Provider Profiling. Substance Abuse Non- Hospital Long Term Rehabilitation. 01/01/12 to 12/31/12

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1 Provider Profiling Substance Abuse Non- Hospital Long Term Rehabilitation 01/01/12 to 12/31/12 1

2 Substance Abuse Non-Hospital Long Term Rehabilitation CBHNP utilizes a provider profiling process that is an important provider-level quality improvement activity, as well as an opportunity to internally track and trend data over a set period of time to identify possible areas of improvement. It is also a tool to make meaningful comparisons based on a varied data set including claims data, authorization data, quality reports and demographic information. Provider profiling results have been compiled using data from January 1, 2012 to December 31, Substance Abuse Non-Hospital Long Term Rehabilitation Services include twenty-four hour professionally directed, medically monitored, evaluation, care and treatment for addicted Members in chronic distress, whose addiction symptomatology is demonstrated by severe impairment of social, occupational, or school functioning. All SA NH Long Term Rehab providers across the Network with Members in service were profiled during this period. The profiled providers by Contract are as follows alphabetically: Bedford/Somerset Providers Adelphoi Village Family Links George Junior Republic in Pennsylvania Pyramid Healthcare, Inc. Summit School Blair Providers Eagleville Hospital Gaudenzia, Inc George Junior Republic in Pennsylvania Pyramid Healthcare, Inc. Summit School Treatment Trends, Inc. Franklin/Fulton Providers Clearbrook, Inc. Colonial House, Inc. Cornell Abraxas, Inc. Drug and Alcohol Rehabilitation Services, Inc. Firetree, LTD. Gaudenzia, Inc. Interim House, Inc. Pyramid Healthcare, Inc. Summit School 2

3 Lycoming/Clinton Providers Bowling Green Brandywine, Inc. Clearbrook, Inc. Colonial House, Inc. Cornell Abraxas, Inc. Eagleville Hospital Firetree, LTD Gaudenzia, Inc. George Junior Republic in Pennsylvania Outside In School of Experiential Education, Inc. Pyramid Healthcare, Inc. Samara House/Comm, Youth, Women s Alliance, Inc. Capital Providers Bowling Green Brandywine, Inc. Children s Home of York, Inc. Clearbrook, Inc. Colonial House, Inc. Cornell Abraxas, Inc. Drug and Alcohol Rehabilitation Services, Inc. Eagleville Hospital Firetree, LTD. Gaudenzia, Inc. George Junior Republic in Pennsylvania Interim House, Inc. (OON) Libertae, Inc. Nuestra Clinica of SACA, Inc. Pennsylvania Counseling Services, Inc. Pyramid Healthcare, Inc. Samara House/Comm, Youth, Women s Alliance, Inc. Summit School Treatment Trends, Inc. Valley Forge Medical Center and Hospital, Inc. Profiled indicators include demographics, utilization, quality, compliance, competency and satisfaction. Demographics Demographic information available for Members receiving SA NH Long Term Rehab services includes age, gender, race and diagnostic data. Demographic mix is consistent with previous years with no developing change in trend. 3

4 Overall, thirty-three percent of the Members who received SA NH Long Term Rehab services were between the ages of thirteen and twenty, twenty-one percent were between twenty-one and thirty, twenty-five percent were between thirty-one and forty-four, twenty percent were between forty-five and sixty-four and one percent of the population was sixty-five years of age or older. Thirty-two percent of Members receiving this service were female and sixty-eight percent were male. Sixty-nine percent of these Members were Caucasian, nineteen percent were African American and twelve percent were categorized as Other. 4

5 The most common diagnoses of Members receiving SA NH Long Term Rehab services were Opioid Dependence at nineteen percent, Cannabis Dependence at seventeen percent, Alcohol Dependence at fourteen percent, Polysubstance Dependence at eleven percent and Cocaine Dependence at eight percent. Utilization 5

6 Utilization information available for Members receiving SA NH Long Term Rehab services includes the total number of discharges, the average length of stay, the number of recidivism episodes and the thirty day readmission rate. The total number of discharges across the Network was 589. There were seventy-eighty discharges in the zero to seventeen age group and 511 in the eighteen and over age group. The average length of stay across the Network was days for both age groups. The average length of stay for the zero to seventeen age group was days and days for the eighteen and over age group. All Contracts except Capital had averages less than 6

7 the Network. Providers that had a total average length of stay below the Network average met one of the three target criteria for performance. Across the Network there were ten episodes of recidivism, which is the number of readmissions for unduplicated Members. There were zero episodes in the zero to seventeen age group and ten in the eighteen and over age group. Bedford/Somerset and Franklin/Fulton had zero episodes of recidivism. The readmission rate, which is readmissions for duplicated Members, for the zero to seventeen age group was 0.00% and 1.96% for the eighteen and over age group. The average thirty day readmission rate for the Network was 1.70%. Bedford/Somerset and 7

8 Franklin/Fulton had total averages of 0.00%. Providers that had a total readmission rate below the Network average met the second of three target criteria for performance. Multi-Year Utilization Comparison The total number of discharges from SA NH 3C Rehab has again been increasing for both age groups since The average length of stay has remained steady since 2009, with a slight decrease from 2011 to The 30 day readmission rate however, has shown a downward trend and is at the lowest rate for the combined age groups in 2012 than any of the previous years. The number of IP admissions during treatment remains steady, and has not exceeded five admissions per year from 2009 through

9 Quality The quality indicators for SA NH Long Term Rehab services were measured by the total number of Mental Health Inpatient admissions during treatment, the number of complaints, the number of quality of care issues and the number of critical incident reports submitted by the provider. There were a total of four Mental Health Inpatient admissions during SA NH Long Term Rehab services during the profiled period, one from the Bedford/Somerset Contract and three from the Capital Contract. The Network number of Inpatient admissions per 1000 Members was ; Bedford/Somerset at and Capital at Across the Network there was one complaint and one quality of care issue during the profiled period, which was an average of complaints and quality of care issues per 1000 Members. Both the complaint and quality of care issue were from the Capital Contract, resulting in complaints and quality of care issues per 1000 Members. 9

10 There were thirty-four Critical Incident Reports (CIR s) filed for SA NH Long Term Rehab services during the profiled period. Three of the CIR s submitted resulted in quality of care issues, and all three were from Drug and Alcohol Rehabilitation Services, Inc. in the Capital Contract. The Network average of Critical Incident Reports resulting in a quality of care or safety issue per 1000 Members was All Contracts had an average of except Capital, which had Compliance Compliance indicators were measured using the number of denied administrative appeals and the number of provider performance issues reported for each provider. There were fifteen denied administrative appeals across the Network, with an average of denied administrative per 1000 Members of Bedford/Somerset, Franklin/Fulton and Lycoming/Clinton had zero denied administrative appeals. Across the Network there were fifty-three documented provider performance issues, with an average of provider performance issues per 1000 Members of All Contracts except Capital scored below the Network average. 10

11 Competency Competency was measured using the percentage of provider trainings that were attended. Providers have the opportunity to attend provider trainings offered by CBHNP throughout the year. Although these meetings are not mandatory, they include valuable information for providers, and all providers are encouraged to attend. However, there were no trainings offered to SA NH Long Term Rehab providers in Satisfaction Member satisfaction was measured by the percentage of Members satisfied with the outcomes of complaints that were filed. There was 100% satisfaction related complaints filed for SA NH Long Term Rehab. Target Criteria Although all aspects of performance are important, these specific targets of a total average length of stay less than the Network average, a total thirty day readmission rate less than the Network average and zero Credentialing Corrective actions since 01/01/12, are goals that all providers should strive to achieve. The following providers from each Contract met the target criteria. Bedford/Somerset Providers Pyramid Healthcare, Inc. Blair Providers Gaudenzia, Inc. 11

12 George Junior Republic in Pennsylvania Treatment Trends, Inc. Franklin/Fulton Providers Clearbrook, Inc. Colonial House, Inc. Drug and Alcohol Rehabilitation Services, Inc. Firetree, LTD. Gaudenzia, Inc. Pyramid Healthcare, Inc. Lycoming/Clinton Providers Clearbrook, Inc. Colonial House, Inc. Eagleville Hospital Firetree, LTD Pyramid Healthcare, Inc. Capital Providers Clearbrook, Inc. Colonial House, Inc. Firetree, LTD. Interim House, Inc. (OON) Libertae, Inc. Nuestra Clinica of SACA, Inc. Treatment Trends, Inc. Valley Forge Medical Center and Hospital, Inc. Network Recommendations When summarizing the information contained above, several strategies for impacting SA NH Rehab provider performance can be identified. Establish an active treatment culture that incorporates evidence based treatment packages. Implement Prevention Plans and aftercare plans that support Recovery. Continue to develop co-occurring competency. Encourage all SA NH Rehab staff to actively focus on appropriate and meaningful discharge planning with full family involvement. Distribute CBHNP resource guide to all internal staff in order to fully develop natural and community supports. Develop a consortium of SA NH Rehab providers in order to share information and collectively address difficulties. 12

13 Develop procedures that will assist SA NH Rehab staff with meeting CBHNP expectations. Develop internal policies and procedures to facilitate more effective collaboration with other mental health providers and community agencies (e.g., Probation; CYS). Utilize Best Practice Guidelines to inform all treatment efforts. 13