March 1, 2017

Areas of Focus

MembershipTotal UniqueDCF & Non-DCF

Composition of DCF MembershipDemographics

Inpatient FacilitiesAdmits/1,000 & Days/1,000Average Length of Stay

In-State PAR Hospital Average Length of StayPercent of Days Delayed & Discharge Delay Reason Code(s)

Inpatient Solnit CenterAverage Length of StayNumber of Days Delayed

Discharge Delay Reason Code(s)

Community & Solnit PRTFAdmissions & Days/1,000Average Length of Stay

Total Overstay Days & Overstay Reason Code(s)

Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

Utilization ProfileProvider Volume

Outpatient Enhanced Care Clinics (ECC)Registration VolumeAccess Standards

Table of ContentsSelect Bookmark Icon to View "Areas of Focus"

And Go Directly to Selected Page

For this report, the following utilization data points have been placedin the Appendix and are not discussed:

RTCAdmissions &ALOS

PHP, IOP, &EDT

Admits/1,000

IICAPSAdmits/1,000

Outpatient(OTP)

Admits/1,000

Youth Medicaid MembershipTotal Membership Volume

PG 1

Adult Members without DualsYouth Members without DualsDCFNon-DCF

Select to Show Table or Text

Membership CountMethodology

Dual EligibilityInformation

2012 2013 2014 2015 2016

0K

100K

200K

300K

400K

500K

Members

Total Unique Membership

Select to View TotalsMultiple values

Total MembershipThe Youth Members without Duals decreased in CY 2016; the first annual decrease in the last five years. Youth Members without Duals represents 40.1% of thetotal Medicaid membership for CY 2016. Like the Total Youth Members without Duals the Non-DCF membership decreased in CY 2016. The DCF membershipincreased by 14.83% in CY 2016 to 14,116; this is the highest level since CY 2011 (14,966).

Data RefreshThe last three refresh rates for the Total Youth Membership without Duals were 0.50%, 0.51%, and 0.46%. These are lower than historic rates for this populationsuggesting that the underlying process has changed. This would suggest the state is up to date on entering eligibility data.

Youth Medicaid MembershipMembership by DCF Status & Benefit Group

PG 2

2012 2013 2014 2015 2016

0K

2K

4K

6K

8K

10K

12K

14K

Members

Total Youth Membership by DCF Group (0-17)

Select Individual TypesMultiple values

Select Group TypeDCF Groups

Overview & SummaryThe Non-DCF group decreased in CY 2016 after increasingeach year from 2012 to 2015. The Child Welfare/Committedgroup increased by 1,907 members (16.48%) in CY 2016driven by an increase of 1,726 in In-Home Child Welfare. Thethree groups, Child Welfare/Committed, In-Home ChildWelfare, and Out-of-Home Committed all increased in CY2016. The Voluntary Services, Juvenile Justice, and Familywith Service Needs groups have been trending downward insize each year since 2012.

Child Welfare/CommittedVoluntary ServicesJuvenile JusticeDually CommittedFamily With Service Needs

2012 2013 2014 2015 2016

Youth DCFTypes

Child Welfare/Committed

In-Home Child Welfare

Out-of-Home Committed

Voluntary Services

Juvenile Justice

Dually Committed

Family With Service Needs

Youth TotalsDCF/Non-DCF

DCF

Non-DCF

6

39

166

567

5,249

9,971

13,482

10

40

221

592

4,886

8,245

11,575

22

39

281

746

4,701

8,170

11,438

33

43

315

929

4,661

7,930

10,998

35

40

356

1,128

4,937

8,999

12,219

346,070

14,116

351,656

12,293

338,921

12,334

325,232

12,133

319,761

13,567

Total Unique Membership

Note: A youth may be included in more than one DCF category in a reporting period and therefore the values will not add up to the total unique youth. The "Committed/CPS In-Home" and "Committed/CPS Out-of-Home" aretwo subcategories within the total "Committed/CPS" category. Youth, again, may be counted in each group. Each category is the number of unique youth that had that particular DCF indicator within the reporting period.

Youth Medicaid MembershipDemographic Composition by Group Type (DCF & Eligibility)

PG 3

OverviewThe Non-DCF group continues to be over 95% of the Youth membership. For both the DCF andNon-DCF groups the largest age cohort is the 3-12 year olds; they make up 50.7% and 55.4% of thegroup, respectively. Males and females are about equally divided for the Youth members.

DCF Non-DCF

2011 2012 2013 2014 2015 2016 2011 2012 2013 2014 2015 2016

0K

50K

100K

150K

200K

250K

300K

350K

Members

Composition of Youth Membership by DCF GroupNo Demographic Breakout

Select Group TypeDCF Groups

Select DCF GroupsMultiple values

Choose DemographicNo Demographic Breakout

Please note, within this report “DCF Involvement” includes any youth under eighteen who is involved with the Department of Children and Families through any of its mandates. Thisincludes youth committed to DCF through child welfare or juvenile justice, and those dually committed. It also includes youth for whom the Department has no legal authority, but for whomDCF provides assistance through its Voluntary Services, Family with Service Needs and In-Home Child Welfare programs.

Demographic SelectionAll

PG 4

2013 2014 2015 2016

0

2

4

6

8Admits/1,000

Inpatient Psychiatric Facility-Excluding Solnit (State Facility) - Youth (0-17)Admits/1,000

2013 2014 2015 2016

0

50

100

Days/1,000

Inpatient Psychiatric Facility-Excluding Solnit (State Facility) - Youth (0-17)Days/1,000

2013 2014 2015 2016

0

5

10

15

Average Length of Stay

Inpatient Psychiatric Facility-Excluding Solnit (State Facility) - Youth (0-17)Average Length of Stay (ALOS)

2013 2014 2015 2016

0K

1K

2K

Admissions

Inpatient Psychiatric Facility-Excluding Solnit (State Facility) - Youth (0-17)Admissions

Group TypeAll Members without DualsDCFNon-DCF

Click for Summary

Inpatient Psychiatric Facility: Excluding Solnit (State Facility)

Group TypeAll

State HospitalExcluding Solnit (State Facility)


In-State / Out-of-StateAll

The per 1,000 rates above are calculated based on the total admissions or days for the identified population divided by the total members of the same population, multiplied by 1,000. Total members is calculated by addingthe number of unique eligible members in each month within the reporting period. For example, the DCF Admits/1,000 denominator is the DCF youth population, not the entire Medicaid youth population.

Change filters below to view In or Out-of State Hospitals or Solnit Hospital only.

Inpatient Psychiatric: Excluding SolnitSummary

PG 5

Conclusions

In 2016, Beacon staff met with the pediatric inpatient hospitals in continued efforts to improve access to care and quality of care for Medicaid youth. Measuresreviewed include Average Length of Stay (ALOS), discharge delay, readmission rates and HEDIS Follow-Up After Hospitalization for Mental Illness rates (FUH). Inaddition to individual hospital meetings, two statewide workgroups were held in June and December.

One main statewide theme identified through the PAR meetings is the high acuity of cases including, but not limited to significant trauma history, autism, andintellectual disability. Due to these challenges, additional programming has been put in place at the hospital level to meet the needs of the youth on inpatient unitsand prevent crises. These include the IDEA team at Hartford Hospital, the Show of Support team at St. Vincent’s Hospital, the implementation of sensory roomsand use of sensory carts, and the addition of a diversionary room. Beacon staff have identified this additional programming as potential best practices and haveshared and will continue to share this information with the pediatric hospitals. For example, through the Spring Pediatric Inpatient Workgroup meeting, St. VincentHospital discussed their sensory room. St. Francis Hospital then outreached to St. Vincent Hospital who provided them with a tour of their sensory room, and thehospital is now in the process of creating a sensory room at their facility.

The HEDIS FUH measure was also reviewed in our PAR meetings in an effort to understand the barriers to connecting youth to care and the potential impact onreadmission rates. In addition, best practices were shared in the Pediatric Inpatient Workgroup meeting through a hospital spotlight focused on achieving higherFUH rates. Ambulatory follow-up will continue to be a focus in 2017.

Overview: The total Inpatient Psychiatric ALOS for All Members increased by 0.72 days in CY 2016 with both the DCF and Non-DCF groupsincreasing over the last year. This was driven by the adolescent cohort (the 13-17 year-olds), which experienced an increase in ALOS in 2016 to12.16 days. The 3-12 year-olds had a decrease in ALOS. The ALOS for 3-12 year-olds continued to trend downwards reaching 13.02 days in 2016.This is the closest these two metrics have been in the last four years.

Overall, admissions declined slightly for this level of care in the last year with Non-DCF decreasing and DCF increasing slightly. Days/1,000 hasbeen trending downward since 2013 and was essentially flat in CY 2016.

The ALOS for In-State Psychiatric Hospitals (excluding State Hospital) increased by 0.86 days in CY 2016 with admissions deceasing slightly.The Out-of-State Hospital ALOS decreased 1.46 days to 20.12 days in CY 2016 with admissions unchanged. This decrease was driven by the 3-12year-olds who decreased by 7.59 days to 24.41 days. The adolescent cohort increased by 1.57 days to 18.75 days.

Inpatient Psychiatric: Excluding SolnitSummary

PG 6

Recommendations

1. Develop an infrastructure which supports easy access and connection to treatment services for specialized populations such as those children with an AutismSpectrum Disorder diagnosis (ASD): Most children with an ASD diagnosis who require acute care services utilize out-of-state facilities for acute stabilization whichoften leads to longer lengths of stay secondary to the increased distance from their home and the inability of families to participate in the treatment due totransportation issues. Youth with an ASD diagnosis often stay longer in inpatient care than their non-ASD identified peers who utilize the same services.

Update - Beacon has continued to collaborate with state agencies to support efforts to develop and connect Medicaid youth to needed clinical and communityservices. The lack of in-network community ABA direct care providers and lack of specialized in state inpatient beds is often a barrier for youth diagnosed withASD to receive timely services.

In partnership with state agencies, Beacon has continued to collaborate with the Hospital for Special Care (HSC) to meet the clinical inpatient needs for childrendiagnosed with Autism Spectrum Disorder (ASD). The HSC opened an 8-bed inpatient unit about a year ago to provide the longer term behavioral and clinicaltreatment needed for stabilization to youth diagnosed with ASD. Due to the in-state location, families are able to actively engage in the behavioral plan to learn theskills needed to promote a timely transition home. Beacon has continued to support these services through utilization review, case management and carecoordination to Medicaid members admitted to the unit. Over the past year, Beacon has established a weekly on site clinical rounds process and regularoperations meetings with the HSC to promote successful clinical treatment, discharge planning and outcomes. Beacon will continue to collaborate with the HSCand monitor utilization trends.

Beacon also continues to authorize ABA services and provides assistance to families to connect Medicaid youth to ABA community providers. Beacon has workedwith state agencies and the community to expand the Medicaid ABA provider network, and specifically the direct care provider network. The Medicaid ABAprovider network has grown significantly in the past year to meet the needs of many youths.

The Department of Children and Families (DCF) and the Department of Social Services (DDS) continue to collaborate with an Autism behavioral specialty groupto provide training to the Psychiatric Residential Treatment Facilities (PRTFs) within the Medicaid network. This effort was first initiated with the Village for Familiesand Children and has been expanded this year to the Children’s Center of Hamden and Boys and Girls Village. The goal of this supportive training is to promotethe overall ability of the PRTFs to provide treatment and stabilization of youth requiring specialized treatment, in addition to promote increased admissions ofyouth with specialized clinical need. Beacon has continued to collaborate on this project with regular review meetings and case conferences.

Beacon continues to recommend the expansion of Emergency Mobile Psychiatric Services (EMPS) to include a Board Certified Behavioral Analyst (BCBA). Thishas the potential to increase the availability of rapid clinical services to families and children in crisis and prevent an inpatient or an emergency department visit.This could serve as a much needed resource and bridge service while members wait for community services to be implemented.

Based upon feedback from the pediatric inpatient hospital providers, DDS-involved youth and families were reported as some of the most challenging in terms ofnavigating the system and obtaining services for post-discharge. As a result, DDS collaboration was a focus of individual PAR meetings and the December 2016inpatient workgroup. Beacon provided the hospitals with an overview of DDS services and a contact list of the DDS Regional Directors, the Director of WaiverServices and the Director of Psychological Services at DDS. An overview of Beacon’s ASD program was also provided.

Recommendations continue on the next page.

Inpatient Psychiatric: Excluding SolnitSummary, Continued

PG 7

Recommendations, continued from previous page

2. Continue to expand the implementation and development of Rapid Response model: The Rapid Response model focuses on the collaboration amongcommunity, State agencies and Beacon staff to provide emergency departments support and case management. Opportunities remain to implement a RapidResponse model in other emergency departments (ED) with high pediatric behavioral health volume.

Update - The Rapid Response model continues to provide successful collaboration between Connecticut Children’s Medical Center (CCMC), the Department ofChildren and Families (DCF), Emergency Mobile Psychiatric Services (EMPS), and Beacon Health Options. Frequent meetings and daily clinical rounds continue.

In addition to these efforts, Beacon, in collaboration with state agencies and the Connecticut Hospital Association (CHA), held a forum in January 2016 dedicatedto raising awareness of ED utilization by youth for behavioral health crises. ED data was presented to 85 providers across the state, comprised mainly of hospitalsand Emergency Mobile Psychiatric (EMPS) program staff. Following presentation of the data the large group then broke out into smaller groups by region todiscuss strategies for reducing overall ED volume, visits by frequent visitors, “stuck” youth in the ED and readmissions. Upon regrouping, each region reported outon suggested solutions and responses; many of them included a call for a larger presence or enhanced role of EMPS in the community and enhancedpartnerships and coordination between stakeholders. Following the January 2016 forum, the RNMs and clinical team have coordinated meetings across the stateto continue the conversation and to develop regional or hospital specific strategies. A statewide meeting will be held in 2017 to provide an update on the regionalactivity and to review updated data.

Beacon continues to recommend developing a rapid response model consortium to support and assist Connecticut emergency departments in connecting youth toneeded services in a timely, efficient manner. This will serve to prevent unnecessary emergency department visits and inpatient stays, in addition to connectingyouth and families to the community services and support they need.

3. Establish, in each of the regional areas, a centralized forum which meets regularly to discuss at-risk youth who have high utilization of crisis and behavioralhealth services. Beacon continues to recommend the establishment of a centralized forum in each regional area to coordinate care for those youth identified as atrisk for high utilization of inpatient and emergency department services. This forum would serve to engage communities, families, schools, and providers in theplanning, and delivery of behavioral health services.

Update - The Integrated Service System (ISS) meeting has been established in each regional DCF area office. Beacon Health Options’ staff attend thesemeetings to support coordination of care and dialogue to engage communities in the planning and delivery of behavioral health services.

Beacon has continued to meet with emergency departments and providers to discuss crisis and emergency services. In addition, Beacon continues to recommendthe forum of the Integrated Service System meeting to include emergency departments and community providers to promote the planning and delivery of rapidbehavioral health services.

As noted above, a follow up to the CHA forum held in January 2016, Beacon staff continue to meet with Pediatric Emergency Department personnel to furtherdiscuss ED frequent visitors, volume, readmission rates, and connect to care rates. Strategic discussions are driven by data and Emergency Department specificchallenges.

Recommendations continue on the next page.

Inpatient Psychiatric: Excluding SolnitSummary, Continued

PG 8

Recommendations, continued from previous page

4. Continued State Agency collaboration with Beacon Health Options: Beacon continues to recommend ongoing collaboration with the State Agencies on multiplelevels to develop an integrated, community-based, preventive healthcare system.

Update - Beacon Health Options has continued to meet with State partners on a weekly basis in multiple forums. The Department of Developmental Services(DDS) has continued to participate with DCF and Beacon in weekly Complex Case discussions to review high-risk children who require additional escalation andstate agency intervention. The focus of the meeting includes emergency department, inpatient facility and DCF area office concerns which require escalation.DDS supervisors have attended complex care rounds several times this year to discuss Money Follows the Person (MFP). This has been helpful in connectingyouth to behavioral health services and supports within the community from inpatient facilities. In addition, Beacon has continued to meet weekly with DCF andDSS to discuss and review ASD operations.

PG 9Inpatient Discharge Delay: Excluding SolnitPercent of Days Delayed & Delay by Reason

2012 2013 2014 2015 2016

0%

5%

10%

15%

% of Days Delayed

Inpatient (Excluding Solnit) Percent of Days Delayed: All Youth

■ Total Youth ■ Non-DCF ■ DCF

2012 2013 2014 2015 2016

0

50

100

150

Delayed Discharges

Inpatient Discharges with Delayed Days: All YouthHover to View Delayed Reason

Percent of Days DelayedThere was a 1.5 percentage point increase in the percent of days delayed for all youth from 7.7% to 9.2%. This is the highest percentage since 2012. The DCFgroup had an increase of 5.1 percentage points which drove the increase; the Non-DCF members were essentially unchanged in 2016. The number of cases withdischarge delay was essentially unchanged from 2015 to 2016.

Days in Delay by ReasonThere has been an increase in thepercent of days delayed over thepast year. Most children were ondelay awaiting inpatient admissioninto Solnit. This is potentially relatedto decreased bed capacity whichoccurred earlier in the year at Solnit,in addition to the decreased staffingavailable to provide clinical treatmentto complex youth.

2012 2013 2014 2015 2016

Awaiting State Hospital

Awaiting PRTF

Awaiting Solnit PRTF

Awaiting RTC/GH

Awaiting DDS Services

Awaiting Foster Care

Awaiting Other

37

57

40

20

8

32

72

30

5

8

31

66

13

4

4

53

36

12

12

3

3

0

59

22

17

11

3

1

1

Inpatient Delayed Discharges by Reason CodeHover for more information on avg. delayed days and total delayed days

Note: The Reason Code "Awaiting Solnit PRTF"was not implemented until late 2014.

PG 10Inpatient Discharge Delay: Excluding Solnit Tables

Percent Delay Days & Delay by Reason Code

2012 2013 2014 2015 2016

DCF % of Days Delayed

Cases Delayed

Non-DCF % of Days Delayed

Cases Delayed

Total % of Days Delayed

Cases Delayed

46

13.30%

44

8.20%

68

12.70%

73

11.50%

122

18.80%

78

7.90%

85

7.50%

69

4.60%

88

7.10%

55

5.40%

124

9.20%

129

7.70%

137

6.90%

161

8.40%

177

10.50%

Inpatient (Excluding Solnit) Table (Ages 0-17)Percent of Days Delayed & Cases Delayed 2012 2013 2014 2015 2016

AwaitingStateHospital

Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

AwaitingSolnit PRTF

Delayed Discharges



AwaitingPRTF

Delayed Discharges



AwaitingRTC

Delayed Discharges



AwaitingGH

Delayed Discharges



AwaitingFoster Care

Delayed Discharges



AwaitingOther

Delayed Discharges



AwaitingComm ServDDS

Delayed Discharges



AwaitingDDS

Delayed Discharges



28

1,673

59

21

1,091

53

22

697

31

23

744

32

34

1,267

37

29

500

17

16

193

12

15

337

22

19

697

36

14

926

66

20

1,441

72

19

1,058

57

19

93

5

15

107

7

22

202

9

17

382

23

23

748

32

43

256

6

7

37

5

14

55

4

27

189

7

26

204

8

3

3

1

16

48

3

7

29

4

14

68

5

13

107

8

25

25

1

0

0

0

11

42

4

46

367

8

11

225

20

106

212

2

36

72

2

126

126

1

359

359

1

Inpatient Discharges with Delayed Days by Reason Code

Inpatient Psychiatric: Excluding Solnit Discharge DelaySummary

PG 11

Conclusions

There has been an increase in the percent of days delayed over the past year. Most children were on delay awaiting inpatient admission into Solnit. This ispotentially related to decreased bed capacity which occurred earlier in the year at Solnit, in addition to the decreased staffing available to provide clinical treatmentto complex youth.

Recommendations

1. Develop community-based behavioral health services which meet the higher acuity behavioral health needs of child/adolescents, including crisis andWraparound Teams, who follow children throughout the level of care continuum. – As the system moves towards community-based behavioral health care, withlimited options regarding children’s' placement in congregate care and Solnit, there is a greater need to develop behavioral health services. Those services canprovide coordination of care, family support, and clinical services to a clinically complex youth cohort. This activity has the potential to decrease emergencydepartment utilization, inpatient length of stay and discharge delay. Beacon recommends a potential expansion of the current Emergency Mobile PsychiatricService scope and capacity to service families and youth in crisis.

Update - Beacon currently provides support of services that follow children throughout the level of care continuum. Beacon's Intensive Case Managers providecase management and coordination to assist with clinical facilitation from the emergency department through inpatient to discharge planning into another level ofcare or the community. This is achieved on various levels such as co-location and collaboration with DCF and EMPS. In addition, Beacon's ASD and ICC teamsoffer care coordination and peer services which focus on collaboration within the community.

Beacon continues to recommend a potential expansion of the current Emergency Mobile Psychiatric Service scope and capacity to service families and youth incrisis, including those children with specialized clinical needs such as children diagnosed with Autism and/or intellectual disabilities. This expansion of an EMPSteam would include a BCBA and provide direct clinical assessment, education to families and provide services while bridging the connection to readily availablecommunity teams to begin treatment.

Inpatient: Solnit CenterAverage Length of Stay & Delay Days

Benefit GroupCourt OrderedNon-Court Ordered

Total

2012 2013 2014 2015 2016

0

50

100

150

Avg. Length of Stay

IPF Solnit Average Length of Stay (ALOS)Court-Ordered, Non-Court-Ordered, and Total

2012 2013 2014 2015 2016

0

200

400

600

800

1000

1200

1400

1600

1800

2000

# of Days Delayed

IPF Solnit Number of Delayed DaysTotal Youth

PG 12

Overview

The ALOS for Solnit remained essentially unchanged in CY 2016 compared tothe previous year. The Court-Ordered cohort's ALOS increased by 43.50 days inCY 2016. Total discharges were down to 115 in CY 2016, the lowest number inthe last five years.

The number of overstay days decreased slightly in CY 2016 to 952 days.Awaiting RTC had 330 overstay days while Awaiting Group Home had 281overstay days.

2012 2013 2014 2015 2016

0

50

100

150Discharges

IPF Solnit Total DischargesCourt-Ordered, Non-Court-Ordered, and Total

Inpatient: Solnit Center TablesAverage Length of Stay & Delay Days

2012 2013 2014 2015 2016

Court Ordered ALOS

Discharges

Non-Court Ordered ALOS

Discharges

Total ALOS

Discharges

21

74.40

24

30.90

44

62.70

28

76.90

68

64.50

94

124.50

105

133.80

109

115.10

120

118.70

76

171.70

115

115.40

129

114.70

153

100.00

148

110.80

144

121.10

Inpatient Solnit Center Average Length of StayCourt-Ordered, Non-Court-Ordered & Total Youth

2012 2013 2014 2015 2016

Total # of Days Delayed

Cases Delayed 19

952

16

1,020

22

796

15

1,011

48

2,055

Inpatient Solnit Center Number of Delayed DaysTotal Youth

2012 2013 2014 2015 2016

Awaiting PRTF Delayed Discharges



Awaiting RTC Delayed Discharges



Awaiting GroupHome

Delayed Discharges



Awaiting FosterCare

Delayed Discharges



21.8

87

4

9.0

9

1

27.3

82

3

37.0

37

1

174.0

696

4

110.0

330

3

40.0

80

2

21.0

63

3

49.0

49

1

69.0

552

8

70.3

281

4

96.0

96

1

55.5

222

4

35.0

35

1

66.7

600

9

111.0

111

1

0.0

0

0

119.0

119

1

260.0

260

3

259.0

259

3

Inpatient Solnit Center Delayed Discharges by Reason

PG 13

Inpatient Psychiatric: SolnitSummary

PG 14

Conclusions

The ALOS for all youth at Solnit has remained stable this year with minimal change. There was an increase in the ALOS for those youth court ordered to Solnit.The number of youth in overstay status however continues to be minimal. Throughout the year, there has continued to be youth on delayed status from inpatientfacilities awaiting admission into Solnit. This continues to be related to the increased in inpatient provider referrals and decreased bed capacity and staffing atSolnit Inpatient to manage youth with highly acute behavioral health needs.

Recommendations

1. Beacon will continue to collaborate with Solnit facilities and State agencies to increase timely access and effective treatment and discharge planning.

Update - This year, Beacon increased collaboration with Solnit Inpatient to support timely access to care and effective care planning. Beacon’s Intensive CareManagers (ICMs) are currently on site daily to provide utilization review, clinical case coordination, triage, and participation within multiple case conferenceforums. Beacon's ICM team has worked with CSSD to assist those youth court ordered to Solnit to connect with services upon evaluation completion at Solnit.Weekly clinical rounds and triage has been established this year with all of the units at Solnit

PG 15

PRTF: Excluding Solnit (State Facility)

Type of PRTFExcluding Solnit (State Facility)

2013 2014 2015 2016

0

20

40

60

80

100

Admissions

PRTF: Excluding Solnit (State Facility) - Admissions

2013 2014 2015 2016

0

50

100

150

200


PRTF: Excluding Solnit (State Facility) - AverageLength of Stay

2013 2014 2015 2016

0

20

40

60

80

100

Days/1,000

PRTF: Excluding Solnit (State Facility) -Days/1,000


Group TypeAll

Group TypeAll Members without Duals DCF Non-DCF

2013 2014 2015 2016

BOYS & GIRLS VILLAGEINC

CHILDRENS CENTER OFHAMDEN

VILLAGE FOR FAMILIES& CHILDREN

Totals

30313524

32283437

33253332

958410293

PRTF: Excluding Solnit (State Facility) Admissions

24 102Admissions or DischargesOverview

The ALOS for Community PRTF decreased 12.39days in CY 2016 to 160.72 days. This was driven bythe DCF youth with a decrease of 21.88 days to175.69 days. Admissions increased by 11 in CY2016, again driven by the DCF membership.Days/1,000 is down from a high in 2014 of 108.3days to 58.2 days in 2016.

The ALOS for Solnit PRTF increased by 13 days(8.44%) in CY 2016. This was driven by the DCFyouth which had an increase of 37.88 days (25.20%)and a decrease in admissions. The Non-DCF youthhad a decrease in ALOS and an increase inadmissions.

Admissions or DischargesAdmissions

Use "Type of PRTF" filter to view either PRTF Excluding Solnit (Community PRTFs) or Solnit Only PRTF (State Facility)

PG 16 Community PRTF: Excluding Solnit (Youth Ages 5-13)Overstay Days & Overstay Reasons

OverviewAfter trending upward for three years the Total Overstay Days decreased in CY 2016 by 107 days. Almost half the cases (46.7%) were Awaiting Going Homewhile 36.7% were Awaiting Foster Care.

2012 2013 2014 2015 2016

0

500

1000

1500

2000

2500

3000

# of Days in Overstay

PRTF (Excluding Solnit) Total Overstay Days

2012 2013 2014 2015 2016


Awaiting GH

Awaiting Going Home 46.7%

13.3%

36.7%

42.4%

18.2%

39.4%

43.5%

13.0%

43.5%

5.3%

5.3%

68.4%

6.7%

6.7%

73.3%

PRTF (Excluding Solnit) Percent of Overstay Discharges by Top Reasons2012 2013 2014 2015 2016

# of Days Delayed

Cases Delayed

Average Days Delayed 87

33

2,857

90

33

2,964

82

26

2,138

40

44

1,744

46

33

1,533

PRTF (Excluding Solnit) Table

2012 2013 2014 2015 2016

0

10

20

30

40

Cases in Overstay

PRTF (Excluding Solnit) Total Overstay Cases

PG 17 PRTF: Solnit North & South (Youth Ages 13-17)Overstay Days & Number of Youth in Overstay by Reason Code

2012 2013 2014 2015 2016

0

500

1000

1500

2000

2500

# of Days in Overstay

PRTF Solnit Overstay Days (ages 13-17)Number of Overstay DaysThe number of Overstay Days increased for the third straight year reaching2,743 days in CY 2016. This was an 8.94% increase from CY 2015. Thereasons for overstay were split evenly among three groups: Awaiting FosterCare, Awaiting RTC/GH, and Awaiting Other. The Solnit PRTF ALOS increased13 days to 167.06 in CY 2016. The DCF group increased 37.88 days while theNon-DCF group decreased 8.21 days. For the first time since 2013 theNon-DCF youth had more admissions to Solnit PRTF than the DCF group.

2012 2013 2014 2015 2016

0

10

20

30

# of Overstay Cases

PRTF Solnit Overstay Cases (ages 13-17)

2012 2013 2014 2015 2016

Awaiting Community Services


Awaiting Other

Awaiting PRTF

Awaiting RTC/GH

Awaiting State Hospital

0

2

0

0

2

0

0

1

1

0

4

0

10

3

3

6

0

0

10

11

6

8

0

0

12

12

11

1

0

0

PRTF Solnit Number of Youth by Overstay Reason Code (ages 13-17)

PRTF Excluding Solnit: Community PRTFs & PRTF Solnit (State Facility)Summary

PG 18

PRTF Solnit Recommendations

1. Beacon will monitor the Solnit PRTF level of care for additional trending, and include data relevant to discharge delay reason codes, specifically for Solnit Northcampus. It is recommended that we identify the specific delay reasons for the males at the Solnit North campus and implement increased discharge planning withBeacon's Intensive Care Mangers, DCF and Solnit. Beacon continues to have weekly care coordination meetings to review current treatment and dischargeplanning with both facilities.

Update - Beacon has continued to monitor the Solnit PRTF level of care indicating specific reason codes for overstay status. Onsite collaboration and utilizationreviews continue and have expanded to include triage of cases and the inclusion of Beacon's ICMs within case conferences. This recommendation has beenachieved, is now monitored on an ongoing basis, and has become standard operating procedure. This recommendation will therefore be concluded.

Beacon continues to recommend earlier intensive care coordination of clinical services focused on supporting and educating the family in the management ofcomplex psychiatric behavior and crisis response. This could include a clinician with specialty crisis training who works with the family in their home to prepare thefamily for the child’s discharge.

Additionally, Solnit South and Solnit North PRTFs are now participating in Beacon’s PRTF PAR program. Beacon and DCF state partners met with Solnit PRTFsin December of 2016 to review their first PAR profile. They also attended the PRTF workgroup meeting held in December. Two PAR areas of focus movingforward will be inpatient stays during and post PRTF discharge and overstay.

ConclusionsFor the third straight year, the number of days in overstay at Solnit PRTF have increased. Community PRTF's had continued increase in overstay days through2015 with a slight decline in 2016. The increased days in delay contributes to system delay. This year, the most significant reasons for delay at Solnit PRTF wereawaiting foster care, awaiting “other”, and awaiting RTC/GH, while at Community PRTFs youth were primarily waiting for foster care and to go home. Thissupports the recommendation to expand community services, including the foster care network, direct care providers who service families and children withcomplex behavioral health needs that can provide a crisis response and educational component to families.

Community PRTF Recommendations

1. Expand PRTF scope of services to include a continuum of care, crisis stabilization and Care Coordination. Beacon continues to recommend expanding thescope of PRTF to include an integrated continuum of services, which includes crisis stabilization and coordinated care. With limited access for the youngerpopulation to congregate care and Solnit Center's inpatient unit, PRTF-referred youth are a clinically complex population. In addition to the already existing clinicalservices provided by PRTF, the addition of Medicaid covered services for crisis stabilization as part of a continuum of care model is recommended. This modelwould include care coordination to provide education and support to parents while a member is receiving treatment, and to coordinate care for the family when thechild is discharged into the community. It is also recommended that PRTFs expand capacity and add a trained workforce to provide treatment to those youth withdevelopmental disabilities or children with Autism Spectrum Disorder.

Update - Beacon has continued to support this recommendation including the expansion of these services to include youth with an intellectual disability, inaddition to those children with complex behavioral health needs which require family education and training. The Integrated Care Coordination (ICC) programthrough DCF has supported this recommendation. The ICC program provides care coordination and peer support to families utilizing a wraparound communitymodel. The PRTFs have also collaborated with a specialized behavioral group in support from DCF and DSS to train staff at the PRTF in addition to working withfamilies for those youth with an ASD diagnosis.

PG 19 Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

Hover over Puzzle Piece for Definition of Each Service ClassCorresponding Below

Admissions & Admits/1,000While all Autism Spectrum Disorder (ASD) services increasedin CY 2016 the number of diagnostic evaluations increasedsignificantly from 120 in CY 2015 to 851 in CY 2016. Similarly,Admits/1,000 increased for each service in CY 2015 withdiagnostic evaluations going from 0.03 in CY 2015 to 0.23 inCY 2016.

2015 2016

0

100

200

300

400

500

600

700

800

Admissions

Autism Spectrum Disorder Services AdmissionsYouth Ages 0-20

Service Class (group)Diagnostic EvaluationBehavioral AssessmentTx Plan Dev & Prog Book DevService DeliveryDirect Obs & Direction

2015 2016

0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

0.18

Admits/1,000

Autism Spectrum Disorder Services Admits/1,000Youth Ages 0-20

Autism Spectrum Disorder ServicesUtilization Demographics

PG 20

Utilization ProfileIn CY 2016 there was significant growth in the number of unique youth served. In CY2015, 293 unique youth were served in the program; in CY 2016 that number rose to1,159 unique youth. Males continue to be the larger part of this group; in CY 2016 theywere 77.91% of the ASD Program with females at 22.09%. This is consistent with currentresearch that indicates that boys are five times more likely than girls to receive an autismdiagnosis.

As of December 30, 2016, data shows 1,313 unique youth have obtained authorizationsfor ASD services; 673 youth are in various stages of determining eligibility for ASDservices, 536 youth have open authorizations and are receiving direct services and 202youth have open authorizations for an Autism Diagnostic Evaluation.

The youngest members (0- 6 years) had significant increases in all services in CY 2016.The number of Diagnostic Evaluations increased from 55 in 2015 to 540 in CY 2016.Similarly, Behavior Assessments increased from 61 to 120, Treatment Plan Delivery from61 to 132, and Service Delivery from 37 to 102. Also, this age group grew as apercentage of each service category in 2016 compared to 2015 while all other age groupshad decreases. The 7- 12 age group also had a large increase in Diagnostic Evaluationsand Service Delivery. In CY 2015 there were 23 authorizations for evaluations and 40 forservice delivery; in 2016, these increased to 198 and 86, respectively.

There continue to be differences in the breakdown of utilization among racial and ethnicgroups across all ASD services classes. Autism is reported to occur in all racial, ethnic,and socioeconomic groups. As far as diagnostic evaluations, 44.9% were completed forWhite youth, 36.4% for Hispanic and 13.2% were completed for Black youth. However,Connecticut Medicaid is doing a better job at identifying and diagnosing youth in theHispanic community as compared to the national average where non-Hispanic Whiteyouth were almost 50% more likely to be identified with ASD than Hispanic youth. Theresearch consistently notes that youth of Black, Hispanic, and Asian decent are morelikely to be identified later. Recent research has found that ethnic minority youth mayhave subtle communication delays compared to non-minority youth that may beundetected or presumed unremarkable by parents of minority toddlers. As a result, forethnic minority youth more significant delays are needed to prompt early identification andthe search for intervention services. In our CT Medicaid ASD Program, this disparity ismore pronounced across the services of behavior assessment, plan of care developmentand service delivery where White youth accessed services at a significantly higher ratethan Hispanic, Black, Asian or other youth.

77.91%

22.09%

Total Youth by Gender: CY2016

■ Male ■ Female

88.35%

10.44%1.21%

Total Youth by DCF Status: CY 2016■ Non-DCF ■ Voluntary■ Child Welfare/Committed

Diagnostic Evaluation

Behavior Assessment

Tx Plan Dev & ProgBook Dev

Service Delivery

Direct Obs & Direction

26.9%

28.0%

28.2%

24.3%

23.8%

28.0%

28.7%

32.1%

33.2%

64.8%

44.3%

42.0%

38.9%

41.7%

Total Youth by Level of Service and Age Group: CY 2016■ 0-6 ■ 7-12 ■ 13-18 ■ 19-20

Diagnostic Evaluation

Behavior Assessment

Tx Plan Dev & ProgBook Dev

Service Delivery

Direct Obs & Direction

13.2%

14.4%

14.6%

14.1%

15.4%

36.4%

26.2%

24.2%

23.3%

25.5%

44.9%

54.6%

56.7%

57.6%

54.1%

Total Youth by Level of Service and Race: CY 2016■ White ■ Hispanic ■ Black ■ Asian ■ All Others

Because members may have multiple authorizations with differences in, specifically, age andDCF status at the time of admission, demographics are captured as of the last/most recentauthorization record. Each member is only counted once in this calculation.

These values will not add up to the total unique youth as youth may utilize more than oneservice. However, each youth is only counted once in each demograhic category within each se..

PG 21 Autism Spectrum Disorder ServicesAdmissions by Provider

0 100 200 300 400Admissions

CT CHILDREN'S SPECIA, LTY GRP CCMC

ABLE HOME HEALTH, CARE LLC

CONNECTICUT BEHAVIOR, AL HEALTH LLC

FAMILY STRONG CT LLC,

YALE UNIVERSITY SCHL, OF MEDICINE

SHORELINE SOCIAL, LEARNING

RUSSOLILLO, PATRICK J

FOCUS CTR FOR, AUTISM INC

HOSPITAL FOR SPECIAL, CARE GROUP

BEHAVIORAL HLTH CONS, ULTING SVCS LLC

STRONG, FOUNDATIONS

ADELBROOK COMM, SERVICE INC

WHEELER CLINIC INC

CT BH CONSULTANTS, LLC

HILTON BEHAVIOR, THERAPY

TRADING SPACES, ABA, LLC

ADVANCED PSYCHOLOGIC, AL SERVICES

EASTER SEALS COASTAL, FAIRFIELD CNTY

ROSALES, MANUEL J

CLIFFORD BEERS GUIDANCE CLINIC

KOZODOY, PAUL

COMKEY THERAPY PLLC,

ZABA THERAPY LLC,

INTERLOCKING CONNEC, TIONS LLC

ALL POINTE CARE, LLC

BLOOM BEHAVIOR &, CNSLT SERVICES

ALTERNATIVE SERVICES, CT INC

CREATIVE POTENTIAL, LLC

GROWING POTENTIAL, SERVICES

ROGINSKY, BINA

WEST, CYNTHIA W

ASD Provider Volume of Authorizations by Service Class

Service Class (group)Diagnostic EvaluationBehavioral AssessmentTx Plan Dev & Prog Book DevService DeliveryDirect Obs & Direction

Select Year2016

Service Class (group) 2015 2016Diagnostic Evaluation

Behavioral AssessmentTx Plan Dev & Prog Book Dev

Service DeliveryDirect Obs & Direction 21

2624

2420

1922

2213

Volume of Unique Providers Providing ASD Services

Provider EnrollmentThe provider network experienced minimal growth in Q1 and Q2 of CY 2016. Only fourunique practices (individuals or groups) enrolled during this time for a variety of services witha total of 42 providers enrolled as Autism Service providers. This is up from 34 enrolledAutism Service providers in CY 2015. 19 are enrolled to complete diagnostic evaluations, 33to provide behavioral assessments and plan of care development and 39 to provide servicedelivery while the actual number of unique providers accessing authorizations is much lower.Some programs have enrolled and are still getting their service delivery teams operational.

As of July 1, 2016, Beacon Health Options became responsible for qualifying potential ASDproviders prior to enrollment with Medicaid. Since this time, 44 new providers have enrolledbringing our total to 86 individual providers, 53 of whom are able to provide ASD directservice delivery services. Amongst other provider group types, these 53 are partiallycomprised of 30 BCBA group practices, six individual BCBAs, five LCSW/LPC individualsand two LCSW groups.

New service classes were implemented September 1, 2016. These included Program BookDevelopment, Group Treatment Services, and Direct Observation and Direction. Also,BCBA/Licensed Clinician Direct Service Delivery versus BCaBA and Behavior TechnicianDirect Service Delivery were broken out with separate rates. Changes to the current AutismServices regulations and rates will be implemented in order to encourage additional providerenrollment sometime in Q2 or Q3 of CY 2017.

Ongoing recruiting and outreach to current birth to three providers, DDS/DSS and DCF ASDproviders and attendance at regional Applied Behavioral Analysis (ABA) associations inConnecticut, Rhode Island, New York and Massachusetts are taking place. The monthlyLearning Collaborative for ASD providers continues to cover topics related to best practicesfor ASD services, identify trends and allow providers to network and get questions answeredin a timely manner. The new ASD provider orientation is highly individualized andstreamlines the process of educating new providers regarding staff enrollment, accessingauthorizations and documentation expectations for clinical review.

Service ClassAll

Autism Spectrum Disorder ServicesSummary

PG 22

ConclusionsWhile access to a diagnostic evaluation is quick and easily accessible for Medicaid youth, access to in-home and community-based services continues to develop.Building the provider network continues to be of primary focus. Continued attention is also being given to sending referrals to providers from areas with thegreatest number of Medicaid members waiting for service delivery to begin. Clinical Care Managers (CCMs) weekly communication with providers helps providersidentify where staff is needed most for Medicaid members waiting throughout the State and many providers are targeting their staff recruitment efforts in theseareas.

Monthly rounds and case consultation with National Beacon Health Options Autism Services Program allows the Connecticut ASD team to share and access bestpractice models and continue efforts to increase provider enrollment. Monthly Learning Collaboratives allow for communication of best practices, standards andMedicaid expectations on an ongoing basis.

Networking with ASD providers has provided low cost to no cost opportunities to improve training and quality of behavior technician staff by engaging with stateuniversities and other providers offering Registered Behavior Technician (RBT) training to new and prospective employees for the provider network.Behaviorally-focused trainings are shared on a monthly basis with the enrolled Autism Services provider network as well.

Recommendations

1. Beacon continues to recommend ongoing workforce development. Enrolling direct care providers within the network remains a priority. In order to grow thenumber of providers as well as improve the adequacy of the treatment being provided. Provider Learning Collaboratives will continue to focus on both of theseareas and outreaches to current providers not enrolled with Medicaid will also continue.

Update - Informational flyers specific to families and community providers will be developed. The flyer for families will focus on educating families regardingaccessing Medicaid services, what services can be authorized under Medicaid, what to expect from ABA in home services and resources. The flyer forcommunity providers will focus on helping families they work with connect to ASD Medicaid services, how to make a referral, eligibility criteria and servicesprovided.

Provider chart reviews are expected to begin Q3 following final revisions on the chart review tool. Along with this, ASD Clinical Care Managers are developingclear criteria for document reviews in order to move towards providers “qualifying” for bypass when reviewing documents.

New workflows will be developed Q2 and Q3 to track trends in timelines and length of time between service authorizations and dates of service delivery. This willhelp educate Beacon Health Options on areas that may require more training and support for providers.

Collaboration with State agencies, Birth to Three and specialty hospitals like the Hospital for Special Care’s new inpatient Autism unit continues. New partnershipshave been formed with subcontractor, Padres Unidos of Greater Danbury and FAVOR to increase parent support group options for families who are primarilySpanish-speaking with special needs youth. Renewed efforts will be focused on outreach to AFCAMP and collaboration with the African-American and Caribbeanparents of children with special needs. Identification of the care coordination needs for transition services for the young adult population from State Plan servicesinto the Department of Mental Health and Addiction Services (DMHAS) is also being examined.

PG 23 Outpatient Registration VolumeAdult and Youth

2011 2012 2013 2014 2015 2016

0%

10%

20%

30%

40%

50%

60%

70%

80%

% of Outpatient Registration Volume

Percent of Outpatient Registration Volume and Total Volume: ECC andNon-ECC

2011 2012 2013 2014 2015 2016

0K

20K

40K

60K

80K

100K

120K

140K

Outpatient Registration Volume

Total Outpatient Registration Volume: ECC and Non-ECC

2011 2012 2013 2014 2015 2016

ECC

Non-ECC

Total 138,650

117,773

20,877

119,001

100,008

18,993

105,928

83,969

21,959

85,841

63,116

22,725

76,532

55,046

21,486

67,974

49,191

18,783

Registration VolumeThe “Total Outpatient Registration Volume” measure captures the overallvolume of newly registered Medicaid members, including those evaluationsexcluded from meeting the ECC access standards. From 2011 to 2016, the totaloutpatient registration volume greatly increased from year to year. Mostrecently, the total outpatient registration increased 16.51% from CY 2015 to CY2016.

Over the past six years, the total ECC registration volume remained ratherconstant, while non-ECC volume continued to increase, therefore expanding thegap between ECC and non-ECCs with each passing year. In CY 2016, ECCsaccounted for approximately 15% of the total outpatient registration volume,while non-ECCs accounted for approximately 85%.

ECCNon-ECC

ECCNon-ECC

PG 24Youth Outpatient Registration VolumeEnhanced Care Clinics (ECC) vs. Non-ECC Providers

2012 2013 2014 2015 2016

0K

2K

4K

6K

8K

10K

12K

14K

16K

18K

20K

22K


Total Outpatient Registration Volume: ECC Youth & Non-ECC Youth

OverviewNon-ECC youth registrations have been trending upward since CY 2012 and reached the highest point in CY 2016, making up approximately 71% of youthregistration volume, while ECC youth registrations slightly declined.

2012 2013 2014 2015 2016

0K

5K

10K

15K

20K


Total Outpatient Registration Volume: ECC Adult & ECC Youth-- ECC Total

ECC YouthNon-ECC Youth

ECC AdultECC Youth

Type of Care (Age grp)Youth Measures

PG 25 Youth Outpatient Registration VolumeEnhanced Care Clinic (ECC) vs. Freestanding Clinics (FSC)

OverviewThe “Registrations Required to Meet ECC Access Standards” measure captures only those evaluations that are relevant to meeting ECC access standards.Outpatient clinics are able to identify and exclude from calculation the “exempt registrations” which include: 1) those clients stepping down from a higher level ofcare within their agency; and/or 2) those clients who have been in treatment at the ECC but who experienced a change in insurance coverage to Medicaid. Theaccess measures are based only on the timeliness of appointments for those members who are truly new clients in the ECCs. Total evaluations needing to meetthe access standards accounted for approximately 61% in 2016. This has remained fairly constant over the reporting period, while the total outpatient registrationvolume has increased. When comparing ECCs vs. FSCs for youth, ECCs have consistently had a higher number of evaluations, however, the gap between ECCsand FSC has decreased over time.

2011 2012 2013 2014 2015 20160K

20K

40K

60K

80K

100K

120K

140K


Total Outpatient Registration Volume: Volume of Registrations Required toMeet ECC Access Standards and Volume of Exempt Registrations ECC

and Non-ECC

2012 2013 2014 2015 2016

0K

2K

4K

6K

8K

# of Evals Required to Meet ECC Access Standards

Total Number of Evaluations Required to Meet ECC Access Standards:ECC and Non-ECC Freestanding Clinics (FSC)

Select GroupYouth Measures

ECC YouthFSC Youth

Outpatient Registration VolumeExempt Evals

PG 26Youth Outpatient ECC Access StandardsRoutine, Urgent and Emergent Registrations

Access StandardsYouth urgent evaluations were below the 95% access standard in CYs 2012 and 2013, but increased the following year and remained above the access standardfrom 2014 through 2016. Emergent evaluations were above the access standard from 2012 through 2015, but dipped below in CY 2016 at 94%. Routineevaluations have consistently remained above the access standard from CY 2012 through CY 2016.

The percent of total outpatient evaluations offered within the ECC access standard have been consistently met by ECCs for routine and emergent. In CY 2014,total urgent evaluations increased and was able to rise above the 95% access standard. Urgent continued to meet the access standard from CY 2014 through CY2016, although it has been trending downward.

Both routine and urgent evaluations have been consistently unmet by FSCs, although urgent dramatically increased 22.5 percentage points from 2015 to 2016.Emergent met the access standard in CY 2014 at 95.2% but dipped below the 95% access standard the following year and continued to trend downward in 2016.

2012 2013 2014 2015 2016

50%

60%

70%

80%

90%

100%

% of ECC Evaluations that Met the ECC Access Standards

Access Standard 95%

ECC Evaluations that Met the ECC Access StandardsYouth

2012 2013 2014 2015 2016

50%

60%

70%

80%

90%

100%

% of OTP Evaluations Offered Within Access Standard

Access Standard 95%

Percent of Routine Outpatient Evaluations Offered within the ECC AccessStandard: ECC and Non-ECC Freestanding Clinics (FSC) - All Members

ECCFSC

RoutineUrgentEmergent

RoutineUrgentEmergent

PG 27Outpatient Enhanced Care ClinicsCompliance, Interventions, & Activities

Compliance

Provider Compliance for CY '16

Routine Access compliance with the 14 day standard for the 38 ECCs fell into the following categories:1. Met the access standard of 95%: 352. ECC falling below the 95% Routine Standard for at least one quarter: Hartford Hospital (IOL): 92.31% in Q1 2016 and 94.12% in Q2 '16; CY 2016: 94.87% Catholic Charities (Torrington): 91.30% in Q4 '16; CY 2016- 93.75% Connecticut Renaissance (Bridgeport): 90.34% in Q3 '16 and 94.67% in Q4 '16; CY 2016: 92.54%

Urgent Access compliance with the 2 day standard for the ECCs fell into the following categories:1. Number of ECCs that reported Urgent volume during the year: 332. Met the access standard of 2 days: 273. ECC falling below the 95% Urgent Standard: Charlotte Hungerford (Adult): 50% in Q1 2016 (vol. of 2); CY 2016: 88.89% Clifford Beers: 33.33% in Q1 2016 (vol. of 3); CY 2016: 33.33% Community Health Resources: 33.33% in Q2 2016 (vol. of 3); CY 2016: 25.00% Catholic Charities (Torrington): 75.00% in Q3 2016 (vol. of 4); CY 2016: 83.33% Connecticut Renaissance (Bridgeport): 66.67% in Q3 2016 (vol. of 3); CY 2016: 66.67% Connecticut Renaissance (Norwalk): 50.00% in Q4 2016 (vol. of 2); CY 2016: 50.00%

Emergent Access compliance with the 2 hour standard for the ECCs fell into the following categories:1. Number of ECCs that reported Emergent volume: 132. Met the access standard of 2 hours: 93. ECC falling below the 95% Emergent Standard: Central CT Child Guidance: 0% in Q4’16 (vol. of 1); CY 2016: 0% Family and Children’s Aid: 0% in Q4’16 (vol. of 1); CY 2016: 0% The Village for Families and Children: 50.00% in Q3 2016 (vol. of 2); CY 2016: 60.00% Yale Child Study: 0% in Q2’16 (vol. of 1); CY 2016: 0%

Continued on the next page.

PG 28Outpatient Enhanced Care ClinicsCompliance, Interventions, & Activities

Interventions and Activities

Interventions to address ECC performance on Access Standards:

Although the formal measurement period has been annualized, ECC’s continue to receive data on a quarterly basis. This includes both quarterly and year to datetotals for each standard. Those agencies below 95% for any measure will be required to submit a Corrective Action Plan (CAP) with one exception. The seven newECC locations will not be required to submit a CAP since they currently have a provisional designation and any performance on access standards below the 95%is currently not being counted until their designation becomes permanent. Community Health Resources, Clifford Beers, Charlotte Hungerford and The Village have all indicated that the percentages received on the urgent or emergentmeasures where they did not meet the 95% access standard were a data entry error and have sent in paperwork currently being reviewed. Family and Children’sAid and Yale Child Study have also been given the opportunity to present paperwork to support their missing the emergent measure in Q2 and Q4 2016. Allpaperwork submitted will be presented at the ECC Operations meeting for review. Catholic Charities Norwich which had been on probation for not meeting the Routine Access standard in Q3 2015 and the Urgent Access standard in Q4 2015came off probation in Q3 2016.

Activity Around New ECC Locations in Q3’16 and Q4’16:

The seven ECC locations have been going through an orientation process as follows:● On 6/28/2016 – the first orientation meeting was held at CTBHP and covered general information about being an Enhanced Care Clinic.● On 10/11/2016 – a follow up to the initial orientation meeting was held and covered information about what to expect as part of the process of the Onsite Surveywhich all new ECC locations will go through as a part of moving from a provisional designation to a permanent designation. In addition, clinics were offered theopportunity to have any documents that they had ready reviewed. Connecticut Renaissance and Recovery Network of Programs submitted documents for review.Clinics were also informed that the Onsite Surveys would occur in Q1 2017.● In December 2016, the clinics were asked to submit charts for review that could be used as a part of the Inter-rater Reliability process in preparation for theOnsite Surveys. Those charts were reviewed and each clinic received feedback in January 2017.

*Wellmore had been approved as an additional adult location withdrew just before the 7/1/2016 start date.

Continued on the next page.

PG 29Outpatient Enhanced Care Clinics

Compliance, Interventions, & Activities, continued

Interventions and Activities, continued

Mystery Shopper Program:

In Q3 2016, Catholic Charities – Torrington, Connecticut Renaissance – Norwalk, and Recovery Network of Programs were mystery shopped. All three agenciesare part of the seven new ECC locations. Calls were made in both Spanish and English in Q3 2016 and the results were as follows:● There were issues with no Spanish speaking staff available in some cases and no initial calls answered or voicemails responded to over a 24-hour period. Thisinformation/feedback was communicated to the agencies in October 2017.

In Q4 2016, Charlotte Hungerford (Adult), Intercommunity, and United Services were mystery shopped. All three agencies met the mystery shopper standard. Asa follow up to Mystery Shopper calls done in Q2 2016 with Hartford IOL, a meeting was held on August 17th, 2016 to address their triaging process. Since theinitial meeting, the clinic has submitted several iterations of a Triage Tree and more than one phone conference has been held with the clinic to address themodifications. They have now eliminated one step of their initial process and modified their screening tool to more easily identify a member in crisis at thebeginning of the triage process. Their final iteration and triage protocol were forwarded to the state partners on 2/9/2017.

Percentage of Members Requesting Later Appointment Even Though They Have Been Offered Appointment Within Required Time Frame

This information was shared with providers along with the Q3 2016 ECC results and clinics were contacted to try and get a better understanding of the data. Inmost cases the clinics reported that even though members may have requested a later appointment than what was offered, they were often still seen within the 14days. This is supported by the data when we look at what the statewide average was for members receiving appointments outside of the 14-day window; 4.83% inboth Q3 2016 and Q4 2016. (Tableau – Offered vs. Accepted)

ECC Operations: There were ongoing meetings throughout Q3 ’16 and Q4 ’16.

ECC Provider Workgroup on Capacity and Access: Did not meet in Q3 ’16 and Q4 ‘16.

Activities Going Forward:1. Continue monitoring access data on a quarterly basis within the context of annualized methodology2. Continue the Mystery Shopper program to ensure effective triage and screening3. Complete the Onsite Surveys of the seven new ECC locations

Residential Treatment FacilitiesIn and Out-of-State Utilization

PG 30

2013 2014 2015 2016

0

50

100

150

200

250

Admissions or Discharges

Residential - Youth: Ages AllAdmissions

2013 2014 2015 2016

0

100

200

300

400

500

600

700

800

900

1000

1100


Residential - Youth: Ages AllAverage Length of Stay

In / Out of In State RTCIn-State RTCsOut-of-State RTCs

Admissions or DischargesAdmissions

Age GroupAll

2013 2014 2015 2016

In-State RTCs

AdmissionsDischarges


Out-of-State RTCsAdmissionsDischargesAverage Length of Stay

326.64146155

282.03146130

272.05185149

232.61299253

529.258

3

1,048.577

4

993.2512

4

563.3677

5

Residential - Youth: Ages AllData Table

PG 31 Lower Levels of CareAdmissions & Admits/1,000

2013 2014 2015 2016

0

2

4

6

8

Admits/1,000

Lower Levels of Care - Youth: Ages AllAdmits/1,000

2013 2014 2015 2016

0K

10K

20K

30K

Admissions

Lower Levels of Care - Youth: Ages AllAdmissions

Select Benefit Group TypeAll Members without Duals

Filter by Age GroupAll

2013 2014 2015 2016Partial Hospitalization (PHP) Admissions

Admits/1,000Intensive Outpatient (IOP) Admissions

Admits/1,000Extended Day Treatment (EDT) Admissions

Admits/1,000IICAPS Admissions

Admits/1,000FFT Admissions

Admits/1,000MDFT Admissions

Admits/1,000MST Admissions

Admits/1,000Outpatient Admissions

Admits/1,000

0.341,054

0.381,174

0.401,246

0.411,193

0.531,626

0.551,682

0.571,761

0.651,879

0.25783

0.24738

0.26803

0.25710

0.712,192

0.712,169

0.742,273

0.642,265

0.10316

0.09279

0.10298

0.12337

0.21653

0.22682

0.22679

0.21615

0.12367

0.13389

0.13388

0.11327

9.4635,125

8.5631,757

8.0229,865

7.8327,547

Lower Levels of Care Table - All Members without Duals for ages 0 - 2, 3 - 12, 13 - 17

Service ClassPartial Hospitalization (PHP)Intensive Outpatient (IOP)Extended Day Treatment (EDT)IICAPSFFTMDFTMSTOutpatient

Filter by Level of CareAll

Global Youth RecommendationsPG 32

Recommendations:This section documents activity since the previous quarterly report.

1. Beacon recommends a preventive model of integrated health care which includes behavioral health and physical health. We continue to recommend thispreventative model incorporate crisis services and intervention for both adults and youth.

Update: Many HUSKY members experience co-occurring medical, behavioral health and substance use disorders. These members often present with complexclinical needs resulting in frequent high utilization of services and associated higher Medicaid costs. Integrated approaches to health care delivery has evolvedfrom an optional activity to an essential system requirement. Integrated case management models which incorporate prevention, and crisis services/ educationcan reduce unnecessary emergency department utilization, reduce inpatient utilization and promote improved overall health outcomes.

Documents

UTILIZATION MANAGEMENT FOR YOUTH MEMBERS · UTILIZATION MANAGEMENT FOR YOUTH MEMBERS Executive Summary & Analysis by Level of Care Calendar Year 2016: Januar\-December 2016 - Submitted