ValueAdded

This is the 207th issue of our VBH-PA information update. These updates will be

emailed to network providers monthly. Please feel free to share our newsletter

with others, and be sure your appropriate clinical and financial staffs receive

copies.

Inside this issue

Provider Policy Clarification Update ........................................ 2 Partners for Performance Improvement ................................ 3 Save the Date! Best Practice Forum for Inpatient Providers .................. 4 National Recovery Month ............. 5 National Suicide Awareness Month ........................................... 5 Adherence to Antipsychotic Medications for Individuals with Schizophrenia ................................ 6 Save the Date! “Acknowledging The Journey” ................................. 7 Updated Services Webpage ......... 7 VBH-PA Receives NAMI Walks Award ........................................... 7 Join Us! 10th Annual Family Forum ................................ 8 2016 CAMP “T.A.A.G.” Picnic ........ 10

Vol. 18 Issue 9 September 2016

Notification of Change in Access

to Services

Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA)

by calling their Provider Field Coordinator or through notification in writing by

mail, email or facsimile to 1-855-541-5211 (attention Provider Relations

Department) upon the occurrence of any of the following:

1. Inability to provide emergent care within one hour, urgent care within 24

hours, or routine care within seven days.

2. Usage of alternative provider coverage in any situation when unable to

treat VBH-PA members in active treatment, e.g. vacation.

3. When reaching full (100%) capacity. Full capacity is considered the point

at which the provider is unable to meet the access standards noted above

or is unable to accept referrals for a particular level of care. Notices for full

(100%) capacity should contain the reason for reaching capacity, the

effective date, and the steps the provider will take to resume functioning at

normal capacity.

4. The inability to provide any portion of a prescribed service, e.g. BHRS.

Network providers must offer hours of operation that are no less than the hours

of operation offered to commercial members or comparable to Medicaid fee-for-

service if the provider serves only Medicaid members. You may find this

information in our online Provider Manual:

http://www.vbh-pa.com/provider/info/prvmanual/4_PartPrvResp/

notification_change_access_svcs.htm

2 ValueAdded—September 2016

VBH-PA Provider Policy Clarification Update Encounter Coding for HealthChoices Outpatient Psychiatric Clinic Services

The Office of Mental Health and Substance Abuse Services (OMHSAS) issued a policy clarification effective August 10,

2016, outlining changes to Bulletin #03-16-01 Encounter Coding for behavioral health HealthChoices (BH-HC) service

providers for outpatient psychiatric clinic service encounters by using an evaluation and management (E/M) code based on

the complexity of an individual’s condition rather than both complexity and duration of the encounter. VBH-PA supports

providers in making the changes outlined in the bulletin August 10th and forward.

On January 1, 2013, the American Medical Association (AMA) published updated E/M codes. CMS then published an

updated E/M services guide in November 2014. The coding and guidance provided by CMS allowed for use of complexity

of care to be a primary criterion for reimbursement for services. In implementing the 2013 E/M services, the Pennsylvania

Department of Human Services (DHS) exercised its right as a State Medicaid Program to be more restrictive. Specifically,

DHS required specific minimum units of time in addition to the complexity. In response to requests by stakeholders,

including VBH-PA and its primary HealthChoices contractors, OMHSAS convened the affected bureaus to consider

implementing a revised approach to the E/M usage for outpatient psychiatric clinic codes in HealthChoices as proposed by

the AMA and allowable by CMS.

The policy clarification identifies the changes required for E/M submission. The change requires, as an alternative,

identification of the appropriate code application using the consideration of three key components:

The extent of history

The extent of examination performed

The extent of the medical decision-making

These three components establish a relationship within the coding to identify the complexity of the presenting problems so

time and/or duration of the service is not being used as a proxy for complexity.

The code sets to bill for E/M services are organized into various categories and levels. In general, the more complex the

visit, the higher the level of code you may bill within the appropriate category. To bill any code, the services furnished must

meet the definition of the code. You must ensure that the codes selected reflect the services furnished. Providers can

reference the Department of Health and Human Services Centers for Medicare & Medicaid Services Evaluation and

Management Services’ booklet at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/

MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf.

While VBH-PA recognizes the above changes effective August 10, 2016, VBH-PA may take up to nine months to amend its

provider agreements accordingly. Further, the policy clarification states the actual time spent is required for documentation

but will not be considered as a measure of complexity when the code choice is made based upon the three components and

documented appropriately.

Please visit http://www.vbh-pa.com/provider/info/pr/OMHSAS-Policy-Clarification-03-16-01.pdf for the complete policy

clarification. Providers may contact Jennifer.putt@beaconhealthoptions.com for additional clarification.

3 ValueAdded—September 2016

Update on the statewide project “Successful Transitions from Inpatient

Care to Ambulatory Care”

Partners for Performance Improvement

OMHSAS has selected this topic for a three-year statewide performance improvement project. The core objectives of this

project include:

Reducing behavioral health and substance abuse inpatient readmission rates

Increasing kept ambulatory follow-up appointments after an inpatient discharge

Improving medication adherence rates of individuals with schizophrenia post inpatient discharge

Improving discharge management planning

One key aspect of this performance project includes evaluating the documentation of discharge planning, via chart reviews,

that occurs at inpatient facilities and then measuring members’ attendance of their scheduled follow-up appointments. The

elements to be reviewed were established at the start of this project by OMHSAS and are being measured consistently by all

five BHMCOs. In April 2015, VBH-PA conducted reviews to obtain a baseline score at our four selected inpatient

providers (Sharon Regional Health System, Washington Health System Greene, Heritage Valley Beaver, and Excela

Westmoreland). In February and March of 2016, VBH-PA conducted follow-up chart abstractions to identify any changes

in the documentation of discharge planning. Table 1 shows the average of the 2015 and 2016 chart reviews conducted at the

four inpatient facilities (30 charts per facility).

Chart Review Results

2015

Overall Average

2016 Overall Average

Discharge Plan/Discharge Instruction Sheet (DMP) was present in the chart

99% (119/120)

96% (111/120)

Copy of the DMP was given to the member 98%

(117/120) 90%

(108/120)

Medication reconciliation was documented 25%

(30/120) 25%

(30/120)

Follow-up visit scheduled within 0-7 days of discharge 8%

(10/120) 35%

(42/120)

Follow-up visit scheduled within 0-14 days of discharge 13%

(15/120) 44%

(53/120)

Scheduled follow-up visit kept 67%

(10/15) 45%

(24/53)

Medication reconciliation was documented and follow-up visit scheduled within 0-7 days

3% (3/120)

13% (15/120)

Medication reconciliation was documented and follow-up visit scheduled within 0-14 days

3% (3/120)

14% (17/120)

Medication reconciliation was documented and follow-up visit kept within 0-14 days

3% (3/120)

8% (10/120)

Table 1

Article continued on page 4.

Save the Date!

Best Practice Forum for Inpatient Providers

Join Value Behavioral Health of Pennsylvania as we host an all-day Best Practice Forum

for our Inpatient Providers, Friday, October 14, 2016 at Marriott North in Cranberry

Township. Topics of focus include presentations from our Best Practice providers, poster

presentation review and networking, and afternoon round table discussions. This is your

chance to meet with your peers to see what they are doing to be a Best Practice

provider! Learn how your facility can reach quantifiable goals more efficiently. There is

no cost to attend this training; breakfast and lunch will be provided free of charge. Look

for your invitation coming soon!

4 ValueAdded—September 2016

Partners for Performance Improvement (continued)

Below is a sample of a well-documented follow-up appointment:

Provider Name/Specialty or Degree: Dr. Seuss, Psychiatrist

Provider Organization: Maple Counseling Services

Full Address: 100 Main St., Town, PA 15222

Provider Phone Number: (724) 888-8888

Date/Time of Appointment: 1/1/2016 @ 2:00 p.m.

Medication reconciliation needed to include the medication the member was taking prior to admission, during the inpatient

stay, and upon discharge in order to be considered as compliant.

As part of the project requirements, VBH-PA had to establish specific quantifiable goals to reach by the end of this project

in 2017. The information below shows our current results compared to our established goals. These results illustrate that

progress has been made, but that additional improvement opportunities remain in order to positively impact these rates.

Metric Goal 2016

Results 2015

Results

Medication reconciliation was documented and follow-up visit scheduled with 0-7 days

40% 13% 3%

Medication reconciliation was documented and follow-up visit scheduled within 0-14 days

40% 14% 3%

Medication reconciliation was documented and follow-up visit kept within 0-14 days

50% 8% 3%

VBH-PA will be conducting the next round of chart reviews with these same four providers in February/March of 2017.

VBH-PA would like to thank our partner providers for their work and collaboration on this project.

5

ValueAdded—September 2016

About Recovery Month National Recovery Month (Recovery Month) is a national observance held every

September to educate Americans that substance use treatment and mental health

services can enable those with a mental and/or substance use disorder to live a

healthy and rewarding life. People can and do recover!

Recovery Month celebrates the gains made by those in recovery, just as we

celebrate health improvements made by those who are managing other health

conditions such as hypertension, diabetes, asthma, and heart disease. There are

millions of Americans whose lives have been transformed through recovery. Since

these successes often go unnoticed by the broader population, Recovery Month

provides a vehicle for everyone to celebrate these accomplishments.

Now in its 27th year, Recovery Month highlights the achievements of individuals who

have reclaimed their lives in long-term recovery and honors the treatment and

recovery service providers who make recovery possible. Recovery Month also

promotes the message that recovery in all of its forms is possible and encourages

citizens to take action to help expand and improve the availability of effective

prevention, treatment, and recovery services for those in need.

The Recovery Month theme is carefully developed each year to invite individuals in

recovery and their support systems to spread the message and share the successes

of recovery. Learn more about this year’s theme.

Materials produced for the Recovery Month observance include print, Web,

television, radio, and social media tools. These resources help local communities

reach out and encourage individuals in need of services, and their friends and

families, to seek treatment and recovery services and information. Materials provide

multiple resources including SAMHSA’s National Helpline 1-800-662 HELP (4357) for

information and treatment referral as well as other SAMHSA resources for locating

services.

Local Recovery Events

Join the 5th Annual Recovery Celebration at Diamond Park in Meadville, PA on

September 23rd. VBH-PA is sponsoring a new speaker at this year’s celebration,

Brandon’s Dad. Don’t miss out on this poignant topic—alcohol and the effects of

DUI.

September is Also National Suicide Awareness Month

Suicide is the third leading cause of death among young

people and is often the result of mental health conditions

that effect people when they are most vulnerable. In

many cases the individuals, friends and families affected

by suicide are left in dark, feeling shame or stigma that

prevents talking openly about issues dealing with suicide.

See more at: http://www.nami.org/Get-Involved/

Awareness-Events/Suicide-Prevention-Awareness-

Month#sthash.1aaCZ8AI.dpuf

September 2016 is known as National Suicide Prevention Awareness Month which helps promote awareness around the

issues of suicide prevention, how you can help others, and how to talk about suicide without increasing the risk of harm.

6 ValueAdded—September 2016

Adherence to Antipsychotic Medications for Individuals with

Schizophrenia: Goals Met Within First Year of Study

Gateway HealthSM and VBH-PA are collaborating on an initiative to increase medication adherence for our shared members

with schizophrenia who are prescribed antipsychotic medications. An article published in the World Journal of Psychiatry in

2012 estimated that non-adherence rates in schizophrenia are about 50%, and of the over $10 billion annual cost of

schizophrenia, 40% was observed to be attributed to non-adherence. (Acosta FJ, et al. Medication Adherence in

Schizophrenia. World J Psych. 2012; 2(5):74-82 [NCBI]).

Upon review of prescription and refill history, members are identified for an educational mailing who may be less than 80%

adherent based on the proportion of days covered for their antipsychotic medications. The reasons for non-compliance are

varied and can depend on the many factors which influence the strategies for improving adherence. We have developed a list

of tips for your reference to address non-adherence with your patients (Table 1).

Reason for Poor Medication Adherence Possible Tools and Strategies for Addressing

Adherence Barriers

Cognitive factors (such as poor memory, difficulty understanding, etc.)

Encourage patients to sign up for automatic refills at their pharmacy

Set up an alarm; place post-it notes around the house

Use a pill box

Internal beliefs about medicine Provide simple, patient-friendly education about the disease state and why the medication is important to take

Consider cultural, spiritual, and religious beliefs that may impact treatment plans

External system and health barriers Adverse event—education on best ways to take medication to avoid unnecessary adverse events/side effects or change to a medication that is better tolerated

Complicated regimens—look for ways to simplify or use pill boxes

Table 1

Please consider using this information to reach out to your members if they have not been into the office recently to see you

or to initiate a conversation with them at their next visit about the importance of taking their medications. Please also

explore the potential cause of their non-adherence and develop a plan together to address the main causes.

Did You Know?

Many retail pharmacies offer automatic refills. Remind your patients to take advantage of this service.

If patients have trouble getting to the pharmacy there are sometimes free delivery programs available. Refer your

patients to their retail pharmacist.

Open communication with your patients’ other providers can help with medication reconciliation. If you are not a

particular patient’s PCP, consider reviewing the medical chart together with the PCP.

As part of the statewide improvement project, one of the measures to be analyzed included adherence to antipsychotic

medication for individuals with schizophrenia. The network-wide average, set back in 2014, indicated that only 57% of our

members had an 80% or higher compliance rate (Figure 1).

Article continued on page 9.

7 ValueAdded—September 2016

VBH-PA Receives NAMI Walks Award for

Being in the Top Ten Fundraisers

Upcoming BHRS Summits

(Your choice of two

locations per month.)

September 9 —

Hampton Inn & Suites

Mercer, PA

September 16 —

Courtyard by Marriott

Greensburg, PA

December 2 —

Courtyard by Marriott

Greensburg, PA

December 9 —

Hampton Inn & Suites

Mercer, PA

Upcoming RTF Summits

Friday, October 7th

9:00 a.m.—11:00

a.m.

Location:

Doubletree by Hil-

ton

910 Sheraton Drive,

Mars, PA 16046

View all of our

upcoming trainings

on the Provider

Trainings webpage:

http://www.vbh-

pa.com/provider/

prv_trn.htm

At the NAMI Walks kick-off luncheon on August 24th, VBH-PA

was awarded a special certificate for their hard work and dedication

in support of NAMI Walks. Specifically, we were in the Top Ten

Team Fundraisers for the first time in our history! Go Team VBH-

PA! We are looking for a similarly successful Walk this year on

Sunday, October 2nd at the Waterfront in Homestead. Sue Klaus,

PE&O Manager and our team leader, accepted the award and will be

organizing our team this year. This is NAMI SWPA’s 10th

anniversary. Support NAMI’s mission by walking and raising funds

for this great organization. Visit their website at: http://

www.namiwalks.org.

All are welcome—adult members, family members, County staff, provider staff and anyone

interested in learning more about how people with mental illness recover!

Save the Date!

Thursday, November 10, 2016

Registration begins at 8:00 a.m.

9:00 a.m. — Child Services Sessions

Noon — Exceptional Individual and Parent Awards Luncheon

1:45 p.m. — Adult Services Sessions

More information and registration coming soon!

Please consider nominating an Exceptional Individual (Adult) and/or an Exceptional Parent/

Caregiver for the Annual Awards Ceremony. Contact Shelley Thomas with any questions you

may have regarding nominations. Nomination forms will be available soon! If you are

interesting in exhibiting at this year’s forum, please email Shelley Thomas at

shelley.thomas@beaconhealthoptions.com.

Sue Klaus, PE&O

Manager, accepting

NAMI Walks award

“Acknowledging the Journey” 9th Annual Family & Adult Behavioral Health Forum

A Value Behavioral Health of Pennsylvania Family and Adult Members Forum

Crawford, Mercer and Venango Counties

Updated Services Webpage

Visit http://www.vbh-pa.com/services.htm to view our updated Services webpage. Click

on Psychiatric Rehabilitation Services to view services updates, requirements, forms and

much more! The Services webpage will be going through ongoing changes — Outpatient

Mental Health Services is next — so check back often!

8

ValueAdded—September 2016

Join Us! 10th Annual Family Forum

For Families with Children in HealthChoices

“Transition and Effective Storytelling:

Blueprints into Our World”

Where: Ramada Greensburg Hotel

and Conference Center

100 Ramada Inn Drive

Greensburg, PA 15601

When: Friday, October 7, 2016

Time: 9:00 a.m. to 3:00 p.m.

Registration begins at 8:30 a.m.

Featuring:

Twisted Sisters—A Funny Thing Happened on the Way

to the White Picket Fence

The ever-inspiring Exceptional Parent/Caregiver

Awards Ceremony

Afternoon Breakout Sessions

Tons of exhibitor tables, and much more!

GENERAL REGISTRATION

General registration is now open! Click here for the Family Forum Registration

Brochure. Hurry! Deadline for registration is September 30, 2016.

EXHIBITORS

Would you like to exhibit at this year’s forum? Visit our homepage at www.vbh-pa.com

for the Family Forum Exhibitor Registration Form. Hurry! Deadline for exhibitor

registration is September 30, 2016.

HealthChoices’ families living in Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Lawrence,

Washington and Westmoreland Counties are invited to attend. Mercer, Crawford and Venango Counties

HealthChoices’ families will have the opportunity to attend other regionally held VBH-PA forums in 2016.

9

ValueAdded—September 2016

VBH-PA expected to reach a final goal of 61% compliance rate by the end of project year 2017. However, in one year VBH-PA

was able to reach a goal of 61% medication adherence by 2015 (Figure 2). VBH-PA was able to achieve this goal by partnering

with Gateway Health Plan. The team implemented targeted interventions, which included providing education to members on

the importance of medication adherence, and developing a communication tool for prescribers in regards to the members’ rates

of compliance.

Figure 1

Adherence to Antipsychotic Medications (continued)

Although the project goal for medication adherence was met, further analysis and additional interventions are still needed to be

pursued in the near future. One such avenue is the utilization of Long Acting Injectable Antipsychotics (LAIAs). VBH-PA is

exploring such options with Janssen Pharmaceuticals of Johnson & Johnson. This program utilizes local pharmacy participation

to increase members’ flexibility in scheduling and provides a neutral site for medication administration. Prescribers are also

notified when their member has missed a scheduled injection that day. Due to surveillance of the monthly medication injection,

adherence rates are more easily tracked and interventions can be achieved faster and at a higher success rate. Variables that are no

longer a factor with regards to member compliance with oral medication include forgetting to refill prescriptions or taking daily

medication. This once a month injection allows members freedom to pursue normal day-to-day activities without the nuances of

remembering to take their medication.

For further information about the information in this article, please contact Neil Amina at (724) 744-6381 or email at

Neil.Amina@beaconhealthoptions.com.

Figure 2

10 ValueAdded—September 2016

The 5th Annual “T.A.A.G.” Picnic was held on Wednesday, August 10, 2016, at the Family

Resources Family Retreat Center in Mars, PA. Eighty-eight youth/young adults attended

from 11 counties, along with VBH-PA staff and other adults who supported the youth/

young adults during their time at CAMP “T.A.A.G.”, for a total of 148 registrants! With the

schedule jammed packed, the participants enjoyed fishing, canoeing, hiking, swimming, a

sports court, crafts, dancing, a team-building rope course, a zip line, and much more!

Exhibitors brought their information and swag for the youth/young adults to collect. This

year’s exhibitors included “T.A.A.G.”, VBH-PA, AMI, Human Services Center, Keystone

Wellness Programs, Allegheny Health Choices, Pressley Ridge, Gaudenzia Erie, Inc., Family

Behavioral Resources, UPMC for Kids, UPMC for You, Washington Health System Greene,

Westmoreland Community Action, Clarion Psychiatric Center, Aetna Better Health, Center

for Community Resources, Inc., and Westmoreland Casemanagement and Supports, Inc.

The youth/young adults stated on their evaluation forms that they really enjoyed the

exhibitors and want to ask them back for next year.

We were fortunate to have Lon Emerick come and bring his “Stamp Out Stigma” racecar.

It was a huge hit! Other special events that took place during the day were a pass, punt and

kick contest, scavenger hunt, 99.7 Street Treat Patrol, and corn hole competition. Another

highlight of the day was DJ Gia. She really had members movin’ and groovin’ on the dance

floor!

After all the donated gift baskets from the exhibitors were raffled off, thank-you’s were

made, and final goodbyes said, I was reminded once again of how youth/young adults,

given the chance to interact from a variety of very diverse cultures, can come together and

enjoy each other’s company. At this year’s CAMP “T.A.A.G”, we all STAMPED OUT

STIGMA! Until next year’s “T.A.A.G.” picnic, we bid a fond adieu.

The 6th Annual “T.A.A.G” picnic will once again be at the Family Resources Family

Retreat Center in Mars, PA. Save the Date—Wednesday, August 9, 2017. We hope to

see you there!

2016 CAMP “T.A.A.G.” Picnic

Suggestions or ideas

for articles that you

would like to see pub-

lished in ValueAdded

can be faxed to Kim

Tzoulis, ValueAdded

Editor, at (724) 744-

6363 or emailed to

kimberly.tzoulis@

beaconhealthop-

tions.com

Articles of general

importance to the

provider network will

be considered for

publication.

Value Behavioral

Health of PA, Inc.

520 Pleasant Valley Rd

Trafford, PA 15085

Phone: (877) 615-8503

Fax: (724) 744-6363

www.vbh-pa.com

Article by Karan Steele, Prevention, Education and Outreach Coordinator