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Santa Clara MHP

Santa Clara MHP Feedback to CalEQRO Outside Review Draft Report FY14-15

All feedback must be sent to CalEQRO within 10 business days of receiving the review draft.

Submitted By: Mary Harnish, Compliance & Privacy Manager-Mental Health Services

Date Submitted: 8-31-15

Contact Person/Phone/Email: Mary Harnish, Compliance & Privacy Manager-Mental Health Services 1(408) 885-5784

Mary.Harnish@hhs.sccgov.org

Page

Number Report Statement MHP Clarifying Response MHP Request for Change CAEQRO Response

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Recommendation #4: Provide contract providers with reports from the

Adult/Older Adult Database, as requested, and develop a similar resource for

Children’s providers.

The Family and Children (F&C) Division utilizes a different database than the Adult/Older Adult database. F&C staff met on a quarterly basis with the F&C

Contractors to review budget and program performance during the year. Budget

documents provided by the Finance Director included Medi-Cal/EPSDT current

performance projections as well as average number of clients served per month and average cost per client, per month. These in-person program review meetings created a venue for tracking performance of

programs, contracts and budgets for F&C programs.

Please incorporate this information into your final report.

CalEQRO will revise the narrative for Recommendation #4 as follows:

o As of February 2015 SCBHS continues to

implement Co-Contrix Coordinated Care Plan (CCP) system that includes full electronic health record functionality. They anticipate going live in early 2016 at county-operated clinics and

programs. It is anticipated contract providers will use electronic data interchange transactions with Co-Contrix CCP at a future date.

o Most participants in CALEQRO’s February 19,

2015 Contract Providers Break-Out session stated that they do not routinely receive data or reports from Co-Contrix system.

o The Demand Capacity and Census Management

Work Group, with participation from contract providers, has begun to meet to develop baseline data for the various levels of care. The workgroup

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is communicating with Electronic Health Record and Electronic Data Interchange groups to support the changes to Co-Contrix CCP system which are consistent with requested information. In addition the work group is working on a variety of tasks among them is reports from Co-Contrix CCP to share with providers to support shared management of capacity.

o Contract providers maintain separate EHRs with

no interoperability with SCBHS’s Co-Contrix. . SCBHS staff continue to upload contract provider service transactions into Co-Contrix for billing purposes. This requires significant contract provider staff time to reconcile differences.

o Family and Children (F&C) Division staff meet on a quarterly basis with the F&C contractors to review budget and program performance during the year. Budget documents provided by the Finance Director include Medi-Cal/EPSDT current performance projections, average number of clients served per month and average cost per client per month. These in-person program review meetings create a venue for tracking performance of programs, contracts and budgets for F&C/children’s programs.

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The Access Call Center lacks a common

Scheduling/Preadmission function electronically

The Call Center does not schedule appointments. The function of the Call Center is to complete clinical screenings, determine level of service and refer to

Please incorporate this information into your final report.

CalEQRO will revise this “Access to Care” Opportunity as follows:

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linked to Contract Providers and FQHC’s to electronically identify open appointment “slots”. Development of a common

Scheduler/Preadmission EHR function, EDI or other electronic interoperability may be critical to integrating services and assessing capacity.

appropriate providers for services. The assigned providers contact the clients to schedule the first appointment. The Call Center has been receiving weekly capacity reports from all providers. A spreadsheet has been designed and implemented to track capacity utilization. The Call Center is

exploring a software that could address the need to track the capacity to eliminate the “white board”.

o The Access Call Center lacks a common

Scheduling/Preadmission function electronically linked to Contract Providers and FQHCs to electronically identify open appointment “slots”. Development of a common

Scheduler/Preadmission EHR function, EDI or other electronic interoperability may be critical

to integrating services and assessing capacity.

The Access Call Center does not schedule appointments. The function of the Call Center is to complete clinical screenings, determine the level of service and refer consumers to appropriate providers for services.

o The Call Center currently receives weekly

capacity reports from providers and a

spreadsheet is used to track capacity (i.e. the “white board”). The Call Center lacks a Scheduling/Preadmission function linked to Contract Providers and FQHCs to

electronically identify open appointment “slots”. The Call Center is exploring a

software that could address the need to track capacity to eliminate the “white board”.

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Related, the SCBHS lacks the capacity for timely

placement of consumers in lower or higher levels of

Starting November 2014, new Level 1 clients discharged from acute or emergency

psychiatric care have been seen at the Mental Health Urgent Care Clinic for their

Please incorporate this information into your final report.

CalEQRO will revise this “Access to Care” Opportunity as follows:

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care. In particular, new Level 1 clients discharged from acute or emergency psychiatric care are often delayed in access to outpatient treatment. Improving the throughput of treatment through EHR capacity should be a major goal of SCBHS going forward.

first appointment. Since this

implementation, 100% of these cases are scheduled to be seen within 5 days of the date of discharge. This is part of the Clinical PIP.

BHS Leadership has identified external consultants that have expertise in capacity analysis and system throughput, and could provide technical assistance to the

Adult/Older Adult Division, ensuring timely access, throughput to appropriate levels of care and capacity for the Call Center.

o Data provided to CalEQRO at the time of the

review Related, indicated that SCBHS lacks the capacity for timely placement of consumers in lower or higher levels of care. In particular, new Level 1 clients discharged from acute or

emergency psychiatric care were are often

delayed in access to outpatient treatment.

o SCBHS’s FY14-15 Clinical PIP addresses the

issue of improving access for discharged Level 1 consumers. SCBHS states that starting November 2014, new Level 1 consumers discharged from acute or

emergency psychiatric care have been seen at the Mental Health Urgent Care Clinic for their first appointment and that since this implementation, 100% of these cases are scheduled to be seen within 5 days of the date of discharge SCBHS Leadership has also identified external consultants that have expertise in capacity analysis and system throughput to ensure timely access to appropriate levels of care. Improving the throughput of treatment through EHR capacity should be a major goal of SCBHS going forward.

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SCBHS should consider working with provider stakeholders to complete the adult and children’s

The Adult/Older Adult and F&C RFP’s have been completed and SCBHS is in the process of conducting contract negotiations. It is standard policy to hold bidder conferences

Please incorporate this information into your final report.

CalEQRO will revise this “Access to Care” Opportunity as follows:

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outpatient SOC RFP and re-contracting process

including (if still within the RFP timeline), issuing RFP Instruction Letters, holding informational meetings or bidders conferences, issuing RFP amendments if possible, or considering any other means to improve services and include evidence-based practices under these procurements and to

address any other legitimate issues which provider

stakeholders may raise.

and send out addendums (RFP updates and changes) for all RFP’s that are released by the Department. Requests for Information can also be utilized to gather input from our service providers, prior to releasing a RFP. Program outcomes and data

gathering/reports have been incorporated in the RFP’s.

o SCBHS should maximize collaboration

consider working with provider stakeholders to complete the adult and children’s outpatient SOC

RFPs and other re-contracting processes. It is

standard policy for SCBHS to hold bidder conferences and send out addendums (RFP updates and changes) for all RFP’s released. Requests for information can also be utilized to gather input from service providers prior to releasing an RFP. including (if still within the RFP timeline), issuing RFP Instruction Letters, holding informational meetings or bidders conferences, issuing RFP amendments if possible, or considering any other means to improve services and include evidence-based practices under these procurements and to address any other legitimate issues which

provider stakeholders may raise. Program

outcomes and data gathering along with performance reports have been incorporated in the RFP’s.

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Clinical line staff and lead need to be directly involved and fully integrated in SCBHS

Committees/Workgroups, Executive processes, and decision-making.

Clinical line staff participate on all the Performance & Quality Improvement Committee (PQIC) workgroups and have input into all recommendations that are presented to PQIC and the System of Care committees. All levels of the organization are represented and these

Please incorporate this information into your final report.

These were comments from the Clinical Line Staff Focus Group. CalEQRO will revise this “Quality of Care”

Opportunity to state:

o Clinical line staff and lead staff stated during

Focus Group sessions that they feel they are not sufficiently need to be directly involved and

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recommendations inform the Executive decision-making process. The attached sample of workgroup reports (see attachments: 0- 5 Workgroup, TCP Workgroup, High Utilizer Workgroup, Inpt./Outpt. Workgroup) indicate the participants in the process. Each workgroup is designed to have cross-representation of participants throughout the system. As the Department convenes new workgroups and planning processes, BHS Leadership plans to include line staff.

fully integrated inSCBHS Committees,

Workgroups, Executive processes, and

decision-making processes.

Selected clinical line staff participate on all Performance & Quality Improvement Committee (PQIC) workgroups and have input into all

recommendations presented to PQIC and System of Care committees. All levels of the organization are represented and these recommendations inform Executive decision-making process.

Based on focus group feedback not all levels of the organization are aware of how decision-making processes function.

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The 2015 QIWP PLM’s to track and trend: a) timely appointments for urgent conditions; and b) timely follow-up appointments after hospitalization, should be implemented and

timeliness PLM’s should track data separately for children and adults.

Data for Urgent Conditions was tracked and used to formulate the Clinical PIP for Level I placements. Extensive analysis was

completed to assist in the formulation of the PIP.

For timely follow-up appointments after hospitalization, Decision Support began running monthly reports (see attachment: EQRO BAP/Inpt. Contract) after last year’s EQRO visit. The data from this report has been used over the last year by the

Inpatient/Outpatient Coordination

workgroup to support the development of the charter and ongoing analysis activities.

Please incorporate this information into your final report.

It should be noted that the MHP plans to implement

reliable and valid timeliness measures, and produce routine reports.

o Data for urgent conditions was tracked and

used to formulate the Clinical PIP, and

Decision Support has begun running monthly reports for timely follow-up appointments.

o The 2015 QIWP PLMs to track and trend: a)

timely appointments for urgent conditions; and b) timely follow-up appointments after

hospitalization, should be implemented and timeliness PLMs should track data separately for children and adults.

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Most contract providers report that they do not routinely receive data or reports from Co-Centrix CCX.

All agencies have been trained in how to access data reports in UNI/Care. They are also provided technical assistance by

Decision Support upon request. In addition, when the Performance Learning Measure (PLM) dashboard is sent to an agency, the background data that creates the dashboard graphs is included. The data is provided in an Excel spreadsheet to allow the agency to work with the data and create their own internal reports as needed (see attachments: PLM - F&C AACI, PLM - F&C Division for sample of an agency’s PLM). Decision Support also provides the appropriate system level (Adult/Older Adult Division or Family and Children Services Division PLM) for comparison purposes. While the data is provided quarterly, all the agencies can access the data at any time for whatever time period they wish to examine. Supporting documentation on how the measures are developed has been provided to the agencies in the past (see attachment #8 -Guide to the PLM).

Please incorporate this information into your final report.

These findings were strongly expressed by almost all participants in the Contract Providers Focus Group. This issue was also brought up by many contract providers participating in other break-out sessions. CalEQRO will revise this “Quality of Care” Opportunity as follows:

o Although SCBHS provides contract providers

with their quarterly PLM dashboard and a background excel spreadsheet of these results,most contract providers report that they do not routinely receive data or reports from Co-Contrix.

o SCBHS noted all agencies have been trained

in how to access data reports in Co-Contrix. They are also provided technical assistance by Decision Support upon request.

67 Cathy Smidde, Mental Health Program Specialist Spelling/Title Cathy Smiddy Mental Health Program Specialist Change accepted and included in Final Report.

68 Mary Harnish Compliance Officer Spelling/Title Mary Harnish, Compliance & Privacy Mgr., Mental Health

Services Change accepted and included in Final Report.

69 Mikelle Le, Senior Program Specialist Spelling/Title Mikelle, Senior Mental Health Program Specialist Change accepted and included in Final Report.

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69 Paul Trugman, Therapist Spelling/Title Paul Trugman-LCSW Change accepted and included in Final Report.

69 Sheila Yater, Senior Program Specialist Spelling/Title Sheila Yuter, Senior Health Care Program Manager Change accepted and included in Final Report.

69 Steve Lawnsbery, QIC DADS Spelling/Title Steve Lownsbery, QIC II - DADS Change accepted and included in Final Report.

69 Tiffany Lee, MD, Medical Dtr. Spelling/Title Tiffany Ho, M.D., Medical Director Change accepted and included in Final Report.

69 Toni Tullys, Director Spelling/Title Toni Tullys, Behavioral Health Services Director Change accepted and included in Final Report.

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References

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