Transcript Bridge Appointments - indianamedicaid.com

Integrated Healthcare:
Striving for Better Care
APP0040
(09/10)
A combined presentation
from the MCO’s
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Presented by Lynn Bradford, Ph. D.,
HSPP
Director of Behavioral Health
MDwise, Inc.
Purpose of today’s
presentation
Philosophy
 Administration
 Integration
 MDwise
 Managed Health Services
 Anthem
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Philosophy
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Integrated Care is one way to open up access to
behavioral health services of which the 7 day follow
up is one.
Local management of behavioral health services.
Improved coordination and collaboration between
medical and behavioral health providers (work in
progress)
Utilization management and case management
services are integrated, medical and behavioral
health managers work together to manage members’
needs.
Building a “right sized” network of skilled providers,
statewide.
Administration
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MDwise medical and behavioral health
case managers and utilization mangers
work together to mange our members as
a unified team at the Delivery Systems.
At the delivery system level of MDwise
there is integrated staffing of member’s
cases.
Integration Grant Project
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MDwise is piloting metrics with our grant
recipients who are implementing integrated
care so that each recipient can present their
projects to other providers in the State to further
implement integrated care throughout the State.
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The pilot participants will include:
St. Vincent Primary Care
Midtown CMHC
Gallahue CMHC
 St. Francis Medical Group
Integration Grant Project
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A seminar is planned for November for primary
care and behavioral health providers; continuing
education credit will be offered
A historical overview of integrated care will be
presented
Grantees will present their projects and outcome
metrics
National best practice will be discussed
Next steps for Indiana so that integrated care can
move forward
Discharge Planning
 Transition
 History
Planning
of fragmentation in systems of care
 Not part of treatment planning
 Little communication between service
providers
 Interruption of care is among the most
significant obstacles to a stable recovery
Discharge Planning
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In response, MDwise is moving towards transition planning
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AACP (2001,2009) developed “Best Practices for Managing Transitions
Between Levels of Care”. (www.communitypsychiatry.org)
http://www.communitypsychiatry.org/publications/clinical_and_administrati
ve_tools_guidelines/COG.doc
Guidelines developed through clinical experience and existing information
Committee consensus determined each element
Each element has an outcome indicator to measure adherence to the
principles
14 elements identified as best practices for transition planning
Guidelines not yet considered evidence based
Bridge Appointments
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MDwise uses codes 99401 and 99402 billed on a CMS1500 claim form. Revenue Code 513 is paid on a UB
form
 Code 99401 pays a flat fee of $25 (15 minutes)
 Code 99402 pays a flat fee of $50 (30 minutes)
 Rev. Code 513 pays a flat fee of $50
A prior authorization through the member’s Delivery
System must be obtained prior to discharge. This can be
done during the initial call for an inpatient authorization.
The progress report, after the Bridge Appointment is
completed, is faxed to the MDwise Delivery System, the
outpatient therapist, and the member’s case manager at
MDwise.
Provider Education
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Network Improvement Program Team and
Provider Relations provide outreach and
education to the Behavioral Health provider
network.
Provide education on claims, PA, and billing
guidelines.
Provide education on HEDIS and the quality
measures.
Provide education on Case Management.
Provide educational materials and reports.
Provide materials to assist in meeting the 7-day
follow up standard.
Hoosier Alliance & Select Health –
Case Management Case Study
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Kept Hoosier Alliance and Select Health have
increased case management efforts and tracking of
inpatient discharges.
The following information is tracked: Inpatient facility,
date of discharge, bridge appointment provided,
outpatient appointment schedule and date, reminder
call, bridge and/or outpatient appointment kept.
The case manager does not allow a discharge without
the 7 day follow up appointment scheduled.
The case manager contacts the member to remind
them of the appointment and follows up after the
appointment to ensure the appointment was.
Administration
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MHS Case Managers, Cenpatico
Intensive Case Managers (ICM) and
Utilization Managers work together as
integrated teams to ensure a seamless
delivery of services. Cases are staffed
jointly to identify service gaps and
develop an integrated plan to improve
member outcomes.
Intensive Case Management
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Cenpatico Intensive Case Managers (ICMs)
start intervening as soon as we are notified of
and inpatient event.
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Outreach to the Hospital Social Worker,
Discharge planner and family prior to discharge
to coordinate community appointments.
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Once discharged from an in-patient stay, each
member is followed by an ICM for 6 months to
help ensure that there are no barriers to follow
up care.
Intensive Case Management
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Once discharged, ICMs contact the
member/parent to confirm appointment. If
appointment falls outside the 7 day window
assistance is provided to obtain an appointment
with seven days.
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Summary of discharge information is faxed to
member’s PMP and outpatient behavioral
health providers.
Perinatal Depression
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MHS/Cenpatico have worked to increase the
identification and treatment of pregnant or postpartum
women with depression.
In an effort to better coordinate medical and behavioral
health care, Intensive Case Managers notify the
member’s medical provider when a member returns a
depression screening tool that scored positive for signs
of depression.
The Intensive Case Manager informs the medical
provider that education will be provided to the member
regarding depression, the available benefits to her
under MHS and how to access these services.
Post Hospitalization Safety
Incentive
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An Incentive targeted at ensuring the 7 day follow up
appointment for members discharged from Inpatient
Hospitalization.
Target members: Ages 4 – 18 years of age.
Members are informed during an Inpatient Hospitalization
and/or immediately following that if they complete their 7
day follow up appointment they will receive an incentive.
The incentive consists of a Build A Bear, a book on
feelings and a $10.00 gift card to Wal-Mart.
January – September 2010 226 incentive packages have
been mailed.
Caring Voices
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Intensive Case Managers identify high-risk members
who otherwise have little or no access to telephone
service and provide free cell phones.
All Cenpatico Intensive Case Managers currently have
a Caring Voices phone available to deliver to inpatient
providers prior to discharge to aid in bridging the gap
between member and provider, increasing member
compliance and improving healthy outcomes.
Caring Voices phones allow outgoing calls only to
preprogrammed numbers: Community Mental Health
Centers, MHS/Cenpatico, Primary Medical Provider,
transportation, pharmacy. Incoming calls are always
open.
Provider Education Efforts
The Bridge Appointment
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A detailed explanation of the HEDIS measure is provided to the
provider
Discussions take place to ensure that the provider understands
the value of ensuring that the member is assisted in making the
transition back to their home, family and community
Informed that this is a “last resort” and not to take the place of a
valid OP appointment
Primarily used when getting an appointment within 90 days is
very difficult
Explanation of how to bill for the Bridge Appointment for IP
Providers and list of other services that OP Providers can
perform that count toward the HEDIS measure
Bridge Appointments
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Cenpatico has identified several High volume Hospitals to
provide Bridge appointments.
The Bridge Appointment takes place on the day of
discharge.
Demographic information, Community Provider information,
including date of next appointment is reviewed.
Completed Bridge Appointment document is faxed to ICM
staff within 24 hours.
ICM staff follow up with member/ parent to ensure 7 day
appointment is made and to assist with barriers in
completing the appointment.
Bridge Appointment Cont..
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If there is an appointment listed on the Bridge Appointment
document outside of the 7 day expectation the ICM staff
assist with rescheduling a more appropriate appointment.
No Prior Authorization is needed
Bridge Provider will contact Cenpatico ICM’s via fax with
Bridge Appointment Documentation
Bridge Provider will create a report with the names and
dates of those members that participated
Revenue Code 513 will be used to process all Bridge
Appointment claims and will be billed on a separate claim
Bridge Appointments
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Cenpatico uses Revenue Code 513 to assist with
ensuring that members that are being discharged from an
in-patient stay have an opportunity to meet with a
behavioral health provider after discharge to the
discharge plan and any post discharge information.
Revenue Code 513 should be billed on a UB Form.
A prior authorization through the member’s Delivery
System must be obtained prior to discharge. This can be
done during the initial call for an inpatient authorization.
The progress report, after the Bridge Appointment is
completed, is faxed to the MDwise Delivery System, the
outpatient therapist, and the member’s case manager at
MDwise.
Managed Health Services
What is Cenpatico is doing to make
integration easier?
 No need to bill Cenpatico when billing
96150-96155 and billing under a PMP
for health providers
 PMP is allowed to supervise mid-level
behavioral health providers
School-Based Health Care
Services
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MHS and Cenpatico also facilitates
the planning, development,
implementation, and evaluation of
comprehensive integrated SchoolBased Health Centers (SBHCs).
What is a School-Based
Health Center -- SBHC?
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A SBHC is a “health center located in
a school or on school grounds that
provides school-aged children on-site
comprehensive preventive and
primary health services, including
behavioral health, oral health,
ancillary, and enabling services.”
Services provided in a
SBHC:
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General health assessments
EPSDT screenings
Laboratory and Diagnostic screenings
Immunizations
First Aid
Family Planning and counseling
Prenatal and postpartum care
Services Provided in a
SBHC:
 Dental Services
 Behavioral Health Services
o Billing codes: 96150-96155
 Drug & Alcohol Abuse Services
 Prescription Drug Distribution &
management
 Patient Education & other services based
on student need
Anthem Blue Cross and Blue Shield
Values and Beliefs
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Development of strong collaborative relationships with
our providers / partners in care
Integration, coordination, and collaboration between
medical and behavioral health delivery systems /
providers
Innovation- Advanced programs to provide proactive
interventions geared to promote and improve better
health
Timely follow up after hospitalization promotes sustained
progress and longer community tenure
Anthem Blue Cross and Blue Shield
Strategy
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One Team caring for the Whole Person
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Collocated Behavioral Health and Medical Case Managers
Shared medical information system
Coordinated Care Conferences
• Case Managers work closely with the “clinical team” involving behavioral
health / medical management case managers as well as the Primary
Medical Provider and Behavioral Health Service Provider
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Mutual referral processes
State of the Art Disease Management Programs
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Co-Existing Depression and Anxiety Program (CODA)
Maternity Depression Program (MDP)
Bipolar Disease Management Program
Attention Deficit Hyperactivity Disorder
(ADHD) Program
Autism Program
Anthem Blue Cross and Blue Shield
Strategy
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Tiered Case Management Program
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Community Partnerships
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Members move between a three tier program based upon
need and progress
Maintenance and development of collaborative community
relationships, i.e. ASK (About Special Kids)
Provider Collaboration and Education
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Case Managers work with providers as team members and
not “vendors”
Comprehensive educational seminars and opportunities
geared toward integration of care and best practices
Anthem Blue Cross and Blue Shield
Discharge Planning
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Comprehensive Discharge Planning is crucial to the
overall success of the member’s treatment
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Engages the member and his/her family in the ongoing
treatment plan
Encourages member and PMP interaction and assists the
member in choosing a medical home if one has not been
selected
Establishes a follow up appointment with an outpatient
provider within 7 days of discharge
Transitions the member to a longer term provider along
the continuum of care
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Alignment of the right care in the right setting
for the right amount of time
Anthem Blue Cross and Blue Shield
Discharge Planning
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Educates the member about their medications and the
importance of compliance
Supports integrated and non-disrupted ongoing care
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Members who attend an outpatient appointment within
seven days of discharge have:
• Longer community tenure
• Increased commitment to treatment with fewer failed
appointments
Anthem Blue Cross and Blue Shield
Transition Program
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Provides a seamless transition from inpatient to
outpatient care
Facilitates integration of care through expedited
communication with the outpatient provider regarding the
member’s history and treatment plan
Addresses barriers to continued treatment / medication
compliance
Supports member engagement with their community
provider
Demonstrated Results
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Increased follow up rate with community provider
Decreased hospital readmissions
Anthem Blue Cross and Blue Shield
Provider Outreach
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Provides educational opportunities and materials around
HEDIS, quality improvements, and billing tips
Provides feedback on performance and opportunities for
improvement through Facility Report Cards
Provides tips and tools to assist in improving ambulatory
care follow up
Provides education on member outreach and Anthem’s
Case Management Programs
Provides numerous webinars, seminars, and materials for
increased knowledge
Anthem Blue Cross and Blue Shield
Transition Program
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Providers should bill Revenue Code 0513 along with the
accompanying CPT code of xxxxx
 Revenue Code 0513 is reimbursed at $70
Authorization is required at the time of the appointment
and is obtained by sending the summary report via
facsimile to Anthem’s case management staff
The summary report is sent to the outpatient provider via
facsimile
Questions?????