NOVA-IC, Inc. CABHA Performance Improvement Analysis January 1, 2011

Transcription

1 ..lighting the way to new beginnings BEHAVIORAL HEALTHCARE CORPORATION..lighting the way to new beginnings NOVA-IC, Inc. CABHA Performance Improvement Analysis January 1, 2011 Introduction NOVA-IC, Inc. is dedicated to a process of continuous quality improvement as our services and programs have expanded dramatically, and somewhat unexpectedly, over the last 3 years. Predicated on the collection of information and data that are reliable, valid specific and linked to established Indicators, NOVA has sought to achieve goals through Action Plans that: improve business functions and fiscal stability; improve effectiveness of services; improve the efficiency of service delivery; improve accessibility to services; and, improve Consumer and Stakeholder satisfaction with NOVA programs and services. Perhaps ideally, all improvement would be driven by this type of inductive approach. However, it must be noted that a considerable portion of NOVA s recent quality improvement has been the result of the achievement of certification as a Critical Access Behavioral Health Agency (CABHA). The CABHA certificaton is an initiative of the N.C. Division of Medical Assistance and the Division of Mental Health to identify effective and efficient providers and eliminate poorly performing providers. This is not to denigrate the importance of NOVA s Information Measurement and Management and Performance Improvement programs, but simply to point out that NOVA s significant gains over the last three years have come from two sources. This document only covers results from our IM&M program. 1. BUSINESS FUNCTION NOVA-IC uses a detailed and comprehensive system of financial data analysis to manage its business affairs. The CBHS Budget covers all community-based services including Child and Adolescent Day Treatment services (DT); Intensive In-Home services (IFB); Targeted Case Management-MH/SA (CM/SC); Outpatient Treatment (OP); and numerous other small services. Page 1 of 7

2 The CBHS Finance Committee includes: Director of Clinical / Corporate Operations Director of Business Operations Director of CBHS Operations Operations Coordinator Certified Public Accountant (ex-officio) Each June the Finance Committee meets to review the previous year s budget, identify problems and issues that need to be addressed, and formulate a detailed, departmentalized Budget that establishes spending caps and revenue projections. These finalized Annual Budgets (July 1 through June 30) are then presented to the Governing Board for approval. On a monthly basis the Finance Committee meets to review revenue and expenses against projections and caps. Problems and issues identified through this process are immediately addressed. An annual Financial Review is completed by an independent CPA, and the results are reviewed by the Finance Committee and Corporate CPA. All recommendations are considered and acted on as appropriate. In terms of financial position, the ICF/MR Services Budget for FY projects total revenues will slightly exceed expenses. Because of ICF/MR budgeting rules any revenue over expense will be passed on to direct care staff as bonuses. The CBHS FY budget projects revenues exceeding expenses.. These figures are likely to change significantly due to the expansion of services into the Smithfield-Selma, NC communities. #1 An analysis of business functions revealed that there was no diligent monitoring of actual billings collected compared to billings submitted, for CBHS services. As these services have expanded rapidly concern was raised that NOVA was not being fully compensated for all services rendered. Goal: For Day Treatment services collections will achieve a benchmark of 97% of billings. Goal: For Intensive In-Home services collections will achieve a benchmark of 97% of billings. Page 2 of 7

3 Action Plan: A tracking system was implemented between the Billings Manager and the Information Measurement and Management Consultant to track collections data. New software (Medisoft) was purchased to expedite the billing / collection function. Additional training was provided to the Billings Manager by the Division of Medical Assistance to improve billing skills. In July, 2010 data showed that Benchmark s were consistently met and that the Action Plan was successful. These goals were discontinued. #2 A review of budget needs and service delivery revealed that revenue was barely meeting expense projections. The review also showed that CBHS services were being under utilized. Goal: For FY for each Day Treatment service a benchmark of 31,200 paid unit hours will be met. Goal: For FY for Intensive In-Home services a benchmark of 1152 paid unit hours will be met. Action Plan: Full-time Licensed Professional positions were added to each service, replacing the part-time positions. Outreach initiatives were conducted with the Public Schools and Community Collaboratives relative to capacity. Final Endorsement from Eastpointe LME, and the Medicaid Provider number was obtained for New Beginnings-Kinston in November, As of December 31, 2010 New Beginnings-Kinston was 1489 units below the benchmark, solely due to the delay of obtaining an MPN. New Beginnings-Goldsboro had exceeded the benchmark by over 6000 paid units. The Intensive In-Home program was paid 45 units below the benchmark. This deficit reflects the number of Consumers transitioning out of the service and State Mental Health imposed limits on the number of Consumers per Team. Both Goals are continued. Effectiveness of Services Page 3 of 7

4 #1 To reinforce ongoing efforts to reduce / eliminate any use of restrictive interventions, reduce Consumer injury, reduce unfounded Consumer allegations, reduce Med errors, reduce elopements, reduce Law Enforcement involvement, etc, all of which are considered Level II incidents. NOVA Leadership chose to monitor and intervene in these areas, since they are germane to the health and safety of Consumers. Goal: In CBHS Services a benchmark of 12 or less Level II Incidents will be achieved during FY Action Plan: Staff training was accelerated in proactive detering methods of intervention. Through December 31, Level II Incidents were documented. Data collection continues per these goals. #2 The Behavioral and Emotional Rating Scale 2 nd Edition has been in use on an admission-discharge basis for CBHS childrens services. Preliminary aggregate data for Day Treatment Consumers only suggest that a 5% benchmark is a reasonable expectation for improvement in the overall Strength Index. More data and a comprehensive aggregation is needed to reach a more valid conclusion regarding program outcomes. Goal: For the CBHS program, for children s services aggregate BERS Strength Index scores will improve by a benchmark of 5% or greater on an admission-discharge basis. Action Plan: Continue to administer the BERS on an admission/ discharge basis. Conduct a full aggregation of data, to include Intensive In-Home services Consumers. Generate a full Annual Outcomes Measures report. The Preliminary aggregation of BERS data for Day Treatment Consumers showed a mean improvement in the Strength Index Score of 14 points (84 98), which is a 16% improvement. Adding data for Intensive In-Home Consumers is expected to reduce improvement, because it is a shorter term less vigorous service. Service Access Page 4 of 7

5 #1 For the CBHS program, Leadership determined that accessibility information was important since these were new services and no data were available. NOVA was motivated to ensure that services were being delivered in a timely manner given the tremendous need, due to the closure of many residential programs for children. Goal: Elapsed days from Intake to Case Disposition will meet a benchmark of 3 days (72 hours) or less for 100% of cases. Goal: Elapsed days from Referral to Med Management appointment will meet a benchmark of 7 days or less for 100% of cases. Action Plan: NOVA implemented a more efficient Intake system designed to only probe for the exact information relevant to process the case. A full-time Licensed Professional position was added to the Day Treatment programs to provide immediate access to Comprehensive Clinical Assessment services. Intake QPs were instructed on the importance of meeting the benchmarks. Leadership met with the Psychiatrist and identified strategies to expedite appointment scheduling. Through December 31,2010 the mean elapse days from Intake to Case Disposition was 1.86 days, with 100% of Cases meeting the benchmark. For Med Management appointments the mean elapsed time from referral to appointment was 1.17 days, which was significantly under the benchmark for 100% of cases. Subsequently, the benchmark for this goal has been changed to 3 days (72 hours or less). These goals and data collection will continue as NOVA proceeds in rapidly adding services. #2 Based on meetings with Johnston County LME, NOVA was invited to help address treatment need accessibility issues. Goal: Develop Day Treatment and Intensive In-Home Services in the Smithfield-Selma area by July 1, Action Plan: Identify suitable facilities for all programs. Obtain License and Provider Numbers for services. Execute contracts and MOAs with Johnston County.. Aspects of the Action Plan are under development and execution. Page 5 of 7

6 Satisfaction #1 Though Satisfaction data suggest that NOVA does not have a problem with Consumer or Stakeholder Satisfaction. Leadership is committed to a formal, ongoing monitoring system for this critical area. In addition, responding to Stakeholder comments is a valuable tool for program improvements. Goal: NOVA will maintain a benchmark mean rating of 4.0 on a 5.0 scale for the CBHS programs, based on Satisfaction Surveys. Action Plan: NOVA Leadership will distribute, evaluate and respond to Satisfaction Survey data, and will upgrade the format and methodology, as needed. For the CBHS program the mean Stakeholder satisfaction rating was 4.18, again exceeding the benchmark. #2 In order to improve communication and create another venue for satisfaction data, NOVA Leadership decided that adding a satisfaction page to the NOVA website would be an invaluable tool. This also has implications for improved accessibility.. Goal: Add a satisfaction page to the NOVA website by June 30, Action Plan: Upgrade the NOVA Website to make it interactive using Survey Monkey software. Develop the content for the webpage, and a system for retrieving and analyzing data. Aggregate and report data on a scheduled basis. Page 6 of 7

7 Page 7 of 7