Semi-Annual Behavioral Health Stakeholders ConveningMagellan in Louisiana: Transforming our System

04.17.13

Getting started – A year of transition

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Pre 3/1

• Build the infrastructure• Train and engage• Build the network

3/1

• Turn on the lights• Answer the phones• Ensure continuity of care (Priority No. 1)

3/1- Now

• Address challenges that come with large-scale change

• Refine the program• Learn the nuances; adjust as needed• Train and teach and train some more

Before the Louisiana Behavioral Health Partnership

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IP CRISIS SERVICES ADULT SERVICES CHILDREN

SUBSTANCE ABUSE OUTPATIENT

General Hospital ER OBH/LGE CMHC services

OBH/LGE CMHC services

Medical Detoxification

Psychiatrist

LSU teaching Hospital

Medication Management/Nursing medication administration

Medication ManagementNursing medication administration

APRN

Psychiatric Hospitals

Psychological TestingMHR services-PSR/Community Support /Family child interaction

Some nursing and SW services

State Hospitals Psychological Testing

Medical and nonmedical psychologists

MST

After the Louisiana Behavioral Health Partnership

IP CRISISNEW &

EXPANDED SERVICES ADULT

NEW & EXPANDED SERVICES CHILDREN

CSOCCHILDREN

SUBSTANCE ABUSE OUTPATIENT

General Hospital Telephonic Crisis Triage ACT /FACT TGH TGH

Detox IPDetox RTCDetox OP

Outpatient CMHC/ FQHC

Free Standing Psychiatric Hospital

Mobile Services (Face to Face) PSR PSR PSR SA RTC MHR

LSU Teaching Hospital Crisis Residential CPST CPST CPST IOP Individual

State Hospital CI services CI CI CI OP Psychiatrist

Emergency Rm Telepsychiatry Case Conference Case Conference Suboxone Licensed and medical psychologist

FQHC NMGH NMGH LCSW

ECT TFC TFC LPC

ICM MST MST LMFT

Psychotherapy FFT FFT LAC

Psychological Testing PRTF PRTF

Psychotherapy Independent Living/Skills Building

Psychological TestingParent /Youth Support

and Training(FSO)

Wrap around Facilitation (WAA)

Crisis Respite

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Transformation Is Not Easy…

… But it’s the END GAME that counts

Mission: Magellan will provide a platform to achieve the goals of the Louisiana Behavioral Health Partnership by improving the behavioral health care of children, adults, and families of Louisiana so that they may live long happy lives in their communities. Magellan will partner with our diverse stakeholders to create an innovative landscape so that resilient Louisianans may truly take control of their lives and achieve personal Recovery.

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Vision: Magellan will transform the landscape of behavioral health care delivery in Louisiana by providing an infrastructure that paves the road to Recovery, Resiliency, good health and happiness. Louisiana’s behavioral health system will be first in its class.

Reshaping lives for generations

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Meeting challenges head on

Meet people where they are: About 100,000 miles travelled across Louisiana

Ensure Continuity of Care: Priority No. 1

Address provider concerns• Adjusted Care Management

program to reduce wait times• Train staff constantly on nuances of

program• Focus on eligibility• More than 300 fixes or

enhancement to Clinical Advisor

Transforming Care in Louisiana

Clinical Outcomes

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Shifting the Paradigm

April May June July Aug Sept Oct Nov0

5

10

15

20

25

30

35

Adult IP Bed Days Per 1,000

BD/K

April May June July Aug Sept Oct Nov0

1

2

3

4

5

6

7

Adult IP Admits/k and ALOS

10

Shifting the Paradigm

April May June July Aug Sept Oct Nov0

50

100

150

200

250

300

350

Adult Medicaid CPST (HCBS)

April May June July Aug Sept Oct Nov0

2

4

6

8

10

12

Adult Medicaid CPST (HCBS) Admits/k

11

Shifting the Paradigm

April May June July Aug Sept Oct Nov0

1

2

3

4

5

6

7

8

Child Psych IP ALOS and BD/k

April May June July Aug Sept Oct Nov0

0.2

0.4

0.6

0.8

1

1.2

1.4

Child Psych IP Admits/k

12

Shifting the Paradigm

April May June July Aug Sept Oct Nov0

50

100

150

200

250

300

350

400

Child Medicaid CPST (HCBS) Units/k

April May June July Aug Sept Oct Nov02468

101214161820

Child Medicaid CPST (HCBS) Admits/k

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Examining access and recovery

March April May June July Aug Sept Oct Nov0%2%4%6%8%

10%12%14%16%18%20%

IP Readmits

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Examining access and recovery

March April May June July Aug Sep Oct Nov0%

2%

4%

6%

8%

10%

12%

14%

Residential Readmits

Evidenced-Based Practices

Mar-12Apr-1

2

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

0

1

2

3

ACT (Adults)

Medicaid Adult

Mem

bers

/k re

ceiv

ing

ACT

Mar-12Apr-1

2

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

00.5

11.5

22.5

MSTHomebuildersFFT

Mem

bers

/k i

n se

rvic

e

Moving people toward Recovery

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 3102468

1012141618

Highest Utilizers

TOTAL READMITS BEFORE 09-01-12

TOTAL READMITS AFTER 09-01-12

Top 32 Highest Utilizing Members

Num

ber o

f Rea

dmits

Increasing Access to Care

Improving access through Network Development

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Increasing Access: Building the Network

Feb 28 vs. October 24 network composition

Pre-implementation Adult Bed CapacityCurrent Adult Bed Capacity

-

500

1,000

1,500

2,000

2,500

1,204

2,247

Inpatient psych beds increased by 86% across Louisiana due to contracts with free standing psych units for adults

RFP Deliverables Strategy – Where are we now?

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Network Comparison 11-May 12-Oct

Access Points 10-

12-2012 1-Mar

Access Points 3-

1-2013 OMPT-OTHER MASTER THERAPIST 183 222 216 274 APRN 25 35 39 69 SOCIAL WORKER 157 176 201 273 PSYCHOLOGIST 36 52 62 76 161 PSYCHIATRIST 213 104 168 134 372 SUB-TOTAL 635 521 663 666 1,149 Practitioner Roster Staff 12-Oct 1-Mar Behavioral Health Specialist 84 115 CERTIFIED ADDICTION CONSELOR 12 OTHER MASTER THERAPIST 72 APRN 157 194 SOCIAL WORKER 551 721 PSYCHOLOGIST 37 52 PSYCHIATRIST 257 472 SUB-TOTAL 1,098 1,154 TOTAL 635 1,619 663 1,820 1,149

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Where we are now

86% increase in psychiatric bed capacity300 active provider locations using Clinical Advisor251 provider locations contracted for Crisis Intervention service183 new OMPTs brought in throughout the state all additional capacity

that added since 3/1First two Licensed PRTF beds (108) in placeOngoing dialogue with several hospitals engaged in dialogue about expansion of services array to include PRTFTGH 8 beds licensed in the state- ongoing conversations to encourage programs to obtain licensureTFC 248 bedsNon- medical group home 230 beds

Where we’re going: Network Plan

• Identify network gaps using the following details:– Readmission rates– LOS– Adverse Incidents

• Develop and Submit RFP for:– Crisis Continuum

• Crisis Receiving Centers• Crisis Stabilization• Crisis Residential

– Therapeutic Group Home– Therapeutic Foster Care– PRTF– EBP

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Where we’re going: Network Plan

Complete the Crisis System Build out in all regions

• Mobile Crisis Services

• CART Teams

• 23-hour Observation/Crisis Receiving Centers

• Telehealth

• Peer-run warm lines

• Crisis Stabilization Services

• Crisis Residential Services

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Where we’re going: Network Plan

• Current Strategies To Date– Identifying providers who

could transition existing facility to new levels of care

– Direct outreach– Direct support and direction

with licensing, certification and contracting process

• Strategies Under Consideration– Email blasts to assess interest

of current Network providers– Educational webinars– Regional Town Hall meetings

to engage regional leaders and stakeholders

– Identify licensing, programmatic or financial barriers to any LOC development

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Complete the crisis system build out in all regions- Strategies

Where we’re going: Network Plan

Expand Evidence Based Practice (EBP) capacity through learning and technical assistance

• Partner with Medical Director to expand into EBP for 0-5 population

• Partner with System Transformation to assess the need to expand existing EBP

• MST (30 providers across the state)

• FFT (7 providers across the state)

• Homebuilders (10 providers across the state)

• ACT (11 teams across the state)

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Provider Relations Plan

• Developing plan to include the three overarching goals– Enhanced Provider Communication

• Provider Relations Network team re-structure • Utilization of E-mail blast notification• Timely Provider Communications• Partnership Provider News• Provider Website/Increase Provider Self Service• Timely Telephonic Communication

– Enhanced Collaboration with Providers• Provider Meetings and Combined Stakeholder Meetings• Provider Satisfaction Surveys

– Enhanced Provider Education• Webinar Provider Forums• Provider Relations / On-Site Visits• New and Contracted Provider Orientation and Training

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Provider Dashboard – Monthly Drill Down

What are they?Fully interactive online data management platform for providers, with drill down capabilityEasy to use, visual representation of dataThe same outcome measures which help to guide decisions on the evolution of the LBHP networkOn-line data management platform

Why do we offer them?Provider self-managementUse of data to inform qualityTransparencyPartnershipTool to aid in program improvement, benchmarking, and other QI management strategies

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Provider Dashboard – Phase 2

Rolled out Phase 2 with training to providers on March 21

Providers included:Outpatient Mental HealthOutpatient Addictions TreatmentPsychiatric RehabilitationCommunity Psychiatric Supportive Treatment, including HomebuildersMultisystemic Therapy

Metrics include:Number servedNumber served by diagnostic categoryAverage number of services per member

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Provider Quality Improvement Projects

PCP Coordination: The item with the lowest compliance is coordination of care with PCP. The current compliance rate across all levels of care is 31.2%. The QI department is currently working on a system wide Performance Improvement Project with PCP coordination. This project is still in its pilot phase and rollout is expected within the 2nd-3rd quarters.

Discharge Process/Planning: Discharge planning was also identified as an opportunity for improvement by UM to improve their 7 and 30 day follow-up hospitalization rates and items and QI to address deficiencies identified through the TRR process. The total discharge aggregate is currently 84.7%; however, outpatient facilities have an aggregate score of 51.5% and WAAs have an aggregate of 40%. QI will be collaborating with UM’s Follow-up Hospitalization QIP to improve the discharge process to ensure member’s receive adequate care following discharge. This QIP is in the analyze stage.

A new TRR audit tool under development will have a weighted component to support these two initiatives.

The numbers

Claims

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Claims

1/21/2013 1/31/2013 2/3/2013 2/18/2013 2/24/2013 3/3/2013 3/10/2013 3/17/2013$5,100,000

$25,100,000

$45,100,000

$65,100,000

$85,100,000

$105,100,000

$125,100,000

$145,100,000

Claims Paid

ChildAdult

Looking ahead

Year 2 and refining the program

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Strategy for Year 2

Fully implement 0-5 programsExpand crisis networkExpand children’s network (PRTF; therapeutic group homes)Use data to drive additional service opportunities through “in lieu of” agreementsOutreach to non-traditional referral sources, such as PCP community and law enforcementFocus on PCP, BAYOU HEALTH coordination of careWork toward Meaningful Use in CAImprove reach and focus of RCM program, emphasizing diagnostically-driven criteriaDrive improvements in discharge planningDrive change in crisis response away from ERs and PECs to better use of community programs