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Report to the Transition Sub-Committee May 5, 2006

This report provides updates on hiring key positions, pre-cert and concurrent call volume, ED interface improvements, home-based psychiatric services, IVR/web technology, call management/customer service, provider network status, inquiries/complaints/grievances, and community outreach activities.

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Report to the Transition Sub-Committee May 5, 2006

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  1. Report to the Transition Sub-Committee May 5, 2006

  2. Operations Update • Hiring • 100% of Key Positions • Dr. John Swanson, Associate Medical Director • Dr. Jeffery Gottlieb, Associate Medical Director • Ann Phelan, MA, VP of Clinical Operations • 88% Overall • 3 Peer/Family Specialists • 2 IT/Reporting • 1 Quality Management

  3. Operations Update, con’d

  4. Operations Update, con’d • Pre-cert and Concurrent Call Volume • 1997 calls in April (increase of 70% from March) • Range of time on the phone: 17 seconds to 56 minutes • Average time on the phone: 28 minutes • Riverview on line June 1, 2006 • ED Interface • Opportunities to improve notification/communication • Tracking of members • Drafting educational Alert • Next Phase: EDT 6/1/2006 • Home-Based Psychiatric Services: 7/1/2006 • IVR/Web technology 8/2006

  5. Call Management/Customer Service

  6. CT BHP Call ManagementApril, 2006

  7. CT BHP CALL MANAGEMENTIncoming Calls Totals: April 2006 Total 3,868 (Total Call Volume in March: 2,852, a 36% increase in April)

  8. Types of InquiriesApril, 2006 33% - Provider Referrals for Members 23% - Member Eligibility Verification 39% - Provider Related/Authorization/Enrollment/Billing 5% - General Information38% = Member Inquiries Note: .06% = Inquiries initiated due to provider status changing from in network at the MCO to out of network with new system Note: Discrete MCO lines have been established and will be live and reportable for the June meeting Note: Creation of a warm line transfer with the 211 Perinatal initiative

  9. The Network

  10. CT BHP Provider Network

  11. CT BHP Provider Network

  12. CT BHP Provider Network

  13. CT BHP Provider Network

  14. Network Status • CMAP providers: 1,722 • Increase of 595 providers since 12/12/06 • Addition of Rehab services within the SA continuum • Providers in process with EDS • Add/Change report 20-30 adds per week 10-20 changes per week • DCF Network • 110 RTC and Group Home providers (increase of 24 providers since 11/2005)

  15. Inquires/Complaints/Grievances

  16. Inquiries and Complaints and GrievancesJanuary – April 2006 • 21 inquiries about providers no longer in network, 1 complaint filed, referrals given to the other 20 • 22 complaints - 20 closed provider enrollment appointment scheduling member choosing to continue care with OON provider referrals to MCO pharmacy - 2 open c/o access to MD within 10 miles who will provide therapy as well as medication management c/o facility calling on weekend said our phone message said we were closed. Provider has not called back to verify phone # called.

  17. Inquiries and Complaints and GrievancesJanuary – April 2006 • 4 Grievances - 3 closed - 1 open * Open Case: Member is seeing OON provider and wants direct payment to reimburse provider. Saw IN provider but language of provider was a reported barrier

  18. Community Outreach

  19. Community Outreach • April • Schools Meeting to occur in May with Cheryl Resha • Systems Managers 167 DCF, Provider, Collaborative and MSS meetings in April 289 Meetings year to date • Peer/Family Meetings 30 Family forums, informational meetings, DCF and Collaborative meetings • ICM cases: 60 mid-long term cases 65short-term, high risk cases (some overlap) • Peer/Family Outreach/Coordination: 37 family/peer consultations

  20. Questions?

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