Continuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator

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1 Cntinuus Quality Imprvement: Treatment Recrd Reviews Third Thursday Prvider Call (August 20, 2015) Wendy Bwlin, QM Administratr

2 Gals f the Presentatin Review the findings f Treatment Recrd Review results fr cntract year 3. Discuss pprtunities fr identified imprvement. 2 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

3 Why is Quality Dcumentatin imprtant? Keeping accurate and cmprehensive recrds f the services prvided is essential fr prviders: Prvides evidence f Medical Necessity Criteria fr purpses f financial reimbursement Prvides a mechanism fr internal Quality Assurance mnitring. Ensure cmpliance with federal and state Fraud, Waste and Abuse regulatins (Affrdable Care Act). Assists with Cntinuity f Care fr members. Magellan is cntractually required t mnitr cmpliance with federal and state regulatins as well as adherence t clinical practice guidelines. 3 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

4 What is a TRR? A Treatment Recrd Review (TRR) is a review cnducted as part f Magellan s Quality Assurance Prgram. The purpse f the review is t mnitr treatment recrd dcumentatin and recrd keeping practices as required by Magellan fr prviders in the Luisiana Behaviral Health Partnership. Training n TRRs and the TRR Audit Tl can be fund at the Magellan f Luisiana website 4 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

5 Cntract Year 3 Results 193 Prviders (n=2000 charts) were reviewed frm 3/1/14-2/28/15. The Overall Netwrk Cmpliance Rate fr cntract year three was 86.4%. Elements Elements Cmpliance CORE Sectins Meeting Items Rate (%) Cmpliance A - General 7,276 7,535 97% B - Cnsumer Rights and Cnfidentiality 5,863 7, % C - Initial Evaluatin 22, , % D - Individualized Treatment Plan 7,645 9, % E - Onging Treatment 16,811 19, % F - Addendum fr Special Ppulatins 1, , % H - Crdinatin f Care 2,130 3, % I - Medicatin Management , % 5 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

6 TRR Addendums CORE Sectins Elements Meeting Cmpliance Elements Items Cmpliance Rate (%) Addendum - Access t Care % Addendum - Cultural 1, , % Addendum - Service Delivery 1, , % Addendum - Discharge 3, , % Addendum - Medicatin Management 1, , % Addendum EBP: FFT % Addendum - EBP: MST % Addendum - EBP: Hmebuilders % Addendum - OBH/LGE Addendum % Addendum Restraints/Seclusin Ttals % Addendum - Adverse Incidents % 6 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

7 Opprtunities fr Imprvement Member Rights & Cnfidentiality Signed psychiatric advance directives. As part f the initial evaluatin, members shuld be assessed fr existing Advance Psychiatric Directives. A signed and dated cpy shuld be available in the treatment recrd. If nne exists, the ffer t assist and member refusal shuld be dcumented. Mre infrmatin can be fund at Magellan f Luisiana under Advanced Psychiatric Directives Signed infrmed cnsent fr medicatins. Can be dcumented via a cnsent frm and/r nging in physician prgress ntes. Shuld infrm members f the risks, warnings, benefits, and expected utcmes. Sample frm Releases fr cmmunicatin with PCP and ther relevant prviders. 7 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

8 Opprtunities fr Imprvement Crdinatin f Care Dcumentatin f request t member fr PCP cmmunicatin. Recrd reflects cntinuity and crdinatin f care between behaviral health prviders. 25% f Adults have Mental Health Cnditins Physical and Behaviral Health C-ccurring Cnditins 29% f Adults with Medical Cnditins Als Have Mental Health Cnditins 58% f Adults Have Medical Cnditins 68% f adults with mental disrders in the US have medical cnditins that require treatment Surce: Drss, B.G., and Walker, E.R. (February 2011). Mental Disrders and Medical Cmrbidities. Research Synthesis Reprt N. 21. Princetn, NJ: the Rbert Wd Jhnsn Fundatin. 8 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

9 Crdinatin f Care Crdinatin f care fr clients with mental disrders is vital fr quality care: High rate f c-mrbidity f mental and physical cnditins Increased mrbidity and mrtality Accrding t SAMHSA, nly 7.4% f these individuals with cmrbidities receive treatment fr bth cnditin Increased high risk behavirs Mental disrders such as depressin and schizphrenia can influence the prgressin f serius chrnic diseases such as arthritis, diabetes, strke, heart disease & cancer. Side effects f psychtrpic medicatins Review ur Crdinatin f Care presentatin 9 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

10 Medicatin Management Addendum: Medicatin Management Abnrmal Invluntary Mvement Scale (AIMS) perfrmed and dcumented if member is being treated with antipsychtics. 21.8% f Medicaid Members being served in the LBHP were prescribed an antipsychtic frm 3/1/14-2/28/ % f Adult Medicaid Members 18.6% f Child Medicaid Members 10 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

11 Medicatin Management These members require nging mnitring by a physician fr ptential negative side effects. Fasting bld glucse shuld be dne at baseline and mnitred when cmmencing r changing antipsychtic medicatin and then every 3-6 mnths. A full bld cunt shuld be cnducted every 3-6 mnths as best practice. Weight/Bdy Mass Index (BMI) shuld be checked at every visit r every three mnths. AIMS is needed t mnitr fr Extra-Pyramidal effects, r Tardive Dyskinesia Only 20% f patients n atypical antipsychtics receive needed glucse mnitring and nly 10% receive lipid mnitring. ( 11 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

12 Clinical Practice Guidelines Magellan develps r adpts clinical practice guidelines (CPGs) t assist prviders in screening, assessing and treating cmmn disrders. The CPGs fr the fllwing disrders are available t all Magellan prviders n the Magellan prvider website. Acute Stress Disrder & Pst-Traumatic Stress Disrder ADHD Autism Biplar Disrder Depressin Generalized Anxiety Disrder Managing Suicidal Patients Obsessive-Cmpulsive Disrder Panic Disrder Schizphrenia Substance Use Disrders Medicatin-Assisted Treatment fr Substance Use Disrders Review ur Clinical Practice Guidelines 12 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

13 Clinical Practice Guidelines In Luisiana, we mnitr CPGs fr Majr Depressive Disrder, ADHD, Substance Use Disrder, Schizphrenia, and Suicide Risk as part f its TRR prcess. Data fr cntract year three indicates Majr Depressive Disrder and Schizphrenia CPGs are abve the 80% minimum cmpliance threshld, while CPGs fr ADHD, Substance Use Disrder, and Suicide Risk were belw the minimum perfrmance threshld. 13 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

14 ADHD CPG ADHD CPG results indicate that prviders appear nw t be utilizing multiple surces f infrmatin, such as scales r checklists frm parents and teachers; Hwever the fllwing pprtunities fr imprvement were identified: Recrd indicated that the medical evaluatin was reviewed t rule ut medical causes fr the signs and symptms Recrd indicated a cmprehensive assessment fr cmrbid psychiatric disrders was cnducted These deficits verlap with the lwer scres n TRR fr Crdinatin f Care Guidelines n diagnsing and treating ADHD are available t prviders 14 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

15 Substance Use Disrder CPG Substance Use Disrder CPG results indicate that prviders appear t be educating members well n substance use disrders and helping them t plan fr sbriety. Hwever, pprtunities fr imprvement include: Evaluatin included the cnsideratin f apprpriate psychpharmactherapy. Fr MD prviders, evidence that abstinence-aiding medicatins were cnsidered. If prvider was nt an MD, there was evidence that a referral fr abstinence-aiding medicatin r a diagnstic cnsultatin was cnsidered. Magellan s prgram prmtes the treatment and supprt which is critical fr the management and maintenance f substance use disrders thrugh Integrated Substance Use Slutins. Learn mre abut ASAM criteria and revisins 15 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

16 Suicide Risk CPG Suicide Risk CPG results indicate that prviders are ding a gd jb f identifying members with high risk factrs; Hwever, Opprtunities fr Imprvement include: Assessment fr access t any weapns r LETHAL MEANS, if suicidal. Develped plan t DIMINISH ACCESS TO WEAPONS/LETHAL MEANS, if suicidal. Develped PLAN FOR MAINTAINING SOBRIETY and discussed the rle f substance use in increasing suicide risk. Attempted t INVOLVE FAMILY AND OTHER SUPPORT SYSTEM MEMBERS in suicide management plans, r dcumented why nt apprpriate. Crisis Plan Develpment presentatin and Crisis Plan Template can be lcated n the Magellan f Luisiana Quality Imprvement webpage. Tip sheet fr Assessing and Managing the Suicidal Patient can als be fund n ur Quality Imprvement webpage. 16 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

17 Magellan f Luisiana Quality Imprvement Webpage Dn t frgt t check ut the webpage fr training, templates, and resurces. 17 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

18 Cnfidentiality Statement fr Educatinal Presentatins By receipt f this presentatin, each recipient agrees that the infrmatin cntained herein will be kept cnfidential and that the infrmatin will nt be phtcpied, reprduced, r distributed t r disclsed t thers at any time withut the prir written cnsent f Magellan Health, Inc. The infrmatin cntained in this presentatin is intended fr educatinal purpses nly and is nt intended t define a standard f care r exclusive curse f treatment, nr be a substitute fr treatment. 18 Third Thursday Prvider Call (8/20/15): Treatment Recrd Reviews

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