ValueAdded - Beacon Health OptionsTable 1 shows the average of the 2015 and 2016 chart reviews...
Transcript of ValueAdded - Beacon Health OptionsTable 1 shows the average of the 2015 and 2016 chart reviews...
ValueAdded
This is the 207th issue of our VBH-PA information update. These updates will be
emailed to network providers monthly. Please feel free to share our newsletter
with others, and be sure your appropriate clinical and financial staffs receive
copies.
Inside this issue
Provider Policy Clarification Update ........................................ 2 Partners for Performance Improvement ................................ 3 Save the Date! Best Practice Forum for Inpatient Providers .................. 4 National Recovery Month ............. 5 National Suicide Awareness Month ........................................... 5 Adherence to Antipsychotic Medications for Individuals with Schizophrenia ................................ 6 Save the Date! “Acknowledging The Journey” ................................. 7 Updated Services Webpage ......... 7 VBH-PA Receives NAMI Walks Award ........................................... 7 Join Us! 10th Annual Family Forum ................................ 8 2016 CAMP “T.A.A.G.” Picnic ........ 10
Vol. 18 Issue 9 September 2016
Notification of Change in Access
to Services
Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA)
by calling their Provider Field Coordinator or through notification in writing by
mail, email or facsimile to 1-855-541-5211 (attention Provider Relations
Department) upon the occurrence of any of the following:
1. Inability to provide emergent care within one hour, urgent care within 24
hours, or routine care within seven days.
2. Usage of alternative provider coverage in any situation when unable to
treat VBH-PA members in active treatment, e.g. vacation.
3. When reaching full (100%) capacity. Full capacity is considered the point
at which the provider is unable to meet the access standards noted above
or is unable to accept referrals for a particular level of care. Notices for full
(100%) capacity should contain the reason for reaching capacity, the
effective date, and the steps the provider will take to resume functioning at
normal capacity.
4. The inability to provide any portion of a prescribed service, e.g. BHRS.
Network providers must offer hours of operation that are no less than the hours
of operation offered to commercial members or comparable to Medicaid fee-for-
service if the provider serves only Medicaid members. You may find this
information in our online Provider Manual:
http://www.vbh-pa.com/provider/info/prvmanual/4_PartPrvResp/
notification_change_access_svcs.htm
2 ValueAdded—September 2016
VBH-PA Provider Policy Clarification Update Encounter Coding for HealthChoices Outpatient Psychiatric Clinic Services
The Office of Mental Health and Substance Abuse Services (OMHSAS) issued a policy clarification effective August 10,
2016, outlining changes to Bulletin #03-16-01 Encounter Coding for behavioral health HealthChoices (BH-HC) service
providers for outpatient psychiatric clinic service encounters by using an evaluation and management (E/M) code based on
the complexity of an individual’s condition rather than both complexity and duration of the encounter. VBH-PA supports
providers in making the changes outlined in the bulletin August 10th and forward.
On January 1, 2013, the American Medical Association (AMA) published updated E/M codes. CMS then published an
updated E/M services guide in November 2014. The coding and guidance provided by CMS allowed for use of complexity
of care to be a primary criterion for reimbursement for services. In implementing the 2013 E/M services, the Pennsylvania
Department of Human Services (DHS) exercised its right as a State Medicaid Program to be more restrictive. Specifically,
DHS required specific minimum units of time in addition to the complexity. In response to requests by stakeholders,
including VBH-PA and its primary HealthChoices contractors, OMHSAS convened the affected bureaus to consider
implementing a revised approach to the E/M usage for outpatient psychiatric clinic codes in HealthChoices as proposed by
the AMA and allowable by CMS.
The policy clarification identifies the changes required for E/M submission. The change requires, as an alternative,
identification of the appropriate code application using the consideration of three key components:
The extent of history
The extent of examination performed
The extent of the medical decision-making
These three components establish a relationship within the coding to identify the complexity of the presenting problems so
time and/or duration of the service is not being used as a proxy for complexity.
The code sets to bill for E/M services are organized into various categories and levels. In general, the more complex the
visit, the higher the level of code you may bill within the appropriate category. To bill any code, the services furnished must
meet the definition of the code. You must ensure that the codes selected reflect the services furnished. Providers can
reference the Department of Health and Human Services Centers for Medicare & Medicaid Services Evaluation and
Management Services’ booklet at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/
MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf.
While VBH-PA recognizes the above changes effective August 10, 2016, VBH-PA may take up to nine months to amend its
provider agreements accordingly. Further, the policy clarification states the actual time spent is required for documentation
but will not be considered as a measure of complexity when the code choice is made based upon the three components and
documented appropriately.
Please visit http://www.vbh-pa.com/provider/info/pr/OMHSAS-Policy-Clarification-03-16-01.pdf for the complete policy
clarification. Providers may contact [email protected] for additional clarification.
3 ValueAdded—September 2016
Update on the statewide project “Successful Transitions from Inpatient
Care to Ambulatory Care”
Partners for Performance Improvement
OMHSAS has selected this topic for a three-year statewide performance improvement project. The core objectives of this
project include:
Reducing behavioral health and substance abuse inpatient readmission rates
Increasing kept ambulatory follow-up appointments after an inpatient discharge
Improving medication adherence rates of individuals with schizophrenia post inpatient discharge
Improving discharge management planning
One key aspect of this performance project includes evaluating the documentation of discharge planning, via chart reviews,
that occurs at inpatient facilities and then measuring members’ attendance of their scheduled follow-up appointments. The
elements to be reviewed were established at the start of this project by OMHSAS and are being measured consistently by all
five BHMCOs. In April 2015, VBH-PA conducted reviews to obtain a baseline score at our four selected inpatient
providers (Sharon Regional Health System, Washington Health System Greene, Heritage Valley Beaver, and Excela
Westmoreland). In February and March of 2016, VBH-PA conducted follow-up chart abstractions to identify any changes
in the documentation of discharge planning. Table 1 shows the average of the 2015 and 2016 chart reviews conducted at the
four inpatient facilities (30 charts per facility).
Chart Review Results
2015
Overall Average
2016 Overall Average
Discharge Plan/Discharge Instruction Sheet (DMP) was present in the chart
99% (119/120)
96% (111/120)
Copy of the DMP was given to the member 98%
(117/120) 90%
(108/120)
Medication reconciliation was documented 25%
(30/120) 25%
(30/120)
Follow-up visit scheduled within 0-7 days of discharge 8%
(10/120) 35%
(42/120)
Follow-up visit scheduled within 0-14 days of discharge 13%
(15/120) 44%
(53/120)
Scheduled follow-up visit kept 67%
(10/15) 45%
(24/53)
Medication reconciliation was documented and follow-up visit scheduled within 0-7 days
3% (3/120)
13% (15/120)
Medication reconciliation was documented and follow-up visit scheduled within 0-14 days
3% (3/120)
14% (17/120)
Medication reconciliation was documented and follow-up visit kept within 0-14 days
3% (3/120)
8% (10/120)
Table 1
Article continued on page 4.
Save the Date!
Best Practice Forum for Inpatient Providers
Join Value Behavioral Health of Pennsylvania as we host an all-day Best Practice Forum
for our Inpatient Providers, Friday, October 14, 2016 at Marriott North in Cranberry
Township. Topics of focus include presentations from our Best Practice providers, poster
presentation review and networking, and afternoon round table discussions. This is your
chance to meet with your peers to see what they are doing to be a Best Practice
provider! Learn how your facility can reach quantifiable goals more efficiently. There is
no cost to attend this training; breakfast and lunch will be provided free of charge. Look
for your invitation coming soon!
4 ValueAdded—September 2016
Partners for Performance Improvement (continued)
Below is a sample of a well-documented follow-up appointment:
Provider Name/Specialty or Degree: Dr. Seuss, Psychiatrist
Provider Organization: Maple Counseling Services
Full Address: 100 Main St., Town, PA 15222
Provider Phone Number: (724) 888-8888
Date/Time of Appointment: 1/1/2016 @ 2:00 p.m.
Medication reconciliation needed to include the medication the member was taking prior to admission, during the inpatient
stay, and upon discharge in order to be considered as compliant.
As part of the project requirements, VBH-PA had to establish specific quantifiable goals to reach by the end of this project
in 2017. The information below shows our current results compared to our established goals. These results illustrate that
progress has been made, but that additional improvement opportunities remain in order to positively impact these rates.
Metric Goal 2016
Results 2015
Results
Medication reconciliation was documented and follow-up visit scheduled with 0-7 days
40% 13% 3%
Medication reconciliation was documented and follow-up visit scheduled within 0-14 days
40% 14% 3%
Medication reconciliation was documented and follow-up visit kept within 0-14 days
50% 8% 3%
VBH-PA will be conducting the next round of chart reviews with these same four providers in February/March of 2017.
VBH-PA would like to thank our partner providers for their work and collaboration on this project.
5
ValueAdded—September 2016
About Recovery Month National Recovery Month (Recovery Month) is a national observance held every
September to educate Americans that substance use treatment and mental health
services can enable those with a mental and/or substance use disorder to live a
healthy and rewarding life. People can and do recover!
Recovery Month celebrates the gains made by those in recovery, just as we
celebrate health improvements made by those who are managing other health
conditions such as hypertension, diabetes, asthma, and heart disease. There are
millions of Americans whose lives have been transformed through recovery. Since
these successes often go unnoticed by the broader population, Recovery Month
provides a vehicle for everyone to celebrate these accomplishments.
Now in its 27th year, Recovery Month highlights the achievements of individuals who
have reclaimed their lives in long-term recovery and honors the treatment and
recovery service providers who make recovery possible. Recovery Month also
promotes the message that recovery in all of its forms is possible and encourages
citizens to take action to help expand and improve the availability of effective
prevention, treatment, and recovery services for those in need.
The Recovery Month theme is carefully developed each year to invite individuals in
recovery and their support systems to spread the message and share the successes
of recovery. Learn more about this year’s theme.
Materials produced for the Recovery Month observance include print, Web,
television, radio, and social media tools. These resources help local communities
reach out and encourage individuals in need of services, and their friends and
families, to seek treatment and recovery services and information. Materials provide
multiple resources including SAMHSA’s National Helpline 1-800-662 HELP (4357) for
information and treatment referral as well as other SAMHSA resources for locating
services.
Local Recovery Events
Join the 5th Annual Recovery Celebration at Diamond Park in Meadville, PA on
September 23rd. VBH-PA is sponsoring a new speaker at this year’s celebration,
Brandon’s Dad. Don’t miss out on this poignant topic—alcohol and the effects of
DUI.
September is Also National Suicide Awareness Month
Suicide is the third leading cause of death among young
people and is often the result of mental health conditions
that effect people when they are most vulnerable. In
many cases the individuals, friends and families affected
by suicide are left in dark, feeling shame or stigma that
prevents talking openly about issues dealing with suicide.
See more at: http://www.nami.org/Get-Involved/
Awareness-Events/Suicide-Prevention-Awareness-
Month#sthash.1aaCZ8AI.dpuf
September 2016 is known as National Suicide Prevention Awareness Month which helps promote awareness around the
issues of suicide prevention, how you can help others, and how to talk about suicide without increasing the risk of harm.
6 ValueAdded—September 2016
Adherence to Antipsychotic Medications for Individuals with
Schizophrenia: Goals Met Within First Year of Study
Gateway HealthSM and VBH-PA are collaborating on an initiative to increase medication adherence for our shared members
with schizophrenia who are prescribed antipsychotic medications. An article published in the World Journal of Psychiatry in
2012 estimated that non-adherence rates in schizophrenia are about 50%, and of the over $10 billion annual cost of
schizophrenia, 40% was observed to be attributed to non-adherence. (Acosta FJ, et al. Medication Adherence in
Schizophrenia. World J Psych. 2012; 2(5):74-82 [NCBI]).
Upon review of prescription and refill history, members are identified for an educational mailing who may be less than 80%
adherent based on the proportion of days covered for their antipsychotic medications. The reasons for non-compliance are
varied and can depend on the many factors which influence the strategies for improving adherence. We have developed a list
of tips for your reference to address non-adherence with your patients (Table 1).
Reason for Poor Medication Adherence Possible Tools and Strategies for Addressing
Adherence Barriers
Cognitive factors (such as poor memory, difficulty understanding, etc.)
Encourage patients to sign up for automatic refills at their pharmacy
Set up an alarm; place post-it notes around the house
Use a pill box
Internal beliefs about medicine Provide simple, patient-friendly education about the disease state and why the medication is important to take
Consider cultural, spiritual, and religious beliefs that may impact treatment plans
External system and health barriers Adverse event—education on best ways to take medication to avoid unnecessary adverse events/side effects or change to a medication that is better tolerated
Complicated regimens—look for ways to simplify or use pill boxes
Table 1
Please consider using this information to reach out to your members if they have not been into the office recently to see you
or to initiate a conversation with them at their next visit about the importance of taking their medications. Please also
explore the potential cause of their non-adherence and develop a plan together to address the main causes.
Did You Know?
Many retail pharmacies offer automatic refills. Remind your patients to take advantage of this service.
If patients have trouble getting to the pharmacy there are sometimes free delivery programs available. Refer your
patients to their retail pharmacist.
Open communication with your patients’ other providers can help with medication reconciliation. If you are not a
particular patient’s PCP, consider reviewing the medical chart together with the PCP.
As part of the statewide improvement project, one of the measures to be analyzed included adherence to antipsychotic
medication for individuals with schizophrenia. The network-wide average, set back in 2014, indicated that only 57% of our
members had an 80% or higher compliance rate (Figure 1).
Article continued on page 9.
7 ValueAdded—September 2016
VBH-PA Receives NAMI Walks Award for
Being in the Top Ten Fundraisers
Upcoming BHRS Summits
(Your choice of two
locations per month.)
September 9 —
Hampton Inn & Suites
Mercer, PA
September 16 —
Courtyard by Marriott
Greensburg, PA
December 2 —
Courtyard by Marriott
Greensburg, PA
December 9 —
Hampton Inn & Suites
Mercer, PA
Upcoming RTF Summits
Friday, October 7th
9:00 a.m.—11:00
a.m.
Location:
Doubletree by Hil-
ton
910 Sheraton Drive,
Mars, PA 16046
View all of our
upcoming trainings
on the Provider
Trainings webpage:
http://www.vbh-
pa.com/provider/
prv_trn.htm
At the NAMI Walks kick-off luncheon on August 24th, VBH-PA
was awarded a special certificate for their hard work and dedication
in support of NAMI Walks. Specifically, we were in the Top Ten
Team Fundraisers for the first time in our history! Go Team VBH-
PA! We are looking for a similarly successful Walk this year on
Sunday, October 2nd at the Waterfront in Homestead. Sue Klaus,
PE&O Manager and our team leader, accepted the award and will be
organizing our team this year. This is NAMI SWPA’s 10th
anniversary. Support NAMI’s mission by walking and raising funds
for this great organization. Visit their website at: http://
www.namiwalks.org.
All are welcome—adult members, family members, County staff, provider staff and anyone
interested in learning more about how people with mental illness recover!
Save the Date!
Thursday, November 10, 2016
Registration begins at 8:00 a.m.
9:00 a.m. — Child Services Sessions
Noon — Exceptional Individual and Parent Awards Luncheon
1:45 p.m. — Adult Services Sessions
More information and registration coming soon!
Please consider nominating an Exceptional Individual (Adult) and/or an Exceptional Parent/
Caregiver for the Annual Awards Ceremony. Contact Shelley Thomas with any questions you
may have regarding nominations. Nomination forms will be available soon! If you are
interesting in exhibiting at this year’s forum, please email Shelley Thomas at
Sue Klaus, PE&O
Manager, accepting
NAMI Walks award
“Acknowledging the Journey” 9th Annual Family & Adult Behavioral Health Forum
A Value Behavioral Health of Pennsylvania Family and Adult Members Forum
Crawford, Mercer and Venango Counties
Updated Services Webpage
Visit http://www.vbh-pa.com/services.htm to view our updated Services webpage. Click
on Psychiatric Rehabilitation Services to view services updates, requirements, forms and
much more! The Services webpage will be going through ongoing changes — Outpatient
Mental Health Services is next — so check back often!
8
ValueAdded—September 2016
Join Us! 10th Annual Family Forum
For Families with Children in HealthChoices
“Transition and Effective Storytelling:
Blueprints into Our World”
Where: Ramada Greensburg Hotel
and Conference Center
100 Ramada Inn Drive
Greensburg, PA 15601
When: Friday, October 7, 2016
Time: 9:00 a.m. to 3:00 p.m.
Registration begins at 8:30 a.m.
Featuring:
Twisted Sisters—A Funny Thing Happened on the Way
to the White Picket Fence
The ever-inspiring Exceptional Parent/Caregiver
Awards Ceremony
Afternoon Breakout Sessions
Tons of exhibitor tables, and much more!
GENERAL REGISTRATION
General registration is now open! Click here for the Family Forum Registration
Brochure. Hurry! Deadline for registration is September 30, 2016.
EXHIBITORS
Would you like to exhibit at this year’s forum? Visit our homepage at www.vbh-pa.com
for the Family Forum Exhibitor Registration Form. Hurry! Deadline for exhibitor
registration is September 30, 2016.
HealthChoices’ families living in Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Lawrence,
Washington and Westmoreland Counties are invited to attend. Mercer, Crawford and Venango Counties
HealthChoices’ families will have the opportunity to attend other regionally held VBH-PA forums in 2016.
9
ValueAdded—September 2016
VBH-PA expected to reach a final goal of 61% compliance rate by the end of project year 2017. However, in one year VBH-PA
was able to reach a goal of 61% medication adherence by 2015 (Figure 2). VBH-PA was able to achieve this goal by partnering
with Gateway Health Plan. The team implemented targeted interventions, which included providing education to members on
the importance of medication adherence, and developing a communication tool for prescribers in regards to the members’ rates
of compliance.
Figure 1
Adherence to Antipsychotic Medications (continued)
Although the project goal for medication adherence was met, further analysis and additional interventions are still needed to be
pursued in the near future. One such avenue is the utilization of Long Acting Injectable Antipsychotics (LAIAs). VBH-PA is
exploring such options with Janssen Pharmaceuticals of Johnson & Johnson. This program utilizes local pharmacy participation
to increase members’ flexibility in scheduling and provides a neutral site for medication administration. Prescribers are also
notified when their member has missed a scheduled injection that day. Due to surveillance of the monthly medication injection,
adherence rates are more easily tracked and interventions can be achieved faster and at a higher success rate. Variables that are no
longer a factor with regards to member compliance with oral medication include forgetting to refill prescriptions or taking daily
medication. This once a month injection allows members freedom to pursue normal day-to-day activities without the nuances of
remembering to take their medication.
For further information about the information in this article, please contact Neil Amina at (724) 744-6381 or email at
Figure 2
10 ValueAdded—September 2016
The 5th Annual “T.A.A.G.” Picnic was held on Wednesday, August 10, 2016, at the Family
Resources Family Retreat Center in Mars, PA. Eighty-eight youth/young adults attended
from 11 counties, along with VBH-PA staff and other adults who supported the youth/
young adults during their time at CAMP “T.A.A.G.”, for a total of 148 registrants! With the
schedule jammed packed, the participants enjoyed fishing, canoeing, hiking, swimming, a
sports court, crafts, dancing, a team-building rope course, a zip line, and much more!
Exhibitors brought their information and swag for the youth/young adults to collect. This
year’s exhibitors included “T.A.A.G.”, VBH-PA, AMI, Human Services Center, Keystone
Wellness Programs, Allegheny Health Choices, Pressley Ridge, Gaudenzia Erie, Inc., Family
Behavioral Resources, UPMC for Kids, UPMC for You, Washington Health System Greene,
Westmoreland Community Action, Clarion Psychiatric Center, Aetna Better Health, Center
for Community Resources, Inc., and Westmoreland Casemanagement and Supports, Inc.
The youth/young adults stated on their evaluation forms that they really enjoyed the
exhibitors and want to ask them back for next year.
We were fortunate to have Lon Emerick come and bring his “Stamp Out Stigma” racecar.
It was a huge hit! Other special events that took place during the day were a pass, punt and
kick contest, scavenger hunt, 99.7 Street Treat Patrol, and corn hole competition. Another
highlight of the day was DJ Gia. She really had members movin’ and groovin’ on the dance
floor!
After all the donated gift baskets from the exhibitors were raffled off, thank-you’s were
made, and final goodbyes said, I was reminded once again of how youth/young adults,
given the chance to interact from a variety of very diverse cultures, can come together and
enjoy each other’s company. At this year’s CAMP “T.A.A.G”, we all STAMPED OUT
STIGMA! Until next year’s “T.A.A.G.” picnic, we bid a fond adieu.
The 6th Annual “T.A.A.G” picnic will once again be at the Family Resources Family
Retreat Center in Mars, PA. Save the Date—Wednesday, August 9, 2017. We hope to
see you there!
2016 CAMP “T.A.A.G.” Picnic
Suggestions or ideas
for articles that you
would like to see pub-
lished in ValueAdded
can be faxed to Kim
Tzoulis, ValueAdded
Editor, at (724) 744-
6363 or emailed to
kimberly.tzoulis@
beaconhealthop-
tions.com
Articles of general
importance to the
provider network will
be considered for
publication.
Value Behavioral
Health of PA, Inc.
520 Pleasant Valley Rd
Trafford, PA 15085
Phone: (877) 615-8503
Fax: (724) 744-6363
www.vbh-pa.com
Article by Karan Steele, Prevention, Education and Outreach Coordinator