Report to the Transition

1

• Report to the Transition
• Sub-Committee
• June 2, 2006

2
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

3
Authorization and Concurrent Review Update
4
Operations Update, cond

• 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

5
Operations Update, cond

• 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 addt care
• 21 Awaiting PRTF
• 8 Awaiting Group Home

6
Stuck ED Volume, May 2006
7
Call Management/Customer Service
8
CT BHP Call ManagementMay, 2006Please note
Enclosed data includes reporting period 5/1/2006
5/27/2006
9
Types of InquiriesMay, 2006

• 37 - Provider Referrals for Member
• 20 - Member Eligibility Verification
• 34 - Provider Related/Authorization/Enrollment/B
  illing
• 9 - General Information
• 46 Member Inquiries
• (Increase from April - 38of total calls)
• Note
• 0.06 Inquiries initiated due to provider
  status change from IN to OON
• 7 MCO calls, 211 Initiative not yet live, but
  discrete phone line operational

10
CT BHP CALL MANAGEMENTIncoming Calls Totals May
2006

• Total 4677
• Note Increase of 17 since April

11
The Network
12
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)

13
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

14
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

15
Quality Management
16
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

17
Quality Initiatives, cond

• 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

18
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

19

• Community Outreach

20
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

21
Provider Trainings

• May 22nd May 30th
• Overview and QA following EDS Provider Forums
• May 25th
• Provider Training Hill Health, New Haven
• June 5th
• Clinical Directors 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)

22
Questions?