Chrysler LLC and ValueOptions Partnering to Achieve Quality Outcomes

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Chrysler LLC and ValueOptions Partnering to
Achieve Quality Outcomes
Christine O. Leush, LMFT, CEAP NASHO Annual
Summit Las Vegas October 22, 2008
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Largest independently owned behavioral health
and wellness organization with 25 million
members nationwide

• Founded in 1986 by psychiatrist, Ronald Dozoretz,
  M.D.
• Barbara Hill, CEO
• Michele Alfano, COO
• Serving employers, health plans, Medicare,
  Medicaid, as well as US military populations
• NCQA and URAC accredited.

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OUR VISION STATEMENTWe Improve The Lives Of
The People We Serve
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Partnering with Chrysler to Achieve Quality
Outcomes

• Analysis of behavioral health trends broken out
  by business lines identifying outlier over and
  under utilization by regional areas
• Recognition that health care delivery is local
• Effective change opportunities occur at the local
  level
• Identification of local areas that impact overall
  utilization trends
• Regional health delivery practice
• Local community health and resources
• Work factors influencing observed trends
• Engage in dialogue to identify and offer
  opportunities

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Partnering with Chrysler to Achieve Quality
Outcomes(continued)

• Concerns identified
• Plants located in one particular community
  experiencing spike in STD leaves for primary
  behavioral health diagnosis compared to other
  sites
• The rural, mid-western site was targeted
  following a joint client intervention and
  ValueOptions was asked to conduct analysis to
  uncover reasons for this and assure quality of
  care
• Macro analysis conducted of the behavioral health
  utilization
• Engaged medical carrier who was responsible for
  claims payment and network provider contracts.
• Micro analysis of individual cases to identify
  potential drivers for the identified trends.

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Problem Identification

• ValueOptions identified admissions to higher
  levels of care that were
• 25 higher as compared to the company wide
  average
• 36 higher than like industry normative data
• 100 higher than overall ValueOptions book of
  business norms
• Drivers for these utilization trends included
• High number of inpatient behavioral health
  admissions from emergency room visits with short
  inpatient stays (lt48 hours)
• Suggestive of using alternative level of care
• Pre-notification not required in benefit design

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Problem Identification(continued)

• Higher than company wide norms for readmissions
  within one year post inpatient discharge
• 20 of members discharged from inpatient care
  were non-compliant with aftercare
• Majority of discharged members received first
  aftercare follow-up appointment 10 business days
  post discharge
• Only 50 compliant with outpatient aftercare 30
  days post discharge

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Initial Intervention

• ValueOptions operating premise was that any
  intervention to change the behavioral health
  utilization patterns required recognition of the
  outlier status and involvement by the community
  stakeholders
• i.e., medical carrier, member representatives,
  internal plant EAP professionals, plant medical
  staff, representatives of the two major health
  delivery systems responsible for delivering
  behavioral health programs in the community and
  region where members resided.
• Joined with existing community/regional health
  initiative forum where requisite stakeholders met
  monthly to address overall community health
  issues
• Behavioral health concerns presented in preceding
  6 months brought to forefront
• Commitment to behavioral health delivery
  improvement

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Initial Intervention(continued)

• Presented initial analysis of behavioral health
  utilization data to community health initiative
  stakeholders
• Acknowledged that the client data appeared
  normative for the community at large
• Expressed concern that community utilization data
  was higher than comparative populations across
  the US and overall book of business
• Identified goal to achieve more normative
  utilization
• Echoed concern that achieving results should not
  be at the expense of their increased
  administrative burden

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Initial Intervention(continued)

• Engaged in brainstorming session with community
  stakeholders led by the clinical directors of the
  two community health systems and input from the
  clients internal EAP and medical staff.
• Obtained mutual agreement by all parties that the
  charges and interventions would not be born
  solely by the providers
• Analysis of high number of brief behavioral
  health admission from the ER revealed majority
  were initiated after normal business hours
• Onsite psych consults were not available after
  hours due to limited number of specialty
  providers in community
• ValueOptions agreed to authorize 4 days of
  partial hospitalization without pre-authorization
  if patient did not require 24 hour
  care/observation, but did require more intensive
  care than traditional outpatient offered

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Initial Intervention(continued)

• Analysis of low aftercare compliance identified
  unaddressed drivers
• Ambivalence and/or denial of need for ongoing
  care
• Limited community resources to do follow up
• Lack of awareness that rapid first appointment
  can positively impact ongoing aftercare
  attendance
• ValueOptions agreed to take on administrative
  tasks
• Follow up calls within 48 hours of discharge to
  review aftercare plan and assess commitment to
  comply
• Follow up after 1st aftercare appointment and
  again at 30 days to ensure compliance
• Commitment by all stakeholders achieved to
  convene monthly to
• Analyze data collected
• Review effectiveness of the interventions

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Process

• Metrics to assess outcomes
• Developed agreement on data points that would be
  exchanged between organizations
• Admissions to ER for primary behavioral health
  diagnoses and specific referral resource provided
  from ER by health systems to ValueOptions
• Communication to member by health system of
  aftercare provider name, appointment date/time
  within 5 calendar days post discharge with follow
  up calls provided by ValueOptions
• Track member admission and discharge by
  diagnosis, level of care, compliance with
  aftercare and intervention by ValueOptions

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Process(continued)

• Monthly calls attended by identified key
  stakeholders
• Modifications to this intervention program or
  other behavioral health program delivery
  components as indicated. Examples include
• Longitudinal analysis of the data at 9 months
  into the program, revealed
• if one family member was admitted to inpatient
  level of care,
• a second family member would be admitted and
  start their treatment at the inpatient level of
  care.
• Providers agreed to expand their existing family
  therapy intervention to include prevention focus
  for all family members.

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RESULTS

• Aftercare Compliance
• Community analysis of data after one year
• Continuation of existing program intervention to
  maintain positive results
• Explore expansion of existing program to other
  employer groups within community

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RESULTS

• Emergency Room
• Pre intervention
• 78 ER/27 inpatient referral
• Post intervention
• 10 ER/2 partial admits
• ValueOptions intervention
• 2 calls from ER with ValueOptions facilitating
  next day admit and auth for partial
• Inpatient MHSA Admissions

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CONCLUSION

• Positive outcomes from multiple partnerships
• ValueOptions, Chrysler, Insurance Carrier,
  Community Health Systems, Providers
• Continuation of established processes
• At present community to continue positive
  outcomes for Chrysler members
• Expand to other employer groups
• Identify other sites to implement initiative

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The End

• Every end is a new beginning