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1 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Feedback t CalEQRO Outside Review Draft Reprt FY14-15 All feedback must be sent t CalEQRO within 10 business days f receiving the review draft. Submitted By: Mary Harnish, Cmpliance & Privacy Manager-Mental Health Services Date Submitted: Cntact Persn/Phne/ Mary Harnish, Cmpliance & Privacy Manager-Mental Health Services 1(408) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse CalEQRO will revise the narrative fr Recmmendatin #4 as fllws: 12 Recmmendatin #4: Prvide cntract prviders with reprts frm the Adult/Older Adult Database, as requested, and develp a similar resurce fr Children s prviders. The Family and Children (F&C) Divisin utilizes a different database than the Adult/Older Adult database. F&C staff met n a quarterly basis with the F&C Cntractrs t review budget and prgram perfrmance during the year. Budget dcuments prvided by the Finance Directr included Medi-Cal/EPSDT current perfrmance prjectins as well as average number f clients served per mnth and average cst per client, per mnth. These inpersn prgram review meetings created a venue fr tracking perfrmance f prgrams, cntracts and budgets fr F&C prgrams. Please incrprate this infrmatin int yur final reprt. As f February 2015 SCBHS cntinues t implement C-Cntrix Crdinated Care Plan (CCP) system that includes full electrnic health recrd functinality. They anticipate ging live in early 2016 at cunty-perated clinics and prgrams. It is anticipated cntract prviders will use electrnic data interchange transactins with C-Cntrix CCP at a future date. Mst participants in CALEQRO s February 19, 2015 Cntract Prviders Break-Out sessin stated that they d nt rutinely receive data r reprts frm C-Cntrix system. The Demand Capacity and Census Management Wrk Grup, with participatin frm cntract prviders, has begun t meet t develp baseline data fr the varius levels f care. The wrkgrup

2 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse is cmmunicating with Electrnic Health Recrd and Electrnic Data Interchange grups t supprt the changes t C-Cntrix CCP system which are cnsistent with requested infrmatin. In additin the wrk grup is wrking n a variety f tasks amng them is reprts frm C- Cntrix CCP t share with prviders t supprt shared management f capacity. Cntract prviders maintain separate EHRs with n interperability with SCBHS s C-Cntrix.. SCBHS staff cntinue t uplad cntract prvider service transactins int C-Cntrix fr billing purpses. This requires significant cntract prvider staff time t recncile differences. Family and Children (F&C) Divisin staff meet n a quarterly basis with the F&C cntractrs t review budget and prgram perfrmance during the year. Budget dcuments prvided by the Finance Directr include Medi-Cal/EPSDT current perfrmance prjectins, average number f clients served per mnth and average cst per client per mnth. These in-persn prgram review meetings create a venue fr tracking perfrmance f prgrams, cntracts and budgets fr F&C/children s prgrams. 55 The Access Call Center lacks a cmmn Scheduling/Preadmissin functin electrnically The Call Center des nt schedule appintments. The functin f the Call Center is t cmplete clinical screenings, determine level f service and refer t Please incrprate this infrmatin int yur final reprt. CalEQRO will revise this Access t Care Opprtunity as fllws:

3 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse linked t Cntract Prviders and FQHC s t electrnically identify pen appintment slts. Develpment f a cmmn Scheduler/Preadmissin EHR functin, EDI r ther electrnic interperability may be critical t integrating services and assessing capacity. apprpriate prviders fr services. The assigned prviders cntact the clients t schedule the first appintment. The Call Center has been receiving weekly capacity reprts frm all prviders. A spreadsheet has been designed and implemented t track capacity utilizatin. The Call Center is explring a sftware that culd address the need t track the capacity t eliminate the white bard. The Access Call Center lacks a cmmn Scheduling/Preadmissin functin electrnically linked t Cntract Prviders and FQHCs t electrnically identify pen appintment slts. Develpment f a cmmn Scheduler/Preadmissin EHR functin, EDI r ther electrnic interperability may be critical t integrating services and assessing capacity. The Access Call Center des nt schedule appintments. The functin f the Call Center is t cmplete clinical screenings, determine the level f service and refer cnsumers t apprpriate prviders fr services. The Call Center currently receives weekly capacity reprts frm prviders and a spreadsheet is used t track capacity (i.e. the white bard ). The Call Center lacks a Scheduling/Preadmissin functin linked t Cntract Prviders and FQHCs t electrnically identify pen appintment slts. The Call Center is explring a sftware that culd address the need t track capacity t eliminate the white bard. Related, the SCBHS lacks the capacity fr timely 56 placement f cnsumers in lwer r higher levels f Starting Nvember 2014, new Level 1 clients discharged frm acute r emergency psychiatric care have been seen at the Mental Health Urgent Care Clinic fr their Please incrprate this infrmatin int yur final reprt. CalEQRO will revise this Access t Care Opprtunity as fllws:

4 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse care. In particular, new Level 1 clients discharged frm acute r emergency psychiatric care are ften delayed in access t utpatient treatment. Imprving the thrughput f treatment thrugh EHR capacity shuld be a majr gal f SCBHS ging frward. first appintment. Since this implementatin, 100% f these cases are scheduled t be seen within 5 days f the date f discharge. This is part f the Clinical PIP. BHS Leadership has identified external cnsultants that have expertise in capacity analysis and system thrughput, and culd prvide technical assistance t the Adult/Older Adult Divisin, ensuring timely access, thrughput t apprpriate levels f care and capacity fr the Call Center. Data prvided t CalEQRO at the time f the review Related, indicated that SCBHS lacks the capacity fr timely placement f cnsumers in lwer r higher levels f care. In particular, new Level 1 clients discharged frm acute r emergency psychiatric care were are ften delayed in access t utpatient treatment. SCBHS s FY14-15 Clinical PIP addresses the issue f imprving access fr discharged Level 1 cnsumers. SCBHS states that starting Nvember 2014, new Level 1 cnsumers discharged frm acute r emergency psychiatric care have been seen at the Mental Health Urgent Care Clinic fr their first appintment and that since this implementatin, 100% f these cases are scheduled t be seen within 5 days f the date f discharge SCBHS Leadership has als identified external cnsultants that have expertise in capacity analysis and system thrughput t ensure timely access t apprpriate levels f care. Imprving the thrughput f treatment thrugh EHR capacity shuld be a majr gal f SCBHS ging frward. SCBHS shuld cnsider wrking with prvider 56 stakehlders t cmplete the adult and children s The Adult/Older Adult and F&C RFP s have been cmpleted and SCBHS is in the prcess f cnducting cntract negtiatins. It is standard plicy t hld bidder cnferences Please incrprate this infrmatin int yur final reprt. CalEQRO will revise this Access t Care Opprtunity as fllws:

5 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse utpatient SOC RFP and recntracting prcess including (if still within the RFP timeline), issuing RFP Instructin Letters, hlding infrmatinal meetings r bidders cnferences, issuing RFP amendments if pssible, r cnsidering any ther means t imprve services and include evidence-based practices under these prcurements and t address any ther legitimate issues which prvider stakehlders may raise. and send ut addendums (RFP updates and changes) fr all RFP s that are released by the Department. Requests fr Infrmatin can als be utilized t gather input frm ur service prviders, prir t releasing a RFP. Prgram utcmes and data gathering/reprts have been incrprated in the RFP s. SCBHS shuld maximize cllabratin cnsider wrking with prvider stakehlders t cmplete the adult and children s utpatient SOC RFPs and ther re-cntracting prcesses. It is standard plicy fr SCBHS t hld bidder cnferences and send ut addendums (RFP updates and changes) fr all RFP s released. Requests fr infrmatin can als be utilized t gather input frm service prviders prir t releasing an RFP. including (if still within the RFP timeline), issuing RFP Instructin Letters, hlding infrmatinal meetings r bidders cnferences, issuing RFP amendments if pssible, r cnsidering any ther means t imprve services and include evidence-based practices under these prcurements and t address any ther legitimate issues which prvider stakehlders may raise. Prgram utcmes and data gathering alng with perfrmance reprts have been incrprated in the RFP s. 57 Clinical line staff and lead need t be directly invlved and fully integrated in SCBHS Cmmittees/Wrkgrups, Executive prcesses, and decisin-making. Clinical line staff participate n all the Perfrmance & Quality Imprvement Cmmittee (PQIC) wrkgrups and have input int all recmmendatins that are presented t PQIC and the System f Care cmmittees. All levels f the rganizatin are represented and these Please incrprate this infrmatin int yur final reprt. These were cmments frm the Clinical Line Staff Fcus Grup. CalEQRO will revise this Quality f Care Opprtunity t state: Clinical line staff and lead staff stated during Fcus Grup sessins that they feel they are nt sufficiently need t be directly invlved and

6 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse recmmendatins infrm the Executive decisin-making prcess. The attached sample f wrkgrup reprts (see attachments: 0-5 Wrkgrup, TCP Wrkgrup, High Utilizer Wrkgrup, Inpt./Outpt. Wrkgrup) indicate the participants in the prcess. Each wrkgrup is designed t have crssrepresentatin f participants thrughut the system. As the Department cnvenes new wrkgrups and planning prcesses, BHS Leadership plans t include line staff. fully integrated in SCBHS Cmmittees, Wrkgrups, Executive prcesses, and decisinmaking prcesses. Selected clinical line staff participate n all Perfrmance & Quality Imprvement Cmmittee (PQIC) wrkgrups and have input int all recmmendatins presented t PQIC and System f Care cmmittees. All levels f the rganizatin are represented and these recmmendatins infrm Executive decisin-making prcess. Based n fcus grup feedback nt all levels f the rganizatin are aware f hw decisin-making prcesses functin. 56 The 2015 QIWP PLM s t track and trend: a) timely appintments fr urgent cnditins; and b) timely fllw-up appintments after hspitalizatin, shuld be implemented and timeliness PLM s shuld track data separately fr children and adults. Data fr Urgent Cnditins was tracked and used t frmulate the Clinical PIP fr Level I placements. Extensive analysis was cmpleted t assist in the frmulatin f the PIP. Fr timely fllw-up appintments after hspitalizatin, Decisin Supprt began running mnthly reprts (see attachment: EQRO BAP/Inpt. Cntract) after last year s EQRO visit. The data frm this reprt has been used ver the last year by the Inpatient/Outpatient Crdinatin wrkgrup t supprt the develpment f the charter and nging analysis activities. Please incrprate this infrmatin int yur final reprt. It shuld be nted that the MHP plans t implement reliable and valid timeliness measures, and prduce rutine reprts. Data fr urgent cnditins was tracked and used t frmulate the Clinical PIP, and Decisin Supprt has begun running mnthly reprts fr timely fllw-up appintments. The 2015 QIWP PLMs t track and trend: a) timely appintments fr urgent cnditins; and b) timely fllw-up appintments after hspitalizatin, shuld be implemented and timeliness PLMs shuld track data separately fr children and adults.

7 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse Mst cntract prviders reprt that they d nt rutinely receive data r reprts frm C-Centrix CCX. Cathy Smidde, Mental Health Prgram Specialist Mary Harnish Cmpliance Officer Mikelle Le, Senir Prgram Specialist 69 Nel Paulil, Cmpliance All agencies have been trained in hw t access data reprts in UNI/Care. They are als prvided technical assistance by Decisin Supprt upn request. In additin, when the Perfrmance Learning Measure (PLM) dashbard is sent t an agency, the backgrund data that creates the dashbard graphs is included. The data is prvided in an Excel spreadsheet t allw the agency t wrk with the data and create their wn internal reprts as needed (see attachments: PLM - F&C AACI, PLM - F&C Divisin fr sample f an agency s PLM). Decisin Supprt als prvides the apprpriate system level (Adult/Older Adult Divisin r Family and Children Services Divisin PLM) fr cmparisn purpses. While the data is prvided quarterly, all the agencies can access the data at any time fr whatever time perid they wish t examine. Supprting dcumentatin n hw the measures are develped has been prvided t the agencies in the past (see attachment #8 -Guide t the PLM). Please incrprate this infrmatin int yur final reprt. Cathy Smiddy Mental Health Prgram Specialist Mary Harnish, Cmpliance & Privacy Mgr., Mental Health Services Mikelle, Senir Mental Health Prgram Specialist Nel Panlili, Senir Health Care Prgram Manager These findings were strngly expressed by almst all participants in the Cntract Prviders Fcus Grup. This issue was als brught up by many cntract prviders participating in ther break-ut sessins. CalEQRO will revise this Quality f Care Opprtunity as fllws: Althugh SCBHS prvides cntract prviders with their quarterly PLM dashbard and a backgrund excel spreadsheet f these results, mst cntract prviders reprt that they d nt rutinely receive data r reprts frm C-Cntrix. SCBHS nted all agencies have been trained in hw t access data reprts in C-Cntrix. They are als prvided technical assistance by Decisin Supprt upn request. Change accepted and included in Final Reprt. Change accepted and included in Final Reprt. Change accepted and included in Final Reprt. Change accepted and included in Final Reprt.

8 Behaviral Health Cncepts, Inc. - Califrnia EQRO 400 Oyster Pint Blvd, Suite 124, Suth San Francisc, CA (855) Reprt Statement MHP Clarifying Respnse MHP Request fr Change CAEQRO Respnse 69 Paul Trugman, Therapist 69 Sheila Yater, Senir Prgram Specialist Paul Trugman-LCSW Sheila Yuter, Senir Health Care Prgram Manager Change accepted and included in Final Reprt. Change accepted and included in Final Reprt. 69 Steve Lawnsbery, QIC DADS Steve Lwnsbery, QIC II - DADS Change accepted and included in Final Reprt. 69 Tiffany Lee, MD, Medical Dtr. Tiffany H, M.D., Medical Directr Change accepted and included in Final Reprt. 69 Tni Tullys, Directr Tni Tullys, Behaviral Health Services Directr Change accepted and included in Final Reprt. If needed, rws can be added by clicking n the bttm right cell f the table abve and hitting the TAB buttn.

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