Santa Barbara. Conducted on April 19 20, Prepared by:

Transcription

1 FY Medi-Cal Specialty Mental Health External Quality Review MHP Final Reprt Santa Barbara Cnducted n April 19 20, 2016 Prepared by: Behaviral Health Cncepts, Inc Christie Avenue, Suite 502 Emeryville, CA

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3 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year TABLE OF CONTENTS INTRODUCTION... 5 PRIOR YEAR REVIEW FINDINGS, FY STATUS OF FY14 15 REVIEW RECOMMENDATIONS... 9 Assignment f Ratings... 9 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 BARBARA MHP PIPS IDENTIFIED FOR VALIDATION CLINICAL PIP IMPROVING TREATMENT: TRAINING, CLIENT ENGAGEMENT & TEAM BASED CARE NON CLINICAL PIP TIMELINESS TO PSYCHIATRY SERVICES 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 MAJOR CHANGES SINCE LAST YEAR PRIORITIES FOR THE COMING YEAR OTHER SIGNIFICANT ISSUES PLANS FOR INFORMATION SYSTEMS CHANGE ELECTRONIC HEALTH RECORD STATUS INFORMATION SYSTEMS REVIEW FINDINGS IMPLICATIONS SITE REVIEW PROCESS BARRIERS CONCLUSIONS STRENGTHS AND OPPORTUNITIES Access t Care Page 3

4 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year 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 4

5 Santa Barbara 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 (42 CFR 438; Medicaid Prgram, External Quality Review f Medicaid Managed Care Organizatins) rules specify the requirements fr evaluatin f Medicaid Managed Care prgrams. These rules require an nsite 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 fifty six (56) cunty Medi Cal MHPs t prvide Medi Cal cvered specialty mental health services t Medi Cal beneficiaries under the prvisins f Title XIX f the federal Scial Security Act. MHP infrmatin: Beneficiaries served in CY14 4,828 MHP Size Medium MHP Regin Suthern MHP Threshld Languages Spanish MHP Lcatin Santa Barbara This reprt presents the fiscal year (FY 15 16) findings f an external quality review f the Santa Barbara (MHP) by the Califrnia External Quality Review Organizatin (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 seven (7) Mandatry Perfrmance Measures as defined by DHCS. The seven perfrmance measures include: Ttal Beneficiaries Served by each cunty MHP Ttal Csts per Beneficiary Served by each cunty MHP 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 5

6 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Penetratin Rates in each cunty MHP Cunt f Therapeutic Behaviral Services (TBS) Beneficiaries Served Cmpared t the fur percent (4%) Emily Q. Benchmark (nt included in MHP reprts; a separate reprt will be submitted t DHCS) Ttal Psychiatric Inpatient Hspital Episdes, Csts, and Average Length f Stay Psychiatric Inpatient Hspital 7 Day and 30 Day Recidivism Rates Pst Psychiatric Inpatient Hspital 7 Day and 30 Day Specialty Mental Health Services (SMHS) Fllw Up Service Rates (2) VALIDATING PERFORMANCE IMPROVEMENT PROJECTS 2 Each MHP is required t cnduct tw perfrmance imprvement prjects (PIPs) during the 12 mnths preceding the review; Santa Barbara MHP submitted tw PIPs fr validatin thrugh the EQRO review. The PIP(s) are discussed in detail later in this reprt. (3) MHP HEALTH INFORMATION SYSTEM (HIS) 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 (PM). (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 tw 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: 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 6

7 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year 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 serve 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 Page 7

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9 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year PRIOR YEAR REVIEW FINDINGS, FY14 15 In this sectin we first discuss the status f last year s (FY14 15) recmmendatins, as well as changes within the MHP s envirnment since its last review. STATUS OF FY14 15 REVIEW RECOMMENDATIONS In the FY14 15 site review reprt, the prir EQRO made a number f recmmendatins fr imprvements in the MHP s prgrammatic and/r peratinal areas. During the FY15 16 site visit, CalEQRO and MHP staff discussed the status f thse FY14 15 recmmendatins, which are summarized belw. Assignment f Ratings Fully addressed reslved the identified issue Partially addressed Thugh nt fully addressed, this rating reflects that 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 The MHP perfrmed n meaningful activities t address the recmmendatin r assciated issues. Key Recmmendatins frm FY14 15 Recmmendatin #1: The Clinical Reprting System (CRS) Prject needs t be a pririty t address changing needs f clinical and financial reprting with better alignment between the tw. While Management Infrmatin Systems (MIS) needs t cntinue t generate standard reprts n mnthly and quarterly cycles, there is a need fr dashbard and alert type reprts t prvide n demand and/r daily t weekly basis t reprt n key clinical and financial peratins. The MHP shuld develp frm three t five key peratins indicatrs during the next year that align with and supprt Tri West Reprt findings and recmmendatins. Fully addressed Partially addressed Nt addressed The targeted launch f the CRS fr the Fall 2015 was delayed due t the MHP underging a name/branding change. The CRS will be part f the MHP s Page 9

10 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year website, s when name/branding change was delayed, s was the design and deplyment f the CRS. Upn cmpletin f the MHP change, the MIS and Research and Evaluatin staff made significant prgress tward develping and implementing the CRS. The MHP staff met n a weekly basis with the vendr, Visus, t develp the CRS, which included the prgramming f the system, user interfaces, data validatin, Infrmatin Technlgy (IT) infrastructure (servers, security and rle based permissins) and demnstrating the system t ptential users. The MHP has installed a test versin f the CRS n apprximately 40 MHP Clinical Reprting System Prject staff cmputers. Staff have been testing the CRS fr ease f use, functinality and usefulness f the data generated by the CRS. When fully develped and implemented, users will be able t create reprts thrugh a series f cascading filter ptins. Additinally, there will be canned reprt structures available that will have the capacity t be refreshed with current data. The canned reprts that Visus is develping will be drawn frm examples f existing reprts currently generated n a weekly/mnthly/quarterly basis. The CRS is very clse t deplyment. The MHP s IT staff, Visus staff and the Cunty IT staff are finalizing user testing as well as testing the system fr ptential server r infrastructure issues. It is anticipated that the CRS will be deplyed by May After initial CRS deplyment, the MHP plans fr there t be cntinued effrts fr nging reprt develpment. Recmmendatin #2: Develp and disseminate unifrm plicies and standards systemwide fr key aspects f care t include Clinical Operatins, Financial, Administratin, and Cmpliance areas as the MHP implements the Tri West Reprt recmmendatins. The prgram lacks cnsistency acrss the three regins abut prcedures, expectatins and plicy with cntracted prviders re the fidelity t cre mdel practice. As subclass identified children/yuth cntinues t grw, a standardized prgram is needed. Fully addressed Partially addressed Nt addressed The MHP reprts that a significant number f plicies and prcedures have been develped and disseminated acrss prgrams ver the past year, including an nline training platfrm ( elearning ) t train staff n new and updated Plicy and Prcedures and cllect receipts f acknwledgements. All new and updated Plicy and Prcedures are ed t staff and CBO partners, are shared at ur Steering Cmmittee mnthly meetings with staff, managers and CBO partners in attendance, shared at the CBO Calitin meeting that ccurs quarterly and the CBO Cllabrative meeting that meets mnthly (see attachment f participants labeled #1 P&P). Page 10

11 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Staff cntinues t reprt a lack f cnsistent understanding and adherence t plicies and prcedures acrss the MHP s three regins at the emplyee level. This is being addressed thrugh the training as nted abve. Recmmendatin #3: Adequate staff fr this MHP, mst especially bi lingual Spanish speaking staff, remains a challenge. Recruitment fr this staff needs t be a pririty. Fully addressed Partially addressed Nt addressed Line staff and cntract prviders bth acknwledged there are adequate staffing levels f bilingual Spanish speaking staff. 119 f the MHP s clinical staff are bilingual. 105 are Bilingual in Spanish and English. 33 f the 80 administrative staff are Bilingual. 25 are English and Spanish speaking. When languages beynd Spanish are included, mre than 40% f staff are bi lingual, with 11 additinal languages utilized by staff (including sign language). Line staff and cntract prviders bth nted a significant lack f case management staff and cntinued unfilled clinical vacancies. 65 psitins were added t the budget t allw fr fewer gaps in service delivery. Cnsumers reprt that there is a need fr mre Spanish speaking clinical and administrative staff. Recmmendatin #4: Althugh the Katie A. Prgram has prgressed in the past year, this prgram is nt sufficiently launched in Santa Barbara Cunty. There are still several imprtant issues that in rder fr Katie A. t be a successful nging prgram need reslutin including staffing, cnsistency f prgram delivery, and timeliness in beginning services. Fully addressed Partially addressed Nt addressed Dedicated Katie A. staff are nw present at all reginal children s clinic sites. Six new clinicians were hired, with fur being bilingual Spanish. Althugh cnsistency and timeliness f services have imprved, challenges remain in timeliness given the frequency f scial wrkers changing in Child Welfare Services (CWS) frm referring scial wrker t nging scial wrker. There are n designated scial wrkers wh are assigned cnsistently t specific Katie A. cases. Tw separate mnthly meetings are held with clinic managers and line staff and Divisin Chiefs frm bth departments t imprve cmmunicatin and reduce errrs. Prtracted time t initial cnsent fr assessment and treatment cntinue t adversely affect timeliness. The MHP reprts this is partially amelirated with imprved relatinships and cmmunicatin with CWS. Page 11

12 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year As prgress t timeliness and cnsistency f prgram delivery cntinue, the MHP is wrking t ensure every child is ffered an assessment within 72 hurs frm when the referral is receive frm CWS. The MHP is develping an MOU with CWS t utline the prtcl and prcedures and t address the issues with CWS t help t imprve timeliness f a referral. 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 Alameda Huse, a six bed residential facility that prvides utpatient cmpetency restratin services fr misdemeanants fund Incmpetent t Stand Trial (IST), pened. A secnd six bed facility, Cttage Grve, pened at full capacity in March A Crisis Stabilizatin Unit (CSU) and a Crisis Residential Facility were pened in Santa Barbara. Telepsychiatry services, prvided by JSA Health Tele psychiatry, are available at the CSU after hurs and has been and will cntinue t be implemented in the clinics as interims when vacancies exist. Crisis Triage teams were established and nw perating in all three regins f the Cunty. At tw utpatient clinics, there is increased capacity t care fr medically cmprmised individuals with Substance Use Disrders thrugh establishing the Medicated Assisted Treatment (MAT) teams. Medically Integrated teams have been added t the clinics t prvide services t individuals with physical and mental health needs The use f Screenings, Brief Interventin, and Referral t Treatment (SBIRT) fr alchl and drug issues is being used t better address c ccurring issues at utpatient mental health clinics. Timeliness f Services A Mbile Crisis Team was established in Lmpc. Mbile Crisis Teams are nw present in all three regins f the Cunty. Orientatin grups are nw ccurring at all clinic sites. A welcme brchure has been develped and a welcming vide is being develped. All are expected t Page 12

13 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year help decrease wait time frm request fr services t infrmatin and assessment. The MHP cntinues t recruit Psychiatrists/Physician Assistants/Nurse Practitiners t enhance timeliness t psychiatric/medicatin assessment and treatment. Quality f Care Medicatin rms in the clinics were updated, medicatin plicies and prcedures were reviewed and revised and a new medicatin dispsal prcess was put in place which is in cmpliance with Drug Enfrcement Agency (DEA) regulatins. The hiring f key staff, including an IT Manager, Assistant Directr f Clinical Operatins, Deputy Directr fr Operatins and Administratin, Human Resurces (HR) Manager and Chief Financial Officer (CFO), was finalized. A Memrandum f Understanding (MOU) was finalized with CenCal Health that is intended t imprve health care integratin between primary care and mental health services. The MHP has been wrking t facilitate referrals t and frm The Hlman Grup, CenCal s mental health prvider, fr lw t mderate mental health services. A 5150 wrkgrup was established t imprve the prcesses fr assessing individuals in crisis, identifying least restrictive placement ptins, enhancing training and cnducting safety plans and suicide risk assessments. Cnsumer Outcmes The Resiliency and Interventin fr Sexually Explited individuals (RISE) prgram develped as an innvatin prject within MHSA. RISE prvides mental health services and supprt t girls and bys that are victims f sex trafficking within a multi agency Cunty cllabrative. All MHP staff are trained t use Child and Adlescent Needs and Strengths/Milestnes f Recvery Scale (CANS/MORS) utcme measures t evaluate cnsumer utcmes f treatment. Thrugh an Office f Statewide Health Planning and Develpment (OSHPD) grant, numerus peers have participated in cre trainings as well as received reimbursement fr individualized trainings. Mental Health Cmmissin data wrk grup (named Vital Signs ) includes a cllabratin f mental health cmmissin members, department staff as well as peer and family stakehlders. Page 13

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15 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE MEASUREMENT CalEQRO is required t validate the fllwing seven (7) Mandatry PMs 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 (4%) Emily Q. Benchmark (nt included in MHP reprts; a separate reprt will be submitted t DHCS) Ttal Psychiatric Inpatient Hspital Episdes, Csts, and Average Length f Stay Psychiatric Inpatient Hspital 7 Day and 30 Day Recidivism Rates Pst Psychiatric Inpatient Hspital 7 Day and 30 Day SMHS Fllw Up Service Rates In additin t the seven PMs abve, CalEQRO will include evaluatin f five (5) additinal PMs in the Annual Statewide Reprt, which will apply t all MHPs; this reprt will be prvided t DHCS by August 31, TOTAL BENEFICIARIES SERVED Table 1 prvides detail n beneficiaries served by race/ethnicity. Table 1 Santa Barbara MHP Medi Cal Enrllees and Beneficiaries Served in CY14 by Race/Ethnicity Race/Ethnicity Average Mnthly Unduplicated Medi Cal Enrllees* Unduplicated Annual Cunt f Beneficiaries Served White 74,524 3,157 Hispanic 18, African American 1, Asian/Pacific Islander 4, Native American Other 6, Ttal 106,121 4,828 *The ttal is nt a direct sum f the averages abve it. The averages are calculated separately. Page 15

16 Santa Barbara 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. 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 Medium MHPs. $7,000 Figure 1A. Overall Average Apprved Claims per Beneficiary $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 CY12 CY13 CY14 Santa Barbara Medium State 7.00% Figure 1B. Overall Penetratin Rates 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% CY12 CY13 CY14 Santa Barbara Medium State Page 16

17 Santa Barbara 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 Medium MHPs. $10,000 $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 Figure 2A. FC Average Apprved Claims per Beneficiary CY12 CY13 CY14 Santa Barbara Medium State 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Figure 2B. FC Penetratin Rates CY12 CY13 CY14 Santa Barbara Medium State Page 17

18 Santa Barbara 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 Medium MHPs. $7,000 Figure 3A. Hispanic Average Apprved Claims per Beneficiary $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 CY12 CY13 CY14 Santa Barbara Medium State 8.00% Figure 3B. Hispanic Penetratin Rates 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% CY12 CY13 CY14 Santa Barbara Medium State Page 18

19 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year HIGH COST BENEFICIARIES Table 2 cmpares the statewide data fr high cst beneficiaries (HCB) fr CY14 with the MHP s data fr CY14, as well as the prir 2 years. High cst beneficiaries in this table are identified as thse with apprved claims f mre than $30,000 in a year. MHP Year HCB Cunt Table 2 High Cst Beneficiaries Ttal Beneficiary Cunt HCB % by Cunt Average Apprved Claims per HCB HCB Ttal Claims HCB % by Apprved Claims Statewide CY14 12, , % $50,358 $617,293, % CY , % $49,176 $7,573, % Santa Barbara CY , % $51,628 $11,874, % CY , % $48,126 $11,405, % 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 CY13 and CY14. 70% Figure 4A. 7 Day Outpatient Fllw up and Rehspitalizatin Rates, Santa Barbara MHP and State 60% 50% 40% 30% 20% 10% 0% Outpatient MHP Outpatient State Rehspitalizatin MHP CY13 CY14 Rehspitalizatin State Page 19

20 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year % Figure 4B. 30 Day Outpatient Fllw up and Rehspitalizatin Rates, Santa Barbara MHP and State 70% 60% 50% 40% 30% 20% 10% 0% Outpatient MHP Outpatient State Rehspitalizatin MHP CY13 CY14 Rehspitalizatin State 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 CY14. 35% Figure 5A. Diagnstic Categries, Beneficiaries Served 30% 25% 20% 15% 10% 5% 0% Depressin Psychsis Disruptive Biplar Anxiety Adjustment Other Deferred Santa Barbara CY14 State CY14 Page 20

21 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year % Figure 5B. Diagnstic Categries, Ttal Apprved 35% 30% 25% 20% 15% 10% 5% 0% Depressin Psychsis Disruptive Biplar Anxiety Adjustment Other Deferred Santa Barbara CY14 State CY14 PERFORMANCE MEASURES FINDINGS IMPACT AND IMPLICATIONS Access t Care The MHP s Overall penetratin rate declined each year frm CY12 t CY14 and is nw cmparable t the medium size cunty average and less than the statewide average. The MHP s Fster Care penetratin decreased frm CY13 t CY14, but remains abve bth medium size cunty and statewide averages. While the MHP s Hispanic penetratin rate decreased ntably each year frm CY12 t CY14, it remains abve bth medium size cunty and statewide averages. Timeliness f Services In CY14, the MHP s 7 and 30 day utpatient fllw up rates after discharge frm a psychiatric inpatient episde decreased frm crrespnding CY13 rates, but bth rates remain abve statewide averages. Quality f Care While the MHP s percentage f HCB decreased frm CY13 t CY14, it remains greater than the statewide average. The percentage f ttal HCB claim dllars als decreased, but als remains greater than the statewide average. The CY14 Page 21

22 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year average apprved claims per HCB declined frm CY13 and is nw less than the statewide average. The MHP s CY14 average verall apprved claims per beneficiary decreased frm CY13 and is less slightly less than the medium size cunty average, but greater than the statewide average. The MHP s average FC apprved claims per beneficiary increased each year frm CY12 t CY14 and remains less than bth medium size cunty and statewide averages. The MHP s average Hispanic apprved claims per beneficiary declined each year frm CY12 t CY14, but is cmparable t the medium size cunty average and greater than the statewide average. Varying frm the statewide diagnstic pattern, a primary diagnsis f Adjustment disrders accunted fr the largest percentage f beneficiaries served by the MHP. The MHP had ntably lwer rates f Depressive and Disruptive disrders and a cmparable rate Deferred diagnsis when cmpared t statewide averages. While having a slightly higher percentage f Psychtic disrder diagnses, the crrespnding apprved claims fr this categry was significantly greater than the crrespnding statewide apprved claims percentage. Cnsumer Outcmes While the MHP experienced a decline in bth 7 and 30 day re hspitalizatin rates in CY14 cmpared t its crrespnding rates in CY13, 7 day rehspitalizatin rates remain abve the statewide average while 30 day rehspitalizatin rates are cmparable t the statewide average. Page 22

23 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year PERFORMANCE IMPROVEMENT PROJECT VALIDATION A PIP is defined by the 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 BARBARA MHP PIPS IDENTIFIED FOR VALIDATION Each MHP is required t cnduct tw PIPs during the 12 mnths preceding the review; Santa Barbara MHP submitted tw PIPs fr validatin thrugh the EQRO review, as shwn belw. PIPs fr Validatin Clinical PIP Nn Clinical PIP PIP Titles Imprving Treatment: Training, Client Engagement and Team Based Care Timeliness t Psychiatry Service Table 3A 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 3A 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 M 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 PM 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 23

24 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 3A PIP Validatin Review Step PIP Sectin Validatin Item 3 Study Ppulatin 4 Study Indicatrs Imprvement Strategies Data Cllectin Prcedures Analysis and Interpretatin f Study Results Review Assessment Of PIP Outcmes Item Rating* Clinical PIP Nn Clinical PIP 3.1 Clear definitin f study ppulatin M M 3.2 Inclusin f the entire study ppulatin M M Objective, clearly defined, measurable indicatrs Changes in health status, functinal status, enrllee satisfactin, r prcesses f care Address causes/barriers identified thrugh data analysis and QI prcesses 6.1 Clear specificatin f data M M 6.2 Clear specificatin f surces f data M 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 NM M 7.1 Analysis as planned UTD PM 7.2 Interim data triggering mdificatins as needed M PM M M NM NM UTD 7.3 Data presented in adherence t the plan UTD NM 7.4 Initial and repeat measurements, statistical significance, threats t validity UTD 7.5 Interpretatin f results and fllw up UTD PM 8.1 Results and findings presented clearly UTD NM Issues identified thrugh analysis, times when measurements ccurred, and statistical significance Threats t cmparability, internal and external validity Interpretatin f results indicating the success f the PIP and fllw up UTD UTD UTD PM M M PM M PM PM NM UTD UTD UTD 9.1 Cnsistent methdlgy thrughut the study UTD UTD Page 24

25 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 3A PIP Validatin Review Step PIP Sectin Validatin Item Dcumented, quantitative imprvement in 9.2 prcesses r utcmes f care 9 Validity f Imprvement 9.3 Imprvement in perfrmance linked t the PIP Item Rating* Clinical PIP UTD UTD Nn Clinical PIP UTD UTD 9.4 Statistical evidence f true imprvement UTD UTD 9.5 Sustained imprvement demnstrated thrugh repeated measures. *M = Met; PM = Partially Met; NM = Nt Met; NA = Nt Applicable; UTD = Unable t Determine UTD UTD Table 3B gives the verall rating fr each PIP, based n the ratings given t the validatin items. Table 3B PIP Validatin Review Summary Summary Ttals fr PIP Validatin Clinical PIP Nn Clinical PIP Number Met Number Partially Met 2 8 Number Nt Met 3 3 Number Applicable (AP) (Maximum = 30) Overall PIP Rating ((#Met*2)+(#Partially Met))/(AP*2) 81% 73% CLINICAL PIP IMPROVING TREATMENT: TRAINING, CLIENT ENGAGEMENT & TEAM BASED CARE The MHP presented its study questin fr the clinical PIP as fllws: Is the clinical care and client experience imprved by implementing 1) training fr clinical staff n quality treatment planning, with an emphasis n best practices, engaging clients and team based care; 2) team based care tls; and 3) revised MIS treatment plan reprting t team supervisrs and managers? Date PIP began: Nvember 2015 Page 25

26 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Status f PIP: Active and nging Cmpleted Inactive, develped in a prir year Cncept nly, nt yet active Submissin determined nt t be a PIP N PIP submitted The PIP attempts t crrelate imprvement in the prcess and utcmes f care by implementing mandatry trainings n treatment planning which include a fcus n best practices in treatment planning. The PIP des nt describe hw utcmes will imprve nr which utcmes f care they will measure. There seems t be sme cnfusin in the presentatin f the PIP between indicatrs and interventins. There is als a lack f specificity as t what the PIP intends t d achieve (i.e. mve clients n the Level f Care (LOC) scale, increase kept clinical appintments, increase engagement.). Relevant details f these issues and recmmendatins are included within the cmments fund in the PIP validatin tl. The technical assistance prvided t the MHP by CalEQRO cnsisted f: the EQRO ffered technical assistance in feedback frm during the review. An exchange f s and telephne calls since the review April 19 and 20, 2016 has delivered further assistance in develpment f this PIP. The plan is t cntinue t ffer this assistance t the MHP n an as needed basis. It is hped this will shrtly becme an active PIP and that the 2017 EQRO review will be able t dcument the same. NON CLINICAL PIP TIMELINESS TO PSYCHIATRY SERVICES The MHP presented its study questin fr the nn clinical PIP as fllws: Will implementing the six (6) interventins f the PIP, described in Sectin 5, result in: a) Reductins in client n shw rates; b) Reductins in wait time between admissin and fr psychiatric appintment in the adult and children s system f care. [Sectin 5 refers t Implementatin & Submissin Tl, Sectin 5: Describe Study Interventins. Interventins are as fllws: Page 26

27 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year All MHP clinics will cnduct daily (Mnday-Friday) appintment reminder calls t clients fr psychiatric appintments (staff r peer staff/vlunteers cnduct reminder calls). 2. Clinic teams will incrprate time in their regularly scheduled team meetings t review the upcming psychiatric appintments and t discuss/determine if clients are able t attend, gaps in the schedule and pprtunities t fill pen appintment times and the like. 3. The MHP will increase cntacts with clients between admissin and their first psychiatric appintment by ffering Welcming System Orientatins grups (implemented in July 2015). 4. Engage with emplyment agencies specializing in recruiting psychiatrists and physician assistants, and develp web-based recruitment materials t entice ptential civil service and temprary physicians/physician assistants. This effrt began in FY2014/15 and cntinues in FY2015/ Implement a financial incentive prgram fr psychiatric staff that rewards staff fr higher prductivity and client engagement activities. 6. Wrk with the electrnic health recrd develper t revise and update the previusly develped scheduling system, and create a re-implementatin/staff training plan t intrduce staff t the remdeled system.] Date PIP began: April 2014 Status f PIP: Active and nging Cmpleted Inactive, develped in a prir year Cncept nly, nt yet active Submissin determined nt t be a PIP N PIP submitted The PIP was designed, in part, as a respnse t the data presented in the TriWest reprt which nted that althugh there was an MHP established standard f timeliness fr a client t see a mental health prvider within 10 days f cntact with the Access Team r inpatient discharge, there was n standard fr psychiatry services timeliness. This reprt went n t nte that wait time t psychiatry services was excessive (in 2014 average f 40 days fr adults and 45 days fr children). In defining the PIP, the MHP did nt fcus n the amunt f time that new clients wait between admissin t services and their first psychiatry appintment, but n the insufficient number f psychiatrists t meet the need. This is a presumed and nt data driven cnclusin. Last year EQRO suggested rewrding the study questin and this was suggested in this EQRO review as well again. The current study questin lacks definitin f what will ccur in rder t bring abut mre timely access t psychiatry. It als creates a prblem in designating an anchr date in Page 27

28 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year that the prcess fr children t be referred t a psychiatrist is different than fr the adult client ppulatin. Relevant details f these issues and recmmendatins are included within the cmments fund in the PIP validatin tl. The technical assistance prvided t the MHP by CalEQRO cnsisted f discussin f hw t define referral date fr tw disparate ppulatins. Since the April 19 20, 2016 EQRO review, and telephne cnversatins are nging as MHP expresses the need t crrect issues within the PIP that are barriers t a useful study. PERFORMANCE IMPROVEMENT PROJECT FINDINGS IMPACT AND IMPLICATIONS Access t Care The clinical PIP des nt address access. The nn clinical PIP addresses access nly in defining the prblem as including lack f sufficient psychiatrists t meet the MHP s needs. Timeliness f Services The clinical PIP speaks t timeliness f initial and updated treatment plans. The nn clinical PIP attempts t address timeliness t psychiatry services as well as n shw rates. Quality f Care The clinical PIP includes mandatry training in quality treatment planning with an emphasis n engaging clients and instituting team based care. The clinical PIP fcuses n best practices in treatment planning t include increasing percentage f current/active treatment plans in charts. Cnsumer Outcmes The clinical PIP requires a cnsumer Perceptin Survey as prvided by the Department f Health Care Services (DHCS), specifically fur questins that assess client engagement and satisfactin. The nn clinical PIP lacks specific cnsumer utcme measures. 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 an Page 28

29 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year 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 are discussed belw. Access t Care As shwn in Table 4, 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 4 Access t Care Cmpnent Cmpliant (FC/PC/NC)* Cmments 1A Service accessibility and availability are reflective f cultural cmpetence principles and practices FC Thirty fur Prmtres received training which included Emtinal CPR and Mental Health First Aid. Eight are regularly prviding Hispanic utreach. The MPH is develping the RISE prgram which will prvide mental health services t victims f sex trafficking within a multi agency Cunty cllabrative. 1B Manages and adapts its capacity t meet beneficiary service needs FC A CSU and a Crisis Residential Facility were pened in Santa Barbara. Tele psychiatry is available at the CSU during the vernight hurs. Mbile Crisis Teams are nw present in all three regins f the Cunty. The Narctic Treatment Prgrams (NTP) was expanded and is nw serving ver 700 piid dependent clients cuntywide. 1C Integratin and/r cllabratin with cmmunity based services t imprve access FC An MOU was finalized with CenCal Health that will imprve health care integratin between primary care and mental health services Timeliness f Services *FC = Fully Cmpliant; PC = Partially Cmpliant; NC = Nt Cmpliant As shwn in Table 5, 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 29

30 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 5 Timeliness f Services Cmpnent Cmpliant (FC/PC/NC)* Cmments 2A Tracks and trends access data frm initial cntact t first appintment PC The MHP reprts a standard f 14 days with an verall average f 39.6 days and reprts it meets this 47% f the time. Fr its adult services, the MHP reprts an average f 44.5 days meeting this 46% f the time. Fr its children s services, the MHP reprts an average f 34.5 days meeting this 48% f the time. It wuld benefit the MHP t analyze this metric fr imprvements fr bth adult and children services since this is met less than half f the time. 2B Tracks and trends access data frm initial cntact t first psychiatric appintment PC The MHP reprts a standard f 14 days with an verall average f 46 days and reprts it meets it 39%. Fr its adult services, the MHP reprts an average f 45.3 days meeting this 44% f the time. Fr its children s services, the MHP reprts an average f 49.0 days meeting this 18% f the time. Again, it wuld benefit the MHP t analyze this metric fr imprvements fr bth services since this is met less than half f the time. In additin, stakehlders ften viced cncern in being able t access required medicatins in a timely manner. 2C Tracks and trends access data fr timely appintments fr urgent cnditins PC The MHP reprts a standard f 1 day with an verall average f 2.9 days and reprts it meets it 83%. Fr its adult services, the MHP reprts an average f 2.1 days meeting this 88% f the time. Fr its children s services, the MHP reprts an average f 5.6 days meeting this 67% f the time. Page 30

31 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 5 Timeliness f Services Cmpnent Cmpliant (FC/PC/NC)* Cmments 2D Tracks and trends timely access t fllw up appintments after hspitalizatin PC The MHP reprts a gal f 7 days with an average f 18.4 days and reprts it meets it 54%. Fr adult services it reprts an average f 17.6 days with 53% meeting this metric. Fr children s services it reprts an average f 25.6 days and reprts meeting this 65% f the time. 2E Tracks and trends data n rehspitalizatins FC The MHP reprts a gal f n mre than 15%. Fr bth adult and children services it reprts readmissin rates f 13%. 2F Tracks and trends N Shws PC The MHP reprts a standard f 20% with an average fr clinicians f 3% and an average fr psychiatrists f 13%. Quality f Care *FC = Fully Cmpliant; PC = Partially Cmpliant; NC = Nt Cmpliant The MHP reprts N Shw data is nt cnsistently entered. Therefre it is difficult t measure bth Systems f Care capacity t serve current and new clients. As shwn in Table 6, 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, 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 6 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments The MHP presented dcumentatin f a variety f Quality Imprvement trainings and Plicies and Prcedures acrss varius prgrams during the past year. 3A Quality management and perfrmance imprvement are rganizatinal pririties FC Page 31

32 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 6 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments 3B Data are used t infrm management and guide decisins FC MHP staff as well as ther stakehlder grups participate in the Mental Health Cmmissin s data wrk grup, Vital Signs. A set f system metrics were develped, data elements include clients served in system, age, lcatin f service, crisis cunts, crisis residential services prvided, distributin f services prvided by crisis teams, timeliness t first psychiatrist appintment and number f admissins t (Psychiatric Hspital Facilities ) PHF. 3C Evidence f effective cmmunicatin frm MHP administratin PC A significant number f plicies and prcedures have been develped and disseminated acrss prgrams ver the past year. A lack f cnsistent understanding and adherence t plicies and prcedures acrss the MHP s three regins cntinues t be reprted. 3D Evidence f stakehlder input and invlvement in system planning and implementatin PC Althugh the MHP invites line staff and CBO partner t participate in a number f change agent wrk grups as well as facilitates the CBO Cllabrative and attends the CBO calitin meeting, cntractrs reprted nt feeling cmfrtable bringing things t administratin fr system planning r prgrammatic changes. Department staff reprted that they receive infrmatin but have n effective avenue fr dialg with administratin r prgram decisins. 3E Integratin and/r cllabratin with cmmunity based services t imprve quality f care FC Cmmunity Based Organizatins (CBOs) endrse integratin and cllabratin with MHP administratin. 3F Measures clinical and/r functinal utcmes f beneficiaries served FC MORS is nw being utilized as a level f care indicatr. CANS previusly implemented and cntinues in use. Page 32

33 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 6 Quality f Care Cmpnent Cmpliant (FC/PC/NC)* Cmments 3G Utilizes infrmatin frm Cnsumer Satisfactin Surveys FC The MHP cnducted independent analysis f cnsumer satisfactin survey data. 3H Evidence f cnsumer and family member emplyment in key rles thrughut the system FC Cnsumer and family member emplyment cntinues t grw thrugh the MHP and cntractr prviders. There is n system wide career ladder in place. 3I Cnsumer run and/r cnsumer driven prgrams exist t enhance wellness and recvery FC Recvery learning Centers cntinue t be staffed and run by cnsumer family members. Wrkfrce Educatin and Training supprts part time peer psitins thrugh the Peer Expert Pl t prvide annual Crisis Interventin Training fr law enfrcement prfessinals and ther first respnders. *FC = Fully Cmpliant; PC = Partially Cmpliant; NC = Nt Cmpliant KEY COMPONENTS FINDINGS IMPACT AND IMPLICATIONS Access t Care The three reginal teams specializing in access and assessment based in Lmpc, Santa Maria, and Santa Barbara have imprved access t services. The Prmtre Cmmunity Health Educatrs Prgram frm culturally underserved ppulatins prvide culturally and linguistically apprpriate service t ensure linkage t services. Thirty fur received training which included Emtinal CPR and Mental Health First Aid. Eight are regularly prviding Hispanic utreach. Timeliness f Services The Cmmunity Health Centers f the Central Cast (CHCC) ffer mental health services at three clinics in Santa Maria and ne in Lmpc fr individuals with mild t mderate mental illness. This imprves timeliness t services fr referral f individuals at risk f a serius mental health cnditin. Page 33

34 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year The MHP established a 5150 wrkgrup t imprve the prcesses fr assessing individuals in crisis, identifying least restrictive placement ptins and prviding treatment in a timely manner. The MHP cntinues t recruit Psychiatrists/Physician Assistants/Nurse Practitiners t decrease wait times fr medicatin treatment. It is expected that they will be at full staffing this fiscal year. A PIP is in place t study this issue. Clinical staff are nt cnsistently dcumenting client services n a timely basis. Data fr appintment n shws are nt cnsistently entered. Quality f Care Cultural cmpetency is addressed acrss all levels f care and prgrams. Dcumentatin f multiple trainings t facilitate and assess this issue were presented t the EQRO. The Department cntinues t wrk n develpment and adptin f a Department Strategic Plan. There is expected cmpletin date at this time. The Department f Behaviral Wellness with partnering cunty agencies cnducts an annual training fr law enfrcement prfessinals and ther first respnders in dealing effectively with individuals experiencing a behaviral health crisis. Cnsumer Outcmes The MHP cntracted with a vendr t administer satisfactin surveys fr all discharged clients frm PHFs. This is a paper based survey sent t the vendr and analysis returned t the MHP. The elearning system has included Califrnia's Office f Statewide Health Planning and Develpment (OSHPD) peer trainings t include cultural cmpetency, empwerment in the wrkplace, and mental health first aid. The MHP has analyzed its DHCS mandated Perfrmance Outcmes and Quality Imprvement (POQI) surveys in huse this year in rder t facilitate mre timely feedback infrmatin n cnsumers satisfactin with services. Page 34

35 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year CONSUMER AND FAMILY MEMBER FOCUS GROUP(S) CalEQRO cnducted tw 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, which included the fllwing participant demgraphics r criteria: Cnsumer Family Member Fcus Grup #1: Culturally diverse grup f 8 10 parents/caregivers f child/yuth beneficiaries including bth high and lw utilizers f MHP services. At least three beneficiaries wh have initiated services within the last year. Cnsumer Family Member Fcus Grup #2: Culturally diverse grup f 8 10 adult beneficiaries, including bth high and lw utilizers f MHP services. At least three beneficiaries wh have initiated services within the last year. The fcus grup questins were specific t the MHP reviewed and emphasized the availability f timely access t care, recvery, peer supprt, cultural cmpetence, imprved utcmes, and cnsumer and family member invlvement. CalEQRO prvided gift certificates t thank the cnsumers and family members fr their participatin. CONSUMER/FAMILY MEMBER FOCUS GROUP 1 Fcus Grup cnsisted f six female parents/caretakers f child/yuth beneficiaries receiving services and ne Transitin Age Yuth (TAY)/yung adult female receiving services. Three f the family members initiated services in the past 12 mnths. Fr participants wh entered services within the past year, the experience was described as: All participants reprted easy Access Line cnnectins t services as a unifrm experience. The time t initial therapy appintment fr assessment ranged frm ne t tw days. The time t an initial psychiatrist appintments were reprted t be ne t tw weeks. The nly barrier reprted was the Safety Line with several participants reprting there was n call back when they left a message. All receive wraparund services and expressed appreciatin that family and friends can be included in this prcess. Recmmendatins arising frm this grup include: All participants agree that mre Spanish speaking staff wuld be useful fr cmmunicatin. Page 35

36 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year The participants agree that the Safety Line needs t be enhance s that calls are all prmptly returned. Table 7A displays demgraphic infrmatin fr the participants in grup 1: Table 7A Cnsumer/Family Member Fcus Grup 1 Categry Number Ttal Number f Participants* 7 Number/Type f Participants Cnsumer Only Cnsumer and Family Member Family Member 1 6 Ages f Fcus Grup Participants Under 18 Yung Adult (18 24) Adult (25 59) Older Adult (60+) 1 6 Preferred Languages Race/Ethnicity Gender English Spanish Bilingual English/Spanish Other(s) Caucasian/White Hispanic/Latin African American/Black Asian American/Pacific Islander Native American Other(s) Male Female Transgender Other Decline t state *Number f sub categries may nt add up t ttal number f participants due t the fact that sme participants may nt have cmpleted a Demgraphic Infrmatin Frm. Interpreter used fr fcus grup 1: N Yes Language(s): Spanish Page 36

37 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year CONSUMER/FAMILY MEMBER FOCUS GROUP 2 Fcus Grup cnsisted f five adult beneficiaries wh were receiving services ranging frm six t 24 years. There were n participants wh entered services within the past year. Experiences f the past twelve mnths were described as: The majrity f the participants agreed that the change in name, branding f the MHP was nted as having caused sme cmmunicatin prblems and service delays. One participant discussed feeling n lnger welcme at the utpatient clinic because f having spent a lnger time in treatment than was preferred. All participants agreed that the shrtage f availability f psychiatrists created difficulty with appintments and medicatin cmpliance. The participants reprted that incnsistent scheduling practices which include cancelling appintments withut ntificatin, and the discntinuatin f appintment ntices and reminders, interfered with their ability t sustain engagement in treatment. All participants nted this was the first time their pinins had been sught fr them t vice any feedback. Recmmendatins arising frm this grup include: Imprve cmmunicatin between clients, clinical staff and frnt desk, t reduce cnfusin f times and appintments. Prvide nging guidance when there are changes within the system f care, particularly thse that address prerequisites t medicatin services. Real time respnse t cmplaints and prblems by clinic manager wuld help reslve issues. Administratin cmmunicatin n branding and system integratin changes need t be cmmunicated mre clearly t cnsumers. Table 7B displays demgraphic infrmatin fr the participants in grup 2: Page 37

38 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 7B Cnsumer/Family Member Fcus Grup 2 Categry Number Ttal Number f Participants* 5 Number/Type f Participants Cnsumer Only Cnsumer and Family Member Family Member 4 1 Ages f Fcus Grup Participants Under 18 Yung Adult (18 24) Adult (25 59) Older Adult (60+) 4 1 Preferred Languages Race/Ethnicity Gender English Spanish Bilingual Spanish/English Other(s) Caucasian/White Hispanic/Latin African American/Black Asian American/Pacific Islander Native American Other(s) Male Female Transgender Other Decline t state *Number f sub categries may nt add up t ttal number f participants due t the fact that sme participants may nt have cmpleted a Demgraphic Infrmatin Frm. Interpreter used fr fcus grup 2: N Yes Language(s): Spanish CONSUMER/FAMILY MEMBER FOCUS GROUP FINDINGS IMPLICATIONS Access t Care The cnsumer family member grups all agreed that initial access is nt a prblem. Safety Line needs imprvement. Majrity f participants reprt leaving message and nt receiving a call back. Timeliness f Services Page 38

39 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year The timeliness f medicatin assessment bth initially and nging was an issue fr mst f the participants in the fcus grups. All nte lack f availability f psychiatrist appintments. Clinical appintments are nt always available r clearly defined as t hw t schedule. Cnsumers reprt that appintments are smetimes cancelled with them being ntified in advance f arriving at appintment. Quality f Care All grup participants endrsed that quality f care is adequate and they are respected culturally and linguistically in receiving services. The participants agreed that there is a need fr mre Spanish speaking staff, bth clinical and administrative staff. Several participants reprted that frnt desk staff are nt discrete with client cnfidential infrmatin. Cnsumer Outcmes The participants reprted that infrmatin and cmmunicatin n what is available and hw t access services is nt transparent. The participants reprted having the pprtunity t be invlved in a satisfactin survey f ne type r anther. Page 39

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41 Santa Barbara 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 8 shws the percentage f services prvided by type f service prvider: Table 8 Distributin f Services by Type f Prvider Type f Prvider Distributin Cunty perated/staffed clinics 41.93% Cntract prviders 56.40% Netwrk prviders 1.67% Ttal 100% Nrmal cycle fr submitting current fiscal year Medi Cal claim files: Mnthly Mre than 1x mnth Weekly Mre than 1x weekly MHP self reprted percent f cnsumers served with c ccurring (substance abuse and mental health) diagnses: 12.69% MHP self reprted average mnthly percent f missed appintments: 4.53% Des MHP calculate Medi Cal beneficiary penetratin rates? Page 41

42 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Yes N The fllwing shuld be nted with regard t the abve infrmatin: A penetratin rate reprt is autmatically generated mnthly and is utilized fr budgeting and service level determinatin. The MHP submits ne current fiscal year claim file and ne supplemental claim file each mnth. CURRENT OPERATIONS The MHP cntinues t utilize ShareCare frm The Ech Grup t supprt practice management, billing, and state reprting functinality. Clinician s Gateway, by Plattn Technlgies, is utilized fr electrnic health recrd (EHR) functinality including prgress ntes, treatment plans and assessments. Data is exchanged between the tw systems. The MHP reprts that 41.93% f services are prvided by cunty perated/staffed clinics, 56.40% by cntract prviders and 1.67% by netwrk prviders % f services are claimed t Shrt Dyle/Medi Cal (SD/MC). The MHP reprts timely claim files submissin. The March 2016 claim was submitted April 12, The MHP rutinely tracks denied claims and prvided a claims summary fr the mnth f March The SD/MC claim summary reprted a denied claims rate f 3.36% with 16,032 services submitted and 539 services denied. The MHP reprts the tp reasn fr denial in this perid was Aid cde invalid fr Medi Cal specialty mental health billing. The last Client Services Infrmatin data file submitted was the September 2015 file which was submitted in Octber Due t a ShareCare functinality issue, the MHP has been unable t submit CSI data since Octber 2015, ICD10 transitin. The Ech Grup has nt yet been able t prvide the MHP an expected date fr the reslutin f this issue. The MHP requests regular updates n the status f the prgress twards a reslutin f this issue. Technlgy staffing cnsists f 15 Full Time Emplyee (FTE) psitins. As f April 2016, there were three unfilled technlgy psitins: Prgrammer Analyst (1 FTE), Cmputer Systems Specialist (1 FTE), Office Autmatin Specialist (0.5 FTE). The Infrmatin Technlgy Manager psitin was vacated in August 2015 and filled in March Page 42

43 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Cntract prvider staff lgn t the Santa Barbara Cunty secure netwrk t access ShareCare and Clinician s Gateway. Prviders use file transfer prtcl (FTP) prcess t uplad service transactins and ther data t ShareCare. Frm July 2015 thru March 2016, 183 adults and 37 children received services via telepsychiatry. The MHP is currently utilizing telepsychiatry at the CSU during the vernight hurs. Services are prvided by JSA Health Telepsychiatry. There are currently n plans t expand telepsychiatry use beynd the CSU. The Infrmatin Systems Steering Cmmittee cntinues t meet n a mnthly basis. MAJOR CHANGES SINCE LAST YEAR elab was implemented in July The Milestnes f Recvery Scale (MORS) was implemented in the EHR in July 2015 and clinical use began in December A Plicy & Prcedures (P&P s) database went live in February 2016 and enables staff t easily access all department P&Ps by categry. A Cnsumer Perceptin Survey data analysis reprt was develped. As a result f a Tri West reprt recmmendatin, ADP Cntract Prviders are being trained t utilize Clinician s Gateway t cmplete their dcumentatin, enabling easier access t ADP client infrmatin and regular auditing f services. ShareCare client Face Sheets nw include the ability t enter and reprt the client s primary care physician. There is nw unifrm use f electrnic prescribing (RxNT) by all psychiatrists. New psychiatrists nw receive RxNT training during their first week f emplyment. All clinics have been prvided with electrnic tablets t facilitate cllabratin between client and clinician in the develpment f treatment plans. A set f system metrics were develped and is reprted t the Bard f Supervisrs every six mnths, data elements include number f clients served in system, age, lcatin f service, crisis cunts, crisis residential services prvided, distributin f services prvided by crisis teams, timeliness t first psychiatrist appintment and number f admissins t PHF. The electrnic clinical dcumentatin manual was updated and mnthly trainings are cnducted fr the writing f assessments, treatment plans and prgress ntes. Page 43

44 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Clinicians and Supervisrs are tracking prgress nte cmpletin by regularly reviewing a dashbard which indicates, per clinician, the date and time prgress ntes were cmpleted, as well as the prcedure cde attached t the nte. In May 2015, the MHP partnered with the Cunty CEO, Prbatin Department and Sheriff s Department t analyze the increasing Incmpetent t Stand Trial (IST) declaratins that the cunty was experiencing. The Cunty CEO wanted t understand the lngitudinal nature f the type f residents that were declared IST (demgraphics, criminal histry, diagnstic infrmatin and dispsitin). Data was used fr a presentatin t the Bard f Supervisrs and fr planning purpses between departments t develp strategies and prgrams t better meet the needs f these residents such that an IST declaratin might be prevented. In February 2016, the MHP determined that the CANS was nt rutinely being cmpleted fr new clients r every 6 mnths fr nging clients. MORS data in the nn FSP prgrams was als sparse, but that was anticipated since the nn FSP prgrams began using the MORS in December In respnse t the lw cmpliance rate, the MHP began reprting n these items twice mnthly and clinical peratins management made this a pririty staff supervisin issue. PRIORITIES FOR THE COMING YEAR Cmplete develpment f the CRS. Users will be able t create reprts thrugh a series f cascading filter ptins. Additinally, there will be canned reprt structures available that will have the capacity t be refreshed with current data. The canned reprts are being develped will be drawn frm examples f existing reprts currently generated n a weekly/mnthly/quarterly basis. A pre cnsumer database is being develped t track an individual s first encunter with the mental health system and ensure that there is clear data f when the individual is first referred t services and whether the individual presents fr services. The dcument imaging prject is nearing cmpletin. All utpatient clinics are expected t be 95% electrnic by June 2016; hard cpy dcuments will cntinue t be scanned int the EHR regularly t maintain a cmplete electrnic file. T imprve tracking and fllw up f mandatry training requirements, they are mving t the Relias training platfrm, which will prvide increased training tls and ptins as well as imprved tracking f training cmpletin and administrative reprts. This prject is expected t be live June Cllabrate with Clinicians Gateway t develp a prcess fr cleaning up prgress ntes that are held in draft/pending status. Cntinue EHR replacement mdule evaluatin. Page 44

45 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year OTHER SIGNIFICANT ISSUES While the MHP has adpted a Plicy & Prcedure that establishes standards fr the cmpletin f prgress ntes since the last EQRO review: Clinical staff cntinue t nt cnsistently dcument client services n a timely basis. Als, n shw appintments are nt cnsistently reprted. Therefre, it is difficult t accurately measure bth adult and children Systems f Care and capacity t serve bth current and additinal clients. Table 9 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 SD/MC and ther third party claims, track revenue, perfrm managed care activities, and prvide infrmatin fr analyses and reprting. Table 9 Current Systems/Applicatins System/Applicatin Functin Vendr/Supplier ShareCare Practice Management, Managed Care, Master Patient Index Years Used The Ech Grup 7 MHP Clinician s Gateway EHR Plattn Technlgies 8 MHP Operated By RxNT/eRX e Prescribing RxNT 6 MHHP/Vendr PLANS FOR INFORMATION SYSTEMS CHANGE While there are n current plans t replace the ShareCare/Clinicians Gateway system, the MHP plans t cntinue its EHR replacement mdule evaluatin. ELECTRONIC HEALTH RECORD STATUS Table 10 summarizes the ratings given t the MHP fr EHR functinality. Table 10 Current EHR Functinality Functin System/Applicatin Present Assessments Gateway X Partially Present Clinical decisin supprt Gateway X Dcument imaging Gateway X Rating Nt Present Nt Rated Page 45

46 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Table 10 Current EHR Functinality Functin System/Applicatin Present Electrnic signature client Gateway X Electrnic signature prvider Gateway X Labratry results (elab) Gateway X Outcmes CANS, MORS X Prescriptins (erx) RxNT/eRx X Prgress ntes Gateway X Treatment plans Gateway X Partially Present 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: elab was implemented in July The MORS was implemented in the electrnic health recrd in July There is nw unifrm use f RxNT by all psychiatrists. New psychiatrists nw receive RxNT training during their first week f emplyment. INFORMATION SYSTEMS REVIEW FINDINGS IMPLICATIONS Access t Care The MHP is currently utilizing telepsychiatry at the CSU during the vernight hurs. Timeliness f Services A pre cnsumer database is in develpment t allw fr the capability t track an individual s first encunter with the mental health plan. Quality f Care Clinical staff are nt cnsistently dcumenting client services n a timely basis. Data fr appintment n shws are nt entered cnsistently. Clinicians and Supervisrs have begun tracking prgress nte cmpletin by regularly reviewing a dashbard reprt which indicates the date and time prgress ntes were cmpleted. elab as implemented in the electrnic health recrd in July Page 46

47 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year ADP Cntract Prviders are being trained t utilize Clinician s Gateway t cmplete their dcumentatin, enabling easier access t ADP client infrmatin and regular auditing f services. All clinics have been prvided with electrnic tablets t facilitate cllabratin between client and clinician in the develpment f treatment plans. ShareCare client Face Sheets nw include the ability t enter the primary care physician. The dcument imaging prject is nearing cmpletin. The establishment f a cmplete EHR will enhance cntinuity f care between the regins. Cnsumer Outcmes The Milestnes f Recvery Scale was implemented in the EHR in July The MHP determined that the Child and Adlescent Needs and Strengths was nt rutinely being cmpleted fr new clients r every 6 mnths fr nging clients. A Cnsumer Perceptin Survey data analysis reprt was develped. Page 47

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49 Santa Barbara 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: There were n barriers r cnditins that significantly affected CalEQRO s ability t prepare fr and/r cnduct this review. Page 49

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51 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year CONCLUSIONS During the FY15 16 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: Crisis Triage Teams are nw established and perating in all three regins f the cunty. Mbile Crisis Teams are nw present in all three regins f the cunty. At utpatient mental health clinics there is better capacity fr serving persns with c ccurring disrders fr alchl and drug issues with the use f Screenings, Brief Interventin, and Referral t Treatment (SBIRT). Telepsychiatry services, prvided by JSA Health Telepsychiatry, are available at the CSU during the vernight hurs. Orientatins grups are nw ccurring at all clinic sites. A welcme brchure was develped and a welcming vide is in develpment. A MOU was finalized with CenCal Health that will imprve health care integratin between primary care and mental health services. Opprtunities: Parents f children/yuth receiving services reprt the Safety Line recrding gives them an ptin f leaving a message, but smetimes their calls are nt returned. Telepsychiatry des nt exist utside f the CSU vernight hurs. Lack f sufficient capacity fr psychiatrist appintments was nted by clients and staff acrss Levels f Care and Prgrams. Timeliness f Services Strengths: Page 51

52 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year The MHP cntinues t recruit Psychiatrists/Physician Assistants/Nurse Practitiners t enhance timeliness t psychiatric/medicatin assessment and treatment. Walk ins are nw accepted at all MHP clinics. Opprtunities: Clients reprt issues with medicatin cmpliance due t lack f available psychiatry appintments. Quality f Care Strengths: A significant number f plicies and prcedures have been develped and disseminated acrss prgrams ver the past year t increase cnsistency and cmmunicatin f standards. The MHP has created a website fr staff that ffers resurces fr nline as well as in persn trainings fr staff. This site als allws access t plicies and prcedures and frms and manuals that cver sme department prgrams, ShareCare, Clinician s Gateway and ther tpics. Permanent hirings f key staff have been made including: IT Manager, Assistant Directr f Clinical Operatins, Deputy Directr fr Operatins and Administratin, HR Manager, and CFO. These have added cnsistency t the administratin f day t day peratins. Opprtunities: While plicies and prcedures have been develped and disseminated, staff cntinues t reprt a lack f cnsistent understanding f plicies and prcedures acrss the MHP s three regins. High turnver f staff in the past year has negatively affected cnsistency and cntinuity f service delivery. Cnsumer Outcmes Strengths: A Cnsumer Perceptin Survey data analysis reprt was develped. The MORS was implemented in the electrnic health recrd in July 2015 and clinical use began in December Opprtunities: Page 52

53 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year The CANS was fund nt t be rutinely cmpleted fr new clients r every six mnths fr nging clients. Grwing Grunds Farm Transitins Mental Health Assciatin recently lst funding. Cnsumers nw must vlunteer time and there is n lnger any prjected funding fr salaries. This reduces the benefits f wrking in this envirnment as well as making it mre difficult fr the cnsumer t access. Cnsumers reprt that cmmunicatin between them and the MHP is erratic in appintment changes, cancellatins and/r mdificatins t their services. RECOMMENDATIONS Adequate staffing fr this MHP remains a challenge with implicatins fr access, timeliness and quality f services. Hiring f clinical staff, case management staff and bilingual Spanish speaking staff need t be pririty in recruitment as well as retentin. A lack f cnsistent understanding and adherence t plicies and prcedures acrss the MHP s three regins cntinues t be reprted. Develp and implement a system f plicies and prcedures with checks fr cmpliance t ensure all staff are aware f and cmpliant with plicies and prcedures as well available training pprtunities. Issues arising frm the shrtage f psychiatrists is reprted acrss the system and prgrams. Create a plan t increase telepsychiatry ptins while cntinuing t develp a recruitment and retentin plicy fr effectiveness in filling psychiatry psitins. Cntinue t mnitr the twice mnthly utcme measure reprt t assure the Child and Adlescent Needs and Strengths and MORS is used in cmpliance with MHP standards. Cmplete develpment f the Clinical Reprting System t allw users the ability t create custm reprts as well as expand the capacity t refresh canned reprts with current data as needed. Maintain cnsistent cntact with The Ech Grup t assure a timely reslutin t the MHP s inability t submit Client Service Infrmatin (CSI) data files t the State. Page 53

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55 Santa Barbara 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 55

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57 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT A REVIEW AGENDA Page 57

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59 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Duble click n the icn belw t pen the MHP On Site Review Agenda: Page 59

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61 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT B REVIEW PARTICIPANTS Page 61

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63 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year CALEQRO REVIEWERS Lynda Hutchens, NCC, LMFT, Lead Quality Reviewer Lisa Farrell, Infrmatin Systems Reviewer Marilyn Hillerman, Lead Cnsumer Family Member Cnsultant Luann Baldwin, Cnsumer Family Member Cnsultant 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 Barbara Cunty Department f Behaviral Wellness 300 N. San Antni Rd, Santa Barbara, CA E. Ocean, Lmpc, CA 500 West Fster Rad, Santa Maria, CA CONTRACT PROVIDER SITES Mental Wellness Center, 617 Garden St., Santa Barbara, CA PARTICIPANTS REPRESENTING THE MHP Name Psitin Agency Alice Geanta, MFT PEI TAY Clinician Behaviral Wellness Alice Gleghrn, PhD Directr Behaviral Wellness Amy Wilbrn Children s Katie A. Santa Maria Behaviral Wellness Ana Vicuna Divisin Chief Clinical Operatins Behaviral Wellness Annmarie Camern CEO Mental Wellness Center April Hward Research Prgram Evaluatin Manager Behaviral Wellness Araceli Delgad Children s Katie A. Lmpc Behaviral Wellness Arlene Altbelli Team Supervisr Santa Maria Behaviral Wellness Awena Frnda Katie A. Clinician Behaviral Wellness Careena Rbb QAM Crdinatr Behaviral Wellness Page 63

64 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Name Psitin Agency Cherie Chavez, MFTI Calle Real Santa Barbara Adult clinic Behaviral Wellness Chris Ribeir Interim CFO Behaviral Wellness Crinne Cntreras Peer Recvery Specialist Be Well Crystal Ramirez Reginal Manager Santa Barbara Be Well Dana Gamble Assistant Deputy Directr Public Health Dawn M. Dunn Tbacc Preventin Public Health Department Deana Huddlestn QCM Manager Behaviral Wellness Debra Simn, LMFT Clinical Directr Crescend Health/Phenix Diane Glaser Tbacc Cntrl/Preventin Public Health Department Dnna Slimak Directr Member Services CenCalHealth Eddie Hsueh Lieutenant Sheriff s Office Elizabeth Barbss, RN Psychiatric Nurse Senir Behaviral Wellness Eldie Patarias, MFT Team Supervisr Santa Maria Adult Outpatient Clinic Geff Bernard Team Supervisr Santa Maria Adult Outpatient Clinic Gizelle Mendza Practitiner Intern Fster rad Behaviral Wellness Health Fletcher Audit Manager Auditr Cntrller Hlly Mrris IMF TAY Behaviral Wellness Irvin Lunianski, MD QCM Psychiatrist Behaviral Wellness J. Manuel Casas Mental Health Cmmissiner Santa Barbara Cunty J.T. Turner, MFT Executive Directr Crescend Health Jamie Huthsing QCM Crdinatr Behaviral Wellness Janet Alexander Team Supervisr/CARES Be Well Jeanie Sleigh Health Center Administratr Public Health Jelene Paulr n title given Behaviral Wellness Jennifer Newbld Vice President PathPint Jnathan Gee, IMF WRR Team Clinician Behaviral Wellness Julia Patricia Fara, PhD WRR Team Clinician Behaviral Wellness Katrina Vgt Supervisr CWS Kim Shean Manager Prbatin Krisna Isaac RN, Team Supervisr Behaviral Wellness Krystina Medina Practitiner Intern (CSU) Behaviral Wellness Lee Bthel DCPO Prbatin Leslie Lundt, MD Medical Directr, Acute Psychiatric Services Behaviral Wellness Page 64

65 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Name Psitin Agency Linda Petersn, MFT Maria Bnifaci MH Licensed Clinician, Santa Maria Children s Clinical Practitiner Intern, Mbile Crisis Lead Behaviral Wellness Behaviral Wellness Marjrie McCarthy Waivered Psychlgist Behaviral Wellness/CARES Suth Marshall Ramsey IT Manager Behaviral Wellness Nicle Becker Team Supervisr Lmpc Adult Clinic Behaviral Wellness Ole Behrendtsen Medical Directr Behaviral Wellness Pam Fisher Divisin Manager Behaviral Wellness Patty Almagner Auchard, MD Medical Cnsultant TCRC Refuji Rdriguez Divisin Chief, MHSA Behaviral Wellness Richelle Bucayu Administratr Telecare Crpratin Rita Dwyer, RN PHF UR Behaviral Wellness Sandra Zavate RN Behaviral Wellness Sandy Fahey Reginal Manager Behaviral Wellness Sara Bazan Children s Clinic Team Supervisr Santa Barbara Behaviral Wellness Shereen Khatapush Research and Prgram Evaluatin Behaviral Wellness Silvia P. Perez Peer Recvery Specialist Behaviral Wellness Stacy McCrry Frensic Manager Behaviral Wellness Stephanie Diaz Team Supervisr Alchl and Drug Prgram Susan Sderman QCM Crdinatr Behaviral Wellness Suzanne Grimmesey Chief Quality Care and Strategy Officer Behaviral Wellness Talia Pinnel Systems Training Crdinatr Behaviral Wellness Thelma Macias Guerra Team Supervisr Lmpc Children and TAY Services Tina Wtn Vernica Heinzelmann, LCSW Yaneris Muniz Cnsumer Empwerment Manager Health Care Prgram Crdinatr Plicy and Prject Develpment Crdinatr Behaviral Wellness Behaviral Wellness Behaviral Wellness Page 65

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67 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT C APPROVED CLAIMS SOURCE DATA Page 67

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69 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year These data are prvided t the MHP in a HIPAA cmpliant manner. Page 69

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71 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year ATTACHMENT D PIP VALIDATION TOOL Page 71

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73 Santa Barbara Cunty MHP CalEQRO Reprt Fiscal Year Duble click n the icns belw t pen the PIP Validatin Tls: Clinical PIP: Nn Clinical PIP: Page 73