Understanding Behavioral Health Readmissions. Summary of the work of the Western Regional Behavioral Health Organization (WRBHO)

Transcription

1 Finger Lakes Health Systems Agency Understanding Behavioral Health Readmissions Summary of the work of the Western Regional Behavioral Health Organization (WRBHO) Regional Commission on Community Health Improvement April 2, 2014 April 2,

2 The Context The work of the WRBHO emerged from assessing preparedness for Medicaid Redesign of the Behavioral Health (BH) system across 19 counties in Western New York WRBHO conducted a review of Medicaid Fee For Service Mental Health (MH) and Substance Use Disorders (SUD) admissions with a focus on care coordination and discharge planning 2

3 The Data Time frame: 2012 and ,000 cases reviewed 19 Counties: Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Wyoming, and Yates 3

4 Data Sources WRBHO Reported by inpatient providers Medicaid Fee For Service/Carve out admissions OMH BHO Portal Developed by State Office of Mental Health Medicaid claims data Indicators of performance for MH and SUD inpatient providers PSYCKES Developed by State Office of Mental Health Medicaid claims and managed care encounter data Indicators of performance for MH and SUD inpatient providers Includes recipient specific information 4

5 Data Summary 5

6 Regional Readmission Rates (Within 30 days) Western region better than state overall Mental Health 16.1% vs. 21.7% Substance Use Disorders 5.2% vs. 24.0% Source: WRBHO 6

7 Outpatient Appointment Scheduled as Part of Discharge Planning Mental Health > 90% Substance Use Disorders > 65% Source: WRBHO 7

8 Physical Health (PH) Appointment Scheduled as Part of Discharge Planning If PH Need Was Identified Mental Health < 50% Substance Use Disorders < 50% Source: WRBHO 8

9 Physical Health (PH) Appointment Scheduled as Part of Discharge Planning If PH Need Was Identified Mental Health < 50% Substance Use Disorders < 50% Source: WRBHO 9

10 Improvement in Housing Status for Individuals Homeless At Admission Mental Health > 50% Substance Use Disorders > 70% Source: WRBHO 10

11 Case Summary Sent to Outpatient Provider Mental Health > 95% Substance Use Disorders > 70% Source: WRBHO 11

12 Percentages of Discharges Followed by Outpatient Visit Within 7 Days Mental Health Admissions Western Region Statewide Adult 42.8% 31.6% Youth 52.9% 33.5% Source: NYS OMH BHO Portal 12

13 Percentages of Discharges Followed by a Lower Level of Service Within 14 days Substance Use Disorders Inpatient Admission Type Substance Use Detox Western Region Statewide 54.0% 35.2% Source: NYS OMH BHO Portal 13

14 Percentages of Discharges Followed by a Lower Level of Service Within 14 days Substance Use Disorders Inpatient Admission Type Substance Use Inpatient Rehab Western Region Statewide 52.3% 40.9% Source: NYS OMH BHO Portal 14

15 Percentages of Discharges Followed by 2 or More Outpatient Visits Within 30 days Mental Health Admissions Western Region Statewide Adult 43.3% 33.1% Youth 56.6% 35.3% Source: NYS OMH BHO Portal 15

16 Percentages of SUD or Rehab Services Followed by 2 or More SUD Services Within 14 days of Discharge Substance Use Disorders Inpatient Admission Type Substance Use Disorder Western Region Statewide 37.1.% 23.8% Source: NYS OMH BHO Portal 16

17 Provider Reasons for Readmissions Mental Health (Top 5) Increased symptomatology w/o a clear precipitant Medication Non-Adherence Lack of Engagement with Outpatient Provider Other Substance Use Substance Use Disorder (Top 5) Substance Use Lack of Engagement with Outpatient Provider Other Homeless Legal Issues Source: WRBHO 17

18 Consumer Suggestions for Reducing Readmissions A peer to sit with me to help me through a rough time Respite or crisis service I could have gone to instead of the ER/Hospital A more comprehensive person-centered treatment plan Better personal supports at the time to get me through hard times A crisis prevention/wrap plan, etc. Better knowledge of my own mental illness, triggers, early warning signs Support and education for my family/support system Source: Reflections on the Inpatient Psychiatric Experience, Nov 2012: WRBHO 18

19 Consumer Suggestions for Reducing Readmissions Knowledge of self-calming techniques Treatment or techniques to deal with past trauma I wasn t on the right medications at the time A more skilled outpatient therapist Medical issues that were not taken care of More attention to the role drugs and alcohol were playing on my life Stopped taking medications as prescribed Went to the ER because that was the only way I could get prescriptions filled. Source: Reflections on the Inpatient Psychiatric Experience, Nov 2012: WRBHO 19

20 Summary Considerations The region is doing better compared with the state on MH/SUD readmissions and care coordination but there is definitely work to be done. Improving care coordination for physical health needs Increasing outpatient follow up for MH and SUD after discharge Addressing social determinants like housing Provider reasons readmissions are largely medical in nature Lack of engagement with Outpatient Providers Exacerbations of symptoms Medication non-adherence 20

21 Summary Considerations Cont d Consumer suggestions for reducing readmissions are largely non-medical in nature Engaging social supports Providing alternate locations for management Increasing patient knowledge of disease and how to self-manage But there is crossover.. Medications Addressing physical health needs and co-occurring substance abuse or mental health issues 21

22 Next Steps Next Behavioral Health Work Group Meeting April 22 Describe data for the 9 county region Explore socio-demographics and subgroup analyses Discuss further opportunities within DSRIP Frame the work within the larger context of RCCHI 22

23 Finger Lakes Health Systems Agency The triangle represents our agency s role as a fulcrum the point on which a lever pivots boosting the community s health by leveraging the strengths of all stakeholders. The fulcrum is also a point of equilibrium, reflecting our ability to balance the needs of consumers, providers and payers on complex health matters. The inner triangle also evokes the Greek letter delta used in medical and mathematical contexts to represent change with a forward lean as we work with our community to achieve positive changes in health care. Give me a lever long enough and a fulcrum on which to place it, and I shall move the world. Archimedes 1150 University Avenue Rochester, New York April 2,