Report to the Operations

Sub-Committee

December 8, 2006

Network Operations

Web Registration

• Security Access/User ID Requests• 2,034 User Id’s generated as of 12/4/2006

• 27 Requests currently in process

• Winfax – Non Web/Paper Registrations• 104 Providers currently using paper

registration

Web Registration – TotalsCompleted Web Registrations as of 12/4/06

Outpatient Services………….…..21,963

Methadone Maintenance…….…...1,230

Ambulatory Detoxification …………….77

Family Support Team………………..128 (Home Based Service)

Psychological Testing…………….…..32

Web Registration Continued

• 23,430 - Registrations completed as of December 4, 2006

• Registration 21 day timely limit began November 6, 2006 – Providers have 21 days from the initial visit to

register CT BHP clients for Registered Services

• All fields for web registration required as of November 1, 2006– Race & Ethnicity (Optional)

Provider Relations Phone Stats October 2006 - November 2006

1646 Calls

Web Registration InquiriesGeneral Provider Inquiries

PDV’S Received 1259

PDV’S Keyed 1259

# of new providers added from Add /Change Report

270

# of changes completed from Change Report

574

# of PDV’s mailed to date 3132

Provider Data Verification Stats Aggregate since January 2005

Rapid Response Team Findings

• Reviewed authorization related claims issues for 30 providers

• Provider outreach letters sent to providers to offer assistance in the authorization process

Rapid Response Team

Provider Outreach Correspondences

• 15 – PH.D. level

• 9 – MD level

• 6 – APRN level

Provider Site Visits

• 1 Group Practice

• 3 Facilities

Clinical Operations

Authorizations per LOC for '06

0

200

400

600

800

1000

1200

IPF 0 0 511 779 874 682 731 755 1141 1090

ADR/IPD 0 0 70 99 125 137 120 105 132 154

GHA/GHC 8 30 23 25 74 151 180 162 141 168

PRTF 0 10 13 9 24 42 59 53 84 130

RTC 34 395 281 147 207 241 566 476 422 371

Intermediate (IOP, PHP, EDT) 0 0 0 850 1148 820 958 794 981 1054

HBS(FFT,FST,MDF,HBS,MST) 0 0 0 0 0 0 23 396 239 362

Feb March April May June July Aug Sept Oct Nov

Average Length of Inpatient Stay

not including Riverview (not including discharge delays)

26

64

6

27

11

22

8 6

14 12

60

1

121611

0

20

40

60

Local Area

Days

Current LOS

CT AVG

Percent Per Facility of Discharge Delays

15.6%

3.1%

9.4%

59.4%

6.3%6.3%

Hall Brooke Behavioral Health

Hampstead Hospital

Hartford Hospital

Riverview Hospital for Children

St. Francis Hospital

Yale New Haven Hospital

Discharge Delay Reason Codes

3.1%6.3%

12.5%

3.1%

15.6%

6.3%

12.5%

3.1%

37.5%

Await Com Svc: Home Hlth

Await Com Svc: IICAPS

Awaiting place Grp Hm 2.0

Awaiting place: Ther FC

Awaiting placement: PRTF

Awaiting placement: RTF

Fam Req TX before Return

Other

Pending Abuse/Neglect inv

• 10% of children in an Inpatient setting are defined as Discharge Delay - represents a decrease from 17% last month

37.5% are awaiting placement in Residential and/or PRTF

9.4% are awaiting Community Services12.5% are awaiting Group Home placement12.5% are awaiting Placement: other or unspecified

Inpatient Discharge Delay Status November, 2006

Number of Members in ED Delay Tracking Status per Month

5

1012

26

16

10

0

5

10

15

20

25

30

June July Aug Sept Oct Nov

# of

Mem

bers

JUNE - '06

JULY - '06

AUG - '06

SEPT - '06

OCT - '06

NOV - '06

Average Days Stuck in ED Delay Tracking Status per Month

7.20

2.90

1.581.99 2.47

6.60

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

June July Aug Sept Oct Nov

# of

Day

s

JUNE - '06

JULY - '06

AUG - '06

SEPT - '06

OCT - '06

NOV - '06

Number of DCF vs. Non DCF Identified Members in ED Delay Tracking Status per Month

5

910

1210

01

2

9

4

0

17

02468

1012141618

JUNE -'06

JULY -'06

AUG -'06

SEPT -'06

OCT -'06

NOV -'06

# of

Mem

bers

DCF

Non DCF

Actual Dispostion for Members in ED Delay Tracking Status per Month

0

5

10

15

20

JUNE -'06

JULY -'06

AUG -'06

SEPT -'06

OCT -'06

NOV -'06

# of

Mem

bers

Admitted toInpatientUnitReturnhome/prevplacementTemporaryFosterCareAdmittedResidentialRemanded to JuvDetention

ED Delayed Discharge Activity

• Started trending ED cases, source, length of stay, and disposition

• Despite increased numbers of members presenting to EDs, overall lengths of stay are trending down (3 outliers in November negatively impacted LOS)

• Members presenting to EDs are more likely to be DCF involved than not

• Members presenting to the ED are more likely to be discharged to an Inpatient level of Care than any other option

ICM TRACKING REFERRAL SOURCE MONTHLY REPORT November 2006

REFERRAL SOURCE JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

ED 0 1 8 10 2 7 26 16 11INPATIENT HOSPITAL 0 1 15 19 30 45 47 21 23MCO 2 3 1 1 6 44 36 40 18DCF 0 3 7 10 11 8 13 8 18SELF REFERRAL 0 0 1 1 4 2 1 5 0INTERNAL 1 29 27 41 22 1 6 6 3RIVERVIEW HOSPITAL 0 0 0 0 34 0 0 1 2RESI/GROUP 0 0 0 0 2 11 11 5 175 DAY DISCHARGE DELAY 0 0 0 0 0 0 28 12 2COMMUNITY 0 0 0 0 0 9 15 11 13

TOTAL RECEIVED 3 37 59 82 111 127 183 125 107

DISCHARGES 45 33 19 48

Data source 11/1/06 -11/29/06 YTD Referrals Recieved: 834 YTD ICM Cases: 793

Timeliness of Pre-cert and CCR Process

• Analysis of current forms/process- complete• Re-ordering/re-working of existing forms -

complete• Deletion of redundant information - complete• System was reprogrammed mid-November• Clinician orientation and re-tooled forms on web

site week of November 13, 2006• Revised format implemented week of November

20, 2006

Residential Care TeamTransition

• IT infrastructure complete (tracking system/CANs)

• Follow up training occurring via web

• John Lyons training CSSD

• Final revisions to provider information

• Census reporting has improved to better support matching

• Transition occurred 12/1/06

Customer Service/Call Center Activity

2006 Call Volume YTD

Call Volume

01000200030004000500060007000

2006

Calls answered in < 30 seconds YTD

% Answered in < 30 Seconds

8486889092949698

100

% answered < 30 seconds

% answered < 30 seconds

Types of Service Connect InquiriesNovember, 2006

41% - Provider Referrals for Members

15% - Member Eligibility Verification

36% - Provider Related/Authorization/Enrollment/Billing

8% - General Information

49% = Member Inquiries

No Inquiries initiated due to provider status change from IN to OON

CT BHP CALL MANAGEMENTIncoming Calls Totals: November, 2006

Total 5813

Member Calls: 2550

Provider Calls: 3241

Crisis Calls: 22

Quality Management

Quality Initiatives

• Adult and Child Studies underway

• Final analysis of Provider Satisfaction survey underway

• Member Satisfaction close to completion

• Mercer Post-Implementation evaluation scheduled for January 3-5, 2007

• Continues to support all departments at the CT BHP

Total Number of Complaints Monthly 2006

2 2

6

0 0

3

2

0 0

3

1

2

1

3

0

2

1 1 1

0

1 1

3

0

2

4

3

1

0

4

2

4

9

0

1

2

3

4

5

6

7

8

9

10

Adult Member Complaints 2 2 6 0 0 3 2 0 0 3 1

Child member Complaints 2 1 3 0 2 1 1 1 0 1 1

Grand Total Complaints 4 3 9 0 2 4 3 1 0 4 2

Jan Feb March April May June July August Sept Oct Nov

Complaints

• The complaint categories identified do not have enough volume to suggest a trend at this time

• All complaints will continue to be monitored• Complaints documented at VO’s Helpdesk

related to Web Registration will be transferred to CT BHP data base

Percent of Denials- Administrative and Medical Necessity

66.67%

91.67% 90.24% 91.67%

33.33%

8.33% 9.76% 8.33%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

% Administrative 66.67% 91.67% 90.24% 91.67%

% Medical Necessity 33.33% 8.33% 9.76% 8.33%

Aug Sept Oct Nov

Appeals

• Overall appeal rate is less than 1% of authorizations

• A typical denial (>90%) is generated by failure to adhere to administrative process rather than Medical Necessity determination

Grievances

• No Grievances filed in November of 2006

System’s Management

System Management Update

• System Managers held numerous community meetings to finalize assigned LADPs for submission in November

• The final Six LADPs were submitted and approved by the Departments in November

System Management Update con’d

• System Managers have established local oversight bodies for the implementation and monitoring of the LADPs

• System Managers whose plans were approved in October began the implementation process in November and have convened and facilitated meetings with their respective oversight bodies

System Management Update con’d

• Statewide themes and regional variations across all 15 plans are being compiled for future presentations and strategic planning purposes

• All System Managers were trained and began the initial phase of utilizing project management to monitor, track and prepare for reporting on the status of each plan

System Management Update con’d• System Managers presented approved LADPs

to local Community Collaboratives, Local Department of Children Area Advisory Councils and Managed Service System members

• System Managers continue to actively participate in community meetings and initiatives across the state

• Requests for LADPs are currently being tracked

Community Interaction:Peer/Family Services

Peer Support Unit

The Peer and Family Peer Specialists worked with 68 CT BHP members and/or families in November.

Peer and Family Peer Specialists attended:

9 Community Collaborative Meetings16 Community Outreach Meetings 1 CT BHP Consumer and Family Advisory Sub-Committee Meeting 2 Home visits with members 1 Visit at ED with member 1 Child Specific Team Meeting 3 Treatment/Discharge Planning Meetings with members/families17 Referrals were given to various agencies and organizations

Outreach Activities for Peer Unit Help Me Grow Breakfast in Waterbury In-Service Training to the Middletown Adult Education

Teachers Presentation to the Even Start Program Meeting with the Middlesex Coalition for Children Attended Provider Presentation on Respite Services in South

Central Region Co-Hosted Provider Fair for School District and DCF Personnel

with the NE Collaborative Members Eastern Connecticut Cooperative Workgroup Meeting to Plan

Spring Workshops Attended the Families United Support Group in Plainville

Examples of Referrals Given by Peer Unit

Worked with MCO to resolve a transportation issue for member Department of Mental Health and Addiction Services (DMHAS) Connecticut Autism Spectrum Resource Center Access Agency Office of Protection and Advocacy DCF Ombudsman Children’s Law Center Legal Aid Statewide Legal Services North Star Support Group Tri-State Support Network for Families Raising Children with

Bipolar- The Connecticut Group AFCAMP, Families United, PAP, NAMI-CT FAVOR Advocate