Magellan in Louisiana Louisiana Behavioral Health Partnership Governance Board Minutes of July 17, 2013 PRESENT: Community Members of Governance Board: H. T. Ted Cox, Juvenile Court/Shreveport, Community Member at Large Judy Disotell, NAMI, Parent of Child/Youth Receiving Services Joan Guillory-Williams Board Co-Chair, Adult Service Recipient Kimberlyne Roundtree, Primary Care Solutions, Inc., Adult and Child/Youth Service Provider Lisa Schilling, South Central Louisiana Human Services Authority, LGE Rick Wheat, Louisiana United Methodist Children and Family Services, Child/Youth Provider Staff to Governance Board Jill Dyason, Governance Board Lead, System Development Manager, Magellan in Louisiana Leslie Canady, Executive Assistant, Magellan in Louisiana Governance Board Members Present via Conference Phone ABSENT: Shannon Ost, Network Development Administrator, Magellan in Louisiana Lisa Faust, Chief of Staff, Magellan in Louisiana Magellan Members of Governance Board: Dr. Craig Coenson, Board Chair, Chief Executive Officer, Magellan in Louisiana Kathleen Coenson, VP of System Transformation, Magellan in Louisiana Neal Cohen, Chief Operating Officer, Magellan in Louisiana Dr. Richard Dick Dalton, Chief Medical Officer, Magellan in Louisiana Dr. Seth Kunen, Quality Management Administrator, Magellan in Louisiana Guests: Anita Byrne, SSA Consultants Monica Lewis, Primary Care Solutions IN SESSION: This meeting was called to order at 12:00 pm Board minutes submitted for June 19, 2013 Lisa Schilling moved that minutes be approved. Ted Cox seconded the motion. The Board unanimously approved the Minutes. Board Announcements 1
BOARD UPDATES System Transformation Coordinated System of Care (CSoC) Kathy Coenson, VP System Transformation, Magellan in Louisiana updated Board Members on external activities that the System Transformation Team has been focusing on. The team is outreaching more into the communities by organizing workshops and trainings. She noted that upcoming event announcements were included in the Governance Board packets MyLife Meeting in Shreveport on July 22 at the Goodwill Center and another My Life Event in Baton Rouge with Glen Big Baby Davis speaking on July 25, with Danielle Marshall and Greg Dicharry heading this event. Parent Café is continuing to meet as well. On June 26 at the Opelousas Civic Center, Magellan hosted an eight (8) hour Crisis Intervention Training (Newspaper article in packet) for 150 police officers and first responders. Kurt Gawrisch, a national speaker, presented to the group. Coenson added that this was the kickoff for Magellan sponsored CIT trainings noting that her team is planning to conduct additional trainings in the near future. Training will be primarily focused in the rural areas where the first responders are the most available resource and heavily relied upon. Lisa Schilling noted that they have started a 40- hour program held twice a year and offered that Magellan could partner with her organization going forward. Coenson stated that CSoC completed Phase II Forums for Regions III, IV, V, and VI and reported that they went very well. The Phase II Forums were designed to promote community discussion surrounding moving into the nonimplementing CSoC Regions. Coenson shared that Robert Blue has developed a culture communicating training for the Coalition Meetings that will be presented Statewide this Fall. Quality and Improvement Report Seth Kunen, Quality Management Administrator reviewed satisfaction surveys, QI Committee Meeting highlights, and performance guarantees. Satisfaction Survey Dr. Kunen referenced the IMT Report for Medicaid Waivers that was provided to the Governance Board. Kunen stated that Magellan s QI team tried to match the satisfaction survey questions to the Waiver performance measures and reporting requirements. There were 20-24 issues identified from the survey that Magellan will address with performance improvement plans. The issues identified are broken down by child and adult, and families responding to survey for a child. The timeframe of the surveys was January March 2013. The survey was sent to 2,500 adults and 2,500 families whose children received services and was sent in two (2) waves due to a low initial response rate. There was a 13% response rate from 295 families and 297 adults that were equally split between black and white with predominantly female respondents. The overall satisfaction rate was 79.7% for adults and 85.4% for families for an average of 83%. The questions reviewed were: Satisfaction with services my child received 80% Having other choices, I would still choose Magellan 84% I would recommend provider 84% Convenient location of services 79% Staff willing to see my child 87% Staff return call with 24 hours 83% Acceptable wait times 82% My family received the help we needed 81% 2
Psychiatric availability 73% Comfortable asking questions about treatment 91% Received information about their rights 92% Staff was competent/sensitive to cultural backgrounds 87% Culture was included during treatment planning 74% There was Board discussion surrounding the difference in scores for the last two (2) questions with a 13% difference. Joan Guillory Williams spoke to visualization in that the families may not see representation of their background in the professional office setting. Dr. Kunen gave an example on spirituality spurred from her statement. Lisa Schilling mentioned the lack of Hispanic and Vietnamese representation in pamphlets to target the two groups. Schilling suggested availability of fliers in different languages. Kunen stated that it could be part of the standard intake of a patient to inquire their cultural sensitive issues. Kim Roundtree gave clarification that these questions are mandated as accreditation and assessments require the cultural sensitive questions, such as religion and medicine. Rick Wheat stated that the second statement is personal in reference to the patient s personal culture, which could be one reason for the score difference. Craig Coenson stated that with the information given from the report and the identified issues, we could have discussions with members and providers in different venues. Kathy Coenson added that Robert Blue is currently working with Network to develop a tool to assist providers on how to incorporate cultural sensitivity into a treatment plan. Participated in child s treatment plan 96% Felt they chose their child s treatment goals 87% Staff members helped us obtain the information 83% Dr. Kunen discussed the problem set of outcome measures, which were below 70% (overall goal is 80%). My child was encourage to use consumer run programs 71% In daily life, my child is better able to cope, get along with others, etc. 60% By looking at this as a clinical issue with the percentage below 80%, most would think that it is failing. Kunen gave examples of this and addressed the translation symptom reduction into a measureable item(s). He stated that 63% agree that their child gets along better with others and commended the score. Dr. Dalton indicated that scores and wording of questions are subjective and if 64% of children have a decrease in symptoms after treatment that is substantial. Craig Coenson added that patient/consumer satisfaction is extremely important and that Magellan should look at ways to increase the 2014 survey response rate. Board Members suggested that the data presented should be public knowledge for providers to set benchmarks after QIC approves this information. They encouraged that this information be published on the Magellan provider site. Dr. Kunen added that the survey also indicated that 81% of children were on medication and 23.2% were in out of home settings during the last 6 months. Adult Survey Dr. Kunen stated that the adult outcome measures were all lower than the child outcome measures. He added that Magellan Corporate developed the outcome measures. Deal more effectively with daily problems 3
I have control of my life I get along better with peers More comfortable in social settings Improvement in housing (scores ranged 40-60%) Performance Guarantees The performance guarantee report indicated that we met all guarantee goals except the 7-day follow-up rate and high utilizers that were not near the 70-80% goal. Follow-up after hospitalization is improving, but still has a way to go to meet goal. QIC Report Dr. Kunen reported that child utilization rates for In-patient have been slightly increasing, but the average length of stay is declining. The adult days per 1,000 were 4.5% with the average length of stay slightly decreasing. Discussion/Consideration of Three Community Board Seats Jill Dyason explained the process of selection. Upon the recommendation of the Board, a subcommittee was formed to interview all candidates for the Community Board Seats that are presently open. The subcommittee members were Latisha Anderson, Donna Nola-Ganey and Kimberlyne Roundtree. Dyason reported that the subcommittee interviewed all candidates last week and the process went very well. Kimberlyne Roundtree presented the subcommittee s findings and recommendations to the Governance Board Members: For Community Member at Large Ted Cox o Ted Cox is a current Governance Board Member and provides valuable information o He is a good connection to the Juvenile Judges in North Louisiana o He has a positive attitude for change and recognizes the opportunities that Managed Care brings to the State of Louisiana For Local Governing Entity Lisa Schilling o Lisa Schilling is a current Governance Board Member and has served on several Boards and Commissions o She has extensive experience as a behavioral and mental health provider o Works well with Magellan on a daily basis and provides valuable input toward improvement o Is in a non implementing CSoC Region and can be instrumental for Region implementation o Provides the Board with additional geographic diversity in its current membership o Offers provider knowledge which assists other providers in the same manner o Very opinionated For Parent of Child/Youth Judy Disotell o Judy Disotell is a current Governance Board Member o She is knowledgeable of services and gaps for families o She is active in the community o Is able to speak to differences that Magellan has made and is implementing o Her knowledge of a parent/youth using the system gives great perspective to the Board Kim Roundtree motioned that the Board accept these recommendations and Joan Guillory Williams seconded the motion. The Governance Board unanimously approved the recommendations for H.T. Ted Cox, Lisa Schilling and 4
Judy Disotell to serve as Community Board Members for additional two (2) year terms maintaining the staggered term structure. Discussion/Consideration of Board Co-Chair Craig Coenson stated that the Governance Board had selected a Co-Chair for a one-year term meaning that it is now up for discussion and consideration as well. Jill Dyason stated that the Governance Board Co-Chair position would be a one-year term. The Board was asked to consider continuity of current board Co-Chair versus nominating another Community Board Member. The board asked that Joan Guillory-Williams share her thoughts on this. Joan expressed that she is comfortable in the position and has been honored to serve. She stated her term as a Community Board Member expires next year unless she applies to be re-appointed. Dick Dalton motioned that Joan Guillory-Williams remain as the Governance Board Co-Chair for another one-year term. Ted Cox seconded the motion. The Governance Board Members unanimously approved the motion. Discussion/Consideration of Bi-Monthly Meetings Craig Coenson stated that he wanted to receive board input on the frequency with which the Governance Board meets going forward. He asked for Members thoughts on moving to six (6) meetings per year as opposed to the twelve (12) meeting per year schedule. He said that it is important that the Members decide this to assure that the Governance Board Meetings remain valuable and meaningful and opened the floor for discussion. Ted Cox suggested that the Board consider conducting quarterly meetings around the State to see what other people do and that Magellan reimburse Board Members for mileage. Dr. Dalton stated that where the Board meets is a valid issue, but the frequency of how often the Board meets is different. He indicated that the frequency of meetings depends on how active the Board is going to be. He suggested that moving to meeting every other month makes the Board retrospective as opposed to working in real time. Lisa Schilling stated that if the Board agenda continues as it is now, every two months is good. If Board members are allowed to add agenda items and be a voting Board on actions then we need to meet monthly. Lisa is unsure where the Board Members fit in as a decision-making entity and would like to be able to discuss, review documents and add agenda items. Craig Coenson agreed that Magellan does need to move the needle towards Board involvement. Jill Dyason reminded all of the process for Board Members suggesting agenda items and assured that this is always welcomed. Joan Guillory Williams added that without Lisa s consideration it would be retrospective if the Board met every two months. At this point, it is important to her to meet on a monthly basis so that she can digest all of the information. Craig Coenson stated that we could consider moving some meetings to other geographic locations since they are public meetings. To address the recommendation of travel to other locations, Coenson indicated that he would need to inquire about a stipend for travel. Jill Dyason indicated there is a monthly stipend allowed for each Community Board Member who requests it with a $100 cap per meeting. She explained that there is no stipulation for the use of the stipend as it can be used at the Member s descretion. Dyason expounded that possible uses could include mileage, hotel, childcare, etc. allowing them to attend each Board Meeting. Dyason suggested that the Board consider the ramifications of travel to other State locations for each meeting stating that bi-annually or quarterly may be most practical. She also reminded that the November and December Board Meetings were combined last year, netting a total of eleven Board Meetings. Craig Coenson recommended each member digest the meeting schedule, looking at the pros and cons of meeting monthly, bi-monthly, and quarterly and conducting the Board Meetings at various locations throughout the State and 5
that this can be considered at a future Board meeting. He agreed the Board should be more dynamic. 6
CEO MESSAGE TO THE BOARD Craig Coenson, Board Chair, Chief Executive Officer, Magellan in Louisiana gave several updates to the Board Members. Regarding the Magellan s Chief Medical Administrator, he stated that we are currently in the process of interviewing three (3) candidates. The first candidate will be interviewed Monday of next week. All three are strong candidates for the position. The Mercer Group (State Consultant) reviewed Magellan recently. Magellan is waiting on a final report, but has learned that the audit revealed that within year one Magellan has implemented strong managed care for adults and children. Moving forward, Magellan will need to work on waiver compliance such as independent assessment processes to assure a conflict free process. Year after year, there should be quality improvement showing progress towards this aspect. From this, Magellan will be working hard towards waiver compliance. Louisiana is the first state to have these waivers and other States are learning from us. Joan Dischner who ran the Iowa CMC for nineteen years will be visiting in August to research the waivers and assist us with this endeavor. Craig Coenson discussed the accreditation process for Rural Hospitals. Currently fifteen rural hospitals are not accredited and twenty-two are. The Bayou Health Plans do not require accreditation of Rural Hospitals. At this time, we will research those non-accredited in Magellan s Network to determine if they provide Psychiatric services versus Psychiatric consultation. Coenson stated that Seth Kunen did an excellent job on creating the Quality Improvement and Utilization Management Evaluation. He reported on the highlights indicating that in our first year we have touched 143,000 members, the CMC has answered 120,000 phone calls, 600 facilities are in the Network, we have 215 groups and 2,049 certified providers in the State of Louisiana. He added that Magellan has a list currently of 250 (children and adult) high utilizers and the list has been provided to each Bayou Health Plan. Only 26% of the high utilizers are on an ACT team. Other highlights showing trends of patient utilization were: Number of In-patient days decreased by 24% Number of adults readmissions decreased by 3% Number of adults per 1,000 being admitted into home and community based services increased by 500% Amount of time staying in services increased by 600% 1,200 children are in CSoC with over 2,000 referrals to the program Craig Coenson shared that providers have approached him asking to become a Magellan spokesperson. Magellan has had quotes from providers (substance abuse residential and others) stating that since they are now accredited they are now diversifying their payor sources and have become better providers clinically from data that Magellan has provided. We now have over 10,000 people in the 1915i waiver for expanded services. Our goal over three years is 35,000. We want to expand the capacity by independent assessors and have them meet people where they are. Coenson continued stating that Therapeutic Group Homes have been a big challenge for Magellan. Working through this and despite budget cuts, OJJ and DCFS increased the TGH rate from $202.00 to a $228.00 daily rate. We are actively recruiting five non-medical group entities that are interested in transitioning to a TGH. As a follow-up to the recoupment of advance funds to the TGH s, Magellan has improved their claims process. There have been $3.4 million dollars in claims, which brings the recoupment of advanced funds to zero ($0). 7
Coenson added that money exists for community reinvestments from Magellan, which could fund a crisis center. He emphasized that it is a one-time funding and the Board would need to be strategic on how it is used. Coenson encouraged the Governance Board Members to reread the existing RFP and added there are many exciting opportunities moving forward. NEW BUSINESS None PUBLIC COMMENT None NEXT MEETING The next meeting of the Governance Board is Wednesday, August 21, 2013. ADJOURN Dick Dalton moved to adjourn. Kathy Coenson seconded the motion. The Board voted unanimously to adjourn. The meeting adjourned at 2:00 pm. 8