Magellan Behavioral Health of Nebraska, Inc. Utilization Management April 18, 2014, 3:00 pm – 4:00 pm Magellan Conference Room Committee Chair: Minutes prepared by: Participants Andrew Shapiro Janine Fromm Julie Hoeschen Lori Hack Rachel Nick Tamara Gavin Travis Parker 1 Tamara Gavin Jamaree Maack Capacity/Affiliation Chief Operating Officer Magellan Behavioral Health of Nebraska, Inc. Medical Director Magellan Behavioral Health of Nebraska, Inc. Quality Outcomes Manager Magellan Behavioral Health of Nebraska, Inc. Compliance Officer Magellan Behavioral Health of Nebraska, Inc. Clinical Supervisor Magellan Behavioral Health of Nebraska, Inc. Director of Clinical Services Magellan Behavioral Health of Nebraska, Inc. Director of Systems Transformation Magellan Behavioral Health of Nebraska, Inc. March Minutes Tamara Gavin Discussion: Minutes from the March 24, 2014 meeting were approved unanimously. February 2014 Readmissions Tamara Gavin Discussion: Tamara reported that the March readmission rate for February inpatient discharges was 17.5%. This meets the standard of <20%. Dr. Fromm continues to do reviews for readmissions within 30 days for specific hospitals. Her impression is that the process is educating doctors about the admission criteria and she will continue to do the reviews as long as there is a benefit. The team discussed establishing training for care managers so that they could review all re-admission case similarly to Dr. Fromm and better identify the need for physician review. Ambulatory Follow-Up Tamara Gavin Discussion: Magellan’s targets for Ambulatory Follow-Up from inpatient care are 75% at seven days and 85% at 30 days. The ambulatory follow up rate for individuals discharged from inpatient care in December was 39.7% at seven days and 67.8% at 30 days. Magellan continues to implement interventions to improve AFU rates. A survey will be distributed at the Success Hopes and Dreams conference asking about member experiences with AFU appointments. The survey was reviewed by the Governance Board and the recommendation was made that the zip code be requested. Travis will make this change. There was also discussion about requesting that the survey be posted on the Mental Health Association’s website. Travis will follow up on this recommendation as well. Andrew reported that he is actively working to established Performance-Based Contracting with identified inpatient providers. The contract expectations will include AFU rates. Alegent Hospital has implemented a transition team that provides AFU appointments. There are no claims for these appointments, so it is difficult to determine the frequency of the appointments or include them in AFU rates. Magellan Telehealth is active. Providers have been loaded through Breakthrough, and the committee may be able to look specifically at AFU appointments using telehealth. Julie reported that Provider Dashboards will include the AFU rates of inpatient providers. Preparation for the Dashboards is in final stages and she anticipated initial implementation prior to the next meeting. Customer Service Associates have begun calling Lincoln providers to determine the availability of evening and weekend appointments. They are also asking providers if they prioritize ambulatory follow up appointments. In total, they will be contacting 534 providers. 2 ACTION: Tamara will look at 3 months of data specifically for members who did not have an AFU appointment. She will assess the group more specifically by demographic such as gender, location, age, and diagnosis. Continue- Tamara received this data and is evaluating all of the information. ACTION: Travis will discuss AFU in upcoming meetings with the medical plans. Continue ACTION: Lisa Casullo will begin discussion with the facilitators of community committees she serves on about the possibility of them hosting member forums with Magellan. ACTION: Lisa Casullo will introduce AFU as an agenda item in the children and adult consumer committees, as well as community committees she is a part of as appropriate. Lisa Casullo was not able to attend the meeting. These items will be discussed when she is in attendance. ACTION: Lisa and Teresa will pursue adding a question about 7 day accessibility to the 2014 surveys. They will also ask about the option of adding a qualitative question to seek additional feedback from providers. Teresa and Lisa were not able to attend the meeting. These items will be discussed when they are in attendance. Recovery Care Management Tamara Gavin Discussion: RCM continues to increase the number of members being served in the program. Currently the program is averaging 40 members per RCM care manager. Magellan Mobile Connect is active and distribution of Trac Phones has begun with RCM members. Requests for Higher Levels of Care Tamara Gavin Discussion: In March Customer Service Associates authorized 48% of requests for higher levels of care. Changes in the review metrics allow for the increase in cases that did not require Care Manager review. Inter-rater Reliability Tamara Gavin Discussion: The Inter-Rater Reliability assessment in March was a PRTF application. There were no concerns with the outcome decisions made by care managers or physician reviewers who reviewed the application. Concordance Rate Tamara Gavin Discussion: The Concordance rates for March were consistent with previous months. Performance Improvement Projects Julie Hoeschen Discussion: Julie reported on the ongoing Performance Improvement Projects as they relate to utilization management. One PIP is focused on reducing inpatient readmission rates, and all actions taken by the committee related to readmission and ambulatory follow up are being included as interventions on the PIP. The other PIP is focused on patient safety in inpatient and residential 3 settings. Julie reported that RCM activity and trac phone use have been included as interventions for that PIP. UM Program Description Tamara Gavin Discussion: Tamara reported that the UM Program Description is due for revision and approval. She will be making suggested revisions and sending them to the committee for review. She asked that they review and comment so that the final Program Description is available for approval or focused revision at the May UM meeting. This will allow the document to be forwarded to QIC and Governance Board in June prior to implementation on July 1. Task as Requested by QIC None at this time. Tamara Gavin Tasks as Requested by the Governance Board None at this time. Tamara Gavin Next Meeting May 18, 2014 3:00 – 4:00 Magellan Goldenrod Room Respectfully Submitted, (signature) (date) 4
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