Santa Clara. Conducted on January 10-12, Prepared by:

Transcription

1 FY16-17 Medi-Cal Specialty Mental Health External Quality Review MHP Final Reprt Santa Clara Cnducted n January 10-12, 2017 Prepared by: Behaviral Health Cncepts, Inc Christie Avenue, Suite 502 Emeryville, CA

2 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year TABLE OF CONTENTS SANTA CLARA MENTAL HEALTH PLAN SUMMARY FINDINGS... 4 INTRODUCTION... 6 PRIOR YEAR REVIEW FINDINGS, FY STATUS OF FY15-16 REVIEW RECOMMENDATIONS... 8 Assignment f Ratings... 8 Key Recmmendatins frm FY CHANGES IN THE MHP ENVIRONMENT AND WITHIN THE MHP IMPACT AND IMPLICATIONS PERFORMANCE MEASUREMENT TOTAL BENEFICIARIES SERVED PENETRATION RATES AND APPROVED CLAIM DOLLARS PER BENEFICIARY HIGH-COST BENEFICIARIES TIMELY FOLLOW-UP AFTER PSYCHIATRIC INPATIENT DISCHARGE DIAGNOSTIC CATEGORIES PERFORMANCE MEASURES FINDINGS IMPACT AND IMPLICATIONS PERFORMANCE IMPROVEMENT PROJECT VALIDATION SANTA CLARA MHP PIPS IDENTIFIED FOR VALIDATION CLINICAL PIP ADVANCING RECOVERY NON-CLINICAL PIP INPATIENT AND OUTPATIENT COORDINATION PERFORMANCE IMPROVEMENT PROJECT FINDINGS IMPACT AND IMPLICATIONS PERFORMANCE & QUALITY MANAGEMENT KEY COMPONENTS Access t Care Timeliness f Services Quality f Care KEY COMPONENTS FINDINGS IMPACT AND IMPLICATIONS CONSUMER AND FAMILY MEMBER FOCUS GROUP(S) CONSUMER/FAMILY MEMBER FOCUS GROUP CONSUMER/FAMILY MEMBER FOCUS GROUP CONSUMER/FAMILY MEMBER FOCUS GROUP FINDINGS IMPLICATIONS INFORMATION SYSTEMS REVIEW KEY ISCA INFORMATION PROVIDED BY THE MHP CURRENT OPERATIONS PLANS FOR INFORMATION SYSTEMS CHANGE ELECTRONIC HEALTH RECORD STATUS MAJOR CHANGES SINCE LAST YEAR PRIORITIES FOR THE COMING YEAR OTHER SIGNIFICANT ISSUES MEDI-CAL CLAIMS PROCESSING INFORMATION SYSTEMS REVIEW FINDINGS IMPLICATIONS SITE REVIEW PROCESS BARRIERS CONCLUSIONS Page 2

3 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year STRENGTHS AND OPPORTUNITIES Access t Care Timeliness f Services Quality f Care Cnsumer Outcmes RECOMMENDATIONS ATTACHMENTS ATTACHMENT A REVIEW AGENDA ATTACHMENT B REVIEW PARTICIPANTS ATTACHMENT C APPROVED CLAIMS SOURCE DATA ATTACHMENT D PIP VALIDATION TOOL Page 3

4 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year SANTA CLARA MENTAL HEALTH PLAN SUMMARY FINDINGS Beneficiaries served in CY15 18,286 MHP Threshld Language(s) Spanish, Vietnamese, Mandarin, Tagalg MHP Size Large MHP Regin Bay Area MHP Lcatin Santa Clara MHP Cunty Seat San Jse Intrductin This is a large Bay Area cunty and prvides services and prgrams fr a multilingual, culturally diverse cmmunity. In cllabratin with key stakehlders, it cntinues t develp and implement a plan t fully integrate the cunty s behaviral health visin, values, apprach, infrastructure, systems, prcesses, services and supprts t better meet the needs and expectatins f current and future cnsumers and their families. It cntinues t strive t merge varius perspectives int a brader mdel f integrated care and apply best practices t its wrk with thse with single and dual diagnses. Access Access t care has becme a pririty issue fr the MHP. It has accelerated its needed effrts t autmate and prvide electrnic methds t capture capacity t serve. The MHP submitted a Perfrmance Imprvement Prject (PIP) in Phase I implementatin twards autmatin. With 87% f its services delivered by rganizatinal prviders, this effrt must remain in the frefrnt as it affects its system f care cunty-wide. A backlg f intakes and referrals are impacted secndary t its staffing shrtages. The latter is primarily due t the high cst f living cmbined with the cmpetitive health plans hiring frm the same pl f applicants. Despite this, the MHP deserves recgnitin regarding its initiatives t serve cnsumers in multifaceted ways thrugh its system f care and its strategic planning. Recent funding fr its waiver fr the Organized Delivery Services (ODS) fr substance disrders, the Whle Persn Care (WPC) grant, it Crdinatin Care Refrm (CCR) plicies and prcedures mdeled after the Katie A. implementatin, and its cllabratin with jail diversin prvide access fr these vulnerable ppulatins. Timeliness With the impact at the Access Call Center, timely appintments t care are ptentially affected. Mst ntably the indicatrs fr first appintment and first medicatins supprt services are belw its standards. The MHP recgnizes imprvements t its metric are warranted and it cntinues t Page 4

5 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year strategize fr timely appintments. With its electrnic capacity system develping, this is a primary gal t imprve. Quality The dedicatin t quality is apparent, frm leadership t line staff. The system cntinues t adapt its prcedures t advance a quality management rganizatin. The challenges remain its ability t cmpete fr, and hire, qualified persnnel t keep up with its intended prgress. The system itself is grwing and cntinues t experience flexibility in these times f ecnmic, plitical and fiscally challenged changes. Outcmes Numerus utcme measures are used with evidence based practices, especially prlific within the Family and Children s divisin. The MHP cntinues t use Milestnes f Recvery Scale (MORS) fr adults and the Child and Adlescent Needs and Strength (CANS) assessment fr children t measure utcmes. The MHP utlined numerus quality initiatives establishing a strng fundatin fr psitive cnsumer utcmes with its plans t: Integrate and strengthen its departmental administrative functins. Imprve access and system capacity t meet demand. Implement waivers fr its Substance Use Treatment Services and Whle Persn Care. Expand quality imprvement functins acrss its system with efficiencies. Strengthen wrkfrce thrugh recruitment, retentin and staff develpment. Page 5

6 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year INTRODUCTION The United States Department f Health and Human Services (DHHS), Centers fr Medicare and Medicaid Services (CMS) requires an annual, independent external evaluatin f State Medicaid Managed Care prgrams by an External Quality Review Organizatin (EQRO). External Quality Review (EQR) is the analysis and evaluatin by an apprved EQRO f aggregate infrmatin n quality, timeliness, and access t health care services furnished by Prepaid Inpatient Health Plans (PIHPs) and their cntractrs t recipients f Managed Care services. The CMS rules (42 CFR 438; Medicaid Prgram, External Quality Review f Medicaid Managed Care Organizatins [MCOs]) specify the requirements fr evaluatin f Medicaid Managed Care prgrams. These rules require an n-site review r a desk review f each Medi-Cal Mental Health Plan (MHP). The State f Califrnia Department f Health Care Services (DHCS) cntracts with 56 cunty Medi- Cal MHPs t prvide Medi-Cal cvered Specialty Mental Health Services (SMHS) t Medi-Cal beneficiaries under the prvisins f Title XIX f the federal Scial Security Act. This reprt presents the FY16-17 findings f an EQR f the Santa Clara MHP by the Califrnia EQRO (CalEQRO), Behaviral Health Cncepts, Inc. (BHC). The EQR technical reprt analyzes and aggregates data frm the EQR activities as described belw: (1) VALIDATING PERFORMANCE MEASURES 1 This reprt cntains the results f the EQRO s validatin f eight Mandatry Perfrmance Measures (PMs) as defined by DHCS. The eight perfrmance measures include: Ttal Beneficiaries Served by each cunty MHP Ttal Csts per Beneficiary Served by each cunty MHP Penetratin Rates in each cunty MHP Cunt f Therapeutic Behaviral Services (TBS) Beneficiaries Served Cmpared t the fur percent Emily Q. Benchmark (nt included in MHP reprts; this infrmatin is included in the Annual Statewide Reprt submitted t DHCS). Ttal Psychiatric Inpatient Hspital Episdes, Csts, and Average Length f Stay Psychiatric Inpatient Hspital 7-Day and 30-Day Rehspitalizatin Rates Pst-Psychiatric Inpatient Hspital 7-Day and 30-Day SMHS Fllw-Up Service Rates High Cst Beneficiaries ($30,000 r higher) 1 Department f Health and Human Services. Centers fr Medicare and Medicaid Services (2012). Validatin f Perfrmance Measures Reprted by the MCO: A Mandatry Prtcl fr External Quality Review (EQR), Prtcl 2, Versin 2.0, September, Washingtn, DC: Authr. Page 6

7 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year (2) VALIDATING PERFORMANCE IMPROVEMENT PROJECTS 2 Each MHP is required t cnduct tw Perfrmance Imprvement Prjects (PIPs) during the 12 mnths preceding the review. The PIPs are discussed in detail later in this reprt. (3) MHP HEALTH INFORMATION SYSTEM CAPABILITIES 3 Utilizing the Infrmatin Systems Capabilities Assessment (ISCA) prtcl, the EQRO reviewed and analyzed the extent t which the MHP meets federal data integrity requirement fr Health Infrmatin Systems (HIS), as identified in 42 CFR This evaluatin included review f the MHP s reprting systems and methdlgies fr calculating perfrmance measures. (4) VALIDATION OF STATE AND COUNTY CONSUMER SATISFACTION SURVEYS The EQRO examined available cnsumer satisfactin surveys cnducted by DHCS, the MHP, r its subcntractrs. CalEQRO als cnducted 90-minute fcus grups with beneficiaries and family members t btain direct qualitative evidence frm beneficiaries. (5) KEY COMPONENTS, SIGNIFICANT CHANGES, ASSESSMENT OF STRENGTHS, OPPORTUNITIES FOR IMPROVEMENT, RECOMMENDATIONS The CalEQRO review draws upn prir year s findings, including sustained strengths, pprtunities fr imprvement, and actins in respnse t recmmendatins. Other findings in this reprt include: Changes, prgress, r milestnes in the MHP s apprach t perfrmance management emphasizing utilizatin f data, specific reprts, and activities designed t manage and imprve quality. Ratings fr key cmpnents assciated with the fllwing three dmains: access, timeliness, and quality. Submitted dcumentatin as well as interviews with a variety f key staff, cntracted prviders, advisry grups, beneficiaries, and ther stakehlders serves t infrm the evaluatin f MHP s perfrmance within these dmains. Detailed definitins fr each f the review criteria can be fund n the CalEQRO Website 2 Department f Health and Human Services. Centers fr Medicare and Medicaid Services (2012). Validating Perfrmance Imprvement Prjects: Mandatry Prtcl fr External Quality Review (EQR), Prtcl 3, Versin 2.0, September Washingtn, DC: Authr. 3 Department f Health and Human Services. Centers fr Medicare and Medicaid Services (2012). EQR Prtcl 1: Assessment f Cmpliance with Medicaid Managed Care Regulatins: A Mandatry Prtcl fr External Quality Review (EQR), Prtcl 1, Versin 2.0, September 1, Washingtn, DC: Authr. Page 7

8 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PRIOR YEAR REVIEW FINDINGS, FY15-16 In this sectin the status f last year s (FY15-16) recmmendatins are presented, as well as changes within the MHP s envirnment since its last review. STATUS OF FY15-16 REVIEW RECOMMENDATIONS In the FY15-16 site review reprt, the CalEQRO made a number f recmmendatins fr imprvements in the MHP s prgrammatic and/r peratinal areas. During the FY16-17 site visit, CalEQRO and MHP staff discussed the status f thse FY15-16 recmmendatins, which are summarized belw. Assignment f Ratings Fully addressed is assigned when the identified issue has been reslved: reslved the identified issue Partially addressed is assigned when the MHP has either: made clear plans, and is in the early stages f initiating activities t address the recmmendatin addressed sme but nt all aspects f the recmmendatin r related issues Nt addressed is assigned when the MHP perfrmed n meaningful activities t address the recmmendatin r assciated issues. Key Recmmendatins frm FY15-16 Recmmendatin #1: Fully integrate the Call Center peratins t enhance timely access t care and imprve cnsumer s engagement experience. Prvide Call Center staff with applicatins and electrnic data t supprt 24/7 wrklad respnsibilities. Autmate capacity reprting in Pr-Filer t replace the weekly via fax ntificatin f pen service slts by prviders. Prduce and distribute n a regular schedule summary capacity reprts t all prviders t enhance systems capacity transparency. Fully addressed Partially addressed Nt addressed The Decisin Supprt (DS) team has led an effrt t establish a mechanism that prvides the end user (e.g. Directr, Cntract Mnitr, Prgram Manager, Cntract Service Prvider) the ability t see real-time availability f treatment slts fr MHP prviders. Page 8

9 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year The end result f this effrt is that prviders are nw reprting their treatment slt availability in Pr-Filer and have access t reprts that allw them t see capacity thrughut the system. The wrk fr this prject is captured in a Nn-Clinical Electrnic Capacity PIP discussed n site and referenced in the PIP sectin; the MHP cmpleted the first phase f this endeavr. Recmmendatin #2: Finalize plans t slicit EHR system, t include functinal requirements and selectin phases. Plan needs t address electrnic data interchange slutins fr cntract prviders as they are integral in BHSD verall service delivery system. Plan shuld include cnsumer prtal requirements. Fully addressed Partially addressed Nt addressed Tw significant steps have been cmpleted since the last External Quality Review: The MHP issued a Request fr Prpsal (RFP) fr a new Practice Management Systems Slutin (PMSS). The primary functins f the new system will be t prvide billing, state reprting requirements and an electrnic data interchange fr its cntract prviders. Submitted prpsals have been reviewed and a vendr selectin has been cmpleted. As f January 2017, the MHP is in cntract negtiatins with Netsmart Technlgies. The MHP will be implementing EPIC (lcally knwn as HealthLink) as the electrnic health recrd (EHR) fr individuals served by cunty agencies. Epic is recgnized natinally as a care management system and has successfully been implemented thrughut the Santa Clara Cunty Health and Hspital System. The system includes rbust data-capture abilities, data reprting capabilities and ther features such as a cnsumer prtal. Discvery sessins are in prgress t determine what data can be captured by Epic and hw it will interface with the new PMSS. The intent is t rll ut bth systems at the end f 2017/beginning f Recmmendatin #3: Investigate the feasibility f shrtening the timeline that cntract prviders have t uplad direct services int Pr-Filer frm nce a mnth t either weekly r bi-weekly schedule. Fully addressed Partially addressed Nt addressed Cntract agencies have the ability t uplad data as frequently as needed, hwever, staffing shrtages in the Cunty Infrmatin Services Department limit the ability t prcess the uplads. Mvement t imprve this prcess began with the implementatin f the PMSS. Page 9

10 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Currently adding additinal staff t supprt this functin is nt feasible as the Epic HealthLink and Practice Management Systems Slutin (PMSS) implementatins take pririty. Recmmendatin #4: Investigate the feasibility that allws cntract prvider staff view nly access t cnsumer s HealthLink clinical data. Fully addressed Partially addressed Nt addressed As part f the Epic HealthLink implementatin, the MHP will explre prviding access t EpiCare Link fr the cntract prviders. This will allw them t have chart view fr shared cnsumers and wuld reduce cncerns related t privacy and cnfidentiality that may be created by pening the entire system via read nly. Recmmendatin #5: Create and staff psitins fr an versight prcess t assess and be respnsible fr mnitring the new utpatient prvider cntracts. This wuld include mnitring defined utcme measures and service metrics develped fr each prgram mdality. Fully addressed Partially addressed Nt addressed At the Directr s request, the MHP is in the prcess f cnducting a frmal review f the cntracting prcess, using a quality imprvement apprach, facilitated by Valley Medical Center s Directr f Quality Management and Safety and staff. The gal f the review prcess is t identify the steps fr develping a cntract frm the pint f identifying a service need t the cmpletin and implementatin f the cntract. Thrugh this prcess, prgram and finance staff have identified tasks, timelines and staff rles. In additin t staff, the Health and Hspital System s Directr f Cntracting and Bard Agenda Review Crdinatr and the department s Cunty Budget Analyst have participated in these sessins. The review will result in integrated wrkflws and will clarify the rles and respnsibilities f all invlved staff, including the cntract mnitrs. In additin, the department is develping a cntract mnitring tl t prvide a systematic apprach fr cntractrs and track cntract utcmes measures and service metrics. This effrt will help determine staffing, training and ther resurce needs t address the required duties. The review prcess shuld be cmplete by the end f January Recmmendatin #6: Assess metric fr imprvement f timeliness in initial cntact t first appintment as well as initial cntact t first psychiatrist appintment as presently the standard is met less than half the time. Fully addressed Partially addressed Nt addressed Page 10

11 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year The MHP cntinues t mnitr timeliness n a regular basis. Hwever, significant capacity issues have impeded ability t imprve verall timeliness. Demand fr services exceeds current capacity, simultaneusly impacted by significant wrkfrce retentin and recruitment challenges. This impact is felt by bth the Cunty and cntract prviders, especially the hiring f psychiatrists and licensed clinicians. The initial phase f building its autmated capacity intake and referral system is cmplete, yet far frm full electrnic use. The MHP anticipates evlving int phase tw f this prject t build a real-time appintment availability via an electrnic white bard. The MHP culd cnsider cmbining its Access Call Center fr mental health and substance use services. CHANGES IN THE MHP ENVIRONMENT AND WITHIN THE MHP IMPACT AND IMPLICATIONS Changes since the last CalEQRO review, identified as having a significant effect n service prvisin r management f thse services are discussed belw. This sectin emphasizes systemic changes that affect access, timeliness, and quality, including thse changes that prvide cntext t areas discussed later in this reprt. Access t Care The expansin f adult cmmunity crisis capacity is in prgress 30 new crisis residential beds, 7 Crisis Stabilizatin Unit beds, and tw Mbile Crisis teams. Implementatin is anticipated 1st Quarter In additin, the MHP has identified Psychiatric Emergency Respnse Team pilts fr MHSA Innvatin funding in The MHP increased the Children s Crisis Stabilizatin Unit frm 7-12 beds in December The MHP mdified a screening assessment tl, used by Alameda and Ls Angeles Cunties, t streamline client assessments in the Access Call Center. The new tl will be launched in January 2017, and the MHP anticipates the tl will be used thrughut the Health and Hspital System. Timeliness f Services The MHP implemented Access Call Center transitinal electrnic capacity management tl in Octber 2016 leading t efficiencies and timely appintments. Quality f Care The MHP expanded Executive Leadership and Senir Management staff. New executive psitins include: Deputy Directr, BHSD; Administrative Services Manager III; Children, Yuth and Families Directr and Adult/Older Adult Page 11

12 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Directr. There are als tw new Divisin Directrs fr Quality Imprvement, Mental Health, and Husing Supprtive Services. It has develped an extensive peratinal and fiscal plan fr the 1115 Waiver fr a Substance Use Organized Delivery System. The Department has been preparing fr implementatin and anticipates receiving the final, apprved plan frm DHCS in January The MHP implemented a Cmmunicatin Wrk Grup in June 2016, facilitated by the Senir Health Care Prgram Manager fr System Initiatives, with staff representing all parts f the department, wh were asked t develp a set f recmmendatins t imprve cmmunicatin acrss the system. Staff will present their recmmendatins t Leadership and Senir Management in January Cnsumer Outcmes It has finalized the Pay fr Success (PFS) Prject: Partners in Wellness, designed t decrease Adult Emergency Psychiatric Services (EPS) and Barbara Arns Pavilin (BAP) inpatient stays and t imprve client utcmes in the cmmunity. The Bard apprved the prject n December 13, This is secnd PFS prject in Santa Clara Cunty and the first PFS mental health prject in the cuntry. Page 12

13 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE MEASUREMENT CalEQRO is required t validate the fllwing perfrmance measures as defined by DHCS: Ttal Beneficiaries Served by each cunty MHP Ttal Csts per Beneficiary Served by each cunty MHP Penetratin Rates in each cunty MHP Cunt f TBS Beneficiaries Served Cmpared t the fur percent Emily Q. Benchmark (nt included in MHP reprts; this infrmatin is included in the Annual Statewide Reprt submitted t DHCS) Ttal Psychiatric Inpatient Hspital Episdes, Csts, and Average Length f Stay Psychiatric Inpatient Hspital 7-Day and 30-Day Rehspitalizatin Rates Pst-Psychiatric Inpatient Hspital 7-Day and 30-Day SMHS Fllw-Up Service Rates High Cst Beneficiaries ($30,000 r higher) TOTAL BENEFICIARIES SERVED Table 1 prvides detail n beneficiaries served by race/ethnicity. Table 1 Medi-Cal Enrllees and Beneficiaries Served in CY15 by Race/Ethnicity Santa Clara Race/Ethnicity Average Mnthly Unduplicated Medi-Cal Enrllees* % Enrllees Unduplicated Annual Cunt f Beneficiaries Served % Served White 37, % 3, % Hispanic 146, % 8, % African-American 10, % 1, % Asian/Pacific Islander 97, % 2, % Native American % % Other 33, % 2, % Ttal 326, % 18, % *The ttal is nt a direct sum f the averages abve it. The averages are calculated separately. The actual cunts are suppressed fr cells cntaining n 11. Page 13

14 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PENETRATION RATES AND APPROVED CLAIM DOLLARS PER BENEFICIARY The penetratin rate is calculated by dividing the number f unduplicated beneficiaries served by the mnthly average enrllee cunt. The average apprved claims per beneficiary served per year is calculated by dividing the ttal annual dllar amunt f Medi-Cal apprved claims by the unduplicated number f Medi-Cal beneficiaries served per year. Regarding calculatin f penetratin rates, the Santa Clara MHP: Uses the same methd as used by the EQRO. Uses a different methd. Des nt calculate its penetratin rate. Page 14

15 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Figures 1A and 1B shw 3-year trends f the MHP s verall apprved claims per beneficiary and penetratin rates, cmpared t bth the statewide average and the average fr large MHPs. Page 15

16 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Figures 2A and 2B shw 3-year trends f the MHP s fster care (FC) apprved claims per beneficiary and penetratin rates, cmpared t bth the statewide average and the average fr large MHPs. Page 16

17 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Figures 3A and 3B shw 3-year trends f the MHP s Hispanic apprved claims per beneficiary and penetratin rates, cmpared t bth the statewide average and the average fr large MHPs. See Attachment C, Table C1 fr the penetratin rate and apprved claims per beneficiary fr the CY15 Medi-Cal Expansin (ACA) Penetratin Rate and Apprved Claims per Beneficiary. Page 17

18 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year HIGH-COST BENEFICIARIES Table 2 cmpares the statewide data fr high-cst beneficiaries (HCB) fr CY15 with the MHP s data fr CY15, as well as the prir tw years. HCB in this table are identified as thse with apprved claims f mre than $30,000 in a year. MHP Year HCB Cunt Ttal Beneficiary Cunt HCB % by Cunt Average Apprved Claims per HCB HCB Ttal Claims HCB % by Apprved Claims Statewide CY15 13, , % $51,635 $715,196, % Santa Clara Table 2 High-Cst Beneficiaries CY , % $51,991 $35,145, % CY14 1,149 17, % $56,985 $65,475, % CY13 1,983 16, % $63,045 $125,018, % See Attachment C, Table C2 fr the distributin f the MHP beneficiaries served by apprved claims per beneficiary (ACB) range fr three cst categries: under $20,000; $20,000 t $30,000; and thse abve $30,000. Page 18

19 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year TIMELY FOLLOW-UP AFTER PSYCHIATRIC INPATIENT DISCHARGE Figures 4A and 4B shw the statewide and MHP 7-day and 30-day utpatient fllw-up and rehspitalizatin rates fr CY14 and CY15. Page 19

20 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year DIAGNOSTIC CATEGORIES Figures 5A and 5B cmpare the breakdwn by diagnstic categry f the statewide and MHP number f beneficiaries served and ttal apprved claims amunt, respectively, fr CY15. MHP self-reprted percent f cnsumers served with cccurring (substance abuse and mental health) diagnses: 6% Page 20

21 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE MEASURES FINDINGS IMPACT AND IMPLICATIONS Access t Care While the MHP s number f Medi-Cal eligibles rse frm 325,918 in CY14 t 326,311 in CY15, beneficiaries served increased frm 17,444 t 18,286 during this perid. This crrelates t an increase f penetratin rate frm 5.35% in CY14 t 5.60% in CY15. The MHP s CY15 penetratin rate remains higher than bth the large cunty (4.52%) and statewide (4.82%) averages. The MHP s number f Affrdable Care Act (ACA) eligibles fr CY15 ttal was 70,189 and the beneficiaries served was 4,340, fr a penetratin rate f 6.18% fr this sub-grup (see Table C1 in Appendix C). Cmbining the Medi-Cal and ACA data, the MHP s CY15 ttal eligibles were 396,500 while beneficiaries served ttal were 22,626 giving the MHP a CY15 verall cmbined penetratin rate f 5.71%. The MHP s average Hispanic penetratin rate increased each year frm CY13 t CY15 and is nw higher than large MHPs and statewide averages fr the threeyear perid. (Figure 3B.) Timeliness f Services Fr CY15, the MHP s 7-Day and 30-Day utpatient fllw-up rates fllwing discharge frm a psychiatric inpatient episde are cmparable t CY14 rates and are slightly higher than the statewide averages. (Figures 4A and 4B.) The MHP s 7-Day and 30-Day rehspitalizatin rates slightly increased frm CY14 t CY15 and is slightly higher than statewide averages. (Figures 4A and 4B.) Quality f Care Due t technical difficulties during the SDMC claims adjudicatin prcessing by the State apprximately 108,000 claim transactins were apprved fr zer r small dllars. As a result, the apprved claim dllars used t calculate Figures 1A, 2A, 3A and Table 2 underreprts average apprved claims per beneficiary fr CY15. The self-reprted percent f cnsumers served with c-ccurring (substance abuse and mental health) diagnses f 6 percent is significantly lwer than statewide results. While bth the number f and claims dllars fr High Cst Beneficiaries have decreased ver the three-year perid, they cntinue t exceed statewide percentages. Cnsumer Outcmes Perfrmance measure data fr cnsumer utcmes was nt presented. Page 21

22 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE IMPROVEMENT PROJECT VALIDATION A PIP is defined by CMS as a prject designed t assess and imprve prcesses, and utcmes f care that is designed, cnducted and reprted in a methdlgically sund manner. The Validating Perfrmance Imprvement Prjects Prtcl specifies that the EQRO validate tw PIPs at each MHP that have been initiated, are underway, were cmpleted during the reprting year, r sme cmbinatin f these three stages. DHCS elected t examine prjects that were underway during the preceding calendar year SANTA CLARA MHP PIPS IDENTIFIED FOR VALIDATION Each MHP is required t cnduct tw PIPs during the 12 mnths preceding the review. CalEQRO reviewed and validated tw MHP submitted PIPs as shwn belw. Table 3 PIPs Submitted PIPs fr Validatin # f PIPs PIP Titles Clinical PIP 1 Advancing Recvery Nn-Clinical PIP 1 Inpatient and Outpatient Crdinatin Table 4 lists the findings fr each sectin f the evaluatin f the PIPs, as required by the PIP Prtcls: Validatin f Perfrmance Imprvement Prjects. 4 Table 4 PIP Validatin Review Step PIP Sectin Validatin Item 1 Selected Study Tpics Item Rating* Clinical PIP Nn- Clinical PIP 1.1 Stakehlder input/multi-functinal team M PM Analysis f cmprehensive aspects f enrllee needs, care, and services Brad spectrum f key aspects f enrllee care and services 1.4 All enrlled ppulatins M M 2 Study Questin 2.1 Clearly stated M M M M M M Department f Health and Human Services, Centers fr Medicare and Medicaid Service Prtcl 3 Versin 2.0, September EQR Prtcl 3: Validating Perfrmance Imprvement Prjects. Page 22

23 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 4 PIP Validatin Review Step PIP Sectin Validatin Item 3 Study Ppulatin 4 Study Indicatrs 5 6 Sampling Methds Data Cllectin Prcedures Item Rating* Clinical PIP Nn- Clinical PIP 3.1 Clear definitin f study ppulatin M M 3.2 Inclusin f the entire study ppulatin PM M Objective, clearly defined, measurable indicatrs Changes in health status, functinal status, enrllee satisfactin, r prcesses f care Sampling technique specified true frequency, cnfidence interval and margin f errr Valid sampling techniques that prtected against bias were emplyed Sample cntained sufficient number f enrllees 6.1 Clear specificatin f data M M 6.2 Clear specificatin f surces f data PM M Systematic cllectin f reliable and valid data fr the study ppulatin Plan fr cnsistent and accurate data cllectin Prspective data analysis plan including cntingencies 6.6 Qualified data cllectin persnnel M M M M NA NA NA PM PM PM M M NA NA NA M M M 7 Assess Imprvement Strategies 7.1 Reasnable interventins were undertaken t address causes/barriers M M 8 9 Review Data Analysis and Interpretatin f Study Results Validity f Imprvement Analysis f findings perfrmed accrding t data analysis plan PIP results and findings presented clearly and accurately Threats t cmparability, internal and external validity Interpretatin f results indicating the success f the PIP and fllw-up 9.1 Cnsistent methdlgy thrughut the study PM M 9.2 Dcumented, quantitative imprvement in prcesses r utcmes f care M M M M PM M M M M M Page 23

24 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 4 PIP Validatin Review Step PIP Sectin Validatin Item 9.3 Imprvement in perfrmance linked t the PIP Item Rating* Clinical PIP PM Nn- Clinical PIP 9.4 Statistical evidence f true imprvement PM PM 9.5 Sustained imprvement demnstrated thrugh repeated measures. *M = Met; PM = Partially Met; NM = Nt Met; NA = Nt Applicable; UTD = Unable t Determine; NR = Nt Rated (Cncept Only r Nne Submitted) PM M PM Table 5 gives the verall rating fr each PIP, based n the ratings given t the validatin items. Table 5 PIP Validatin Review Summary Nn- Summary Ttals fr PIP Validatin Clinical PIP Clinical PIP Number Met Number Partially Met 9 3 Number Nt Met 0 0 Number Applicable (AP) (Maximum = 28 with Sampling; 25 withut Sampling) Overall PIP Rating ((#Met*2)+(#Partially Met))/(AP*2) 82% 94% CLINICAL PIP ADVANCING RECOVERY The MHP presented its study questin fr the Clinical PIP as fllws: Will develpment and implementatin f using a Client Feedback Tl result in individual cnsumers engaging and participating in services, making prgress tward their gals as evidenced by increased invlvement in meaningful relatinships and rles utside the mental health system? Date PIP began: April 2015 Status f PIP: Page 24

25 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Active and nging Cmpleted Inactive, develped in a prir year (Nt Rated) Cncept nly, nt yet active (Nt Rated) Submissin determined nt t be a PIP (Nt Rated) N PIP submitted (Nt Rated) This is the secnd and final year f the Clinical PIP submitted by the MHP fcused n adult cnsumers with serius mental illness (SMI) wh have nt experienced significant levels f recvery, appear t lack hpe fr a better future, and rely n the system fr care. Several years ag, staff received training in Transfrmatinal Care Planning (TCP) and sn a prblem was revealed thrugh frm the TCP Wrk Grup wh trained clinical teams n persn-centered care planning. They fund the issues described abve based n the cnsumers Milestnes f Recvery Scale (MORS) scres, revealing lw levels f recvery prgress during treatment and at discharge. Based n the principles f TCP, the MHP initiated this Clinical PIP. TCP is a best practice service planning mdel that builds n the principles f inclusin, hpe, wellness, resiliency, and recvery. It is cllabrative prcess between an individual/family and his/her service prvider. Persncentered/family driven service planning is an integral strategy fr helping cnsumers and families achieve their life gals. It is rganized arund the cnsumer s/family s wn needs. It integrates specific mental health services and supprts t help peple achieve gals. Thrugh the effrts f the Advancing Recvery Wrkgrup and Pilt Team (ARWPT), this PIP seeks t advance the recvery and independence f individuals with serius mental illness. T accmplish this, the team will fcus n supprting cnsumers engagement in recvery, mvement t higher levels f recvery, and verall prgress twards the life f their chice by: Advancing recvery-riented, persn-centered, strength-based practices; Establishing measurements t mnitr cnsumer prgress and utcmes; and Identifying system barriers and needed supprts. The MHP identified its gals: T imprve the verall emtinal and physical health f cnsumers and supprt their invlvement in the management f their wn health. T increase the number f cnsumers with a safe and stable hme cnsistent with their individual desires and resurces. T increase number f cnsumer s wh reprt an increase in supprtive relatinships and cmmunity/scial cnnectins. Page 25

26 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year The bjectives f this PIP will be measured with the use f a cnsumer feedback survey t assess imprved cnsumer invlvement and satisfactin in the key recvery areas f emtinal health, physical health and living situatins. The intent is t increase the number f cnsumers wh are engaged in the recvery prcess as indicated with at least ne survey tl every mnth. The cnsumer feedback survey frm included a seven questin, 5 scale-likert respnse with an Additinal Infrmatin sectin, directed at engagement and satisfactin in key recvery areas f imprved mental health, physical health, cmmunity supprt and/r stable husing. The MHP used the cnsumer survey t validate cnsumer imprvement in the recvery dmains f health, scial supprt, meaningful rles r activities and husing satisfactin. While the survey aimed t capture qualitative self-reprted indicatrs f prgress, it was unclear as t the manner the MHP intended t capture the engagement criteria. Varius strategies addressing use f the survey were initiated and included cnsumer-prvider cnversatins regarding respnses, aligning cnsumer gals with survey respnses, hmewrk as assigned, prvider cnsults t imprve use f survey tl, teach bth cnsumers and staff the value f data, and develp a user guide fr the survey tl. The PIP was nt successful in its quantitative gals fr imprved health and recvery based n the small pl f cmpleted surveys used t measure the results. Althugh the MHP expanded its pilt clinic study grup frm an initial pl f ten cnsumers t ther clinics, the final grup was 37 cnsumers. The results reprted in August 2016 were as fllws: Engagement: Gal--Minimum f 1x per mnth; Results: Pilt team averaged administratins 53% f the time with 2.85 mnths between administratins. Surveys distributed every ther week cnsistently fr 3 mnths. Increase f Meaningful Rles (emplyment, relatinships, etc.): Gal-- At least 40% - 2 ratings pints increase fr each rating item Results: Pilt team cnsumers engaged in meaningful activities 25% f the days surveyed. The MHP reprted the verall number in its data fr each indicatr with detailed graphs run bimnthly fr the MORS scres and the cnsumer survey. The MHP determined that qualitative imprvements ccurred based n prvider feedback, indicating staff used the tl in guiding treatment gals and changed the fcus frm symptmlgy t imprved health factrs and scial engagement. Relevant details f these issues and recmmendatins are included within the cmments fund in the PIP validatin tl. In additin, the MHP submitted its prpsed PIP fr the next review cycle with the study questin: Page 26

27 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Will develpment and implementatin f the fllwing changes result in fewer readmissins and lwer verall utilizatin f services by currently high utilizing, cmplex cnsumers? Develp capacity fr regular reprting f a high utilizer list. Establish a prtcl fr cnsumer and system engagement t address multiple factrs that drive high utilizatin f public services. Implement a prcess fr cllabrative assessment, treatment planning, and interventin with the cnsumer and his/her natural supprt system. Launch the re-engineered prcess fr engagement and service delivery with a chrt (200 individuals per quarter) f the high utilizer ppulatin. The MHP embarked n an initiative fcused n high cst utilizers f services. The lack f a permanent r cnsistent methdlgy t identify and supprt high cst beneficiaries was pinted ut by CalEQRO during the 2014 site visit. The gal f the High Utilizer PIP is t increase the identificatin f cnsumers within the MHP wh are cnnected t utpatient services, and cntinue t experience crises that require emergency r acute care. Furthermre, the PIP aims t increase cmmunicatin and cllabratin acrss Cunty departments and cntract agencies t imprve engagement, assessment, planning and service delivery. Ultimately the hpe is this will reduce the number f crises experienced by cnsumers (imprved health) and reduce the verall cst f care. The technical assistance prvided t the MHP by CalEQRO cnsisted f encuraging the MHP t include cnsumer stakehlder invlvement in its team, t initiate n-ging cnsultatin fr its next PIP endeavrs, t meet regularly and analyze fr immediate mdificatins when gals are delayed and t establish cncrete measurable gals with interventins. NON-CLINICAL PIP INPATIENT AND OUTPATIENT COORDINATION The MHP presented its study questin fr the Nn-Clinical PIP as fllws: Will develpment and implementatin f the fllwing changes result in 7-day a week prcesses that facilitate emergency psychiatric services (EPS) and acute care cnsumers successful and timely pst-discharge engagement/re-engagement t utpatient services and that prevent readmissins r ther set-backs in their recvery prgress. The fllwing changes were identified: Timely access t Urgent Care fr initial pst-acute fllw-up visit in 7 calendar days Fr cnsumers wh d nt shw up fr their initial urgent care/utpatient appintment, utreach t them in their cmmunity t engage them in services Page 27

28 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Supprt warm handff frm Acute Care t utpatient team within 7 days and a psychiatric visit within 30 days Prvide timely utreach t engage cnsumers in services fr up t 30 days Assure all acute care cnsumers have a persn-centered aftercare plan that results in timely access t apprpriate services. Reduce readmissins, Avidable readmissins; and, lst pprtunities t advance cnsumers recvery. Date PIP began: January 2015 Status f PIP: Active and nging Cmpleted Inactive, develped in a prir year (Nt Rated) Cncept nly, nt yet active (Nt Rated) Submissin determined nt t be a PIP (Nt Rated) N PIP submitted (Nt Rated) This PIP fcused n crdinatin f services fllwing discharge frm acute settings, emerging frm a prir year PIP fcused n timely appintments fllwing discharge. The MHP indicated it has nt develped an adequate crdinatin f care prtcl fr cnsumers being admitted r discharged frm bth cunty perated and cntracted inpatient psychiatric hspitals. This review f timeliness f access fr these Level 1 cnsumers (thse wh are discharging frm acute care services) shwed the MHP did nt meet standards. The MHP cntractual requirements and industry practice standard calls fr fllw-up t be within five business r seven calendar days. The MHP fcused n a PIP in the prir year t imprve this and met its gal f 80% f Level 1 cnsumers seen within five business r seven calendar days. This PIP was identified based n data related t timeliness t service fcusing n crdinatin f care t imprve fllw-up pst discharge. The issue was that a gap exists between identifying cnsumers until after discharge frm acute settings and hence limiting crdinatin f care, prir t discharge. This leads t delayed utpatient fllw-up care and can result in use f higher end services fr care. The prblem was revealed via the actual experience f the 24 Hur Team wh discvered this after they were in the cmmunity and nt receiving prper fllw-up services. Multiple factrs impact care crdinatin: Incnsistent ntificatin f admits and discharges r lack f crdinated discharge planning during hspitalizatin; Page 28

29 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Delayed utpatient services pst discharge; Lack f fllw up and utreach t supprt a warm hand-ff and engagement with utpatient services; Disruptive transitin between urgent care and utpatient clinic; and Under-develped tracking and data management f the hspital census. Care crdinatin needs t begin at inpatient admissin and fllw thrugh t the discharge and utpatient clinic appintment. The aim f this prject is t develp seven-day a week prcesses that facilitate emergency psychiatric services (EPS) and acute care fr cnsumers successful and timely pst-discharge engagement/re-engagement t utpatient services and that prevent readmissins r ther set-backs in their recvery prgress. Its gals include: Readmissin Rate: Behaviral Health System all-cause 30-day readmissin rate (9% r less). Timely Access: Cnsumers wh discharge frm acute care services and wh initiate fllw-up care within 7 days fllwing discharge (80%). Engagement: Level 1 cnsumers with 4+ visits in first 30 days (70%). The MHP intends t accmplish this via multiple activities with the fllwing bjectives: Full-Time Hspital Liaisn: designated t track all cnsumers admitted thrugh their discharge and handff t clinics Linkage with hmeless crdinatr by making available 50 new full service partnership slts (fr thse cnsumers wh medically qualify). Ntificatin f Admissin t Clinic-Based Hspital Liaisns: each time a cnsumer arrives in EPS, staff t reach ut t the riginating clinic t begin crdinatin f care. Imprve cmmunicatin and use f discharge summaries. Identify rles and respnsibilities fr treatment sites. The MHP reprted it six-mnth data results fr the indicatrs as fllws: Readmissin Rate: Behaviral Health System all-cause 30-day readmissin rate (10.4%) Timely Access: Cnsumers wh discharge frm acute care services and wh initiate fllw-up care within 7 days fllwing discharge (52.4%) Engagement: Level 1 cnsumers with 4+ visits in first 30 days (61.3%) Page 29

30 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year The PIP was successful in generating a reductin in readmissins, althugh it was nt yet successful in supprting timely access t fllw-up care. The PIP has successfully reduced the vlume f cmplaints received fr nn-receipt f discharge summaries frm the Inpatient hspitals. The additin f a Pr-Filer face sheet t the admissin packet helps the inpatient hspital t knw wh t cntact at the time f a cnsumer s admissin and wh t send the discharge summary t at the time f discharge. Als, access t the HealthLink EHR reduced the number f cmplaints t a zer fr the Cunty Outpatient teams cmpared t 10 cmplaints in tw weeks. The fllwing activities are planned fr 2017: Develp an Alert System: Add a flagging r tickler system t the Cunty Mental Health System t indicate when an active cnsumer has been admitted t BAP. This will be built int HealthLink (manual by Hspital Liaisn until HealthLink is ready). A different system will be required t supprt cnsumers admitted t cntract hspitals & cntracted Outpatient prviders. Develp a tracking and data management system, t include a Database t identify admit and discharge f all cnsumers in acute hspital system. Create a ntificatin/alert system within the E HR. Training f staff t utilize the EHR (Electrnic Health Recrd) systems. Reprts that track and identify utcmes f treatment. Supprt fr transfer f cnsumers transitining frm inpatient t utpatient, wh may require a higher level f utpatient fllw up. A new prcedure will be develped t supprt new cnsumers cming ut f the hspital t receive urgent visit in their SMH clinic (t imprve the quality and lngevity f the warm hand-ff). Relevant details f these issues and recmmendatins are included within the cmments fund in the PIP validatin tl. In additin, the MHP presented a PIP in its first phase, with the study questin: Hw des a large system, BHS Mental Health Divisin, develp a real-time prcess that rutinely mnitrs and manages demand and capacity? Overall, the study tpic narrative addressed the lack f real-time availability f pen appintment slts causing barriers t access fr the entire treatment system. When a system knws abut the demand, but nt the supply, it creates an unknwn fr everyne invlved in attempting t create slutins with the capacity issue. Planning and predicting fr the future is als made mre difficult. The gal f this PIP is t establish a mechanism that prvides the end user (e.g. directr, cntract mnitr, prgram manager, cntract service prvider) with an ability t see real time availability f treatment slts in the Mental Health Divisin. The MHP has cmpleted its first phase f cmpleting Page 30

31 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year the gal, t initiate an effrt addressing barriers t timely access and imprve capacity. Thus, the Access Call Center staff and a variety f stakehlders met with the cunty s Decisin Supprt unit, t cllabratively develp an electrnic capacity reprting tl that wuld be used by all utpatient prviders. Electrnic Capacity reprting has imprved the prcess at the Access Call Center by allwing the Access Call Center t track the vlume f incming capacity thrugh its electrnic Health recrd, Pr-Filer, instead f manually tallying the capacity the CC receives, thereby saving a significant amunt f staff time. This imprvement has increased the staff s ability t free up mre time fr staff t reduce wait times. It als allws fr a centralized prcess s it is easier t run analyses. Additinally, the CC has wrked t imprve the use f their screening tl. The tl will als serve as the universal and cmmn instrument fr transferring f care bi-directinally. The next phase f a fully implemented capacity reprting system is t establish an electrnic white bard t prvide data regarding pen slts and appintment availability thrughut its system f care. The MHP intends t fcus n this aspect in the year ahead. The technical assistance prvided t the MHP by CalEQRO cnsisted f encuraging the MHP t seek cnsultatin nging, t analyze its interventins and indicatrs fr mdificatins regularly and t adjust fr qualitative infrmatin frm its infrmants. It was advised t reprt its data regularly and mdify fr change as needed t supprt its intended gals. PERFORMANCE IMPROVEMENT PROJECT FINDINGS IMPACT AND IMPLICATIONS Access t Care Prvisin f a lwer level services ptentially imprves health indicatrs earlier. Appintments scheduled clser t need increase engagement fr cnsumer care. Timeliness f Services Using right-matched services fr cnsumer needs ptentially expands appintment availability fr timely services. Quality f Care Shifting utilizatin patterns t lwer level services can reduce high end services and assciated csts. Persn-centered, strength-based service delivery supprts the basis f the recvery mdel. Cnsumer Outcmes Advancing recvery and independence can lead t imprved functining. Cllabratin and crdinatin f services acrss agencies prmtes the verall wellness and inclusin f cnsumer care. Page 31

32 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE & QUALITY MANAGEMENT KEY COMPONENTS CalEQRO emphasizes the MHP s use f data t prmte quality and imprve perfrmance. Cmpnents widely recgnized as critical t successful perfrmance management include an rganizatinal culture with fcused leadership and strng stakehlder invlvement, effective use f data t drive quality management, a cmprehensive service delivery system, and wrkfrce develpment strategies that supprt system needs. These are discussed belw. Access t Care As shwn in Table 6, CalEQRO identifies the fllwing cmpnents as representative f a brad service delivery system that prvides access t cnsumers and family members. An examinatin f capacity, penetratin rates, cultural cmpetency, integratin and cllabratin f services with ther prviders frms the fundatin f access t and delivery f quality services. Table 6 Access t Care Cmpnent Service accessibility and availability are reflective f cultural cmpetence principles and practices Cmpliant (FC/PC/NC)* Cmments 1A FC The MHP used data and prvided ge-mapping t identify unserved and underserved ethic/racial ppulatins. The MHP des ge-mapping f clinics and prgram/service capacity and risk ratings by zip cdes/schls. Risk ratings must be manually calculated as they invlve btaining data frm ther agencies. While the MHP des prvide and hire staff t meet linguistic needs, the MHP realizes the limited number f linguistically matched staff t cnsumer needs. Emplyment pprtunities exist fr line staff, hwever, a cmbinatin f the reginal area cmpeting with the private sectr healthcare rganizatins and the high cst f living impact the MHP s ability t increase its wrkfrce. The MHP s Ethnic and Cultural Cmmunities Advisry Cmmittee (ECCAC) is very active and prvided numerus trainings all year. 1B Manages and adapts its capacity t meet beneficiary service needs FC The MHP is aware f its limitatins and inefficiencies at the Access Call Center. It has begun imprvement prcedures initiating electrnic capacity management fr screening and referrals, yet much wrk remains. The MHP cntracts with health plans t serve the mild and mderate, adding t its already verladed system. Staffing vacancies cntribute t wrkflw shrtages. An n-site nted remarkable stacks f intake paperwrk yet t be distributed; many thers were cming in by phne as well. Page 32

33 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 6 Access t Care Cmpnent Cmpliant (FC/PC/NC)* Cmments The center calls ut fr mre autmated systems and centralized physical space t allw staff t wrk mre effectively as a team. Effrts were made but drpped when n adequate space culd be lcated; this current arrangement impedes cmmunicatin and reduces efficiency f all staff. Review infrmants als nted the issues cnfrnting the access team in terms f its capacity challenges and this cncern requires attentin. As mentined previusly, the MHP cntracts with its area Health Plan t serve the mild-mderate pl f cnsumers. This past year, the MHP created a unit dedicated t serve these with rehabilitatin grups and increased psychtherapy. This culd be re-evaluated, given its access barriers. New initiatives: The MHP actively participated in 1115 Medi-Cal Waiver Whle Persn Care (WPC) planning. The Directr serves as a C-Executive Spnsr fr WPC Care Crdinatin and High Utilizer prgrams and staff are invlved in WPC wrk grups. With the Whle Persn Care, the MHP funded seven new psitins, including an executive psitin fr Directr, Quality Management, pen fr recruitment in January Children s Services: The MHP intends t mdel its Cntinuum f Care Refrm (CCR) plicies n the implementatin f its Katie A. mdel. Given its inclusivity, cllabratin and integratin f all stakehlders the value is extended t families, staff and prviders. Prviders state the leadership, cmmunicatin, and psitive partnership is wrking. Teaming between the MHP, scial services, rganizatinal prviders and its Call Center, has develped with imprved timeliness and quality f services fr this target grup. The MHP indicated n waiting fr the service t this subclass with rapid respnse. The MHP cnducts family interviews/surveys f 10% f the ppulatin wh receive the Katie A. services fr satisfactin. The MHP increased its Children's Crisis Stabilizatin Unit frm 7-12 beds (December 2016). The MHP will select a vendr, negtiate a cntract and launch implementatin f Children's Acute Psychiatric Hspital. On anther issue, fr a large MHP, the limitatins appear t exist within its staff infrastructure at the clinical supervisin level. Page 33

34 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 6 Access t Care Cmpnent Cmpliant (FC/PC/NC)* Cmments Despite effrts t address staffing fr this requirement, the MHP des nt have a designatin built in fr adequate incentives t prvide this requirement, leaving the duties t the Lead Clinician r Prgram Specialists t perfrm this task. The MHP cntracts 87% f its services t cmmunity based rganizatins (CBOs). Cntractrs/CBOs d nt have access t the MHP s Pr- Filer electrnic health recrd (EHR). 1C Integratin and/r cllabratin with cmmunity based services t imprve access FC It has develped a frmal prcess with the Health Plans fr linking beneficiaries t primary health care services. It has jined the seven Bay Area Reginal cunties partnership alng with Prbatin and Scial Services t rchestrate standardized prtcls and cntracts reginally fr its yuth cnsumers served acrss neighbring cunties. The MHP cntracts with fur Faith-based grups t prvide re-entry center services fr recently releasedfrmerly incarcerated individuals. At the cunty level a newly created Office fr LGBTQ wrks cllabratively t serve cnsumers. The Pay fr Success (PFS) Prject is a diversin frm acute care with strict criteria fcused n the hmeless ppulatin. It is the first pilt in the cuntry. This uses links t several data systems (criminal justice, Valley Medical Center, MHP, and hmeless services) t identify the highest need clients, lcate them, cnnect them t services, track their prgress and mnitr the success f the prgram. The MHP cllabrates with the Office f Supprtive Husing and priritized the Jail Diversin prgrams with law enfrcement t serve this vulnerable target grup. Timeliness f Services *FC =Fully Cmpliant; PC = Partially Cmpliant; NC = Nn-Cmpliant As shwn in Table 7, CalEQRO identifies the fllwing cmpnents as necessary t supprt a full service delivery system that prvides timely access t mental health services. The ability t prvide timely services ensures successful engagement with cnsumers and family members and can imprve verall utcmes while mving beneficiaries thrughut the system f care t full recvery. Page 34

35 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 7 Timeliness f Services Cmpnent Cmpliant (FC/PC/NC)* PC Cmments The MHP reprts a standard f 14 days with an verall average f 16.2 days and reprts it meets this 54.6% f the time. Fr its adult services, the MHP reprts an average f 13 days meeting this 66% f the time. Fr its children s services, the MHP reprts an average f 19 days meeting this 44.6% f the time. The MHP was encuraged t analyze this metric fr imprvements, especially fr children s services since this was met less than half f the time. 2A Tracks and trends access data frm initial cntact t first appintment 2B Tracks and trends access data frm initial cntact t first psychiatric appintment PC The MHP reprts a standard f 30 days with an verall average f 26 days and reprts meeting this 59% f the time. Fr adult services, it has an average f 25.3 days and reprts meeting this 61% f the time. Fr its children services, the MHP reprts an average f 30.7 days and reprts meeting this 52% f the time. The MHP recgnizes imprvements t this metric are warranted and it cntinues t strategize fr timely appintments. With its electrnic capacity system develping, this is a primary gal t imprve. Stakehlders nted a cncern in being able t access required medicatins in a timely manner and are scheduled at the urgent clinic fr same day appintments. 2C Tracks and trends access data fr timely appintments fr urgent cnditins FC The MHP reprts a standard f 1 day with an verall average f 1 day and reprts it meets this 100% f the time. 2D Tracks and trends timely access t fllw up appintments after hspitalizatin FC The MHP reprts a gal f 7 days with an average f 7 days and reprts it meets it 85.5% f the time. Fr adult services, it reprts an average f 7.5 days with 83.9% meeting this metric. Fr children s services, it reprts an average f 5.6 days and reprts meeting this 89.4% f the time. 2E Tracks and trends data n rehspitalizatins FC The MHP set a gal fr n mre than a 9% readmissin rate. The MHP reprts an verall average f 14.3%. Fr adult services, it reprts a 14.5% readmissin rate and fr children s services, it reprts a 13.5% readmissin rate. 2F Tracks and trends nshws FC The MHP tracks and reprts n -shw data fr clinicians fr cunty-perated prgram with a gal f n mre than 20% n-shw rate. Page 35

36 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 7 Timeliness f Services Cmpnent Cmpliant (FC/PC/NC)* Cmments Overall n-shw rate fr clinicians was 3%; fr adult services it was reprted at 4.1% and fr children s services 2.1%. While this lw n-shw rate is cmmendable, the MHP is encuraged t cntinue t validate the integrity f the data. The MHP tracks n-shws fr cntract prviders; these are reprted in Perfrmance Learning Measures. *FC = Fully Cmpliant; PC = Partially Cmpliant; NC = Nn-Cmpliant Quality f Care As shwn in Table 8, CalEQRO identifies the fllwing cmpnents f an rganizatin that is dedicated t the verall quality f care. Effective quality imprvement activities and data-driven decisin making require strng cllabratin amng staff (including cnsumer/family member staff), wrking in infrmatin systems, data analysis, clinical care, executive management, and prgram leadership. Technlgy infrastructure, effective business prcesses, and staff skills in extracting and utilizing data fr analysis must be present in rder t demnstrate that analytic findings are used t ensure verall quality f the service delivery system and rganizatinal peratins. Table 8 Quality f Care Cmpnent Quality management and perfrmance imprvement are rganizatinal pririties Cmpliant (FC/PC/NC)* FC Cmments The MHP prduces an annual Quality Imprvement Wrk Plan (QIWP) and Perfrmance, Cmpliance and Quality Imprvement (PCQI) Data Dashbard. It has a brad representatin, including cntract prviders and sme peer staff. The MHP recently utilized a quality imprvement prcess t align and strengthen cntracting functins and t develp wrkflws, templates, timelines and tls. The Divisin Directrs develped a draft, cntract mnitr tl that will be shared with the cntract prviders t review. This will use quality imprvement prcesses t align and strengthen cntracting functins: wrkflws, templates, timelines, tls, trainings and capacity. With the additinal Perfrmance Learning Measurements fr rganizatinal prviders, the MHP has mved frward with increased quality care. Infrmatin Technlgy (IT) staff cnduct regular EHR use and refresher trainings fr MHP staff and cntract prviders. 3A Page 36

37 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 8 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments 3B Data are used t infrm management and guide decisins FC It has released an RFP fr Practice Management and Decisin Supprt Team prduces a vast array f charts, graphs and dashbards use t guide the decisinmaking prcesses. The MHP launched discvery fr Epic HealthLink implementatin in Octber The HealthLink implementatin timeline is aligned with the Practice Management and Billing vendr ramp-up. The MHP prduces 30/60/90-day Cntract Mnitr reprts. 3C Evidence f effective cmmunicatin frm MHP administratin FC Its effrts t enhance cmmunicatin thrugh a variety f methdlgies: Cmmunicatin Wrk Grup recmmendatins, All Staff Meetings, All Managers meetings, Executive runds f wrksites and a mnthly newsletter. Our Vice, a cnsumer newsletter is published quarterly (English nly). CFMs are represented n the Cmmunicatins Wrkgrup. The Peer Leadership Grup has regular meetings with the Executive Directr. The current gal is t establish a career ladder fr Cnsumer Family Member emplyees and t expand the existing Peer-run Wellness Centers t include services such as psychiatry and case management. 3D Evidence f stakehlder input and invlvement in system planning and implementatin PC The MHP leadership cntinues t value and supprt its stakehlders with a shared missin, gals and visin. Leadership demnstrates its cmmitment t quality care n numerus levels with its expanded management team, its fcus n retentin strategies and its self-initiated imprvements t expand its cntinuum f care. Infrmatin is dispersed via mems, s, newsletters, and n-ging meetings. Stakehlder fcus grups indicated value in the cntinued pprtunity fr training, with the mnthly full day/nine-mnth Clinical Supervisin Training prgram and the Trauma Infrmed Care guide Cnsumers/Family members actively participate n Cmmunity Living Calitin (Bard and Care issues), serve n the QIC, Ethnic and Cultural Cmmunities Advisry Cmmittee, Peer Supprt Design Cmmittee, Peer Leadership, amng thers. The MHP has abut 30 CBOs/legal entities using abut 10 different electrnic health recrds (EHRs). Nne use the MHP s Pr-Filer EHR. All cntractrs dwnlad data frm their EHRs t manually re-enter in Pr-Filer (i.e. duble data entry ), leading t inefficiencies and data errr. Page 37

38 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 8 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments Cntractrs cited variatin amng MHP cntract mnitrs as anther barrier. CBOs wh cntract fr multiple MHP prgrams ften have multiple MHP cntract mnitrs. New cntracts initiated abut 18 mnths ag include specific requirements fr: staffing; and duratin f treatment/number f hurs per client per prgram/evidence-based practice (EBP). Cntractrs expressed difficulty maintaining r increasing staffing due t the variability/unreliability f referrals and having a lwer ttal cmpensatin package than the MHP r ther health plans. 3E Evidence f strng cllabrative partnerships with ther agencies and cmmunity based services FC It develped a set f Jail Diversin recmmendatins, based n best practices in Ls Angeles Cunty and Behar Cunty, Texas, thrugh cllabratin with the Cunty s Public Safety and Law Enfrcement partners. The intent is t cnnect individuals t services, rather than send them t jail, when apprpriate. Services include mental health, substance use and c-ccurring utpatient treatment. Implementatin is currently underway. Expansin f Supprtive Husing Services in cllabratin with Office f Supprtive Husing has taken place. Cllabratin and the implementatin f Suicide Preventin strategies by wrking with Public Health has ccurred. 3F Evidence f a systematic clinical Cntinuum f Care FC The MHP develped and is currently pilting a new level f adult utpatient care Wellness and Recvery Services t prvide a step dwn frm utpatient services, creating a mre rbust cntinuum f care frm Full Service Partnership (FSP) t utpatient t Wellness and Recvery services t meet the needs f beneficiaries. Within the Family and Children s Services, expanded service delivery includes prgrams fr birth t five years, TAY, substance use treatment, incarcerated persns and lder adult initiatives; all these cntribute t a brader service array. This extends the cntinuum f care frm the preventin stage t the residential phase shuld it be required. Outcme reprts are prduced regularly and analyzed at the prgram level fr specialized treatment, such as the First 5 KIDSCOPE prgram. 3G Evidence f individualized, cnsumer-driven treatment and recvery FC With its fcus n a quality cntinuum f care and the strength f leadership t engage champins, the result has becme the individualized treatment fr cnsumer Page 38

39 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 8 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments benefit. Given the additinal services cited, it is n its way t a mre diverse and individualized treatment apprach. Cnsumers were aware and cited invlvement in treatment plans, including WRAP. The MHP created a Welcming Grup, utilizing its Peer Supprt Wrkers, and includes an rientatin fr new cnsumers t its campus. Wellness and Recvery Actin Plans are used extensively thrughut the MHP. Participant in fcus grups and thse at the Evans Lane Wellness and Recvery Center (AB 109) all had active WRAP plans. Outreach and engagement t the Latin cmmunity includes classes in develping WRAP plans. Extensive utreach int African American, Chinese, Vietnamese, Latin, Filipin and Native American cmmunities with training and educatin ccurs. 3H Evidence f cnsumer and family member emplyment in key rles thrughut the system PC Bth the MHP and cntract prviders emply peers wh are engaged in key rles thrughut the system. Within the cunty, 48 Mental Health Peer Supprt Wrkers (cnsumers and family members) are emplyed and cntract agencies emply 74.9 Cnsumer Supprt Staff and 26 Family Member Supprt Staff. A peer lead staffer attends management meetings and reprts t the directr. Beynd staffing and supprting the tw Peer-Run Wellness Centers (Esperanza and Zephyr), bth the MHP and their cntract prviders use CFM emplyees in meaningful ways. Examples include prviding a welcming rientatin at tw clinics (currently being pilted); teaching a family WRAP curse at a clinic in the evenings fr families in the criminal justice system; teaching Mental Health First Aid in Spanish and t ver 600 Crrectinal Officers; and prviding utreach and supprt at Urgent Care t families in crisis. While the leadership supprts and prmtes the creatin f a career ladder fr its 48 peer emplyees as a pririty, little prgress has been made. There appear t be larger cunty-level administrative hurdles making it difficult t achieve. Cnsultatin with ther MHPs is underway and the Directr is cmmitted t making this happen. There is nw, hwever, a Peer Leadership Grup reprting t the Executive Directr and is tasked with develping a prpsal. Peer participants were hpeful Page 39

40 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 8 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments that this will result in creating new prmtinal pprtunities. 3I Cnsumer run and/r cnsumer driven prgrams exist t enhance wellness and recvery FC The MHP perates tw Self-Help Centers run by cnsumers at Esperanza (in Gilry) and Zephyr (in San Jse behind the Multi-Service Center). Hurs at Esperanza are 9 am-4 pm, Tuesday-Thursday and 1pm- 4 pm n Friday; at Zephyr, hurs are Tuesday-Friday frm 9am t 3 pm. Bth centers are clsed n Mnday due t limited resurces. Cnsumers utilize the scializatin activities and emplyment skills wrkshps. While the MHP indicated these tw centers are limited, it stated the need has nt risen fr mre invlvement. This culd be reviewed and perhaps a cnsumer mechanism fr feedback n this culd infrm the MHP f any unintended barriers fr use. Peer-run, centers fcus n prviding supprt and assistance in wellness and recvery, emplyment, educatin, and husing. WRAP is an integral part f services prvided. Center staff attend staff meetings t infrm MHP prviders f services ffered at the centers. 3J Measures clinical and/r functinal utcmes f cnsumers served FC Fr treatment needs, the MHP cntinues t use, analyze and review these tls: Milestnes f Recvery Scale (MORS) fr adults and the Child and Adlescent Needs and Strength (CANS) assessment fr children t measure utcmes. Additinally, numerus utcme measures are used with evidence based practices, especially prlific within the Family and Children s divisin. Newly initiated surveys include the Suicide Preventin rating scale, intended fr use system-wide. 3K Utilizes infrmatin frm Cnsumer Satisfactin Surveys FC The MHP distributes the required statewide Cnsumer Perceptin Survey (POQI) twice a year during a twweek timeline. Other prgram related surveys take place as warranted fr feedback, such as with the recent Advancing Recvery PIP health survey and the Urgent Care Clinic surveys cnsumers at the end f the visit. The Decisin Supprt staff analyze and publish annual POQI cnsumer satisfactin survey data shared with prviders. *FC = Fully Cmpliant; PC = Partially Cmpliant; NC = Nn-Cmpliant Page 40

41 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year KEY COMPONENTS FINDINGS IMPACT AND IMPLICATIONS Access t Care Expanded Adult services: Increased utpatient capacity and pilt new Wellness Center level f care. Expanded cmmunity crisis capacity 30 crisis residential beds, seven crisis stabilizatin unit beds, tw mbile crisis teams, and Psychiatric Emergency Respnse Team pilt prgrams. Tracking avidable EPS and acute hspital stays and 30-day readmissin rates. The MHP funded and prvided services under its KidCnnectins Netwrk (KCN) delivering therapeutic Services, develpmental specialist services and targeted diagnstic assessment serving birth t five year lds in cnjunctin with the FIRST 5 Santa Clara Cunty, Healthy Families and Valley Health Plan. The MHP prgram entitled KIDSCOPE aligns its prgrams t achieve these gals: Increase natural netwrks f supprtive relatinships. Reduce multiple fster care placements. Reduce disparities in service access. Increase self-help and cnsumer/family invlvement. Children are brn healthy and experience ptimal health and develpment. Families prvide safe, stable, lving, and stimulating hmes. Children enter schl fully prepared t succeed academically, emtinally, and scially. Expanded Substance Use Treatment Services: Plans t implement the Drug Medical Waiver expanding the services t the Medi-Cal beneficiaries (July 2017). Expanded three levels f residential care that cnfrm t ASAM Placement Criteria. Expanded c-ccurring recvery services. Implementatin underway fr a seamless cntinuum f care fr beneficiaries that receive specialty mental health services with the department. Timeliness f Services Strengthened the Call Center functin: new screening assessment tl, wrkflws, electrnic linkage between mental health and its substance use Page 41

42 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year treatment services Gateway and transitinal electrnic capacity management tl. Imprved timeliness f care: Call Center/Gateway t services and acute hspitals t subacute and cmmunity services. Quality f Care The MHP utlined numerus quality initiatives t: Integrate departmental functins and strengthen administrative functins. Imprve access and system capacity t meet demand. Implement 1115 Medi Cal Waivers: Substance Use Treatment Services and Whle Persn Care. Expand quality imprvement functins. Strengthen wrkfrce thrugh recruitment, retentin and staff develpment. It has develped an integrated infrastructure plan and rganizatinal chart. The issue f lack f capacity and staffing resurces resnated with grups thrughut the review. Alng with this, many cmmented n the time that it takes fr the cunty t fill vacancies and the impact that has n service delivery. The MHP is develping a system-wide Wrkfrce Develpment Plan that will include recruitment and retentin strategies, academic partnership and expansin f clinical extenders and cnsumer and family emplyees. Onging recruitment effrts are ccurring fr new Executive Psitins: Administrative Services Manager Ill, Directrs f Children, Yuth and Family Services and Adult/Older Adult Services. A plan fr Child Welfare Cntinuum f Care (fster care and grup hmes) with Scial Services and Prbatin is under develpment. Cntinued partnering with Schl Districts t enhance Schl-I-inked Services t explre new mdels f funding and service design exists. A cmmitment t align Integrated Services with its Health Plan partners: Develping a plan fr Primary Care Behaviral Health with Ambulatry Care. Wrking with Santa Clara Family Health Plan and Valley Health Plan t address needs f mild t mderate ppulatin. Implementing Whle Persn Care services with its partners. Explring expansin f Mental Health Urgent Care services t meet grwing demands. Page 42

43 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year The MHP has installed safety buttns and hired public service fficers in identified Cunty Mental Health clinics. Cnsumer Outcmes Cntinued t cnduct annual Mental Health MHSIP cnsumer survey and pilt prgram-based surveys t imprve client/cnsumer experience f care. Effrts were made t create welcming envirnments in crisis and clinic settings. The Family and Child divisin utilizes a wide variety f utcme tls t measure cnsumer prgress in treatment beginning with birth and extending t transitin age yuth (TAY). Sme f these are the: Trauma Fcused Cgnitive Behavir Therapy (TFCBT) Triple P Levels 4 and 5 Ages and Stages Early Detectin and Interventin fr the Preventin f Psychsis (EDIPP) Mtivatinal Interviewing (MI). MHP peers nly have a single classificatin/pay range whether they are temprary, part-time r full-time thugh full-time MHP peers have benefits. MHP peers reprt minimal training r civil service pprtunities. Despite extensive use f peers thrughut the MHP, Peer Supprt Wrkers ften feel marginalized. (One small example given related t the lack f an assigned wrkspace and/r name plate n the cubicle after several years wrking in a facility.) Mre educatin f management and supervisrs regarding the rle f peers in prviding MHP services may help t build mre understanding and reduce stigma. Page 43

44 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year CONSUMER AND FAMILY MEMBER FOCUS GROUP(S) CalEQRO cnducted three 90-minute fcus grups with cnsumers and family members during the site review f the MHP. As part f the pre-site planning prcess, CalEQRO requested tw fcus grups with 8 t 10 participants each, the details f which can be fund in each sectin belw. The Cnsumer/Family Member Fcus Grup is an imprtant cmpnent f the CalEQRO site review prcess. Obtaining feedback frm thse wh are receiving services prvides significant infrmatin regarding quality, access, timeliness, and utcmes. The fcus grup questins are specific t the MHP being reviewed and emphasize the availability f timely access t care, recvery, peer supprt, cultural cmpetence, imprved utcmes, and cnsumer and family member invlvement. CalEQRO prvides gift certificates t thank the cnsumers and family members fr their participatin. CONSUMER/FAMILY MEMBER FOCUS GROUP 1 This was a grup f adult cnsumers wh resided at the Evans Lane Wellness and Recvery Center and was held at this center lcated at 2090 Evans Lane, San Jse. All participants were frmerly incarcerated and participants f services with the MHP. One had received MHP services fr less than a year. The maximum length f stay in the Evans Lane Residential Prgram is 12 mnths. Number f participants 11 General cmments regarding service delivery that were mentined included the fllwing: All cnsumers have WRAP plans and participate in develping their wn treatment plans and are updated every 8 12 weeks. Participants receive bth individual and grup therapy. All participants attend additinal supprt grups such as 12-Step, anger management, Seeking Safety, etc. Residents have immediate access t crisis services at Santa Clara Valley Medical Center. Psychiatry appintments are mnthly with the psychiatrist n-site mst business hurs. Substance Use Disrder (SUD) services are als prvided n-site, making Evans Lane a One Stp Shp. Recmmendatins fr imprving care included the fllwing: Participants indicated this prgram was an ultimate benefit, with n recmmendatins fr change. All participants felt they were much imprved frm six mnths ag. Page 44

45 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Interpreter used fr fcus grup 1: N CONSUMER/FAMILY MEMBER FOCUS GROUP 2 This was a small grup f culturally diverse parents f yuth beneficiaries wh had utilized services within the past 12 mnths. The grup was held at the Behaviral Health Services Department at 1075 E. Santa Clara Street, San Jse. Number f participants 3 General cmments regarding service delivery that were mentined included the fllwing: Participants indicated schl based services were useful. All participants knew what t d and wh t call in a crisis. Participants stated it is difficult t btain day-care r after-schl prgrams. Each indicated that MHP invlvement in the yuth s Individualized Educatin Plan (IEP) had changed with new versight regulatins and was srely missed by parents. Recmmendatins fr imprving care included the fllwing: Participants indicated supprt grups fr parents/caregivers wuld be beneficial. Increasing after schl activities wuld enhance scializatin pprtunities. Cnsider summer camps, as prgrams are limited during the summer mnths. Interpreter used fr fcus grup 2: N CONSUMER/FAMILY MEMBER FOCUS GROUP 3 This was a grup f culturally diverse adult beneficiaries receiving services within the past 12 mnths. The grup was held at the Behaviral Health Services Department at 1075 E. Santa Clara Street, San Jse. Number f participants 6 General cmments regarding service delivery that were mentined included the fllwing: Mst were invlved in rchestrating their Wellness and Recvery Actin Plan (WRAP). Page 45

46 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Each stated services and prviders were supprtive, and indicated this cntributed t an imprved system. Sme expressed a cncern with prgram changes frthcming, services wuld diminish. Recmmendatins fr imprving care included the fllwing: Imprve the welcming strategies fr the frnt desk staff wh appear indifferent at times. Increase the pr-scial activities and scializatin events at the Self-Help Centers. Prvide enugh permanent staff t stabilize prvider assignments, as temprary psychiatrists change ften. Interpreter used fr fcus grup 3: N CONSUMER/FAMILY MEMBER FOCUS GROUP FINDINGS IMPLICATIONS Access t Care Initial access was timely, fllw up appintments are lagging at times. Timeliness f Services Urgent respnse is immediate. Overall, first appintment was timely. Quality f Care Prviders were supprtive f individuals and treatment plans. Cnsumer Outcmes Individuals were invlved in their treatment plans (WRAP). Page 46

47 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year INFORMATION SYSTEMS REVIEW Knwledge f the capabilities f an MHP s infrmatin system is essential t evaluate the MHP s capacity t manage the health care f its beneficiaries. CalEQRO used the written respnse t standard questins psed in the Califrnia-specific ISCA, additinal dcuments submitted by the MHP, and infrmatin gathered in interviews t cmplete the infrmatin systems evaluatin. KEY ISCA INFORMATION PROVIDED BY THE MHP The fllwing infrmatin is self-reprted by the MHP in the ISCA and/r the site review. Table 9 shws the percentage f services prvided by type f service prvider: Table 9 Distributin f Services by Type f Prvider Type f Prvider Distributin Cunty-perated/staffed clinics 12% Cntract prviders 87% Netwrk prviders 1% Ttal 100% Percentage f ttal annual MHP budget is dedicated t supprt infrmatin technlgy peratins: (includes hardware, netwrk, sftware license, IT staff) 3.3% Cnsumers have n-line access t their health recrds either thrugh a Persnal Health Recrd (PHR) feature prvided within EHR r a cnsumer prtal r a third-party PHR: Yes In Testing/Pilt Phase N Cnsumers whse recrds will transitin t Epic will have access t them in late CY2017. MHP currently prvides services t cnsumers using a telepsychiatry applicatin: Yes In Testing/Pilt Phase N If yes, the number f remte sites currently peratinal: Page 47

48 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year n/a Direct services thrugh telepsychiatry practitiners are available in the fllwing languages (des nt include the use f additinal interpreters) (e.g. English, Spanish): n/a MHP self-reprted technlgy staff changes since the previus CalEQRO review (FTE): technlgy staff changes were minimal during the past year. Number f IS Staff Table 10 Summary f Technlgy Staff Changes Number f New Hires Number f Staff Retired, Transferred, Terminated Current Number f Unfilled Psitins MHP self-reprted data analytical staff changes since the previus CalEQRO review (FTE): n internal data analytical staff changes were nted during the past year. Number f Data Analytical Staff Table 11 Summary f Data Analytical Staff Changes Number f New Hires Number f Staff Retired, Transferred, Terminated Current Number f Unfilled Psitins The fllwing shuld be nted with regard t the abve infrmatin: Cntinued grwth f Behaviral Health Services Department (BHSD) staff and prgrams may hinder IT service level supprt as the BHSD prmtes advanced integratin and autmatin slutins when implementing a new system t replace Pr-Filer and Diamnd systems. See Plans fr Infrmatin Systems Change sectin belw fr further infrmatin. CURRENT OPERATIONS The MHP cntinues t use C-Cntrix Pr-Filer system fr practice management and basic clinical recrds functins. The MHP reprts that 12% f services are prvided by cunty perated/staffed clinics, 87% by cntract prviders and 1% netwrk prviders. Apprximately 76% f services are claimed t Shrt Dyle/Medi-Cal (SD/MC). The MHP des nt use tele-psychiatry t serve clients. Page 48

49 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 12 lists the primary systems and applicatins the MHP uses t cnduct business and manage peratins. These systems supprt data cllectin and strage, prvide EHR functinality, prduce Shrt-Dyle/Medi-Cal (SD/MC) and ther third party claims, track revenue, perfrm managed care activities, and prvide infrmatin fr analyses and reprting. Table 12 Primary EHR Systems/Applicatins System/Applicatin Functin Vendr/Supplier Years Used Operated By Pr-Filer Practice Management, Clinical Recrds C-Cntrix 13 HHS IS Diamnd Manage Care Dell 16 HHS IS HealthLink EHR Epic 4 HHS IS PLANS FOR INFORMATION SYSTEMS CHANGE The MHP has selected a new system, but nt yet in implementatin phase. During the Fall 2016, the MHP released a Request fr Prpsal t replace Pr-Filer and Diamnd systems. As f January 2016, they had selected an IS Vendr and are in cntract negtiatins. Tentative plans are t be ready t g-live by Nvember The new system will directly interface with Epic HealthLink there will be a tw-way exchange f data between the systems. ELECTRONIC HEALTH RECORD STATUS Table 13 summarizes the ratings given t the MHP fr EHR functinality. Table 13 Current EHR Functinality Alerts Functin System/Applicatin Present Partially Present Assessments C-Centrix/Pr-Filer X Dcument imaging/strage Electrnic signature cnsumer Labratry results (elab) Epic/HealthLink X Level f Care/Level f Service Outcmes MORS,CANS,ECBI, PHQ-9, PTSD-RI X Rating Nt Present X X X X Nt Rated Page 49

50 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Table 13 Current EHR Functinality Functin System/Applicatin Present Partially Present Prescriptins (erx) Epic/HealthLink X Prgress ntes C-Centrix/Pr-Filer X Treatment plans C-Centrix/Pr-Filer X Rating Nt Present Nt Rated Summary Ttals fr EHR Functinality Prgress and issues assciated with implementing an electrnic health recrd ver the past year are discussed belw: During the past year, the MHP did nt implement additinal C-Centrix Pr-Filer EHR functins as they had decided t select a replacement EHR system. C-Centrix Pr-Filer has limited clinical recrd functinality. Bth Lab results and prescriptins are accessible fr psychiatrists and nursing staff thrugh Epic HealthLink. Mst cntract prviders have implemented EHR systems but d nt have the capability t use electrnic data interchange transactins; ther than FTP batch prcess fr direct services uplad int Pr-Filer fr billing and reprting purpses. Cnsumer s Chart f Recrd fr cunty-perated prgrams (self-reprted by MHP): Paper Electrnic Cmbinatin MAJOR CHANGES SINCE LAST YEAR During 2015, in preparatin fr a new practice management system, they initiated a cleanup effrt f Pr-Filer data. Over 600 reprts and 30 custm frms were updated r retired. Implemented Behaviral Health Access Call Center capacity reprting and tracking fr cntract prviders and cunty-perated prgrams. The prcess replaces the Access Call Center manual system (Whitebard) with Pr-Filer input screens and reprts that are available t all users. Implemented Care Crdinatin and Transitins Prgram (CCTP) and Executive Dashbard reprting. Prvides system-level care crdinatin t the highest utilizers f Santa Clara Valley Health Human Services (SCVHHS) services. Page 50

51 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Using an interdisciplinary team apprach t stabilize clients wh have fallen between the cracks f existing prgrams, and cnnect clients t cmmunity-based prgrams that are best designed t meet their needs. Results in imprved client utcmes and reduced utilizatin f acute healthcare services. The MHP began t explre using Epic HealthLink system - including client registratin, appintment scheduling, and service referral. A kick-ff meeting was cnducted in Nvember PRIORITIES FOR THE COMING YEAR Prcure and implement a practice management sftware system fr Behaviral Health Services Department (BHSD) t replace Pr-Filer and Diamnd systems. The system is currently referred t Practice Management Systems Slutins (PMSS). Primary functins and features t include: Fully integrated practice management system Cmprehensive billing and accunting platfrm t maximize revenue cycle Manage referral tracking and managed care utilizatin management Staff credentialing Claims and billing State and Federal reprting. Cmplete implementatin f EpicCare Ambulatry and supprting mdules fr BHSD prgrams and clinics; this started in Nvember Current estimated g-live date is Nvember 2017, and is cntingent upn PMSS implementatin fr billing and reprting BHSD prgrams and cntract prviders. Estimated cmpletin date is May 2018, r 6 mnths after the g-live date. Anticipated final system acceptance is Nvember Reduce paper charts and prvide an electrnic mechanism t securely share client treatment data between Epic HealthLink and cntract prviders and all prviders within the netwrk t supprt BHSD clinical and business requirements. BHSD custdy prgrams (e.g. Juvenile Hall) will nw transitin t Epic HealthLink in Nvember The riginal date was Nvember Page 51

52 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year OTHER SIGNIFICANT ISSUES As nted earlier in the reprt all prviders have experience challenges hiring and retaining health care prfessinals. A cntract prvider spent resurces t plan t use tele-psychiatry services and was submitted t the MHP fr review and apprval. It s been apprximately six mnths since the tele-psychiatry prpsal was submitted. Hwever, n infrmatin has been shared r requested frm the cntract prvider. Cntract prviders have mstly implemented IS systems that supprts electrnic health recrds functinality fr their lcal agency use. During the past year, the MHP began t implement Practice Management Systems Slutin (PMSS) prject. One f the primary prject gals is the tw-way exchange data between cntract prviders EHR and PMSS. The MHP needs additinal subject matter expertise t implement interperability (twway exchange f data); t develp cmmunicatins plan that shares technical data exchange infrmatin with cntract prviders r their IS vendrs. The current mdel f tw separate Access Call Centers fr Mental Health and Substance Use services is nt effective slutin t supprt the cmmunity-based capacity challenges. An integrated Access Call Center needs t be a pririty. MEDI-CAL CLAIMS PROCESSING Nrmal cycle fr submitting current fiscal year Medi-Cal claim files: Mnthly Mre than 1x mnth Weekly Mre than 1x weekly MHP perfrms end-t-end (837/835) claim transactin recnciliatins: Yes N If yes, prduct r applicatin: Lcal Excel Wrksheet r Access Database Lcal SQL Database, supprted by MHP/Health/Cunty staff Web-based applicatin, supprted by MHP staff Web-based applicatin, supprted by Vendr r ASP staff Methd used t submit Medicare Part B claims: Clearinghuse Electrnic Paper Page 52

53 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Due t technical difficulties during SDMC claims adjudicatin prcessing apprximately 108,000 claim transactins were apprved fr less than five dllars. As a result, Table 14, Grss Dllars Adjudicated and Grss Dllars Apprved clumns were understated. The MHP stated they did submit vid/replace transactins t crrect the underpayments. Hwever, the vid/replace transactins were nt reflected in CalEQRO claims data received frm DHCS prcessing date as f May 19, INFORMATION SYSTEMS REVIEW FINDINGS IMPLICATIONS Access t Care Access Call Center capacity reprting fr bth cntract prviders and cuntyperated prgrams has been autmated. The prcess uses Pr-Filer input screens and prduces reprts that are available t end-users. Access Call Center capacity reprting prvides real time capability t mnitr pen treatment slts with the gal t imprve client flw system wide. Timeliness f Services The MHP currently mnitrs length f time frm initial client cntact t first appintment fr cntract prviders. Quality f Care Care Crdinatin and Transitins Prgram (CCTP) prvides system-level care crdinatin t the highest utilizers f services. It uses an interdisciplinary team apprach t stabilize clients wh have fallen between the cracks f existing prgrams, and cnnect clients t cmmunity-based prgrams that are best designed t meet their needs. Cnsumer Outcmes CCTP has resulted in imprved client utcmes and reduced utilizatin f acute healthcare services. Page 53

54 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year SITE REVIEW PROCESS BARRIERS The fllwing cnditins significantly affected CalEQRO s ability t prepare fr and/r cnduct a cmprehensive review: One f the participants in a cnsumer family member fcus grup required interpreter services and due t a cmmunicatin errr, n interpreter was available and thus the cnsumer was unable t attend. Page 54

55 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year CONCLUSIONS During the FY16-17 annual review, CalEQRO fund strengths in the MHP s prgrams, practices, r infrmatin systems that have a significant impact n the verall delivery system and its supprting structure. In thse same areas, CalEQRO als nted pprtunities fr quality imprvement. The findings presented belw relate t the peratin f an effective managed care rganizatin, reflecting the MHP s prcesses fr ensuring access t and timeliness f services and imprving the quality f care. STRENGTHS AND OPPORTUNITIES Access t Care Strengths: Effrts at efficiencies fr the Access Call Center were evident with its revised prtcls fr capacity. Numerus expanded prgrams and cllabratins referenced in this reprt indicate imprved access at pints f entry. Average Hispanic penetratin rate increased each year frm CY13 t CY15 and is nw higher than large MHPs and statewide averages fr the three-year perid. Opprtunities: Creating methdlgies t address real-time appintment availability acrss the system f care is limited. The Access Call Center cntinues t rely n fax machines and whitebards t track certain specialty (pediatric) health care prvider requests fr service referrals. Timeliness f Services Strengths: The MHP cntinues t respnd t urgent care cnditins immediately. Opprtunities: An integrated electrnic capacity system has nt been fully develped. Cntinued use f separate Access Call Centers fr Mental Health and Substance Use services is nt an effective slutin t supprt cmmunity-based capacity challenges. Telepsychiatry is nt utilized, hwever, ne site is currently awaiting apprval t pilt this service. Page 55

56 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Quality f Care Strengths: Leadership demnstrated its cmmitment t quality f care fr staff, cnsumers and the cmmunity within the given parameters. The MHP cntinues t rll-ut its detailed and expanded cntinuum f care. Training pprtunities have cntributed t staff mrale, pertinent at a time with its multiple vacancies. Seamless service delivery appears t be demnstrated via the MHPs cmmitment t integratin f physical health, substance disrders and mental health initiatives. Opprtunities: Based n perspectives f varius stakehlder grups, it was evident staffing vacancies impact its ability t maximize capacity and meet its grwth prjectins. The ability t develp plicies, prcedures, and standardized Access Call Center systems is slwly evlving. Cnsumer Outcmes Strengths: With its brad-based evidence-based practices, multiple ptins exist fr cnsumer recvery. Opprtunities: Ntable, the MHP has dedicated many effrts based n quality, althugh perhaps beynd its decisin, it has been unable t ffer career ladder jb psitins fr peer emplyees Cnsider expanded hurs and activities at the Self-Help Centers at Esperanza and Zephyr. RECOMMENDATIONS Develp a prject plan t integrate the tw Access Call Centers as the current mdel is nt an effective slutin t supprt cmmunity-based capacity challenges. Implement Page 56

57 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year the plan as sn as practical since the MHP identified the lack f cmmunity-based capacity as the number ne pririty. Implementatin f Practice Management System Slutin (PMSS) electrnic health recrd (EHR) addressing tw critical elements. Thse elements are: Knwledge f interperability standards: The prject will require that bth Infrmatin Technlgy (IT) and behaviral health prgram staff have advance knwledge f interperability (tw-way exchange f data between systems) standards. Cmmunicatin plan: As cntract prviders serve ver 85 percent f specialty mental services, a cmmunicatin plan that shares technical data exchange requirements with cntractrs r their IS vendrs is a must. Cntinue t wrk with its cunty Human Resurces divisin t expedite and expand recruitment strategies fr increasing line staff hires fr the vacant psitins, and t cnsider an equitable step increase fr clinical supervisin, critical t its expansin effrts. Investigate the feasibility f using telepsychiatry services t augment medicatin supprt r ther tele-health services as an imprvement ptin. Resume discussins with the cunty Human Resurces divisin addressing the need fr a peer emplyee career ladder and cnsider full-time benefitted psitins with jb mbility. Page 57

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59 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENTS Attachment A: Review Agenda Attachment B: Review Participants Attachment C: Apprved Claims Surce Data Attachment D: CalEQRO PIP Validatin Tls Page 59

60 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT A REVIEW AGENDA The fllwing sessins were held during the MHP n-site review either individually r in cmbinatin with ther sessins: Table A1 EQRO Review Sessins - Santa Clara MHP Opening Sessin Changes in the past year; current initiatives; and status f previus year s recmmendatins Use f Data t Supprt Prgram Operatins Disparities and Perfrmance Measures/ Timeliness Perfrmance Measures Quality Imprvement and Outcmes Perfrmance Imprvement Prjects Acute Care Cllabratin and Integratin Health Plan and Mental Health Plan Cllabratin Initiatives Clinical Line Staff Grup Interview Clinical Supervisrs Grup Interview Prgram Managers Grup Interview Cnsumer Emplyee Grup Interview Cnsumer Family Member Fcus Grup(s) Cntract Prvider Grup Interview Administratin and Operatins Cntract Prvider Grup Interview Quality Management Cmmunity-Based Services Agencies Grup Interview Validatin f Findings fr Pathways t Mental Health Services (Katie A./CCR) ISCA/Billing/Fiscal EHR Deplyment Access Call Center Site Visit Wellness Center Site Visit Site Visit t Innvative Clinical Prgrams: Innvative prgram/clinic that serve special ppulatins r ffer special/new utpatient services. Page 60

61 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year CALEQRO REVIEWERS ATTACHMENT B REVIEW PARTICIPANTS Jvnne Price, Quality Reviewer Cnsultant William Ullm, Chief Infrmatin Technlgy Richard Hildebrand, Infrmatin Technlgy Reviewer Deb Strng, Cnsumer/Family Member Cnsultant Rama Khalsa, Directr, Drug Medi-Cal EQRO Additinal CalEQRO staff members were invlved in the review prcess, assessments, and recmmendatins. They prvided significant cntributins t the verall review by participating in bth the pre-site and the pst-site meetings and, ultimately, in the recmmendatins within this reprt. SITES OF MHP REVIEW MHP SITES Santa Clara Cunty Behaviral Health Department 1075 E. Santa Clara Street San Jse, CA Santa Clara Cunty Behaviral Health Department 2325 Enbrg Lane 2nd flr, Cnf. Rm. 210 San Jse, CA Santa Clara Cunty Behaviral Health Department Access Call Center 871 Enbrg Curt San Jse, CA Evans Lane Wellness and Recvery Center 2090 Evans Lane, San Jse, CA PARTICIPANTS REPRESENTING THE MHP Name Psitin Agency Abe Hughes RC SUBHC Adeline Arciaga PBS Revenue Cntrl Analyst HHS Page 61

62 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Amanda Vierra Clinical Standards Prgram Manager BHSD Alys Henry Prject Manager PMO-IS Angela Nunes Administratr Starlight Cmmunity Services April Kihara Mental Health MH II BHSD Aurelia Espinza Psychiatric Scial Wrker II Kidscpe, BHSD Bart Zisa Health Prgram Specialist SCC BHS MHD Bichly Ng RC Sunnyvale BH Billy Wardle LCSW/Lead Mental Health Call Center Brian Cheung ECCAC Chinese Team Lead Mental Health Peer Supprt Brian Salada HCPMII BHSD Bruce Cpley AOD Directr BHSD Cnsumer Affairs Carmen Pizarr ASO III MH Carline Yip IS Manager HHS Cathy Smiddy MH Prgram Specialist MHDS Cha See Prgram Manager BHSD Cecily Nguyen Administratr, Clinical Mekng Center Cheryl Blankenship Kupras SUTS QIDS QIC II BHSD Dana Fster Intake RAIC DFCS David Silva Lead Clinician BHSD David Smith Mental Health Peer Supprt Wrker BHSD Deane Wiley Deputy Directr BHSD Deserine Graze Health Care Manager DTMH Diana Guid, CADC Peer Supprt OFA BHS Diana Neiman Executive Directr Family and Children s Services- Caminar Dinh Chu Senir Manager Prgram Specialist BHSD Dming Aceved QA Manager BHSD Dn Taylr Senir Clinical Directr EMQ Families First Page 62

63 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Eduard B. Alvarez Assciate Training and Staff Develpment Specialist, Learning Partnership BHSD Edward DeLuna Rehabilitatin Cunselr Mental Health Elenre Ssa Pace Directr, Crisis Residential Prgram Emily Esparza PSW II CWBC Enrique Alvarez PSW II MH Kidscpe Mmentum fr Mental Health Enrique Ruiz Mental Health Peer Supprt Cnsumer Affairs Erin O Brien CEO Cmmunity Slutins Fatemeh Hsseini Qi-UR Manager APS-UMC Frankie Ventura Sr. PBSC HHS Fred Hendersn Mental Health Peer Supprt Wrker BHSD Gabby Olivarez Divisin Directr BHSD Gabriela Gnzales-Ortiz Mental Health Specialist II Starlight Cmmunity Services Gail Campanale QI Directr Mmentum fr Mental Health Gayle Peits Katie A. Crdinatr BHSD Hung Nguyen Senir Mental Health Prgram Manager, Decisin Supprt Team BHSD Hussain Rahim Mental Health Peer Supprt Wrker BHSD Iris Carlina Castill Health Prgram Specialist BHSD Isabell DeAnda ID fr AMD VMC Ismuel Beltran Senir Katie A. Admin Manager RCS Iulieta Chan Tung HCFA II HHS James Wilsn Rehab Cunselr EVBH Jasn Peng Psychiatric Scial Wrker Central Wellness/Benefits Center Page 63

64 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Jeannette Ferris Senir Prgram Manager BHSD Jennifer Grier Chief Clinical Officer RCS Jennifer Hubbs Scial Services Prgram Manager Dept. Family and Children Services Jennifer Jnes Health Care Prgram Manager II BHSD Jennifer Pham Mental Health Prgram Specialist BHSD Jerry McCann Chief Perfrmance Officer Mmentum fr Mental Health Jessica Haberti Health Link Prgram Manager HHS Jim Piazza HHS IS Data Entry Manager HHS Jim Stansberry Executive Directr Prject Ninety Je Tansek Health Care Prgram Manager II SCC BHS MHD Jhn Hardy Mental Health Peer Supprt Wrker Cnsumer Affairs Jhn Winckler Prgram Directr Family and Children s Services Juan Perez Judith Calv Mental Health Peer Supprt Wrker Assistant Directr Outcme/Evaluatin BHSD Cmmunity Slutins Judy DeLen Health Care Prgram Manager Central Wellness & Benefits Center Mental Health Urgent Care Julie Helfrich Peer Supprt Wrker Intern Zephyr Center Julie Herzia HL Training Manger SCVMC Kakli Banerjee Directr, Research/Outcmes Substance Use Treatment Services- BHSD Karen Blding IS Manager HHS Karen Flink Mental Health Peer Supprt Wrker Karen Kalk Cntractr BHSD Kate Deaver Nurse Manager BHSD Cnsumer Affairs, Self Help WRAP Kevin Wrley, RN Analyst HealthLink Crpratin Lan Nguyen CMCS BHSD Lan Nguyen Prgram Manager, Suicide and Crisis Services BHSD Larry Pwell Clinical Standards Manager BHSD Page 64

65 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Laura Luna Senir Prgram Manager BHSD Lauren Gavin HCPMII BHSD Juvenile Hall Leslie Sctt Clinic Supervisr CalWrks Leticia Rsad Manager PBS HHS Lisa Davis COO Cmmunity Slutins Lgan Paw Lead Clinician East Valley Behaviral Health Lri Chambers Directr f Cmmunity Services RCS Lrraine Zeller Mental Health Peer Supprt Wrker Cnsumer Affairs Luis Rdriques Psychiatric Scial Wrker Central Wellness/Benefits Center Lydia V. Flasher, Ph.D Directr, Psychlgy Training Prgrams Children s Health Cuncil Madalyn Ppe Therapist Cmmunity Slutins Maggie Williams CAO/CFO Cathlic Charities Maretta Juarez Senir Mental Health Prgram Manager BHSD Margaret Ledesma Katie A. Manager BHSD Margaret Obilr Divisin Directr Adult O/A Services BHSD Maria Eva Pangilinan Sr. Manager Decisin Supprt BHSD Maria Fuentes Senir Mental Health Prgram Specialist BHSD Maria Gnzalez Mental Health Peer Supprt Office f Family Affairs BHSD Marianne Marafin Directr-Katie A. Cmmunity Slutins Maritza Silapasvang Administratr HOPE Marlen Alcaraz Clinician BHSD Martha Brewer Health Care Prgram Manager Narvaez, BHSD Martha Paine Directr, GF Financial Services HHS Mary Bedfrd-Carter Prgram Directr Unity Care Grup Mary Harnish Cmpliance and Privacy Manager, Mental Health Services BHSD Mary Visker Mental Health Specialist II Starlight Cmmunity Services Page 65

66 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Melissa Rubalcwa HL AC ADT/Prelude SCVMC Meldy Hames Mental Health Peer Supprt Wrker BHSD Michael Hutchinsn Divisin Directr, QI and Data SUTS BHSD Michelle Blade MHPSW(TAY) Family Children s Divisin, Cnsumer Affairs Michelle Grady Clinical Katie A. Prgram Manager Michelle H HCPM II BHSD 24 Hur Care RCS Mikelle Le Senir Prgram Manger BHSD Misty McNay PSWI/Lead MHD Evans Lane, CJS Mhamed Ali Mental Health Peer Supprt Wrker Nancy Natin Katie A. Crdinatr BHSD Cnsumer Affairs Nikhil Bansal Infrmatin Technlgy HHS Nshin Rhani LMFT/Lead Mental Health Urgent Care Olivia Brasil Hspital Liaisn BHSD Pamelah Stephens Divisin Directr Behaviral Health Bill Wilsn Center Patricia Chapellne CEO Alum Rck Cunseling Center Patrick Garcia Divisin Directr Administratin BHSD Paul Trugman Clinician BHSD Peter Antns Health Care Prgram Manager BHSD Phil Espej Sr. Health Care Prgram Analyst BHSD Priscilla Rmer Infrmatin Technlgy Directr Cmmunity Slutins Puja Satwani Executive Directr Seneca Family f Agencies Quan Dng Lead Clinician CWBC Rani Khalsa BHSD Rawan Ailan QA Manager Cathlic Charities Rebeca Lemus Prgram Manager Criminal Justice Divisin Regina Caudill Mental Health Peer Supprt Cnsumer Affairs Renee Marguett Mental Health Prgram Specialist II BHSD Ritha Canales-Rssi LCSW Navraez Mental Health Page 66

67 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Rbert Rcc MH QIC II BHSD Rdney Clark Directr Cmmunity Slutins Rxana Alizadeh QI Health Plan BHSD Ryan Frward Mental Health Peer Supprt Wrker BHSD/SUTS Sam O Neal Case Manager Cmmunity Slutins Sandra Hernandez Divisin Directr, Integrated Behaviral Health Services BHSD Sandy Escbar Sr. Divisin Directr Cathlic Charities Sandy Mendza Assciate Management Analyst MH Sara Rgers HL AMB ID SCVMC Sarita Khli Interim CEO AACI Sharn Trres Mental Health Peer Supprt Wrker - ECCAC BHSD Sharla Kibel LMFT/Lead 0-5 Team Kidscpe, BHSD Sheila Yuter MH Prgram Specialist BHSD Sherri Tera Divisin Directr, Family & Children s Services BHSD Sheryl Hgan Analyst Health Care Plan Shuning Liang Psychiatric Scial Wrker II Primary Care Behaviral Health Sphia Huang Mental Health Peer Supprt Wrker BHSD Stephanie Larette PSW II MH Call Center Steven Castr MHPSII Adult/Older Adult BHSD Steve Lwnsbery SUTS QIDS QIC II BHSD Steve Mnte Senir Mental Health Prgram Specialist BHSD Steve Mrales ID Cadence SCC IS Sue Nelsn Executive Directr Substance Use Treatment Services- CFCS Summer Imamura Revenue Cntrl Analyst HHS Sylvia Hawley LCSW/Lead CWBC Syreeta Matthews PBS Supervisr HHS Page 67

68 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year Teresa Nguyen Lead Clinician Mental Health Urgent Care Thuhien Nguyen Health Prgram Specialist BHSD Tiana Nelsn QI- Clinical Standards Substance Use Treatment Services- BHS Tiffany H, MD Medical Directr BHSD Tin Sacasa Clinician Las Plumas Behaviral Health Tirus Ashfrd Tni Tullys Mental Health Peer Supprt Wrker Santa Clara Cunty Behaviral Health Services Directr Urgent Care and Central Wellness Benefit Center BHSD Tva Sweet Vernica Ksles Mental Health Prgram Specialist II Mental Health Prgram Specialist II BHSD BHSD Vicky Le Clinical Crdinatr Cmmunity Slutins William Eya Rehabilitatin Cunselr BHSD Yuki Ascue Lead Clinician Family and Children s Services- Sunnyvale Zelia Faria Csta Senir Mental Health Prgram Manager BHSD Page 68

69 Santa Clara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT C APPROVED CLAIMS SOURCE DATA Apprved Claims Summaries are separately prvided t the MHP in a HIPAA-cmpliant manner. Tw additinal tables are prvided belw n Medi-Cal ACA Expansin beneficiaries and Medi-Cal beneficiaries served by cst bands. The actual cunts are suppressed fr cells cntaining n 11. Table C1 shws the penetratin rate and apprved claims per beneficiary fr the CY15 Medi-Cal ACA Expansin Penetratin Rate and Apprved Claims per Beneficiary. Table C1 CY15 Medi-Cal Expansin (ACA) Penetratin Rate and Apprved Claims per Beneficiary Santa Clara Entity Average Mnthly ACA Enrllees Number f Beneficiaries Served Penetratin Rate Ttal Apprved Claims Apprved Claims per Beneficiary Statewide 2,001, , % $533,318,886 $4,060 Large 950,222 63, % $263,166,307 $4,158 Santa Clara 70,189 4, % $23,652,124 $5,450 Table C2 shws the distributin f the MHP beneficiaries served by apprved claims per beneficiary (ACB) range fr three cst categries: under $20,000; $20,000 t $30,000, and thse abve $30,000. Page 69