Behavioral Health Partnership Oversight Council

Quality Management & Access Subcommittee

Legislative Office Building Room 3000, Hartford CT 06106

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
www.cga.ct.gov/ph/medicaid
 

Meeting Summary: February 24, 2006
Chair: Dr. Davis Gammon, Vice Chairs: Paula Armbruster, Sheila Amdur
(Next meeting: Friday March 31 from 12:30 – 2:30 at VOI/CTBHP, Rocky Hill)

Attendees: Dr. Davis Gammon (Chair), Paula Armbruster (Vice-Chair),Linda Russo (Wheeler), Arnie Pritchard & Aurale Kamm (DCF), Ted Ines, Amy Shuman, Angela Hart, Jan Geiger (VOI/CTBHP), Susan Niemitz (Hartford Behavioral Health), Susan O'Connell (Village), Mark Schaefer & Teddi Creel (DSS), Virginia Mulkern (HSRI-phone).

Intensive Case Management

Janet Geiger has joined VOI/CTBHP as the Director of Quality and Amy Shuman is Director of Utilization Management. Both have had extensive BH management experience: Ms Geiger in quality management in national companies and Ms Shuman in the Massachusetts Behavioral Program's intensive case management and system management. The VOI/CTBHP team reviewed the policies for CT Intensive Care Management (ICM) and the ICM Intake & Referral form (click on icon below to view draft form).

Discussion points on ICM:

• BHP program ICM will be applied to children and adult members. The regional reporting regions will include the 5 DMHAS regions and 15 DCF regions that will be consolidated into 8 larger regions for ICM, system managers and peer specialists teams. ICM manager distribution will be based on population density.
• Adults in the DMHAS LMHA regions could be HUSKY A members. Both the SC and VOI/CTBHP would benefit from information about the LMHAs and overview of the DMHAS system. DSS/DCF will arrange this with DMHAS for VOI/CTBHP & SC.
• 14 ICMs will have an expected case load of 40-50 clients.
• Determining criteria for ICM is an evolving process to which the subcommittee can contribute. Triggers can include frequent high level of care use or high clinical risk, evidence of medical/BH co-occurring diagnoses, history of treatment “failures”, onset of new psychosis. Based on the Ma. experience VOI/CTBHP would want to have flexible criteria to meet the critical needs in the CT population. Dr. Schaefer noted that there is statutory language to address disposition problems, specifically involving hospitalization and ED stays that would be included in ICM.
• ICM referrals will come from external and internal sources. The ICM process will include:

o VOI/CTBHP staff will obtain full information for the referral, followed by internal review of referral, acceptance into ICM by team based on ICM criteria and consideration of saturation level of ICM team. If ICM is determined not to be appropriate, VOI would offer alternative resources in the member's community.

o Once accepted into ICM, the team will develop a crisis prevention plan with parent/family, and send this out to appropriate involved providers, community entities. ICM is most effective when avenues of communication among those in the member's life are created; often ICM team may seem somewhat invisible to the family while coordinating services.

• ICM may also require coordinated efforts of system managers and ICM to address clinical issues.
• ICM involvement is generally short term time focused, although some clients may need more than short-term involvement.

The Subcommittee participants were asked to review the handouts from VOI/CTBHP and provide feedback regarding the final product.
(To insert VOI handouts here when received from Amy Shuman)

HSRI BHP Performance Indicators.

Summary of HSRI Questions for BHP QA Committee: February 2006

Gini Mulkern from HSRI suggested that we need to look at specific measures to determine the relevant unit of analysis and passed out the attached documents. The committee members discussed and suggested options for the following indicators:

1) Coordination of BH and Schools

The committee members suggested these measure be added to the discharge survey that DCF already requires. This modification of the existing survey form will allow easier collection of the necessary data as well as avoid duplication and additional burden on the providers. DSS, DCF and HSRI are to review these surveys to determine if this is a feasible option.

2 – 3) Member Satisfaction and Use of Natural Supports

VO mentioned that they are have a member satisfaction survey as a deliverable and are using Fact Finders. They will share the survey questions and methodology they know of to date at the next meeting. Although this is limited in scope, the fact that this is already a requirement from the Departments may help decide if these data can be used for the PMP.

The committee members suggested that these measures be added to the DMHAS and DCF surveys that are required of grant funded providers. The Departments will review this option and make a recommendation at the next meeting. (click on icon below to view DMHAS client satisfaction survey).

4) Use of Natural Supports/School

The committee discussed the feasibility of obtaining these data and it was decided that due to the level of difficulty in obtaining these date that these measures be tabled for further discussion in the future.

5) School (Attendance, suspension rate, expulsion rate, and drop out rate)

The committee discussed the possibility of obtaining these data from sources that currently collect them on a statewide basis. Although the data will not be specific only to CT BHP children, we can use the data to compare it at the DCF local area, county area, or another selected area breakdown to give some insight into these indicators.

Traditional/non-traditional providers
Discussion: 1) how to define non-traditional providers, identify them and measure impact of services, 2) integration with traditional providers and 3) traditional provider linkage with non-traditional community-based services.

DSS and/or HSRI will follow-up on whether FMHI/Louis De La Parte has any info on measuring participation of non-traditional providers and will report at the next meeting. 
 
In order to not complicate this measure, the committee decided that we should consider tracking:
 
1) Traditional licensed agency with cultural specialty - Asian Family Services
2) Number of providers a) licensed or b) certified to offer non-traditional "rehabilitative" services - EMPS, home-based, etc.
3) #Number of clinic subcontracts to local non-licensed agencies, whether faith based, cultural, etc. offering services that are a) reimbursable under CT BHP or b) not reimbursable under CT BHP but accessible to CT BHP members.
4) Number of clinics offering linkage to indigenous agencies in SED service plans.