Provider Profiling Year-End Report

Transcription

1 Profiling Year-End Report Mental Health Outpatient Services (MHOP) Mental Health Outpatient Therapy Psychiatric Evaluations Medication Management 07/1/2016-6/30/2017 Profiling is conducted in order to collect and trend data to provide information relating to performance, with the overall intent of improving the quality of care rendered to PerformCare s Members. PerformCare encourages s to closely review this information and use this to help inform areas of future development. PerformCare will provide updated Profiling reports twice a year.the first report will be distributed in July, and will provide measures on the first two quarters of the fiscal year ( Profiling Mid-Year Report). The second report will be distributed in January, and will provide the entire fiscal year measures ( Profiling Year-End Report).

2 7-Day Access for Psychiatric Evaluations and Mental Health Outpatient Therapy Measure 1: 7-Day Access for Psychiatric Evaluations and Mental Health Outpatient Therapy: Measuring access rates are important to ensure that PerformCare Members are able to access services when they need them. This measure calculates the percentage of Members receiving or being offered an appointment within 7 days for Psychiatric Evaluations and Mental Health Outpatient Therapy. This measure reflects claims data for unique Members accessing Psychiatric evaluations or Mental Health Outpatient therapy from 7/1/16-6/30/17. The rates are calculated as follows: Denominator: All initial evaluation or therapy assessments, broken out respectively. Numerator: Number of records of a compliant follow-up appointment being offered within 7 days of initial evaluation or therapy assessments. PerformCare calculates this information based on the use of the U7 modifier for claims for Mental Health Outpatient therapy assessments or Psychiatric Evaluations. Goal PerformCare expects MHOP s to achieve an access rate of 80% and Psychiatric Evaluators to achieve a rate of 25%.* Network Average Plan-wide percentage of 7-Day Access for therapy and Psychiatric evaluation Service Records Not In Standard Quarterly in Standard Plan Wide Psychiatric Evaluations 8, ,284 13% 10% 9% 13% 11.2% MH OP Therapy 17,479 13,151 4,328 77% 77% 74% 73% 75.2% breakdown of Psychiatric evaluation access within 7-day standard data. Records Not In Standard Quarterly in Standard Psychiatric Evaluations s with 100+ Evaluations 7, ,383 13% 9% 7% 12% 10% BEDFORD-SOMERSET DBHS-BED. MH-CLINIC % 36% 15% 18% 26% BEDFORD-SOMERSET DBHS-SOM. MH-CLINIC % 3% 6% 0% 2% CSG MH-CLINIC % 6% 9% 18% 10% ESPERANZA HOPE MH-CLINIC % 3% 0% 3% 1% FAMILY BEHAVIORAL RES MH-CLINIC % 0% 3% 2% 1% FRANKLIN FAMILY SERVICES MH-CLINIC % 0% 0% 19% 6% HERSHEY MED CTR MH-CLINIC % 0% 0% 0% 0% HOLY SPIRIT HOSP MH-CLINIC % 0% 0% 2% 0% Momentum Services, LLC MH-Clinic % 100% 100% 100% 100% NHS 2 MH-Clinic % 12% 33% 34% 35% NULTON DIAG & TRT CTR MH-CLINIC % 25% 0% 0% 11% PA COUNSELING SVCS MH-CLINIC % 0% 6% 16% 6% STEVENS CENTER-NHS MH-CLINIC % 0% 10% 30% 11% SUMMIT PHYSICIANS SERVICES (KAUR APWINDER) % 0% 0% 0% 0% SUMMIT PHYSICIANS SERVICES (MUKHERJEE SATYAJIT) % 0% 0% 2% 0% SUMMIT PHYSICIANS SERVICES (SYED SYYEDA) % 0% 0% 0% 0% T W PONESSA AND ASSOC MH-CLINIC 1, ,200 0% 0% 0% 0% 0% TEAMCARE BH MH-CLINIC % 68% 44% 2% 31% WELLSPAN PHILHAVEN MH-CLINIC 1, ,411 2% 4% 5% 8% 5% YOUTH ADVOCATE PROG MH-CLINIC % 5% 2% 0% 12% s with 30 to 100 Evaluations % 21% 24% 22% 22% ACRP MH-CLINIC % 33% 29% 39% 32% Catholic Charities, Inc MH-Clinic % 9% 17% 0% 9% DIAKON MH-CLINIC % 0% 0% 0% 0% LAUREL LIFE SERVICES MH-CLINIC % 0% 0% 10% 1% MARC L TURGEON DO (TURGEON MARC) % 0% 0% 0% 0% NUESTRA CLINICA MH-CLINIC % 22% 3% 0% 11% PA PSYCHIATRIC INSTITUTE MH-CLINIC % 0% 0% 0% 0% Pressley Ridge Schools MH-Clinic % 100% 87% 93% 90% PYRAMID MH-CLINIC % 100% 75% 63% 82% READING PSYCHIATRY (YASMEEN NIKHAT) % 0% 0% 0% 0% TRUENORTH WELLNESS MH-CLINIC % 80% 75% 52% 64% Note: Cells with a dash represent that there were no services delivered to calculate a measure within that quarter and category. Individual rates for s with less than 30 evaluations were not calculated due to the smaller sample of data. Members with Third Party Liability (TPL) are excluded from this report. * Individual contracts may have specific goals outlined. Goal noted is based on current baseline scores and the network average. FY Profiling Year End Report 2 Prepared by PerformCare

3 breakdown of MHOP therapy access within 7-day standard data. 7-Day Access for Psychiatric Evaluations and Mental Health Outpatient Therapy Records Not In Standard Quarterly in Standard MH OP Therapy s with 100+ Initial Therapy Assessments 14,646 11,561 3,085 81% 80% 77% 77% 79% ACRP MH-CLINIC % 79% 67% 95% 84% BEDFORD-SOMERSET DBHS-BED. MH-CLINIC % 74% 70% 39% 62% BEDFORD-SOMERSET DBHS-SOM. MH-CLINIC % 83% 84% 84% 82% COLLINS JENNIFER (LANCASTER GENERAL HOSPITAL) % 0% 0% 0% 0% COMMONWEALTH CLINICAL MH-CLINIC % 100% 100% 100% 100% CSG MH-CLINIC % 86% 80% 89% 86% DIAKON MH-CLINIC % 97% 97% 90% 95% ESPERANZA HOPE MH-CLINIC % 100% 100% 100% 100% FAMILY BEHAVIORAL RES MH-CLINIC % 48% 60% 8% 45% FRANKLIN FAMILY SERVICES MH-CLINIC % 93% 92% 90% 93% GONCHER IAN (PEDIATRIC CARE SPECIALISTS) % 100% 100% 100% 100% HERSHEY MED CTR MH-CLINIC % 0% 0% 0% 0% LAUREL LIFE SERVICES MH-CLINIC % 38% 36% 46% 44% Momentum Services, LLC MH-Clinic % 100% 100% 100% 100% NHS 2 MH-Clinic % 89% 100% 99% 93% NULTON DIAG & TRT CTR MH-CLINIC % 19% 14% 14% 25% PA COUNSELING SVCS MH-CLINIC 1,960 1, % 87% 84% 84% 84% PA PSYCHIATRIC INSTITUTE MH-CLINIC % 0% 0% 0% 0% Pressley Ridge Schools MH-Clinic % 98% 99% 100% 99% STEVENS CENTER-NHS MH-CLINIC % 32% 26% 36% 36% T W PONESSA AND ASSOC MH-CLINIC 2,668 2, % 100% 100% 100% 100% TEAMCARE BH MH-CLINIC % 84% 79% 74% 81% TRUENORTH WELLNESS MH-CLINIC % 35% 56% 59% 46% WELLSPAN PHILHAVEN MH-CLINIC 2,399 1, % 77% 72% 67% 73% YOUTH ADVOCATE PROG MH-CLINIC % 69% 88% 97% 80% ZEHRUNG DAVID (PATHWAYS COUNSELING SERVICES) % 96% 69% 69% 77% s with 30 to 100 Initial Therapy Assessments 1, % 65% 54% 51% 56% BEAL R JUSTIN (BEAL COUNSELING AND CONSULTING) % 100% 100% 100% 100% BEHAVIORAL HEALTHCARE CORP MH-CLINIC % 82% 28% 71% 58% BERGE MARY (DR MARY BERGE AND ASSOCIATES) % 100% 100% 100% 100% BOWERS THOMAS (FAMILY DEVELOPMENT SERVICES PC) % 100% 100% 100% 100% Catholic Charities, Inc MH-Clinic % 4% 42% 33% 24% Chambersburg Hospital MH-Clinic % 0% 0% 0% 0% CLARK RHONDA (RHONDA J CLARK LPC) % 100% 100% 100% 100% COLEMAN CHRISTA (LANCASTER GENERAL HOSPITAL) % 0% 0% 0% 0% HEMPFIELD BEHAVIORAL HEALTH MH-CLINIC % 0% 0% 0% HERR TINA (NEWPORT COUNSELING CENTER) % 100% 100% 100% 100% MARTIN MICHELE (MICHELE R MARTIN CP) % 0% 0% 0% 0% MOCK JERRY (MOCK-MAYS ASSOCIATES) % 0% 0% 0% NUESTRA CLINICA MH-CLINIC % 0% 0% 0% 0% PA COMPREHENSIVE BH SVCS MH-CLINIC % 88% 61% 77% 70% PYRAMID MH-CLINIC % 100% 100% 86% 88% RIGBY ANDREA (HERSHEY MED CTR PHYSICIANS GROUP) % 0% 0% 0% 0% RUCH LYNNETTE (LIFESPAN PSYCHOLOGICAL SERVICE) % 100% 100% 100% 100% SHEARER TOINETTE (CENTER FOR HOPE AND HEALING LLC) % 100% 100% 100% SMITH HUGH (HUGH S SMITH PHD AND ASSOC) % 0% 0% 0% 0% STAUFFER CYNTHIA (SUSQUEHANNA PSYCH SVCS) % 100% 100% 100% TAYLOR PHILIP (PHILIP L TAYLOR CP) % 100% 100% 100% 99% TEMPLE JESSICA (LANCASTER GENERAL HOSPITAL) % 0% 0% 0% 0% THOMAS WILLIAM (WILLIAM D THOMAS CP) % 0% 0% 0% 0% VisionQuest National Ltd MH-Clinic % 76% 70% 25% 80% WATT JOSHUA (PEDIATRIC CARE SPECIALISTS) % 100% 100% 100% 97% WEIGEL JOHN (WEIGEL COUNSELING ASSOCIATES INC) % 100% 100% 100% 100% Note: Cells with a dash represent that there were no services delivered to calculate a measure within that quarter and category. Individual rates for s with less than 30 OP therapy assessments were not calculated due to the smaller sample of data. FY Profiling Year End Report 3 Prepared by PerformCare

4 MH OP Therapy Engagement in 2 or more Appointments Measure 2: MH OP Therapy Member engagement following an initial therapy assessment After a Member meets with their therapist for their first session, their continued engagement in treatment is vital in helping to support their wellness. This measure examines the number of Members who had their first session with a therapist that also continued to stay engaged in treatment by attending 2 or more therapy appointments within 30 days. This data is based on initial therapy sessions and follow up appointments from claims submitted for services between 7/1/16-6/30/17. PerformCare calculates the rates as follows: Denominator: All initial therapy appointments (1st session with a therapist after an intake assessment). Numerator: Number of initial therapy appointments that resulted in continued engagement in 2 or more therapy appointments within 30 days. Individual, group and family therapy are treated as valid follow up appointments following the initial therapy appointment. Goal PerformCare is providing this measure for informational purposes. A goal will be established at a later date. Network Average Plan-wide percentage of initial therapy assessments that engaged in 2 or more therapy sessions within 30 days of assessment. Plan-Wide % of Members with 2+ Appointments 68.0% 69.6% 68.0% 62.4% 67.0% of Members who attended an initial therapy assessment and then engaged in 2 or more therapy sessions within 30 days of assessment. s with 100+ First Therapy Sessions ACRP MH-CLINIC BEDFORD-SOMERSET DBHS-BED. MH-CLINIC BEDFORD-SOMERSET DBHS-SOM. MH-CLINIC COLLINS JENNIFER (LANCASTER GENERAL HOSPITAL) COMMONWEALTH CLINICAL MH-CLINIC CSG MH-CLINIC DIAKON MH-CLINIC ESPERANZA HOPE MH-CLINIC FAMILY BEHAVIORAL RES MH-CLINIC FRANKLIN FAMILY SERVICES MH-CLINIC GONCHER IAN (PEDIATRIC CARE SPECIALISTS) HERSHEY MED CTR MH-CLINIC LAUREL LIFE SERVICES MH-CLINIC Momentum Services, LLC MH-Clinic NHS 2 MH-Clinic NULTON DIAG & TRT CTR MH-CLINIC PA COUNSELING SVCS MH-CLINIC PA PSYCHIATRIC INSTITUTE MH-CLINIC Pressley Ridge Schools MH-Clinic STEVENS CENTER-NHS MH-CLINIC T W PONESSA AND ASSOC MH-CLINIC TEAMCARE BH MH-CLINIC TRUENORTH WELLNESS MH-CLINIC WELLSPAN PHILHAVEN MH-CLINIC YOUTH ADVOCATE PROG MH-CLINIC ZEHRUNG DAVID (PATHWAYS COUNSELING SERVICES) 66.7% 51.1% 59.2% 62.6% 30.7% 63.4% 72.1% 68.1% 86.5% 68.3% 69.7% 49.3% 55.4% 82.7% 52.6% 41.5% 39.2% 80.4% 62.4% 80.3% 44.2% 74.6% 59.1% 75.3% 59.7% 57.3% 78.9% FY Profiling Year End Report 4 Prepared by PerformCare

5 MH OP Therapy Engagement in 2 or more Appointments of Members who attended an initial therapy assessment and then engaged in 2 or more therapy sessions within 30 days of assessment by initial. s with 30 to 100 First Therapy Sessions BEAL R JUSTIN (BEAL COUNSELING AND CONSULTING) BEHAVIORAL HEALTHCARE CORP MH-CLINIC BERGE MARY (DR MARY BERGE AND ASSOCIATES) BOWERS THOMAS (FAMILY DEVELOPMENT SERVICES PC) Catholic Charities, Inc MH-Clinic Chambersburg Hospital MH-Clinic CLARK RHONDA (RHONDA J CLARK LPC) COLEMAN CHRISTA (LANCASTER GENERAL HOSPITAL) HEMPFIELD BEHAVIORAL HEALTH MH-CLINIC HERR TINA (NEWPORT COUNSELING CENTER) MARTIN MICHELE (MICHELE R MARTIN CP) MOCK JERRY (MOCK-MAYS ASSOCIATES) NUESTRA CLINICA MH-CLINIC PA COMPREHENSIVE BH SVCS MH-CLINIC PYRAMID MH-CLINIC RIGBY ANDREA (HERSHEY MED CTR PHYSICIANS GROUP) RUCH LYNNETTE (LIFESPAN PSYCHOLOGICAL SERVICE) SHEARER TOINETTE (CENTER FOR HOPE AND HEALING LLC) SMITH HUGH (HUGH S SMITH PHD AND ASSOC) STAUFFER CYNTHIA (SUSQUEHANNA PSYCH SVCS) TAYLOR PHILIP (PHILIP L TAYLOR CP) TEMPLE JESSICA (LANCASTER GENERAL HOSPITAL) THOMAS WILLIAM (WILLIAM D THOMAS CP) VisionQuest National Ltd MH-Clinic WATT JOSHUA (PEDIATRIC CARE SPECIALISTS) WEIGEL JOHN (WEIGEL COUNSELING ASSOCIATES INC) 66.1% 68.2% 84.4% 72.9% 47.6% 74.7% 77.7% 71.9% 45.6% 62.5% 81.8% 72.7% 84.8% 73.2% 57.5% 57.6% 14.8% 71.6% 95.1% 70.0% 73.2% 69.5% 31.6% 48.8% 74.5% 67.9% 75.6% Note: Individual rates for s with less than 30 initial therapy assessments were not calculated due to the smaller sample of data. FY Profiling Year End Report 5 Prepared by PerformCare

6 Follow-Up Visits within 7 and 30 Days of MHIP Discharge Measure 3: Mental Health Outpatient follow-up visits within 7 and 30 Days of discharge from MHIP Follow-up after a Mental Health Inpatient stay is important to help support the Member s wellness and recovery and to prevent readmission. Mental Health Outpatient can help to support Members returning to the community from MH IP by providing timely appointments. This data is based on claims information and includes all unique Members who were discharged from MH IP from 7/1/16-6/30/17. Compliant follow-up visits for this measure include the following (based on HEDIS and PA codes): -An outpatient visit with a Mental Health for therapy or medication management -Additional ambulatory appointments that fall within the PA-specific codes for follow up. The rates are calculated as follows: Denominator: All compliant follow-up visits performed by (s). 7 Day Numerator: Compliant follow-up visit within 7 days of discharge from MH IP service. 30 Day Numerator: Compliant follow-up visit within 30 days of discharge from MH IP service. Goal PerformCare is providing this measure for informational purposes. A goal will be established at a later date. Network Average Plan-wide average of follow-up visits within 7 and 30 Days of discharge for all s. of Follow-Ups within 7 Days Follow-Ups within 30 Days of follow-up visits within 7 and 30 days of discharge by. Plan Wide by Quarter Overall Adult Child 49% 47% 50% 53% 50.0% 45.1% 61.0% 73% 73% 79% 80% 76.4% 72.6% 85.1% of Follow-Ups within 7 Days Average of Follow-Ups within 30 Days Overall Adult Child Overall Adult Child s with 100+ Follow-Up Visits 54% 48% 65% 82% 77% 90% CMU TCM/PSS 47% 42% 57% 73% 67% 86% CSG MH-CLINIC 60% 53% 76% 86% 82% 95% NHS 2 MH-Clinic 36% 36% 36% 69% 71% 55% PA COUNSELING SVCS MH-CLINIC 64% 61% 68% 84% 80% 89% PA PSYCHIATRIC INSTITUTE MH-CLINIC 39% 35% 45% 80% 76% 87% T W PONESSA AND ASSOC MH-CLINIC 48% 48% 49% 75% 74% 78% WELLSPAN PHILHAVEN MH-CLINIC 61% 51% 73% 88% 81% 95% Overall Adult Child Overall Adult Child s with 30 to 100 Follow-Up Visits 46% 43% 55% 74% 71% 80% BEDFORD-SOMERSET DBHS-BED. MH-CLINIC 58% 60% 33% 79% 80% 67% BEDFORD-SOMERSET DBHS-SOM. MH-CLINIC 53% 57% 33% 89% 90% 83% Community Services Group, Inc. TCM 58% 53% 75% 90% 91% 88% County of Dauphin Crisis 17% 18% 11% 39% 38% 56% ESPERANZA HOPE MH-CLINIC 63% 63% 50% 94% 97% 50% FAMILY BEHAVIORAL RES MH-CLINIC 59% 53% 63% 85% 93% 79% FRANKLIN FAMILY SERVICES MH-CLINIC 68% 50% 82% 84% 68% 96% HERSHEY MED CTR MH-CLINIC 57% 67% 42% 83% 89% 75% HOLY SPIRIT HOSP MH-CLINIC 29% 24% 71% 62% 58% 100% Holy Spirit Hosp-BH services Crisis 35% 35% 33% 53% 56% 44% LAUREL LIFE SERVICES MH-CLINIC 56% 50% 58% 84% 100% 79% MUKHERJEE SATYAJIT (SUMMIT PHYSICIANS SERVICES) 39% 38% 43% 72% 72% 71% Pressley Ridge Schools MH-Clinic 56% 60% 53% 84% 80% 88% Service Access and Management TCM 59% 65% 50% 82% 85% 79% STEVENS CENTER-NHS MH-CLINIC 42% 41% 45% 85% 89% 64% TEAMCARE BH MH-CLINIC 53% 55% 51% 84% 84% 83% WELLSPAN PHILHAVEN CRISIS 26% 27% 0% 51% 53% 0% YOUTH ADVOCATE PROG MH-CLINIC 57% 52% 68% 76% 70% 92% Note: Cells with a dash represent that there were no follow-up visits present to calculate a measure within that category. Individual rates for s with less than 30 discharges were not calculated due to the smaller sample of data. Number of follow-up visits, for the purpose of grouping, is based on overall follow-up visits for patients from a MHIP level of care for stated reporting period. Average by Age Group FY Profiling Year End Report 6 Prepared by PerformCare

7 CFST The purpose of the Consumer and Family Satisfaction (also referred to as Individual and Family Satisfaction) Team program and surveys are to gather feedback from adult, children, and families that have used Mental Health and/or Substance Use services funded by PerformCare. These surveys are conducted by external agencies in each region and are mainly done through face-to-face interviews. These surveys focus on determining Member s satisfaction with services and ask questions related to many parts of services/treatment. While the survey tools used in each region are similar, not all questions are the same. The results noted below show results for similar questions that fall into the categories noted. The results are sorted by contract- Capital (which includes Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties), Franklin & Fulton counties, and Bedford & Somerset counties. s that are not listed had less than 10 surveys completed for the level(s) of care. Additionally, if a contract is not listed, that indicates that there were no surveys completed for the level(s) of care during this reporting timeframe. It is important to note that while the number of surveys listed are noted, a Member may not have answered all questions included in the survey. The agencies who conduct these surveys collect this information on a quarterly basis, and the information below is based on the Fiscal Year All of the information included was collected between July 1, 2016 and June 30, Franklin Fulton MH OP Therapy Franklin Fulton Medication Management Keystone Momentum Family Behavioral Resources Laurel Life Keystone Pennsylvania Counseling Services Number of Surveys Number of Surveys quickly 60% 67% 90% 69% quickly 59% 64% The Services provided meet the Member's Needs 93% 80% 91% 81% The Services provided meet the Member's Needs 81% 100% Member's culture and background 94% 92% 100% 100% Member's culture and background 97% 100% Member is satisfied with 96% 75% 91% 94% Member is satisfied with 96% 93% Bedford Somerset MH OP Therapy Bedford Somerset Medication Management ACRP Bedford DBHS Nulton Diagnostic Somerset DBHS Number of Surveys Number of Surveys % 92% 92% 97% 98% 100% 99% quickly. quickly. The services provided meet the The services provided meet the 100% 88% 94% 93% 89% 96% 92% Member's needs. Member's needs. Member's culture and background. 100% 100% 100% 96% Member's culture and background. Bedford DBHS Nulton Diagnostic Somerset DBHS 96% 100% 97% Member is satisfied with. 100% 95% 100% 100% Member is satisfied with. 93% 91% 96% FY Profiling Year End Report 7 Prepared by PerformCare