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Report to the Operations Sub-Committee September 8, 2006

This report provides an update on network operations, web registration, utilization management, discharge delays, authorization and concurrent review, call volume, clinical studies, complaints, and community interactions.

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Report to the Operations Sub-Committee September 8, 2006

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  1. Report to the Operations Sub-Committee September 8, 2006

  2. Network Operations

  3. Network Operations/StatusAugust 2006 • 1,495 Total Individual Providers • Increase of 39 Providers since July 2006 (Count includes referring providers within groups) • 1,046 Facilities • Increase of 10 Facilities since July 2006 (Aggregate of each location by Type and Specialty not including groups)

  4. Web Registration

  5. Web Registration, cont’d • Provider Forums – Web Registration Trainings • Total RSVP’s – 317 • 8/18 - Rocky Hill/ASO Office • 8/22 - New London/Mitchell College • 8/24 - Wallingford/CHA • 8/28 - Bridgeport • 8/30 - Wallingford/CHA • 9/6 - Rocky Hill / ASO Office • Security Access/User ID Requests • 1058 User Id’s generated as of 8/29/06 • 480 Requests currently in process

  6. Web Registration, cont’d • Security Update • Effective August 31, 2006 at 5:30pm • Upgrade to provide additional layer of security • Provider Authorization look up capacity in place • 5,137 Registrations completed since August 1st • Improvement in time to complete noted (average @ 4 minutes) • Winfax Registration Forms • Individual Practitioners without computer and/or web access • 34 Requests as of September 1, 2006

  7. Utilization Management

  8. Members who Access Service by LOCAugust 2006 ADR/IPD: Inpatient detox/rehabilitation EDT: Extended Day Treatment GHA/GHC Group home 1.0/2.0 IOP Intensive outpatient IPF: Inpatient Psychiatric Facility PHP: Partial Hospital Program PRTF: Psychiatric Residential Tx Facility RTC: Residential Treatment Facility

  9. Discharge Delay Status • 21% of children in an Acute Inpatient setting are defined as Discharge Delay • 50% are awaiting placement in Residential and/or PRTF is 44 days • 15% are awaiting Foster Care placement • 15% are awaiting Group Home placement • Average length of stay in Delayed status • Discharge Delay from resi currently being “scrubbed” for accuracy • Care Management training continues • Inter rater reliability to be tested

  10. Valid Reasons For Delay In Discharge From Hospital Or Residential Care

  11. Authorization and Concurrent Review Update

  12. ED Delay Tracking: August 2006

  13. ED Delayed Discharge Activity • Flow charts being developed with DCF • All ED’s being contacted daily • No unanticipated notifications in August, resulting in increased case identification and improved discharge planning, supported by seasonal reduction in need for acute service • Overview: • May: 6 cases, average LOS 3.5 days • June: 5 cases, average LOS 7.2 days (1 outlier) • July: 10 cases, average LOS 2.9 days • August: 11 cases, average LOS 1.1 days

  14. ICM Referral Tracking

  15. ICM Activity • All “delayed status” members currently in inpatient settings are assigned • CCR’s increased to each week, vs. every other week to assist in discharge planning • Beginning to attend MSS mtg’s with System Managers • Sharing daily census reports in MSS mtg’s to review delayed members AND all others in 24 hour care to assist in discharge planning

  16. 2006 Call Volume YTD

  17. Calls answered in < 30 seconds YTD

  18. CT BHP CALL MANAGEMENTIncoming Calls Totals: August, 2006 Total 4872

  19. Types of Service Connect InquiriesAugust, 2006 46% - Provider Referrals for Members 18% - Member Eligibility Verification 19% - Provider Related/Authorization/Enrollment/Billing 17% - General Information 63% = Member Inquiries(highest percentage to date) 0.01% = Inquiries initiated due to provider status change from IN to OON

  20. Quality Management

  21. Clinical Studies Child study: Ambulatory Follow-up within 30 days of inpatient discharge from a hospital or RTC. Adult study: Interface with CT BHP and the MCO’s regarding Intensive Care Management. • data collection re. co-morbidity • Identification of trends in diagnosis • timeliness of CT BHP response for co-management • type of response • member satisfaction

  22. Complaints January – August 2006

  23. Grievances

  24. Community Interaction:Peer/Family Services

  25. Peer/Family ServicesAugust 2006 • Held first CT BHP ASO Consumer Advisory Committee • 37 Community meetings attended (i.e., School, PPT, MSS, Collaborative, Court, DCF, Riverview meetings) • 15 Home Visits conducted • 38 Open Consultations • 13 Closed Consultations • Final interviews complete to fill remaining positions

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