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UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of CareQuarters 3 & 4: July-December 2015 - Submitted March 1, 2016
By Robert W. Plant, Ph.D. with Ann Phelan,Bonni Hopkins, Ph.D., Laurie Van Der Heide, Ph.D.,Sherrie Sharp, M.D., Lynne Ringer, Heidi Pugliese,
Ellen Livingston, Jennifer Krom,Joe Bernardi, Ivan Theobalds, Rebecca Neal, John Broadwell,
Stella Ntate, and Lindsay Betzendahl,as well as the entire Reporting, Clinical and Quality Departments.
For any inquiries, comments, or questions related to the use of Tableau, or its interactive functions, please contact Lindsay Betzendahl at [email protected].
UTILIZATION REPORT FOR YOUTH MEMBERSQuarters 3 & 4: July-December 2015
MethodologyThe shift to semiannual reports was designed to minimize noise created by quarter-to-quarter fluctuations that do not reflect a true trend in the data. However, asagreed, these semiannual reports will continue to include quarterly level detail rather than a simple roll-up of 6-month periods. This achieves the balance of makingsure that significant and meaningful quarterly fluctuations are not missed while maintaining a focus on more persistent trends. The utilization data in the 4A and10B series reports are exclusively based on authorizations entered into the Beacon Connect system. In some cases, additional data, primarily drawn from theProvider Analysis and Reporting program (PAR), are included to enhance the understanding of the drivers of the utilization trends. An example of this is the inclu-sion of the Inpatient child PAR data that helps to further explain how changes in the average length of stay (ALOS) for child inpatient hospitalization for a givenquarter are impacted by individual hospital performance.
The data for the utilization reports are refreshed in each subsequent set of reports. As a result of retrospective authorizations and changes in eligibility, the resultsfor each quarter often differ from the previously reported values. In most cases, the refreshed data does not result in significant differences in the previously re-ported conclusions. However, on some occasions there is sufficient variation that the previous analysis is no longer relevant. This phenomenon has been muchmore common for analyses of adult utilization, as retrospective membership variations have been significantly larger for adults than for youth. For any analysis af-fected by these variations, we identify it in the narrative and describe the implications.
Total membership is based on unique members. This means that even if a member changes age, benefit group or DCF status they will only be captured once inthat reporting period.
The length of stay calculation is based only upon those members who were discharged during the reporting period. The measure includes all days from the begin-ning of the authorization for that level of care, including those from previous reporting periods if applicable. Significance testing was calculated for average lengthof stay by using a mixed effects model with a fixed term.
The numerator for admits/1,000 and days/1,000 are based on the total number of members in the identified group. Days/1,000 include service days consumedduring the reporting period. All per 1,000 calculations, except where noted, use the statewide youth population as the denominator. Significance testing for admitswas calculated using a chi square test. For the purposes of this report, only those measures that are both statistically significant and clinically meaningful will bediscussed and noted as statistically significant.
General OverviewThis is the second report that reflects changes in the timing and format of the utilization review. These reports will continue to cover two quarters and be completedsemiannually. The review of the data will continue to look at quarters; the underlying reports and graphs will not combine the two quarters into 6-month figures. Theformat will continue to be displayed in Tableau, a more interactive data visualization product.
On at least a semiannual basis, the reports mutually agreed upon in Exhibit E of the CT BHP contract are submitted to the State for review. This report focuses onthe utilization management portion of these reports, evidenced in the 4A series, which reviews utilization statistics such as admissions per 1,000 members (ad-mits/1,000), days per 1,000 members (days/1,000), and average length of stay (ALOS).
As stated in previous submissions, results were graphed only for benefit groups that had a sufficient volume of members receiving services in each level of care(LOC). The utilization report focuses only on those levels of care in which the data warranted analysis and discussion as evidenced by significant changes andtrends or in cases when changes and trends are unclear and additional data is needed. As a result, this report outlines/highlights the areas of interest related tocertain utilization trends, as well as the underlying factors which drive the trend and associated programmatic responses taken by Beacon Health Options to im-pact/mitigate or support the trend. We also present recommendations to address remaining challenges and report progress related to these planned recommenda-tions. The areas of focus for this quarter are listed on the following page.
Reports Used for Youth Report
Reports Used4A_2 Total Unique Membership4A_2 Total Unique Membership: All Youth (ages 17 and under)4A_1 Membership Youth (ages 17 and under) DCF Members4A_1 Membership Youth (ages 17 and under) Non-DCF Members Composition of DCF Membership; 2012 – 20144A_1/4A_2 Inpatient Admits/1,000; All Youth (ages 17 and under); DCF vs. Non-DCF Members4A_1/4A_2 Inpatient Days/1,000; DCF vs. Non-DCF Members (ages 17 and under)4A_1/4A_2 Inpatient Average Length of Stay, DCF vs. Non-DCF MembersPAR Inpatient Average Length of Stay (ALOS) and Discharges for In-State Pediatric Hospitals; All Youth (ages 3-12)PAR Inpatient Average Length of Stay (ALOS) for In-State Pediatric Hospitals; Child (ages 3-12) and Adolescent (ages 13-17), DCF vs. Non-DCFPAR Inpatient Pediatric Hospitals Average Length of Stay (ALOS) Comparison10B_7 Inpatient Percent of Days Delayed , DCF vs. Non-DCF MembersCTBH12087 Inpatient Days in Delay by Reason code(s)CTBH12087 Inpatient Solnit Center ALOS; All Youth, Court Ordered and Non Court Ordered data10B7 Inpatient Solnit Center Number of Days DelayedCTBH12212 Inpatient Solnit Center Days in Delay by Reason Code4A_2 Community PRTF Admissions; Youth (ages 5 – 13), Community PRTF Days/1,000 and PRTF Average Length of Stay, Youth (ages 5 – 13)10B7 Community PRTF Number of Days Delayed; Youth (ages 5- 13), Discharge Delay Descriptions10B4B PRTF (excluding Solnit) Discharge Delay Reason Awaiting Placement4A_2 Solnit Center PRTF Admissions; Youth (Ages 13 – 17)4A_2 Solnit Center PRTF Days/1,000; Youth (Ages 13 – 17)4A_2 Solnit Center PRTF Number of Days Delayed; Youth (Ages 13-17)CTBH10035 RTC Length of Stay AnalysisCTBH08006 Outpatient Registration (OTP) Timely Receipt of Evaluations, ECC Providers - All MembersCTBH08006C Outpatient Registration (OTP) Timely Receipt of Evaluations, ECC Providers (Ages 0-17)CTBH07082C_18D Outpatient (OTP) Registration Timely Receipt of Evaluations, Excluding ECCs (Ages 0-17)
UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of CareQuarters 3 & 4: July-December 2015 - Submitted March 1, 2016
Areas of Focus
MembershipTotal UniqueDCF & Non-DCF
Composition of DCF Membership
Inpatient FacilitiesAdmits/1,000 & Days/1,000Average Length of StayPAR Hospitals
Percent of Days DelayedDischarge Delay Reason Code(s)
Inpatient Solnit CenterAverage Length of StayNumber of Days Delayed
Discharge Delay Reason Code(s)
Community & Solnit PRTFAdmissions & Days/1,000Average Length of StayTotal Overstay Days
Overstay Reason Code(s)
Autism Spectrum Disorder ServicesAdmissions & Admits/1,000
Utilization ProfileProvider Volume
Outpatient Enhanced Care Clinics (ECC)Registration VolumeAccess Standards
Table of ContentsSelect Bookmark Icon to View "Areas of Focus"
And Go Directly to Selected Page
For this report, the following utilization data points have been placedin the Appendix and are not discussed:
RTCAdmissions &ALOS
PHP, IOP, &EDT
Admits/1,000
IICAPSAdmits/1,000
Outpatient(OTP)
Admits/1,000
Youth Medicaid MembershipTotal Membership Volume & DCF Membership
PG 1
After decreasing for three consecutive quarters, DCF membership increased in both Q3 ’15 and Q4 ’15.DCF youth continue to make up about 2.5% of the total youth membership.
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0K
100K
200K
300K
400K
500K
600K
700K
800K
900K# of Members
Total Unique Membership■ Adults/Youth ■ Youth ■ Non-DCF ■ DCF
OverviewThe total unique membership increasedslightly in Q3 ’15 and then decreased in Q4‘15. It appears that, even with refreshednumbers, there may be a decrease in mem-bership for both youth and adults in Q4 ’15.
Total youth membership slightly increasedin Q3 ’15, but then decreased 3.5% in Q4’15. The non-DCF youth continue to makeup about 98% of the total youth population.
The Q3 ’15 refresh rate was at more histori-cal levels (0.55%). The enrollment dead-lines for the Affordable Care Act impactedour membership data in the first quarter of2014 and 2015, hence the larger than usualrefresh rates (2.18% and 2.07%, respec-tively). We should expect this to occur againin 2016 given the January 31, 2016 openenrollment deadline. The refresh rates canbe found in the table on page 2.
After decreasing for three consecutivequarters, DCF membership increased inboth Q3 ’15 and Q4 ’15. DCF youth contin-ue to make up about 2.5% of the total youthmembership. And within this 2.5%, the DCFCommitted category continues to be about94% of the group. After decreasing for threeconsecutive quarters, the DCF committedpopulation increased in both Q3 ’15 and Q4’15. All the other categories decreased inQ4 ’15, and these decreases can be seen ifyou deselect "DCF Committed" from thegraph dropdown. Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0K
1K
2K
3K
4K
5K
6K
7K
8K
# of Youth
Composition of DCF Youth■ Committed ■ Voluntary ■ Juvenile Justice ■ Dually
Committed ■ FWSN
Select to Compare DCF YouthAll
Select to Compare GroupsAll
PG 2 Youth Medicaid Membership TablesTotal Membership, Refresh Rate, & DCF Membership
2013
Q3 Q4
2014
Q1 Q2 Q3 Q4
2015
Q1 Q2 Q3 Q4
DCF Committed
Voluntary Services
Juvenile Justice
Dually Committed
Family with Service Needs 24
32
237
500
7,213
19
29
232
552
7,376
10
29
213
402
8,009
15
31
224
458
8,071
17
31
221
478
7,912
21
30
226
475
7,545
6
29
148
322
8,006
7
33
164
328
7,916
5
33
170
341
7,750
8
26
199
383
7,972
Quarterly Youth (0-17) DCF Membership Composition
2013
Q3 Q4
2014
Q1 Q2 Q3 Q4
2015
Q1 Q2 Q3 Q4
Total Membership (Inc Adults)
Total Youth Membership
DCF
Non-DCF 298,545
7,964
304,986
710,829
297,828
8,177
304,190
706,645
319,030
8,695
326,108
838,273
316,142
8,787
323,188
818,021
310,059
8,613
316,976
796,792
304,797
8,275
311,516
772,321
307,928
8,490
314,702
826,148
319,485
8,428
326,203
868,361
318,352
8,279
325,131
862,255
320,718
8,560
327,754
863,147
Quarterly Unique Membership CompositionColumns wil not add up to the total because members can move between DCF groups.
2013
Q3 Q4
2014
Q1 Q2 Q3 Q4
2015
Q1 Q2 Q3
Original Membership
Refresh One Quarter Later
Refresh Percent Change 0.82%
304,986
302,500
0.79%
303,770
301,388
0.80%
326,108
323,534
0.64%
322,899
320,844
1.10%
316,547
313,099
2.18%
310,381
303,773
0.55%
326,203
324,413
1.59%
324,902
319,805
2.07%
326,326
319,721
Quarterly Youth (0-17) Membership Data Refresh
Conclusions
The total unique membership (youth and adult) has decreased 4% from Q2 ’15 to Q4 ’15 (862,255 to 826,148). Individually, both the adult and youth membershiphave decreased.
The total youth membership decreased by 3% (325,131 to 314,702) from Q2 ’15 to Q4 ’15. The driver of this decrease was the non-DCF population which de-creased 3.3%, in contrast to the DCF membership which slightly increased 2.5% (8,279 to 8,490). The driver of the increased DCF membership was noted in theDCF committed population which increased from 7,750 in Q2’15 to 8,006 in Q4 ’15, a 3.3% increase. The DCF voluntary service membership decreased by 6%and the juvenile justice population decreased 13%, reaching the lowest membership for both groups over the past ten quarters.
Overall, in Q4 ’15, youth accounted for 38% (314,702 of 826,148) of the total Medicaid population. DCF continues to represent a small percentage of the totalMedicaid membership (1%), while non-DCF comprises 37% (307,928 of 826,148) of the total Medicaid membership.
We will continue to monitor the DCF population for further trending, specifically, the DCF committed, voluntary and juvenile justice populations which had notedvariations.
PG 3
Youth Membership Summary
Inpatient: Excluding SolnitAdmits/1,000, Days/1,000 & Average Length of Stay
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0.00
0.20
0.40
0.60
0.80
Admits/1,000
Inpatient Admits/1,000: Youth (0-17)Excluding Solnit
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0.00
2.00
4.00
6.00
8.00
10.00
Days/1,000
Inpatient Days/1,000: Youth (0-17)Excluding Solnit
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
2
4
6
8
10
12
14
16
18
Avg. Length of Stay (days)
Inpatient Average Length of Stay: Youth (0-17)Excluding Solnit
At 10.9 days in Q4 '15, the inpatient ALOS for all youth was thelowest it has been over the past 10 quarters.
Select to Highlight GroupDCFNon-DCFTotal Youth
PG 4
OverviewThere are approximately 130 pediatric in-state inpatient psychiatric beds, plus additional out-of-state beds at a few hospitals. After trending upwards for the priorthree quarters, total admits/1,000 decreased in Q3 ’15 then went back up in Q4 ‘15. For the third straight year there was an increase in Q4, suggesting this metricfollows a seasonal trend. These same trends occurred for the non-DCF youth, which is the driving force behind the total. For the DCF youth, admits/1,000 hastrended upwards for the third consecutive quarter. Typically as admits/1,000 go up, ALOS goes down and vice versa, and we see this occur in Q3 and Q4 of 2015.Overall, ALOS has continued to trend downward over time. The DCF youth have had a longer ALOS then the non-DCF youth for each of the last ten quarters.However, in Q4 ’15, the magnitude of the difference was the lowest across this same time period (1.01 days).
The range of ALOS for the DCF members was 1–63 days; for the non-DCF members it was 1–411 days across Q3 ’15 and Q4 ’15; however, the 411 LOS was anoutlier, as the next-longest ALOS was 65 days. Days/1,000 has been trending downward, which indicates that members are using fewer days. The number of cas-es in Q3 ’15 (664) was the lowest number of cases in the last two years, which was driven by a large decrease in the number of non-DCF cases, as the number ofDCF cases actually increased in Q3 ’15.
PG 5 Inpatient: In-State Pediatric HospitalsAverage Length of Stay
Includes the Seven In-State Pediatric PAR Hospitals (Ages 3-17)
OverviewIn Q2 ’15, for youth ages 3-12, DCF youth had a lower ALOS than the non-DCF youth for the first time in eight quarters. In both Q3’15 and Q4 ’15, the DCF group had an ALOS that was again greater than the non-DCF ALOS, which has been the usual trend. Forthe DCF group, Q4 ’15 had the highest number of discharges for CY 2015. This also occurred in Q4 ’14, suggesting there could besome seasonality to this metric. The length of stay range for the DCF 3-12 year olds was 2–63 days while the range for the non-DCFgroup was 1–230 days; the 230 day stay was an outlier, as the next longest length of stay was 81 days.
For youth ages 13-17, the DCF group continues to have a longer ALOS than the non-DCF group. Since Q1 ’14, both the DCF andnon-DCF ALOS have moved in the same direction; they have alternated between decreasing and increasing each of the last sevenquarters. The DCF ALOS has more variability over time. Also, in Q4 ’15, these two measures differ by only 1.2 days; this is thesmallest difference between them in the last ten quarters. For the 13-17 year olds, the range for the DCF group was 1-50 days, whilethe range for the non-DCF group was 1-411 days.
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
2
4
6
8
10
12
14
16
18
Avg. Length of Stay (days)
Inpatient Average Length of Stay; Ages 3-12 & Ages 13-17DCF & Non-DCF Members
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
50
100
150
200
250
300
350
400
Discharges
Inpatient Total Discharges; Ages 3-12 & Ages 13-17DCF & Non-DCF Members
Select Age/DCF Group(s)Multiple Values
DCF, Ages 3-12DCF, Ages 13-17Non-DCF, Ages 3-12Non-DCF, Ages 13-17
PG 6 Inpatient: In-State Pediatric HospitalsAverage Length of Stay & Discharge Volume
Includes the Seven In-State Pediatric PAR Hospitals (Ages 3-17)
0 2 4 6 8 10 12 14Avg. Length of Stay (days)
Hartford Hospital
Manchester Hospital
Natchaug Hospital
St. Francis Hospital
St. Vincent's MedicalCenter
Waterbury Hospital
Yale New Haven Hospital
Statewide PediatricHospitals
11.40
12.20
10.80
10.20
5.40
9.30
9.00
9.80
Quarterly Inpatient In-State Pediatric (PAR) Hospitals Average Length ofStay ComparisonShowing Q4 '15
Q2 '14 Q2 '15
0
5
10
Avg. Length of Stay
Inpatient PAR Hospital: Statewide Pedi-atric Hospitals
ALOS All Youth (Ages 3-17)
Q2 '14 Q2 '15
0
200
400
600
Discharges
Inpatient PAR Hospital: Statewide Pe-diatric Hospitals
Discharge Volume All Youth (Ages 3-17)
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
5
10
15
20
Avg. Length of Stay
Quarterly In-State Pediatric (PAR) Hospitals Average Length of StayHospital Comparison // Select Quarter (point) to Filter Bars
In-State Pediatric HospitalsFor the in-state pediatric hospitals, the ALOS has remained stable over time. Itincreased in Q3 ’15 and then decreased in Q4 ’15 to the lowest level over thelast ten quarters (10.2 days). The top three providers by volume are Yale NewHaven, Hartford, and Natchaug. Since they account for 70.0% of discharges inQ3 and Q4 ‘15 (843/1210 discharges), they are the largest drivers of change inthe statewide ALOS. The ALOS for Hartford, Manchester and St. Vincent’s de-creased from CY ’14 to CY ’15, Natchaug and Waterbury saw a slight increasein ALOS, and St. Francis’ and Yale New Haven’s ALOS remained constant.
The ALOS for the in-state pediatric hospitals has remained stable over the past 10 quarters. During this time period,on average, 614 youth are discharged each quarter.
Highlight HospitalStatewide Pediatric Hospitals
PG 7 Inpatient Hospitals (All and In-State/PAR) TablesAdmits/1,000, Admissions, Days/1,000, Average Length of Stay & Discharges
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Hartford Hospital
Manchester Hospital
Natchaug Hospital
Waterbury Hospital
Yale New Haven Hospital
St. Francis Hospital
St. Vincent's Medical Center
Statewide Pediatric Hospitals 11.8
8.8
11.6
13
9.1
11.6
10.2
13
12.7
13.1
13.7
12.1
9.5
13.7
7
14.8
11.5
10.1
9.5
10.4
10.8
11.6
10.1
18.5
11.8
9.2
11.1
11.9
8.3
11.4
13.6
14.2
10.9
9
14.9
10.3
7.6
11.2
7.1
14.4
11.3
9.5
11.8
11.1
9
11.8
7.1
16.2
10.2
9
9.3
9.8
10.8
12.2
5.4
11.4
12.1
8.2
12.9
13.4
14.6
12.8
8.3
11.3
10.8
6.9
12.5
10.3
8.6
12.3
8.6
14.2
11.5
10.8
11.3
10.7
6.7
12.1
7.6
15.5
Quarterly Inpatient In-State (PAR) Hospitals Average Length of Stay (ALOS): All Youth (Ages 3-17)
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Ages 3-12 DCF
Non-DCF
Ages 13-17 DCF
Non-DCF
All Total Youth
14
14.8
12.9
18.3
12.4
15.2
11.2
15.6
11.8
16.5
11.8
17.2
10.2
13
12.3
13.7
12.9
12.3
12
14.1
10.2
12.7
10.2
16.1
10.2
13.6
10.3
15.6
9.5
12.4
9.6
15.3
9.6
10.8
11.1
14.6
9.1
13.7
10.3
14.7
11.812.7 11.511.810.911.3 10.212.110.811.5
Quarterly Inpatient In-State (PAR) Hospitals Average Length of Stay (ALOS): All Youth (Ages 3-17)DCF & Non-DCF Members
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
DCF
Non-DCF
Total Youth 12.14
11.51
14.02
14.25
13.18
17.06
12.8
12.14
15.28
12.36
11.26
15.83
11.52
10.92
13.87
12.04
10.63
17.2
10.94
10.73
11.74
12.48
11.88
14.49
11.21
10.75
13.37
12.41
11.73
15.5
Quarterly Inpatient (All Hospitals) Average Length of Stay (ALOS): Youth (0-17)Excluding Solnit
Select Measure for PAR TableAverage Length of Stay (ALOS)
Select Measure for TableAverage Length of Stay (ALOS)
10.630 17.200
9.100 18.300
10.000 18.500
PG 8 Pediatric Inpatient SummaryExcluding Solnit
Conclusions
From Q2 ’15 to Q4 ’15, there was a slight increase in admits/1,000, with a decrease in the ALOS for the HUSKY youth population. The ALOS for all youth de-creased 2.4% (11.21 to 10.94) from Q2 ’15 to Q4 ’15. The decrease in the ALOS for DCF (down 11.5%) was the main driver of the decreased ALOS for all youth.
The DCF adolescent (13-17 year old) ALOS decreased the most, by 21% (13.7 to 10.8) from Q2 ’15 to Q4 ’15. The non-DCF 3-12 year old ALOS also decreased,while there was a slight increase in the ALOS for the DCF 3-12 year old and the non-DCF 13 -17 year old populations. Although, the DCF ALOS has remainedhigher than non-DCF, it has again decreased from Q2 ’15 to Q4 ’15. The ALOS in Q4 ’15, for both the DCF and non-DCF groups, was the lowest over the past tenquarters.
RecommendationsBeacon Health Options continues to recommend the development of a preventive model of integrated care, which can provide families easy access and rapid con-nection to treatment services. The following recommendations are opportunities to enhance this type of healthcare delivery.
1. Develop an infrastructure which supports easy access and connection to treatment services for specialized populations such as those children with an AutismSpectrum Disorder diagnosis (ASD): Most children with an ASD diagnosis who require acute care services utilize out-of-state facilities for acute stabilization whichoften leads to longer lengths of stay secondary to the increased distance from their home and the inability of families to participate in the treatment due to trans-portation issues. Youth with an ASD diagnosis often stay longer in inpatient care than their non-ASD identified peers who utilize the same services.
Update: Beacon has authorized ABA services for children with an Autism diagnosis since January 2015. The Beacon ASD team consists of care managers, carecoordinators and peer specialists. During this time, Beacon has collaborated with the Department of Developmental Services, Department of Social Services andthe Department of Children and Families weekly to review operations, cases, and continue to build the Medicaid provider network to serve this population. Beaconhas also worked with the State agencies to collaborate with the Hospital of Special Care which opened a specialized ASD 8-bed inpatient unit. This unit has admit-ted Medicaid members with an ASD diagnosis to provide the specialized longer term behavioral and clinical treatment required for stabilization and transition. Akey component of the unit’s therapeutic intervention has been the increased ability for families to participate within the behavioral plan due to the in state location.Beacon will continue to collaborate with State partners and the Hospital of Special Care to provide utilization review, and case coordination to the members admit-ted to the unit to ensure successful outcomes.
2. Integrate behavioral health services for youth within a Family Care Model Urgent Care Center: There is a need to develop easy, rapid access to behavioralhealth care treatment in local communities as an alternative to emergency departments. The addition of behavioral health services with an already established ur-gent care center to provide integrated care in a family care model has the potential to reduce both behavioral health and medical emergency department and inpa-tient utilization. The recommendation is unchanged from previous quarters.
Update: There are currently no urgent care centers in Connecticut which integrate behavioral health services within a Family Care model. However, some clinicshave expanded their services to include both primary care and behavioral health care. Two Enhanced Care Clinics now provide both behavioral health and primarymedical services. Intercommunity Health Center in Glastonbury CT and Bridges in Milford have expanded access to include both medical and behavioral health of-fering urgent status appointments when deemed clinically necessary. In addition, Cornell Scott and Charter Oak clinics continue to serve as FQHCs (FederallyQualified Health Centers) which provide both medical and behavioral health care to Medicaid members. Beacon continues to recommend expansion of these ex-isting programs to include urgent care and integrating behavioral health services for youth within a family care urgent care center.
Recommendations continue on the next page.
PG 9 Pediatric Inpatient Summary, continuedExcluding Solnit
Recommendations, continued from previous page
3. Continue to expand the implementation and development of Rapid Response model: The Rapid Response model focuses on the collaboration among commu-nity, State agencies and Beacon staff to provide emergency departments support and case management. Opportunities remain to implement a Rapid Responsemodel in other emergency departments (ED) with high pediatric behavioral health volume.
Update: The Rapid Response model continues to provide successful collaboration between Connecticut Children’s Medical Center (CCMC), the Department ofChildren and Families (DCF), Emergency Mobile Psychiatric Services (EMPS), and Beacon Health Options. Monthly meetings and daily clinical rounds continue.Intensive Case Managers continue to call each in state emergency department and track inpatient youth bed availability to provide effective case coordinationwhen needed for HUSKY youth who present to the emergency department. There remain opportunities to expand this model to other high-volume emergency de-partments.
4. Establish, in each of the regional areas, a centralized forum which meets regularly to discuss at-risk youth who have high utilization of crisis and behavioralhealth services. Beacon continues to recommend the establishment of a centralized forum in each regional area to coordinate care for those youth identified as atrisk for high utilization of inpatient and emergency department services. This forum would serve to engage communities, families, schools, and providers in theplanning, and delivery of behavioral health services.
Update: The Integrated Service System (ISS) meeting has been established in each regional DCF area office. Beacon Health Options’ staff attend these meetingsto support coordination of care and dialogue to engage communities in the planning and delivery of behavioral health services. Currently, Beacon is working in col-laboration with DCF and several emergency departments and providers to schedule regional community meetings which focus on discussion of crisis and emer-gency services. Beacon continues to recommend this type of forum to build a preventative behavioral health care system.
5. Continued State Agency collaboration with Beacon Health Options: Beacon continues to recommend ongoing collaboration with the State Agencies on multiplelevels to develop an integrated, community-based, preventive healthcare system. Beacon and DCF will continue to have weekly complex case rounds to discussall HUSKY inpatient children who require additional escalation and collaboration. This process is designed to promote early coordination of care and communica-tion between State Agencies on complex cases.
Update: Beacon Health Options continues to meet with State partners on a weekly basis in multiple forums. The Department of Developmental Services (DDS)has continued to participate with DCF, and Beacon in weekly Complex Case discussions to review high-risk children who require additional escalation and stateagency intervention. In addition, ASD weekly meetings with DDS, DSS and DCF have been established. This process continues to serve as a preventative modelto promote timely escalation and coordination of care.
PG 10 Inpatient Discharge Delay: Excluding SolnitPercent Delay Days & Delay by Reason
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0%
5%
10%
15%
% of Days Delayed
Quarterly Inpatient (Excluding Solnit) Percent of DaysDelayed: All Youth
■ Total Youth ■ Non-DCF ■ DCF
Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
10
20
30
Delayed Discharges
Quarterly Inpatient Discharges with Delayed Days:All Youth
Hover to View Delayed Reason
Percent of Days DelayedThe percent of total delay days decreasedby 0.8 percentage points to 6.10% in Q3’15 and Q4 ’15. The slight decrease in Q3’15 was driven by non-DCF memberswhose percent of delay days decreased by1.2 percentage points to 5.60%. Totalnumber of cases that were delayed in-creased by 5 cases from Q2 ’15 (33) to Q3’15 (38), but then decreased by 3 cases inQ4 ’15 to 35 cases.
Days in Delay by ReasonMembers that were delayed due to await-ing a State Hospital bed increased slightlyin both Q3 ’15 and Q4 ‘15. Members thatwere delayed due to waiting for PRTF ser-vices decreased the last two quarters, from13 in Q2 ’15 to 7 in Q4 ’15. Total delaydays for members waiting for PRTF de-creased in Q3 ’15, then increased slightlyin Q4 ’15. Members that were delayed dueto waiting for Solnit PRTF increased slight-ly in Q3 ’15 and then decreased slightly inQ4 ’15, while the total delay days did theexact opposite.
The DCF percentage of days delayed was lower than non-DCF for the firsttime in Q4 '15. DCF also had the lowest number of children in delayed statusin the last ten quarters.
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting State Hospital
Awaiting PRTF
Awaiting Solnit PRTF
Awaiting RTC/GH
Awaiting DDS Services
Awaiting Foster Care
Awaiting Other
26
8
9
3
1
10
14
3
4
2
17
5
5
2
2
22
7
0
0
4
13
14
3
0
1
13
6
2
1
1
12
7
3
3
0
1
1
13
12
0
0
2
1
1
14
9
8
0
0
4
1
15
7
3
0
0
0
2
Quarterly Inpatient Delayed Discharges by Reason CodeHover for more information on avg. delayed days and total delayed days
Note: The Reason Code "Awaiting Solnit PRTF" was notimplemented until late 2014.
PG 11 Inpatient Discharge Delay: Excluding Solnit TablesPercent Delay Days & Delay by Reason Code
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
DCF % of Days Delayed
Cases Delayed/in Overstay
Non-DCF % of Days Delayed
Cases Delayed/in Overstay
Total Youth % of Days Delayed
Cases Delayed/in Overstay
22
12.40%
25
12.00%
19
14.50%
19
13.50%
15
8.10%
21
14.70%
10
5.60%
15
7.40%
11
7.30%
13
12.40%
21
6.10%
32
9.20%
16
4.80%
22
5.20%
29
5.90%
14
2.30%
25
6.30%
23
5.60%
22
6.80%
30
10.90%
43
8.00%
57
10.20%
35
7.30%
41
7.80%
44
6.50%
35
5.90%
35
6.10%
38
6.10%
33
6.90%
43
11.30%
Quarterly Inpatient (Excluding Solnit) Table (Ages 0-17)Percent of Days Delayed & Cases Delayed
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting StateHospital
Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
Awaiting Solnit PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
Awaiting PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
Awaiting RTC Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
Awaiting GH Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
Awaiting Foster Care Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges
20.320310
26.02088
29.01746
25.633313
17.41227
13.6685
12.618915
13.318614
27.833412
31.838212
22.7683
10.0404
29.0582
9.0273
26.336814
22.257726
15.820513
16.022414
12.327122
13.322617
17.91257
11.71059
27.335513
16.01127
23.3703
14.2856
20.0201
9.0273
12.0242
43.71313
0.000
15.0906
0.000
17.0171
20.0201
29.3883
0.000
0.000
5.0102
22.5452
8.5172
8.0162
4.041
0.000
8.0162
1.011
0.001
7.071
0.000
11.0222
0.000
0.000
0.000
16.0483
Quarterly Inpatient Discharges with Delayed Days by Reason Code
Discharge Delay ReasonMultiple Values
PG 12Inpatient Discharge Delay Summary
Excluding Solnit
ConclusionsThe percent of total days delayed decreased from 7.30% to 6.10%, the lowest percentage of discharge delay in the last ten quarters. Quarter 4 ’15 was the firstquarter the DCF percentage of days delayed (5.60%) was lower than non-DCF (6.30%). DCF also had the lowest number of children in delayed status in the lastten quarters (n=10).
Most of the children in delayed status were awaiting admission into Solnit inpatient. There were a total of 29 youth (Q3 and Q4 ’15) waiting for Solnit inpatient. Al-though less than Q1 and Q2 ’15 (717 days), the youth waiting for Solnit inpatient again utilized the most inpatient days in delay, 375 total days in delay. There were23 youth in delayed status awaiting PRTF level of care. Seven of those youth were adolescents awaiting Solnit PRTF and 16 were awaiting Community PRTF levelof care. Those awaiting Solnit PRTF utilized 108 days in delay, while those awaiting Community PRTF utilized 230 days.
Recommendations
1. Expand PRTF capacity and develop alternatives for the children 12 years and under to include crisis stabilization. – The limited number of PRTF beds continuesto cause delays. With increased limitations in access to other levels of care, there is limited capacity for children with complex behavioral health needs. Beaconcontinues to recommend expanding the current PRTF capacity and increasing additional community services for those children under 12 with complex, highlyacute behaviors, including those children with developmental delays and autism.
Update: PRTF capacity has remained unchanged. There are three PRTF facilities, one of which is only able to admit boys, which leaves a gap for female youth 12years and under. A service agreement with a training component is scheduled to begin in collaboration with the Department of Developmental Services and a pri-vate provider to offer specialized trainings to staff when children with an Autism diagnosis are admitted. In addition, Beacon continues to support timely dischargeplanning with care coordination provided on several levels. The ICM continues to provide clinical coordination with providers and state agencies. Care coordinationand peer services offered through the ASD and Care Management Entity (CME) teams provide support to families by identifying family and clinical needs that maypresent as barriers to discharge.
2. Develop community-based behavioral health services which meet the higher acuity behavioral health needs of child/adolescents, including crisis andWraparound Teams, that follow children throughout the level of care continuum. – As the system moves towards community-based behavioral health care, withlimited options regarding childrens' placement in congregate care and Solnit, there is a greater need to develop behavioral health services. Those services canprovide coordination of care, family support, and clinical services to a clinically complex youth cohort. This activity has the potential to decrease emergency depart-ment utilization, Inpatient length of stay and discharge delay.
Update: Beacon currently provides support of services which follow children throughout the level of care continuum. Beacon's Intensive Care Managers providecare coordination and assist with clinical facilitation from the emergency department through inpatient through discharge planning into another level of care or thecommunity. This is achieved on various levels such as co-location and collaboration with DCF and EMPS. In addition, Beacon's ASDand CME teams offer carecoordination and peer services which focus on collaboration within the community.
Inpatient: Solnit CenterAverage Length of Stay & Delay Days
Benefit GroupCourt-OrderedNon-Court-OrderedTotal Youth
Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0
50
100
150
Avg. Length of Stay
Quarterly Solnit Inpatient Average Length of StayCourt-Ordered, Non-Court-Ordered, and Total
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
100
200
300
# of Days Delayed
Quarterly Solnit Inpatient Number of Delayed DaysTotal Youth
PG 13
OverviewThe average length of stay (ALOS) for all youthplaced inpatient at Solnit Center continued itsupward trend. The ALOS for the non-court-or-dered youth decreased 33.6% from Q2 to Q3’15 (172.4 to 114.5) and accounted for the over-all decrease in ALOS at that time, and then in-creased in Q4 ’15 by 38.3%. The ALOS for thecourt-ordered youth increased from 21.9 days inQ2 ’15 to 53.5 days in Q3 ’15, then increasedslightly in Q4 ’15 to 45 days. There were 39 totaldischarges in Q3 ’15 and 26 in Q4 ’15. In Q3 &Q4 ‘15, the non-court-ordered youth comprised87.7% (n=57) of the total, and the court-orderedcomprised 12.3% (n=8). The non-court-ordereddischarges increased from 24 in Q2 ’15 to 37 inQ3 ’15, and decreased in Q4 ’15 to 20. Thecourt-ordered discharges decreased from 15 inQ1 ’15 to 2 in Q3 ’15, then increased to 6 in Q4’15.
The number of inpatient days delayed at SolnitCenter decreased by 56.6% from Q2 to Q3 ‘15(364 to 158), and there were two less dis-charges (7 to 5). The number of days delayedincreased slightly in Q4 ’15 to 188 days, and thenumber of cases remained the same.
For Q4 ‘15, there were three delayed dis-charges: two awaiting a Residential TreatmentFacility (RTC) with 80 delay days, and oneawaiting "Other" with 48 delay days. Since therewere five cases identified on delay in Q4 ‘15,this means that two remaining youth are still indelay status and have not yet discharged, ac-counting for 60 total delay days. Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
10
20
30
40
50
Discharges
Quarterly Solnit Inpatient Total DischargesCourt-Ordered, Non-Court-Ordered, and Total
The increase in the inpatient average length of stay at Solnit Center hinders timely access to thisfacility for those children on discharge delay in community inpatient units and emergency rooms.
Inpatient: Solnit Center TablesAverage Length of Stay & Delay Days
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Court-Ordered ALOSDischarges
Non-Court-Ordered ALOSDischarges
Total Youth ALOSDischarges
3
40.30
5
90.00
7
57.90
8
42.80
17
62.70
12
78.80
6
45.00
2
53.50
15
21.90
1
36.00
24136.80
3084.60
31107.60
23116.10
31106.70
24134.80
20158.30
37114.50
24172.40
24104.50
27126.10
3585.40
3898.40
3197.20
4891.10
36116.10
26132.20
39111.40
39114.50
25101.76
Quarterly Inpatient Solnit Center Average Length of StayCourt-Ordered, Non-Court-Ordered & Total Youth
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Total Youth # of Days Delayed/in Overstay
Cases Delayed/in Overstay 5
160.0
3
169.0
9
213.0
6
127.0
7
251.0
9
205.0
5
188.0
5
158.0
7
364.0
8
310.0
Quarterly Inpatient Solnit Center Inpatient Number of Delayed DaysTotal Youth
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting PRTF Delayed Discharges
Total Delay Days for Discharges
Average Delay Days for Discharges
Awaiting RTC Delayed Discharges
Total Delay Days for Discharges
Average Delay Days for Discharges
Awaiting GroupHome
Delayed Discharges
Total Delay Days for Discharges
Average Delay Days for Discharges
Awaiting FosterCare
Delayed Discharges
Total Delay Days for Discharges
Average Delay Days for Discharges
37.0
37
1
0.0
0
0
29.5
59
2
0.0
0
0
0.0
0
0
23.0
23
1
0.0
0
0
9.0
9
1
0.0
0
0
0.0
0
0
0.0
0
0
49.0
49
1
0.0
0
0
27.0
27
1
23.0
23
1
13.0
13
1
40.0
80
2
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
37.0
37
1
86.0
86
1
49.5
99
2
0.0
0
0
0.0
0
0
96.0
96
1
0.0
0
0
118.0
118
1
0.0
0
0
0.0
0
0
119.0
119
1
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
0.0
0
0
Quarterly Inpatient Solnit Center Delayed Discharges by Reason
PG 14
PG 15
Inpatient: Solnit Center Summary
ConclusionsThe ALOS for all youth inpatient at Solnit Center increased Q2’15 to Q4 ’15 by 15.5% (114.50 to 132.20).The court-ordered population was the driver of this in-crease as their ALOS increased significantly from 21.90 days in Q2 ’15 to an average of 45 days in Q4 ’15. In comparison, the ALOS for the non-court-orderedyouth decreased 33.6% from 172.4 days to 114.5 days from Q2 ’15 to Q4 ’15.
The overall number of days delayed during this time has decreased from 364 days delayed to 188 total days delayed in Q4 ’15, a 48.4% reduction. There were on-ly a few children on delayed status (n=4). Two were awaiting residential placement, one was awaiting PRTF and the other was waiting for a group home.
Currently, a longer ALOS at Solnit Center inevitably hinders timely access to treatment for those children on delay in the inpatient units and emergency depart-ments. Most of the children on delayed status on the inpatient units are awaiting admission to Solnit hospital. These children utilize more delayed days waiting forSolnit compared to any other reason for delay.
Recommendations
1. Beacon will continue to collaborate with Solnit facilities and State agencies to increase timely access and effective treatment and discharge planning.
Update: Beacon has increased collaboration with Solnit Center to support timely access to care and effective care planning. Beacon’s ICMs are currently on sitedaily to provide utilization reviews, clinical case coordination, triage, and participation within multiple case conference forums. Beacon's ICM team will also workwith CSSD and the court-ordered population to assist with appropriate linkage to services upon evaluation completion at Solnit. Weekly clinical rounds and triagehas been established with the boy’s PRTF Solnit North, however not at the girl’s PRTF. Beacon recommends increased collaboration in a forum such astriage/clinical rounds with the Solnit girl’s PRTF facility.
PG 16 Community PRTF: Excluding Solnit (Youth Ages 5-13)Admissions, Days/1,000 & Average Length of Stay
Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0
10
20
30
Admissions
Quarterly PRTF (Excluding Solnit) Admissions: Youth 5-13
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
1
2
3
4
Days/1,000
Quarterly PRTF (Excluding Solnit) Days/1,000: Youth 5-13
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
50
100
150
Avg. Length of Stay (days)
Quarterly PRTF (Excluding Solnit) ALOS: Youth 5-13
OverviewThe number of community PRTF admissions decreased slightly in Q3 and Q4 '15, to 23 and 21,respectively. However, the number of admissions is within the range of admissions recordedover the past nine quarters.
Days/1,000 for community PRTF essentially remained unchanged over the past nine quarters.
From Q2 ’15 to Q3 ’15, community PRTF ALOS decreased slightly by 10.0% (184.6 to 166.1).From Q3 ’15 to Q4 ’15, community PRTF ALOS increased slightly by 7.3% (166.1 to 178.6).The number of discharges decreased to 23 in Q3 ‘15, then decreased to 21 in Q4 ’15.
2013
Q3 Q4
2014
Q1 Q2 Q3 Q4
2015
Q1 Q2 Q3 Q4
Admissions
Days/1,000
ALOS
Discharges 23
124.60
4.47
21
28
143.40
4.56
29
24
182.80
4.15
30
24
146.70
4.26
21
28
183.70
4.20
29
23
168.30
4.13
23
21
178.60
4.13
21
23
166.10
4.16
23
29
184.60
4.12
26
13
175.80
4.29
15
Community PRTF: Excluding Solnit Measures
PG 17 Community PRTF: Excluding Solnit (Youth Ages 5-13)Overstay Days & Overstay Reasons
The community PRTF days in overstay decreased the past two quarters from 989 in Q2 '15 to 594 in Q4 '15. Theaverage days in overstay increased overall by 2 days during this time period.
Number of Overstay DaysThe community PRTF days in overstay de-creased by 34.9% from Q2 ’15 to Q3 ’15 (989 to644), and decreased again by 7.8% from Q3 ’15to Q4 ’15 (644 to 594). The community PRTFcases in overstay decreased by 26.3% from Q2’15 to Q3 ’15 (19 to 14), and decreased again by21.4% from Q3 ’15 to Q4 ’15 (14 to 11). The av-erage days in overstay decreased by 6.0 daysfrom Q2 ’15 to Q3 ’15, and then increased by8.0 days from Q3 ’15 to Q4 ’15, for an overall in-crease of 2.0 days in overstay in Q3-Q4 ’15.
PRTF Overstay ReasonAwaiting going home became the biggest rea-son for overstay in Q3 ‘15, accounting for 42.9%of overstayed cases (6 out of 14), while awaitinggoing home and awaiting foster care tied for thelargest reason for overstay in Q4 ’15, both ac-counting for 45.5% of overstay cases (5 out of11 for each reason). Awaiting going home de-creased from 26.3% in Q2 ’15 (5 out of 19) to14.3% in Q3 ’15 (2 out of 14), then decreasedagain to 9.1% in Q4 ’15 (1 out of 11). Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
200
400
600
800
1000
# of Days in Overstay
Quarterly PRTF (Excluding Solnit) Total OverstayDays (Ages 5-13)
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting GoingHome
Awaiting FosterCare
Awaiting GH 11.1%
66.7%
0.0%
0.0%
85.7%
14.3%
22.2%
22.2%
55.6%
22.2%
33.3%
44.4%
12.5%
50.0%
37.5%
9.1%
63.6%
27.3%
9.1%
45.5%
45.5%
14.3%
42.9%
42.9%
26.3%
36.8%
36.8%
26.7%
40.0%
33.3%
Quarterly PRTF Ex Solnit Percent of Overstay Discharges by Top Reason Code2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
# of DaysDelayed/in Over..
Cases Delayed/inOverstay
Average DaysDelayed/in Over.. 54.1
11
595
27.7
10
277
38.4
10
384
43.8
10
438
47.2
10
472
64.9
13
844
54.0
11
594
46.0
14
644
52.1
19
989
46.6
15
699
Quarterly PRTF (Excluding Solnit) Table
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
5
10
15
20
Cases in Overstay
Quarterly PRTF (Excluding Solnit) Total OverstayCases
PG 18
Community PRTF (Excluding Solnit) Summary
ConclusionsThe number of admissions, ALOS and discharges for community PRTF have all decreased from Q2 ’15 to Q4 ’15. Admissions decreased by 19% (26 to 21) andthe ALOS decreased slightly by 3.2% from 184.6 to 178.6. In addition, discharges dropped from 29 to 21, a 28% reduction.
Most children in overstay were awaiting going home or foster care placement. Most children who were identified as waiting to go home were waiting for family workand stabilization or community services such as educational needs to be able to meet the child’s service requirements upon discharge home.
There has been a shift in overstay reasons over the past year indicating an increase in those children identified as going home due to lack of foster care resourcesand placement. Often, a change in discharge recommendation has occurred due to not finding a foster care family. When this occurs, efforts shift to work to pro-vide wraparound services to the family.
There continues to be a lack of viable options available for the under-twelve age group who require additional stabilization. It is necessary to increase communityclinical services and foster care resources that are able to provide support and meet the needs of this population.
Recommendations
1. Expand PRTF scope of services to include a continuum of care, crisis stabilization and Care Coordination. Beacon continues to recommend expanding thescope of PRTF to include an integrated continuum of services, which includes crisis stabilization and coordinated care. With limited access for the younger popula-tion to congregate care and Solnit Center's inpatient unit, PRTF-referred youth are a clinically complex population. In addition to the already existing clinical ser-vices provided by PRTF, the addition of Medicaid covered services for crisis stabilization as part of a continuum of care model is recommended. This model wouldinclude care coordination to provide education and support to parents while a member is receiving treatment, and to coordinate care for the family when the child isdischarged into the community. It is also recommended the PRTFs expand capacity and add a trained workforce to provide treatment to those youth with develop-mental disabilities or children with Autism Spectrum Disorder.
Update: These services are not yet in place at the PRTF level of care. This continues to be necessary as an internal service offered by the PRTF. Services suchas clinical care coordination are necessary to work directly with the family and child and follow them upon discharge within the community. Services, while offered,remain fragmented and from different agencies. Beacon continues to provide care coordination offered through ICM clinical coordination and family supportthrough the ASD and CME teams.
PG 19 PRTF: Solnit North & South (Youth Ages 13-17)Admissions & Days/1,000
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
5
10
15
20
25
30
35
40
Admissions
Solnit North PRTF opened 12/1/13
Quarterly Solnit PRTF Admissions (ages 13-17)
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
5.50
Days/1,000
Solnit North PRTF opened 12/1/13
Quarterly Solnit PRTF Days/1,000 (ages 13-17)
OverviewSolnit North PRTF, which has 32 beds and serves males, opened on December 1, 2013, adding to the already established 16 female beds at Solnit South PRTF.This bed-capacity increase accounts for the rise in admissions, days/1,000, and number of days overstayed in that time period. Solnit North PRTF has seen an in-crease in admissions since its opening, and they have now leveled out and become fully operational.
The number of admissions to Solnit PRTF increased from Q2 ’15 to Q3 ’15 by 23.3% (30 to 37), then decreased from Q3 ’15 to Q4 ’15 by 48.6% (37 to 19). SolnitPRTF days/1,000 increased slightly from Q2 ’15 to Q3 ’15 (4.37 to 4.41), then increased from Q3 ’15 to Q4 ’15 (4.41 to 5.28).
PG 20 PRTF: Solnit North & South (Youth Ages 13-17)Overstay Days & Number of Youth in Overstay by Reason Code
Awaiting residential or group home placement was the main reason for overstay in Q3 ’15 (3 of the 6 cases over-stayed), and awaiting foster care was the main reason in Q4 ’15, with 5 of the 13 cases in overstay status.
Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0
200
400
600
800
# of Days in Overstay
Solnit North PRTF opened 12/1/13
Quarterly Solnit PRTF Overstay Days (ages 13-17)Select icon for overstay cases graph
Select Year to Change Chart BelowMultiple Values
Number of Overstay DaysIn Q3 ’15, the number of overstay days de-creased from Q2 ’15 by 63.6% (642 to 234), thenincreased by 214.1% in Q4 ’15 (234 to 735). Thenumber of cases in overstay positively correlateswith the number of overstay days, with 12 casesin Q2 ’15, decreasing to 6 cases in Q3 ’15, thenincreasing in Q4 ’15 to 13 cases. Awaiting resi-dential or group home placement was the mainreason for overstay in Q3 ’15 (3 of the 6 casesoverstayed), and awaiting foster care was themain reason in Q4 ’15, with 5 of the 13 cases inoverstay status.
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting Foster Care
Awaiting Other
Awaiting RTC/GH
Awaiting CommunityServices
2
1
1
3
2
2
1
3
2
2
4
1
1
5
5
3
4
4
1
3
2
1
5
3
4
1
Quarterly Solnit PRTF Number of Youth by Overstay Reason Code (ages 13-17)
PG 21 PRTF: Solnit North & South (Youth Ages 13-17) TablesAdmissions, Days/1,000 & Overstay Days
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Admissions
Days/1,000
ALOS
Discharges
# of Days Delayed/in Overstay
Cases Delayed/in Overstay 4
96.0
12
113.40
1.79
24
2
29.0
13
103.90
1.55
16
13
497.0
33
122.10
4.65
34
7
256.0
29
103.10
4.51
28
8
221.0
39
107.30
4.80
41
4
157.0
14
113.40
3.81
37
13
735.0
16
139.80
5.28
19
6
234.0
32
144.40
4.41
37
12
642.0
25
177.10
4.37
30
17
907.0
26
171.30
4.32
19
Quarterly Solnit PRTF Measures (ages 13-17)
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
Awaiting State Hospital
Awaiting PRTF
Awaiting RTC
Awaiting GH
Awaiting Foster Care
Awaiting Community Services
Awaiting Other
Education Issues
Family Issues
Other 0
0
1
0
0
0
3
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
4
1
1
6
1
0
0
0
0
0
0
2
2
3
0
0
0
0
0
0
1
2
2
3
0
0
0
0
0
0
1
0
1
2
0
0
0
0
0
0
4
1
5
2
1
0
0
0
0
0
1
0
2
2
1
0
0
0
0
0
1
4
3
4
0
0
0
0
0
1
4
5
0
6
1
0
0
Quarterly Solnit PRTF Number of Youth by Overstay Reason Code (ages 13-17)
PG 22
PRTF: Solnit North & South Summary
ConclusionsAdmissions to Solnit PRTF decreased from Q2 ’15 to Q4 ‘15 by 36.7% (30 to 19). In addition, a decrease in discharges by 36% (25 to 16), illustrates decreasedthroughput within the system for children awaiting this level of care while inpatient.
Most children, similar to the community PRTFs, were in overstay status awaiting foster care placement. Only four were awaiting group home and one was waitingfor residential. Due to the lack of appropriate foster homes available, the utilization of group homes which are within the community should be considered whenclinically appropriate. This offers the youth the opportunity to step down to a community setting within a structured environment while awaiting the identification ofan appropriate family. It also offers a more reasonable time frame to collaborate with the foster family to ensure services are in place. This would be beneficial tothe youth, in addition to promoting throughput and decreasing recidivism.
Recommendations
1. It is recommended that Beacon monitor the Solnit PRTF level of care for additional trending, and include data relevant to discharge delay reason codes,specifically for Solnit North campus. It is recommended that we identify the specific delay reasons for the males at the Solnit North campus and implement in-creased discharge planning with Beacon's Intensive Care Mangers, DCF and Solnit. Beacon continues to have weekly care coordination meetings to review cur-rent treatment and discharge planning with both facilities.
Update: Beacon has continued to monitor the Solnit PRTF level of care indicating specific reason codes for overstay status. Onsite collaboration and utilization re-views continue and are expanding to include triage of cases. There are opportunities to include Beacon's Intensive Care managers within case conferences, in ad-dition to working with Beacon's CME team to offer greater timely connection to wrap services within the community.
PG 23 Autism Spectrum Disorder ServicesAdmissions & Admits/1,000
Q1 '15 Q2 '15 Q3 '15 Q4 '15
0
20
40
60
80
Admissions
Quarterly Autism Spectrum Disorder Services AdmissionsYouth Ages 0-20
Q1 '15 Q2 '15 Q3 '15 Q4 '15
0.00
0.02
0.04
0.06
0.08
0.10
Admits/1,000
Quarterly Autism Spectrum Disorder Services Admits/1,000Youth Ages 0-20
Hover over Puzzle Piece for Definition of Each ServiceClass Corresponding Below
2015Q1 Q2 Q3 Q4
Diagnostic Evaluation Admissions
Admits/1,000
Behavior Assessment Admissions
Admits/1,000
Plan of Care Admissions
Admits/1,000
Service Delivery Admissions
Admits/1,000
0.05
44
0.02
22
0.01
12
0.02
16
0.10
88
0.05
50
0.05
43
0.01
14
0.10
88
0.05
49
0.05
44
0.01
12
0.06
58
0.04
40
0.03
32
0.00
1
Quarterly Autism Spectrum Disorder Service Admits/1,000 & AdmissionsAuthorizations Began 1/1/15 for this Level of Service
Level of CareDiagnostic EvaluationBehavior AssessmentPlan of CareService Delivery
Admissions & Admits/1,000As expected, admits/1,000 and admissions continued to grow over the first yearof the program. This may also be due to the increase in Autism Spectrum Disor-der (ASD) prevalence rates during 2015. The Centers for Disease Control(CDC) released National prevalence statistics in March of 2014 estimating that 1in every 68 children is identified as having ASD. Results from the 2014 NationalHealth Interview Survey (NHIS) were released on November 13, 2015. Reorder-ing survey questions regarding ASD on the survey resulted in new data. The re-sults indicated that currently as many as 1 in 45 children are diagnosed withASD.
The behavior assessment and plan of care authorizations are often given to-gether and therefore there is close overlap in the measures. Select the color onthe legend to highlight one of the service classes.
As expected, admits/1,000 and admissions contin-ued to grow over the first year of the program.
These values will not add up to the total unique youth as youth may utilize more than one service. However, each youth is only counted once in each demograhic category within each service class.
41.7%
19.7%
19.8%
22.0%
44.8%
69.2%
69.0%
63.6%
9.4%
6.6%
6.6%
9.3%
Total Youth by Level of Service and Race: CY 2015■ White ■ Hispanic ■ Black ■ Asian ■ Multi-racial
Diagnostic Evaluation
Behavior Assessment
Plan of Care
Service Delivery
17.7%
33.3%
33.0%
34.7%
24.0%
35.4%
35.5%
33.9%
57.3%
30.8%
31.0%
31.4%
Total Youth by Level of Service and Age: CY 2015■ 0-6 yrs old ■ 7-12 yrs old ■ 13-18 yrs old ■ 19-20 yrs old
Autism Spectrum Disorder ServicesUtilization Demographics
PG 24
Utilization ProfileThere were 293 unique youth that were authorized for Autism Spectrum Dis-order Services in CY 2015. By-in-large, the population was male (79%) andnon-DCF (83%). This was consistent for the utilization across the serviceclasses as well.
There was some variance in service class utilization by age groups and race.Youth ages 0-6 accounted for the largest volume of diagnostic evaluations(57%). The new statistic released in November 2015 increases the nationalprevalence rate of ASD from 1.25% to 2.24%. To date, there is no knowncure. What is known is that early identification and intervention are critical.
Utilization by age group was consistent across the other service classes.Each age group made up approximately a third of all authorizations, with theexception of the 19-20 year old group which is exceptionally small. Manyyouth in this age group have already received a diagnosis and accessed ser-vices and community supports through school or other funding sources.
Again, for racial and ethnic groups, there was a difference in the breakdown ofutilization for the diagnostic evaluation service class compared to the remain-ing three services. Hispanic youth had almost 42% of the diagnostic evalua-tion authorizations, but consistently around 20% of the other service classes.Blacks, too, had a higher portion of the diagnostic evaluation authorizations(9.4%) than they did in the other service classes.
79.18%
20.82%
Total Youth by Gender: CY 2015■ Male ■ Female
82.94%
11.60%5.46%
Total Youth by DCF Status: CY 2015■ Non-DCF ■ Voluntary ■ Committed
Because members may have multiple authorizations with differences in,specifically, age and DCF status at thetime of admission, demographics are captured as of the last/most recent authorization record. Each member is
only counted once in this calculation.
PG 25 Autism Spectrum Disorder ServicesProvider Volume
DiagnosticEvaluation
BehavioralAssessment
Plan of Care Service Delivery0
10
20
Enrolled Providers
Austism Spectrum Disorder Services: Quarterly Cumulative Provider En-rollment by Service Class: CY 2015
Provider EnrollmentThe provider network experienced growth in Q3 and Q4 of 2015. An addition-al twelve providers were added to the network for a variety of services. With atotal of 34 providers enrolled as Autism Service providers, 16 providers areenrolled to complete diagnostic evaluations, 28 providers are enrolled for be-havioral assessments, and 26 for plan of care development. Twenty-sixproviders are enrolled for direct service delivery.
Additional efforts for recruiting are underway as are a revision and update tothe existing State ASD guidelines. These updates and guideline revisions,based on provider feedback, will potentially open the network to additionalAutism Services providers who have previously not enrolled. Recruiting out-reach to regional Applied Behavior Analysis (ABA) associations in Connecti-cut, Rhode Island, New York, and Massachusetts are planned to inform prac-titioners and organizations about the need for services within Connecticut andhow to access enrollment.
A monthly series of Learning Collaboratives for ASD providers has expandedthe opportunity for networking among providers of this new service and high-lighted the trends and needs across the network. Initial ASD provider orienta-tions have helped to streamline the process of enrollment, maximize the op-portunity to have frequently asked questions answered and provide educationon accessing authorizations.
Q1 Q2 Q3 Q4
Diagnostic Evaluation
Behavioral Assessment
Plan of Care
Service Delivery 26
26
28
16
23
23
25
16
16
16
18
12
11
10
12
9
Austism Spectrum Disorder Services: Monthly Cumulative Provider Enrollmentby Service Class
Note: A provider may perform more than one service.
0 20 40 60 80 100Number of Authorizations
CONNECTICUT BEHAVIORAL HEALTH LLCFOCUS CTR FOR AUTISM INC
FAMILY STRONG CTSHORELINE SOCIAL LEARNINGHOSPITAL FOR SPECIAL CARETRADING SPACES ABA, LLC
GROWING POTENTIAL SERVICESABLE HOME HEALTH CARE LLC
BEHAVIORAL HLTH CONSULTING SVCS L..EASTER SEALS COASTAL, FAIRFIELD CN..
ADELBROOK COMM. SERVICE INCABA OF CONNECTICUT, LLC
ADVANCED PSYCHOLOGICAL SERVICESRUSSOLILLO, PATRICK JSTRON FOUNDATIONS
INTERLOCKING CONNECTIONS, LLCROSALES, MANUEL J
ALTERNATIVE SERVICES CT INCHULIEN, DEBORAH SROGINSKY, BINA
UNITED SERVICES INCHILTON BEHAVIOR THERAPY
KOZODOY, PAULGREENWICH EDUCATION GRP
THE SEED CENTERTEMP PROVIDER
ASD Provider Volume of Authorizations by Service ClassSort via filter aboveThe provider network experienced growth in
Q3 and Q4. An additional 12 providers wereadded to the network for a variety of services.
Service DeliveryPlan of CareBehavior AssessmentDiagnostic Evaluation
Select Service Class to FilterAll
PG 26
Autism Spectrum Disorder (ASD) Services Summary
ConclusionsThe ASD provider network development continues to be a primary focus to increase member access to services. Targeted outreach and recruiting efforts for en-rolling service delivery organizations is our priority.
Additional assistance will be accessed from National Beacon Health Options as best practice models are developed nationwide and communicated to behavioralservice providers and state ABA organizations in an effort to increase provider enrollment.
Relationships with area colleges, universities and school systems will be fostered to increase provider access to potential behavior technician staff looking forhours and experience. Learning Collaboratives will continue monthly as a platform to provide information, increase overall quality of the network and enroll poten-tial new ASD providers.
Recommendations
Feedback has been gathered from performing ASD providers and incorporated into proposed changes to the existing state ASD regulations. It is anticipated thatproposed changes to the ASD regulations and addition of several new service classes will have an impact on increasing member access to services. These pro-posed changes are expected to be approved and released during Q1 or Q2 of 2016.
Collaboration with the Department of Developmental Services (DDS) continues as children transition off of the autism waiver programs and into Medicaid Servicesfor ASD. Collaboration with the Department of Children & Families (DCF) and the Department of Mental Health & Addiction Services (DMHAS) continues as chil-dren transition from USE and flex fund programs and young adults transition to alternate mental health services when applicable.
New partnerships and collaborations have been formed within the Hispanic communities in relation to parents of children with ASD and access to services. Otherpartnerships will be explored to increase education and resources related to early access to screening and diagnosis for ASD.
PG 27 Outpatient Registration VolumeAdult and Youth
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0%
10%
20%
30%
40%
50%
60%
70%
80%
% of Outpatient Registration Volume
Percent of Outpatient Registration Volume and Total Volume: ECC andNon-ECC
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0K
5K
10K
15K
20K
25K
30K
Outpatient Registration Volume
Total Outpatient Registration Volume: ECC and Non-ECC
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
ECC
Non-ECC
Total 28,741
24,106
4,635
29,592
24,932
4,660
30,238
25,541
4,697
28,022
23,254
4,768
27,427
22,578
4,849
28,068
22,902
5,166
25,180
19,231
5,949
25,253
19,258
5,995
21,747
16,151
5,596
Registration VolumeThe “Total Outpatient Registration Volume” measure captures the overall vol-ume of newly registered Medicaid members, including those evaluations exclud-ed from meeting the ECC access standards. From Q2 ’15 to Q3 ’15, there was a2.4% decrease in total outpatient registration volume, and from Q3 ’15 to Q4 ’15there was a 2.9% decrease.
Total ECC registration volume have been trending downward and non-ECC vol-ume have been trending upward since Q4 ‘13. The gap between ECCs and non-ECCs has been expanding over this time. ECCs accounted for approximately16% of the total outpatient registration volume during Q3 and Q4 ’15, while non-ECCs accounted for approximately 84%.
ECCNon-ECC
PG 28 Youth Outpatient Registration VolumeEnhanced Care Clinics (ECC) vs. Non-ECC Providers
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0K
1K
2K
3K
4K
5K
Outpatient Registration Volume
Total Outpatient Registration Volume: ECC Youth & Non-ECC Youth
OverviewNon-ECC youth registrations have been trending upward since Q4 ’13, and accounted for approximately 16% of total outpatient registration volume in Q3 and Q4’15. ECC youth registrations have been trending downward, and accounted for approximately 7% of total outpatient registration volume in Q3 and Q4 ’15.
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0K
1K
2K
3K
4K
5K
6K
Outpatient Registration Volume
Total Outpatient Registration Volume: ECC Adult & ECC Youth-- ECC Total
Type of Care (Age grp)Youth Measures
ECC YouthNon-ECC Youth
Type of CareECC AdultECC Youth
PG 29 Youth Outpatient Registration VolumeEnhanced Care Clinic (ECC) vs. Freestanding Clinics (FSC)
OverviewThe “Registrations Required to Meet ECC Access Standards” measure captures only those evaluations that are relevant to meeting ECC access standards. Out-patient clinics are able to identify and exclude from calculation the “exempt registrations” which include: 1) those clients stepping down from a higher level of carewithin their agency; and/or 2) those clients who have been in treatment at the ECC but who experienced a change in insurance coverage to Medicaid. The accessmeasures are based only on the timeliness of appointments for those members who are truly new clients in the ECCs.
Evaluations needing to meet the access standards accounted for almost 65% across Q3 and Q4 ’15. This has remained fairly constant over the reporting period.
When comparing ECCs vs. FSCs for youth, ECCs have consistently had a higher number of evaluations, but they have been slightly trending downward over time.FSCs have been slightly trending upward.
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '150K
5K
10K
15K
20K
25K
30K
Outpatient Registration Volume
Total Outpatient Registration Volume: Volume of Registrations Required toMeet ECC Access Standards and Volume of Exempt Registrations ECC
and Non-ECC
Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
0
500
1000
1500
2000
# of Evals Required to Meet ECC Access Standards
Total Number of Evaluations Required to Meet ECC Access Standards:ECC and Non-ECC Freestanding Clinics (FSC)
Select GroupYouth Measures
ECC YouthFSC Youth
Outpatient Registration VolumeExempt Evals
PG 30Youth Outpatient ECC Access StandardsRoutine, Urgent and Emergent Registrations
Access StandardsEmergent evaluations that met the ECC access standards declined in Q4 ’15 below the 95% access standard, to 75% (2 out of 8 registrations did not meet thestandard). Both routine and urgent evaluations remained consistently above the 95% access standard.
The percent of outpatient evaluations offered within the ECC access standard have been consistently met by ECCs for routine, urgent and emergent. Both routineand urgent have been consistently unmet by FSCs, and emergent increased in Q4 ’15 back to meeting the standard after a dip below the access standard the pre-vious two quarters.
Q1 '14 Q3 '14 Q1 '15 Q3 '15
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
% of Evaluations that Met the ECC Access Standard
Access Standard 95%
ECC Evaluations that Met the ECC Access StandardsYouth (0-17)
Q1 '14 Q3 '14 Q1 '15 Q3 '15
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
% of OTP Evaluations Offered Within Access Standard
Access Standard 95%
Percent of Routine Outpatient Evaluations Offered within the ECC AccessStandard: ECC and Non-ECC Freestanding Clinics (FSC) - All Members
ECCFSC
RoutineUrgentEmergent
RoutineUrgentEmergent
PG 31Outpatient Enhanced Care Clinics
Compliance
Quarterly Overview
Provider Compliance for Q3 ’15 & Q4 ’15:
Routine Access compliance with the 14 day standard for the 30 ECCs fell into the following categories:1. Met the access standard of 95%: 292. ECC falling below the 95% Routine Standard: Catholic Charities (Norwich): 93.26% in Q3 ’15 and 87.14% in Q4 ’15
Urgent Access compliance with the 2 day standard for the ECCs fell into the following categories:1. Number of ECCs that reported Urgent volume: Q3: 18 Q4: 152. Met the access standard of 2 days: 293. ECC falling below the 95% Urgent Standard: Catholic Charities (Norwich): 33.33% in Q3 ’15 – volume of 3
Emergent Access compliance with the 2 hour standard for the ECCs fell into the following categories:1. Number of ECCs that reported Emergent volume: Q3: 11 Q4: 82. Met the access standard of 2 hours: 293. ECC falling below the 95% Emergent Standard: The Village for Families and Children: 50% in Q4 ’15 – volume of 2
Annual Overview
Year-to-Date (YTD) Compliance Summaries from January 1, 2015 – December 31, 2015:The information below excludes volume exemptions which are to be completed in March 2016.
ECCs falling below the 95% Routine Standard:Catholic Charities (Norwich): 93.26% in Q3 ’15 and 87.14% in Q4 ’15. YTD %: 93.26%.
ECCs falling below the 95% Urgent Standard:Clifford Beers (50.00%) in Q1 ’15 – volume of 2. YTD %: 66.67%.Catholic Charities (Norwich): 33.33% in Q3 ’15 – volume of 3. YTD%: 33.33%.Bridges: 0% in Q4 ’15 – volume of 1. YTD: 0.00%.
ECCs falling below the 95% Emergent Standard:The Village for Families and Children (50.00%) in Q4 ’15 – volume of 2. YTD %: 87.50%.Yale Child Study Center (0.00%) in Q4 '15 - volume of 1. YTD %: 0.00%
PG 32 Outpatient Enhanced Care ClinicsInterventions & Activities
Interventions and Activities
Interventions to address ECC performance on Access Standards:Although the formal measurement period has been annualized, ECCs continue to receive data on a quarterly basis. This includes both quarterly and year-to-datetotals for each standard. Those agencies below 95% for any measure will be required to submit a Corrective Action Plan (CAP).
Through the data entry error process, Mid-Fairfield Child Guidance Center (which had previously been listed at 91.67% for the urgent access standard) was able tomake a correction and is currently in compliance. The adjustment is reflected in the most recent ECC report.
Clifford Beers has indicated that the 50% received in Q1 ’15 was a data entry error and Bridges has also indicated that the 0.00% received in Q4 ’15 was a dataerror as well. As soon as they send the paperwork to show the entries are errors, this will be presented at the following ECC Operations meeting for approval be-fore having it processed and corrected.
All EC’s who have fallen below the urgent and emergent access standards will be reminded of the available data entry error process.
Mystery Shopper Program:In Q3 ’15, Bridges, Catholic Charities – New Britain, and Wellmore were shopped. Catholic Charities – New Britain did not pass due to not returning the call andWellmore did not pass due to the lack of triage or screening questions being asked during the call. They were mystery shopped again in Q4 ’15 and passed suc-cessfully. In Q4 ’15, Catholic Charities – Norwich, Family and Children’s Aid, and Yale Child Study Center were shopped. Family and Children’s Aid did not passdue to not returning the call. They will be shopped again in Q1 ’16.
ECC Operations:The meeting met regularly and discussions were around the need for potential additional adult ECCs in identified regions and developing the Request for Agree-ment (RFA).
ECC Provider Workgroup on Capacity and Access:Did not meet in Q3 ’15 & Q4 ’15.
Activities Going Forward:1. Continue monitoring access data on a quarterly basis within the context of annualized methodology.2. Continue the Mystery Shopper program to ensure effective triage and screening.
Access Standards – Children:On the child side, the emergent evaluations that met the ECC standards declined in Q4 ’15 below the 95% access standard to 75%. This can be explained by TheVillage for Families and Children which on the emergent measure in Q4 ’15 scored 50% (volume of 2) and Yale Child Study Center which scored 0.00% (volume of1). These low scores had an impact on the overall scores for the emergent access standard in Q4 ’15.
Quarterly Appendix GraphsIICAPS, MDFT, MST, FFT, PHP, IOP, EDT, & Outpatient
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
2,000
4,000
6,000
8,000
Admissions
Quarterly Admissions for Lower Levels of Care: All Youth
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0.00
2.00
4.00
6.00
8.00
Admits/1,000
Quarterly Admits/1,000 for Lower Levels of Care: All Youth Level of CareIICAPSPHPIOPEDTOutpatientFFTMDFTMST
Select VariousLevels of CareBelow To View in
Graphs
By deselectingOutpatient (OTP)you can viewchanges in theother levels of
care.
Level of CareAll
2013
Q3 Q4
2014
Q1 Q2 Q3 Q4
2015
Q1 Q2 Q3 Q4IICAPS Admits/1,000
AdmissionsMDFT Admits/1,000
AdmissionsMST Admits/1,000
AdmissionsFFT Admits/1,000
AdmissionsPHP Admits/1,000
AdmissionsIOP Admits/1,000
AdmissionsEDT Admits/1,000
AdmissionsOutpatient Admits/1,000
Admissions
5300.60
5530.63
5680.60
5600.59
5710.62
5750.63
5090.57
5490.59
5540.59
5530.59
1540.17
1790.20
1510.16
1700.18
1930.21
1640.18
1680.19
1770.19
1790.19
1580.17
1030.12
1130.13
870.09
800.08
1300.14
910.10
800.09
940.10
1070.11
1030.11
970.11
700.08
770.08
570.06
850.09
790.09
900.10
640.07
540.06
690.07
3220.36
2710.31
3510.37
2730.29
3240.35
2940.32
2800.31
2350.25
3380.36
3190.34
4810.54
4100.46
4450.47
3980.42
4890.53
4290.47
4480.50
3430.37
4770.51
4090.43
1580.18
1970.22
2270.24
1760.19
2340.25
1660.18
1790.20
1710.18
2070.22
1790.19
7,1208.06
6,2127.03
7,8278.25
7,0177.44
7,6248.22
7,3678.12
8,3139.26
7,3057.90
7,9928.48
7,9968.46
Quarterly Admits/1,000 & Admissions Table for Lower Levels of Care: All Youth
PG 33
Quarterly Residential Treatment Facility (RTC)Admissions & Average Length of Stay
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0%
20%
40%
60%
80%
100%
% of Admissions
Quarterly Residential Treatment Center Admissions - Percent of Total
■ In-State ■ Out-of-State
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
Avg. Length of Stay (days)
Quarterly Residential Treatment Center Average Length of Stay (ALOS)
■ In-State ■ Out-of-State
Q4 '13 Q2 '14 Q4 '14 Q2 '15 Q4 '15
0%
20%
40%
60%
80%
100%
% of Discharges
Quarterly Residential Treatment Center Discharges - Percent of Total
■ In-State ■ Out-of-State
PG 34
Quarterly Residential Treatment FacilityAdmissions & Average Length of Stay Tables
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
In-State ALOS
In-State Discharges
Out-of-State ALOS
Out-of-State Discharges 4
652.75
55
215.07
12
1,120.58
75
255.60
2
1,343.50
30
273.80
5
1,044.00
53
237.91
3
695.00
56
278.32
7
590.86
44
282.52
0
0.00
41
263.83
1
176.00
32
236.00
5
1,111.40
37
313.62
3
803.00
45
282.62
Quarterly Residential Treatment Center (RTC) Average Length of Stay (ALOS) & DischargesIn-State vs. Out-of-State
2013Q3 Q4
2014Q1 Q2 Q3 Q4
2015Q1 Q2 Q3 Q4
% Instate Admissions
In State Admissions
% OOS Admissions
OOS Admits 3
5.00%
57
95.00%
4
5.97%
63
94.03%
0
0.00%
36
100.00%
3
7.69%
36
92.31%
1
2.08%
47
97.92%
1
2.33%
42
97.67%
2
6.67%
28
93.33%
1
3.03%
32
96.97%
1
2.33%
42
97.67%
1
3.13%
31
96.88%
Quarterly Residential Treatment Center (RTC) AdmissionsIn-State vs. Out-of-State
PG 35
PG 36
Global Recommendations
Recommendations:This section documents activity since the previous quarterly report.
1. Establish a preventive model of behavioral health care and crisis intervention:
Update: Please reference all previous recommendations throughout the various levels of care as each level of care and cooresponding recommendations/updatescontribute to this global recommendation.
2. Increase collaboration with CHN to establish preventative integrated care:
Update: Beacon continues to work in collaboration with CHN to establish a preventative integrated system of care. Beacons’ co-management clinicians work withCHN to provide care coordination and support to those members who present with a co-occurring diagnosis of behavioral health/ substance abuse concomitantlywith a medical diagnosis. Beacon meets with CHN on a weekly basis to develop processes, discuss clinical cases, and further support integrated operations.
