11/2/2015

House Children’s Mental Health Study CommitteeJeff Luce, LPCClinical Director

2

Peach State Health Plan: Overview• Georgia based Care Management

Organization (CMO) since 2006

• 128 hospitals and related facilities state-wide

• 19,000 physicians and other types of providers in network

• Nearly 1,600 Behavioral Health-focused specialty providers in network

• Approximately 8% have primary mental health issues (60% of these are ADHD)

Over 300 Georgia-based employees deliver local services to almost 385,000

Georgia Families members

11/2/2015

• Right Service/Right Time– Behavioral Health services that

meet the unique needs of our Members

– 9,289 average number of Members per month accessing BH services (2015)

• Early Intervention– Identifying and intervening with

kids and families who face escalating Behavioral Health needs

• Solid Systems– Facilitate integration– Pharmacy checks and

balances

Top Priority: Caring for Members

• Strong Network– Behavioral Health continuum of care– Psychiatrists; Therapists; Community Support

Individuals

• Internal Staff– Georgia-licensed mental health professionals– Integrated care delivery teams

• Meaningful Outcomes– Are Members getting what they need?

Programmatic HEDIS measures—down to individual Members in Case Management meeting their treatment goals

11/2/2015

• Tele-health– Access the Georgia Tele-Health Network – Enhances the level of access to care for members in rural areas

• School-Based Mental Health – Highly supportive of school-based delivery (e.g. Georgia APEX project)

• Case Management– Ongoing emphasis on early intervention– Integrated Care Team – We make a difference by coordinating care and helping Members manage their

conditions

• Trauma-Informed Care– Since 2012, we have trained 813 people in trauma and behavioral health. This

includes 194 clinicians we trained in TF-CBT.

Innovation: Access & Quality

11/2/2015

2 Primary types: • Inpatient Psychiatric Utilization

– 13% utilization increase from 2010 to 2014

• Outpatient Behavioral Health Utilization– 130% increase from 2010 to

2014• What does that mean?

UtilizationOur Goal…• Deliver the right services at the

right time to our members– 2 real-life Member examples