Pennsylvania HealthChoices Behavioral Health Quarterly Monitoring Report: Third Quarter 2009
INTRODUCTION The Pennsylvania HealthChoices Behavioral Health Quarterly Monitoring Report: Third Quarter 2009 offers a summary of the Commonwealth s Medical Assistance Managed Behavioral Health Care program. The report utilizes data from Behavioral Health Managed Care Organizations (BH-MCOs) and Consumer/Family Satisfaction Teams to mark progress over time for a variety of performance indicators. Where applicable, there are separate measures monitored for the adult system of community-based care and the children s service delivery system. Findings are grouped by County, HealthChoices Behavioral Health zone and by Behavioral Health Managed Care Organization (BH-MCO). These data allow for a more meaningful comparison across established entities. To facilitate discussion with readers of the report, the report format includes a balance of narrative description and graphical presentations. Each performance indicator includes a goal, a rationale and significant observations. It is important to note here that the HealthChoices Behavioral Health Program is statewide (i.e., it covers all 67 Pennsylvania Counties), this Third Quarter 2009 Quarterly Monitoring Report (QMR) now monitors the performance of all 67 zones/counties: Southeast zone (implemented 02/01/1997): Bucks, Delaware and Montgomery Counties (managed by Magellan Behavioral Health), Chester (managed by Community Care Behavioral Health) and Philadelphia County (managed by Community Behavioral Health). Southwest zone (implemented 01/01/1999): Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and Westmoreland (managed by Value Behavioral Health), and Allegheny county (managed by Community Care Behavioral Health). Lehigh/Capital zone (implemented 10/01/2001): Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties (managed by Community Behavioral Healthcare Network of Pennsylvania), Lehigh and Northampton Counties (managed by Magellan behavioral Health) and Adams, Berks and York Counties (managed by Community Care Behavioral Health). Northeast zone (implemented 07/01/2006): Lackawanna, Luzerne, Susquehanna and Wyoming (managed by Community Care Behavioral Health). North/Central state Option (implemented 01/01/2007) : Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniata, McKean, Mifflin, Montour, Northumberland, Potter, Schuylkill, Snyder, Sullivan, Tioga, Union, Warren, and Wayne (managed by Community Care Behavioral Health). North Central County Option (implemented 07/01/2007): Cambria, Crawford, Mercer, Venango, and Erie (managed by Value Behavioral Health), Bedford, Somerset, Blair, Franklin, Fulton, Clinton, and Lycoming (managed by Community Behavioral Healthcare Network of Pennsylvania), Carbon, Monroe, and Pike (managed by Community Care Behavioral Health). 2
CONTENTS Quarterly Monitoring Report QuickLinks (To access a specific section of the report, simply Ctrl and Click on the link. To return to this page, use the Ctrl and Click functionality from the section link). Executive Summary Adult Involuntary Admissions HealthChoices Southeast Southwest Lehigh/Capital Northeast NCSO NCCO Denials HealthChoices Southeast Southwest Lehigh/Capital Northeast NCSO NCCO 30 Day Readmissions Grievances HealthChoices Children HealthChoices Southeast Children Southeast Southwest Children Southwest Northeast Children Lehigh/Capital Lehigh/Capital Children Northeast NCSO Children NCCO NCSO NCCO HealthChoices Adult Southeast Adult Southwest Adult Lehigh/Capital Adult Northeast Adult NCSO Adult NCCO Complaints HealthChoices Southeast Southwest Lehigh/Capital Northeast NCSO NCCO Performance Improvement Projects Follow-up after MH Inpatient Hospitalization Follow-up after non-hospital D&A Rehab Consumer Satisfaction State Questions HealthChoices 3 Questions Southeast 3 Questions Southwest 3 Questions Lehigh/Capital 3 Questions Northeast -- 3 Questions NCSO -- 3 Questions NCCO -- 3 Questions 3
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EXECUTIVE SUMMARY ADULT INVOLUNTARY ADMISSIONS Voluntary treatment is preferable to involuntary treatment. Accordingly, the state s goal is for involuntary admissions to psychiatric inpatient treatment to decrease over time. For all Established HealthChoices Counties taken together, the number of involuntary admissions, 2,594 was within the range of the last eight quarters but the rate of admissions (3.2 per 1000 adult members) was down from the previous quarter. In the Lehigh/Capital zone, Cumberland, Dauphin, Lebanon, Lancaster, Perry, York, Adams, Lehigh, and Berks Counties had their highest rate for adult involuntary admissions in the last four quarters. Greene Counties had a decreased rate of involuntary admissions in three successive quarters. The North/Central State Option, the Northeast, and the North/Central County Option zones had the lowest number of involuntary admissions per 1,000 Members. These are positive findings. Philadelphia (5.6 per 1000), Delaware(4.9 per 1000), and Montgomery (4.9 per 1000) Counties have been outliers with high rates of involuntary admissions in the last eight measured quarters. Armstrong, Susquehanna, Huntingdon, Bradford, and Warren Counties had an increased rate of involuntary admissions in two successive quarters. These findings represent challenges to the above counties. For the NCSO counties taken together, there were 114 Involuntary Admissions in the quarter and 108 in the prior quarter. The rate for the NCSO region was 1.6 per 1000 adult members, which was below the mean of 3.2 per 10,000 members for all HealthChoices Counties in the same quarter. The rates for all of the NCCO counties, except Bedford and Pike Counties, were below the mean of the HealthChoices counties for this quarter. The rate for the NCCO region was 1.7 per 1000 adult members. 30 DAY INPATIENT PSYCHIATRIC READMISSION Persons who stabilize during hospitalization and access community resources are less likely to need rehospitalization. The state s goal is that less than 10% of persons being discharged from psychiatric inpatient hospitalization will be readmitted within 30 days of discharge. Children: During the Third Quarter of 2009 eleven percent (11%) of children in all established HealthChoices behavioral Health Counties were readmitted to inpatient psychiatric treatment within 30 days of a psychiatric hospital discharge, 1% less than the prior quarter. Thirty-eight counties met the state s goal in the current quarter with the inclusion of the NCCO Counties. These counties were: Three Suburban SE Counties (Bucks, Delaware and Philadelphia), two Lehigh/Capital Counties (Cumberland and York), five Suburban SW Counties (Allegheny, Armstrong, Butler, Greene, and Washington) and three Northeast County (Luzerne, Susquehanna, and Wyoming.) Seventeen of the 23 NCSO Counties met the state s goal (Centre, Huntingdon, Juniata, Jefferson, Cameron, Elk, Forest, McKean, Potter, Warren, Montour, Schuylkill, Union, Bradford, Sullivan, Tioga and Wayne.) Eight of the NCCO Counties met the states goal (Bedford, Blair, Cambria, Franklin, Mercer, Monroe, 5
Pike, and Venango.) Delaware met the state s goal in each of the last seven quarters, as well as Bucks in the last three quarters. Venango County met the state s goal for the last nine quarters; Lycoming Counties for the last four quarters, Pike for the last 3 quarters, as well as Bedford and Carbon Counties for the last 2 quarters. Delaware County met the state s goal in the each of the last seven quarters; Butler County in the last four quarters and Bucks, Delaware, Montgomery, and Northampton in the last two quarters. Washington, Lebanon, Cumberland, McKean, Montour and Bedford Counties had decreased readmissions in two successive quarters. The above counties are commended. Twenty-nine counties did not meet the state s goal in the current quarter with the inclusion of the NCCO Counties: Lawrence, Beaver, Fayette, Indiana, Westmoreland, Chester, Montgomery, Berks, Adams, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, Lackawanna, Mifflin, Clarion, Clearfield, Snyder, Columbia, Northumberland, Somerset, Clinton, Lycoming, Monroe, Cambria, Erie, and Crawford. Chester, Montgomery, Adams, Lehigh, Perry Luzerne Northumberland, Snyder, Bradford Somerset, and Lycoming Counties had increased readmissions in two successive quarters. The low number of hospital admissions may have affected the findings in some counties. However, these results suggest challenges for children s services in the above counties to improve community tenure. Adults: An average of 15% of adults was readmitted in the Established HealthChoices Counties, the same as in the prior quarter. Fifteen of the 67 Counties met the states goal in the current quarter. Juniata County had no readmissions in the last two quarters and Susquehanna in the current quarter. Adams and Potter Counties met the states goal in the last four quarters, Franklin in the last two quarters. Greene, Juniata, Jefferson, Cameron, Schuylkill, Snyder, Union, Wayne, Clinton, Susquehanna, and Wyoming Counties met the state s goal in the current quarter. Dauphin, Lebanon, Wyoming, Juniata, Franklin and Tioga Counties had decreased readmissions in the last two quarters. These are positive findings. Eight Counties Northumberland, Forrest, Sullivan, Huntingdon, Somerset, Fulton, Bedford, and Pike had 20% or more adults readmitted in the quarter, an increase from five counties in the prior quarter. Chester County fell below having more than 20% of their inpatients readmitted for the first time in seven quarters. The percentage of readmissions for 44 counties was between 11% and 19%. These counties were Philadelphia, Chester, Bucks, Delaware, Montgomery, Allegheny, Armstrong, Beaver, Fayette, Butler, Indiana, Washington, Lawrence, Westmoreland, Dauphin, Berks, Cumberland, Lebanon, Lancaster, Lehigh, Northampton, Perry, York, Lackawanna, Luzerne, Bradford, Mifflin, Clarion, Clearfield, Elk, Montour, Tioga, Centre, Snyder, Columbia, Warren, McKean, Lycoming, Monroe, Carbon, Mercer, Cambria, Crawford, and Venango. The low number of hospital admissions may have affected the reliability of the findings in some counties. However, these results suggest that challenges exist for counties in developing the supports necessary to support adult mental health consumers in community-based settings. 6
ANALYSIS OF COMPLAINTS HEALTHCHOICES BH-BH-MCOs Consumer complaints are an important means for consumers to inform counties, BH-MCOs, and the state about concerns with clinical and BH-MCO services. Complaints help counties and BH-MCO s identify opportunities to improve the service system. On average, for all HealthChoices counties there were 232 complaints per month or 1.3 per 10,000 members per month. The Lehigh/ Capital, Northeast, and the North Central State Option Zones had a low frequency of complaints, a frequency less than one per 10,000 members per month. Within these Zones, the Suburban Southwest Counties (Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and Westmoreland), York/Adams, and the Capital Five Counties (Cumberland, Dauphin, Lancaster, Lebanon and Perry) had a low frequency of complaints, a frequency less than one per 10,000 members per month, with the Capital Five having the lowest rate of 0.4 per 10,000Members. The most frequent complaint was Provider Quality of Care with 348 complaints followed by Provider Customer Service with 196. NUMBER OF MEMBERS DENIED REQUESTED SERVICE Denials to pay for a requested service can result in appropriate, efficient care or create a barrier to necessary treatment. The goal is to ensure consumers have access to medically necessary services by monitoring trends for denials to pay for requested services. During the quarter 4196 members were denied a service 1222 more than the prior quarter of 2974 with the inclusion of the NCCO Counties. Any comparison with previous quarters must be made with the consideration of the addition of these counties. There were 3,206 denial events for Behavioral Health Child Rehabilitation Services in the current quarter, 347 denial events for RTF in the current quarter and 65 denial events for MH Case Management Services in the current quarter. The number of denial events for Family Based MH Services was 184 and Psychiatric Outpatient was 149.The number of denial events for Residential Detox was 107 and Psychiatric Partial was 53. Inpatient Psychiatric (301 denials) was the only other services with ten or more denials. In the SE/SW Regions combined (2027 denials) there were an increased number of denial events for Psychiatric Outpatient (23 denials) and Behavioral Health Child Rehabilitation Services (1516 denials) in the last quarter. MH Case Management (65 denials) decreased in the two quarters. Inpatient Psychiatric Hospital (162 denials), Family Based MH (50 denials) and Residential Detox (81 denials) decreased in the last quarter. Psychiatric Partial Hospital (9 denials) and RTF Services (206 denials) increased in the in the last quarter. In the LC Region (873 denials) there were a decreased number of denial events for RTF Services (62 denials) compared to 114 in the last quarter; BH Child Rehab (647 denials) decreased in the last quarter and Family-Based MH Services (80 denials) remained steady. Psychiatric Outpatient (60 denials) increased in the last quarter. Inpatient Psychiatric (71 denials) increased in the last quarter, while Residential Detox (9 denials) remained steady. 7
In the NE Region (231 denials) there was a decrease of denial events for RTF services (25 denials in the current quarter) in each of the last two quarters. The only other service with more than 10 denials was BH Child Rehab Services (180 denials). In the NCSO Region (257 denials) there was a decrease of denial events for BH Child Rehab (221denials) compared to 247 in the last quarter. There were 17 denials for RTF services which remained steady. Psychiatric outpatient went from 16 denials in the last quarter to 21 denials in this quarter. No other service had more than 4 denials. In the NCCO Region (837 denials) BH Child Rehab Services (642 denials) decreased by 149 denials. Inpatient Psychiatric Hospital (64 denials), and Family Based MH (49 denials) decreased in the last quarter. Psychiatric Partial Hospital 42 denials) and Residential Detox (15 denials) increased in the in the last quarter. RTF Services (37 denials) remained the same. GRIEVANCES Consumers and providers grieve denials of service authorization when they have concerns about the authorization decisions. Grievances can be associated with improper denials of service authorization and reflect barriers to care. Grievances ensure that authorization decisions are appropriate and that denials do not present a barrier to appropriate care. For all HealthChoices Counties taken together there were 851 grievances. The number of grievances increased by 270 from the prior quarter with the addition of the NCCO Counties. The percentage of grievances per denial in Cumberland and Lancaster Counties decreased by more than 20%, compared to the average of the prior four quarters. The percentage of grievances per denial in Allegheny County increased by more than 20%, compared to the average of the prior four quarters, in each of the last five quarters, the SW Suburban Counties showed an increase in the last two quarters and Lehigh/Northampton in the last quarter. The percentage of grievances per denial increased by more than 20% in Snyder County in the last two quarters, and Centre, Cameron, Columbia, Snyder, Bradford, and Sullivan Counties in the last quarter. Please note that the low number of grievances, ten or fewer, in several counties may have affected the reliability of the results. The percentage of grievances per denial increased by more than 20% in Monroe, Pike, Franklin, Fulton, and Lycoming Counties compared to the average of the prior four quarters. The percentage of grievances per denial decreased by more than 20%, compared to the average of the prior four quarters, in Clinton County during each of the last two quarters and in Somerset, Crawford and Venango Counties in the current quarter. Please note that the low number of grievances, ten or fewer, in several counties may have affected the reliability of the results. 8
ANALYSIS OF INDICATORS Third Quarter 2009 PERFORMANCE IMPROVEMENT PROJECTS This section reflects the Performance Improvement Project (PIP) activities of the various counties and their associated BH-MCO. The rates reflect the validated rates for calendar year 2007, 2008 and the 2009 year-to-date rate. Rates are based on self-reported data and with the exception of the Follow-up after MH Inpatient Hospitalization, will not be validated. Mental Health Follow-up after MH Inpatient Hospitalization All HealthChoices counties and their BH-MCO participated in this activity. The rationale behind the activity is that improved follow-up rates after discharge would have an impact on readmission rates. This activity was initially undertaken as an external quality review and Performance Based Contracting initiative. To allow comparison to national benchmarks, HEDIS (Health Plan Employer Data and Information Set) standard procedure codes were used for two of the indicators. To facilitate comparison with earlier activities, two measures used the HEDIS procedures plus additional codes for ICM and RC. Additional Recovery-Oriented procedure codes have been added to the HEDIS codes. This PIP is being used by OMHSAS to partially fulfill requirements of the Federal waiver. Follow-up was measured using four indicators: At 7 days using HEDIS defined procedure codes Indicator 1 At 30 days using HEDIS defined procedure codes Indicator 2 At 7 days using the HEDIS procedure codes plus the PA codes Indicator A* At 30 days using the HEDIS procedure codes plus the PA codes Indicator B* The table below shows the 2004 baseline rates, the 2007 validated rates, the 2008 validated rates, and the un-validated rates for 2009 year-to-date. Data from this PIP will be validated by IPRO and may change after validation. The OMHSAS Gold standard is 90% for all indicators. * NCQA added a number of new procedures to HEDIS in 2007 and the validated 2007 and 2008 rates reflect the addition of these codes. * The HEDIS Plus indicators have been renamed from 3 and 4 to A and B and are now referred to as PA Specific. Additional codes for services such as Peer Specialist were added in 2007. Rates are not totally comparable with prior years (2004-2006). * The North/Central County Option counties (Bedford, Blair, Cambria, Carbon, Clinton, Crawford, Erie, Franklin, Fulton, Lycoming, Mercer, Monroe, Pike, Somerset and Venango) have been added to the tables. Since this quarter is the North/Central County Option s first required submission, comparisons of their rate to 2008 were not made. Discussion: 7 days after discharge (HEDIS only does not include ICM or RC or PA local codes). The HC average validated follow-up rate for 2008 of 48.59% represented a noticeable increase from the 2004 baseline year rate of 37.1% and a noticeable increase from the 2007 measurement year. The 3Q2009 rate of (47.4%) shows slight decrease from the last quarter (50.43%) with the addition of the NCCO whose average rate is below the HC average rate. 30 days after discharge (HEDIS only does not include ICM or RC or PA local codes). The HC average validated follow-up rate for 2008 of 69.01% represented a substantial increase from the 2004 baseline year rate of 58.1% and an increase from the 2007 measurement year. The 3Q2009 rate of (69.1%) shows slight decrease from the last quarter (69.3%) with the addition of the NCCO whose average rate is below the HC average rate. 9
7 days after discharge (HEDIS plus PA specific local codes). The HC average validated follow-up rate for 2008 of 60.10% represented a substantial increase from the 2004 baseline year rate of 46.4% and a noticeable increase from the 2007 measurement year. The 3Q2009 rate of (58.9%) shows slight decrease from the last quarter (62.1%) with the addition of the NCCO whose average rate is below the HC average rate. The HC average validated follow-up rate for 2008 of 75.80% represented a substantial increase from the 2004 baseline year rate of 67% and a slight increase over the 2007 measurement year. The 3Q2009 rate of (75.9%) shows slight decrease from the last quarter (77.3%) with the addition of the NCCO whose average rate is below the HC average rate. Columns with a * reflect new specifications. The rates in red bold decreased. Indicator #1 - % of Follow-up After Hospitalization for Mental Illness within 7 days after discharge - HEDIS Indicator #2 - % of Follow-up After Hospitalization for Mental Illness within 30 days after discharge - HEDIS 2004 2007* 2008* 3Q2009* 2004 2007* 2008* 3Q2009* Adams 45.60% 47.4% 64.3% 44.6% 70.90% 71.8% 76.2% 67.3% Allegheny 36.50% 42.1% 40.8% 48.1% 55.00% 60.4% 60.8% 67.2% Armstrong 44.60% 47.9% 46.1% 50.0% 65.26% 73.1% 75.2% 75.0% Beaver 39.41% 47.1% 45.3% 56.0% 59.55% 67.6% 66.4% 72.0% Bedford 26.7% 53.3% Berks 36.50% 51.1% 51.9% 49.9% 57.50% 69.4% 73.6% 70.1% Blair 48.0% 77.1% Bucks 41.98% 44.7% 49.2% 51.3% 51.90% 60.7% 66.3% 68.1% Butler 34.39% 46.1% 45.6% 57.0% 60.51% 69.4% 68.9% 77.0% Cambria 32.0% 57.0% Carbon 42.3% 71.1% Chester 36.00% 45.5% 47.5% 47.3% 53.90% 64.0% 69.2% 68.0% Clinton 46.1% 73.7% Crawford 49.0% 68.0% Cumberland 46.70% 41.6% 34.4% 43.0% 65.70% 65.2% 62.2% 62.7% Dauphin 34.20% 39.5% 40.9% 39.5% 61.70% 60.0% 64.3% 59.7% Delaware 32.10% 41.8% 49.2% 53.0% 40.60% 58.4% 65.7% 69.7% Erie 34.0% 62.0% Fayette 32.83% 44.7% 45.3% 48.0% 59.67% 65.7% 67.5% 70.0% Franklin 38.2% 73.4% Fulton 45.5% 59.1% Greene 39.63% 30.3% 41.1% 47.0% 60.98% 57.3% 70.0% 69.0% Indiana 36.81% 52.2% 44.4% 57.0% 61.11% 70.4% 67.7% 75.0% Lackawanna 59.3% 63.2% 78.7% 83.1% Lancaster 37.60% 34.9% 42.6% 40.7% 59.00% 57.2% 63.2% 60.2% Lawrence 34.79% 46.1% 43.5% 49.0% 62.11% 73.4% 67.9% 74.0% Lebanon 41.60% 44.1% 57.2% 55.8% 70.30% 68.8% 79.0% 76.1% Lehigh 40.90% 48.8% 51.2% 50.2% 53.80% 64.5% 68.0% 64.2% 10
Luzerne 63.9% 70.8% 78.7% 79.9% Lycoming 42.3% 64.2% Mercer 43.0% 69.0% Monroe 55.3% 71.5% Montgomery 36.30% 47.7% 54.0% 49.9% 49.80% 63.9% 67.4% 66.2% Northampton 46.60% 49.2% 56.9% 50.7% 61.40% 66.2% 72.0% 66.9% Perry 25.00% 48.3% 46.2% 39.6% 59.40% 65.5% 65.4% 66.0% Philadelphia 28.30% 33.6% 34.8% 35.1% 40.70% 49.4% 51.2% 51.7% Pike 45.6% 68.4% Somerset 38.4% 61.6% Susquehanna 58.2% 56.9% 78.2% 75.9% Venango 37.0% 67.0% Washington 31.46% 34.9% 39.8% 45.0% 54.06% 61.5% 62.9% 69.0% Westmoreland 34.67% 40.3% 42.6% 44.0% 59.26% 62.7% 66.9% 68.0% Wyoming 72.3% 65.1% 83.0% 81.4% York 33.80% 42.7% 40.7% 44.0% 59.00% 67.1% 65.2% 67.7% NCSO Reg 1 49.4% 55.8% 76.2% 76.2% NCSO Reg 2 45.8% 48.8% 75.5% 75.0% NCSO Reg 3 47.8% 43.0% 72.6% 71.1% NCSO Reg 4 44.1% 50.1% 66.7% 71.7% NCSO Reg 5 55.3% 54.1% 77.1% 76.7% HC AVG 37.13% 43.70% 48.57% 47.40% 58.12% 64.54% 69.01% 69.1% Columns with a * reflect new specifications. The rates in red bold decreased. "Indicator A" - % of Follow-up After Hospitalization for Mental Illness within 7 days after discharge "PA specific" 11 "Indicator B" - % of Follow-up After Hospitalization for Mental Illness within 30 days after discharge "PA specific" 2004 2007* 2008* 3Q2009* 2004 2007* 2008* 3Q2009* Adams 48.10% 51.3% 67.9% 48.5% 73.40% 76.9% 81.0% 69.3% Allegheny 38.90% 51.8% 59.7% 62.6% 59.10% 71.7% 73.1% 76.2% Armstrong 53.99% 61.2% 60.4% 62.0% 69.95% 79.3% 78.7% 82.0% Beaver 45.14% 52.5% 51.4% 62.0% 63.54% 70.3% 70.6% 78.0% Bedford 53.3% 73.3% Berks 38.80% 55.3% 62.6% 61.2% 61.80% 74.5% 80.4% 77.0% Blair 57.8% 80.2% Bucks 56.10% 53.6% 60.8% 64.0% 67.50% 67.0% 74.8% 77.4%
Butler 42.36% 61.7% 61.2% 70.0% 65.29% 77.8% 79.5% 82.0% Cambria 43.0% 65.0% Carbon 51.0% 77.2% Chester 38.00% 52.1% 59.8% 59.0% 59.10% 71.4% 74.5% 72.8% Clinton 60.5% 78.9% Crawford 56.0% 71.0% Cumberland 52.60% 53.8% 52.2% 60.1% 72.30% 74.8% 73.9% 76.2% Dauphin 50.20% 61.6% 66.2% 60.7% 80.50% 76.3% 79.1% 75.9% Delaware 66.10% 58.7% 63.2% 66.0% 77.10% 71.4% 74.0% 78.6% Erie 57.0% 78.0% Fayette 43.18% 53.7% 53.7% 57.0% 67.47% 70.6% 73.8% 76.0% Franklin 51.3% 79.9% Fulton 50.0% 59.1% Greene 51.22% 49.4% 71.1% 68.0% 69.51% 69.7% 82.6% 79.0% Indiana 48.61% 61.1% 57.0% 73.0% 65.28% 75.9% 74.9% 84.0% Lackawanna 65.1% 70.3% 81.3% 85.2% Lancaster 40.60% 44.6% 51.0% 50.2% 62.40% 61.2% 67.0% 67.3% Lawrence 40.72% 60.7% 57.5% 61.0% 63.92% 79.4% 73.7% 78.0% Lebanon 46.10% 55.6% 64.1% 63.3% 74.90% 74.7% 80.6% 81.7% Lehigh 52.30% 58.9% 59.7% 60.9% 66.50% 72.1% 73.8% 71.6% Luzerne 67.4% 73.2% 81.2% 83.3% Lycoming 52.8% 69.1% Mercer 51.0% 73.0% Monroe 65.6% 80.2% Montgomery 53.85% 57.0% 63.5% 60.6% 68.38% 70.0% 74.4% 73.8% Northampton 58.60% 57.8% 66.5% 59.3% 74.70% 72.2% 77.3% 73.5% Perry 25.00% 56.9% 55.8% 49.1% 59.40% 70.7% 73.1% 71.7% Philadelphia 45.60% 51.6% 52.0% 54.6% 59.70% 66.0% 67.4% 70.0% Pike 54.4% 70.2% Somerset 51.4% 69.9% Susquehanna 61.8% 60.3% 78.2% 77.6% Venango 41.0% 68.0% Washington 39.73% 48.8% 51.3% 59.0% 61.00% 71.4% 70.6% 75.0% Westmoreland 48.75% 55.6% 57.5% 59.0% 70.75% 74.5% 75.9% 77.0% Wyoming 74.5% 69.8% 83.0% 81.4% York 35.20% 46.1% 48.3% 49.0% 62.10% 71.1% 70.2% 70.8% NCSO Reg 1 63.3% 71.7% 81.5% 85.6% NCSO Reg 2 57.1% 58.4% 80.6% 79.8% NCSO Reg 3 63.4% 61.2% 81.3% 79.7% NCSO Reg 4 57.7% 62.7% 75.3% 79.5% NCSO Reg 5 66.2% 61.6% 82.9% 80.7% HC AVG 46.39% 54.86% 60.30% 58.9% 67.02% 72.16% 76.47% 75.9% 12
INDICATOR 1 FOLLOW-UP 7 DAY HEDIS Crawford Mercer Lawrence Beaver Erie Washington Venango Butler Allegheny Warren Forest Clarion Jefferson Armstrong Westmoreland McKean Elk Clearfield Indiana Cambria Cameron Blair Potter Centre Huntingdon Tioga Lycoming Snyder Mifflin Juniata Perry Union Cumberland Bradford REGION 3 REGION 5 Clinton Sullivan Dauphin Columbia Montour Northumberland Schuylkill Lebanon Susquehanna Wyoming Lackawanna Luzerne Berks Carbon Lehigh Wayne Monroe Northampton Bucks Montgomery Pike Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Philadelphia COUNTIES OR REGIONS THAT DECREASED IN FOLLOW-UP RATE
INDICATOR A FOLLOW-UP 7 DAY PA SPECIFIC Crawford Mercer Lawrence Beaver Erie Washington Venango Butler Allegheny Warren Forest Clarion Jefferson Armstrong Westmoreland McKean REGION 3 Elk Clearfield Indiana Cambria Cameron Blair Potter Centre Huntingdon Clinton Tioga Snyder Mifflin Juniata Perry REGION 5 Lycoming Union Cumberland Bradford Sullivan Dauphin Columbia Montour Northumberland Schuylkill Lebanon Susquehanna Wyoming Lackawanna Luzerne Berks Carbon Lehigh Wayne Monroe Northampton Bucks Montgomery Pike Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Philadelphia COUNTIES OR REGIONS THAT DECREASED IN FOLLOW-UP RATE
INDICATOR 2 FOLLOW-UP 30 DAY HEDIS Crawford Mercer Lawrence Beaver Erie Washington Venango Butler Allegheny Warren Forest Clarion Jefferson Armstrong Westmoreland McKean REGION 3 Elk Clearfield Indiana Cambria Cameron Blair Potter Centre Huntingdon Clinton REGION 1 Tioga Lycoming Snyder Mifflin Juniata Perry Union Cumberland Bradford REGION 5 Sullivan Dauphin Columbia Montour Northumberland Schuylkill Lebanon Susquehanna Wyoming Lackawanna Luzerne Berks Carbon Lehigh Wayne Monroe Northampton Bucks Montgomery Pike Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Philadelphia COUNTIES OR REGIONS THAT DECREASED IN FOLLOW-UP RATE
INDICATOR B FOLLOW-UP 30 DAY PA SPECIFIC Crawford Mercer Lawrence Beaver Erie Washington Venango Butler Allegheny Warren Forest Clarion Jefferson Armstrong Westmoreland McKean Elk REGION 2 Clearfield Indiana Cambria REGION 3 Cameron Blair Potter Centre Huntingdon Clinton Tioga Lycoming Snyder Mifflin Juniata Perry Union Cumberland Bradford REGION 5 Sullivan Dauphin Columbia Montour Northumberland Schuylkill Lebanon Susquehanna Wyoming Lackawanna Luzerne Berks Carbon Lehigh Wayne Monroe Northampton Bucks Montgomery Pike Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Philadelphia COUNTIES OR REGIONS THAT DECREASED IN FOLOW-UP RATE
Follow-up after Non-hospital D&A Residential Rehab within 7 days The 2009 yearly rate represents a year-to-date approximation. This is a self reported performance based contracting measure and the results will not be validated by IPRO. D&A indicators were selected by the individual counties/bh-mco. This indicator was selected by the CBH, MBH (except Montgomery) and CCBH affiliated counties. Low numbers may influence the rates for some counties (Adams). OMHSAS Gold Standard is 90%. Discussion The EHC average follow-up rate for 2008 of 31.6% represented a modest increase from the 2004 baseline year rate of 29.7%. The rate for 3Q2009 is again higher and experience with this indicator shows that the rate increases as the year progresses. The rate for 2009 shows improvement for Adams, Allegheny, Berks, Bucks, Chester, Delaware, Lehigh, Lackawanna, Northampton, Wyoming, and NCSO. Since 2007 was the first full year that the Northeast Counties (Lackawanna, Luzerne, Susquehanna, Wyoming) submitted data, 2004 data is not available. Since 2008 was the first full year that NCSO (23 counties) submitted data, 2004 and 2007 data is not available. Since this quarter is the North/Central County Option s first required submission, comparisons of their rate to 2008 were not made. % of individuals discharged from non-hospital residential rehab with follow-up services within 7 days post discharge under 65 2004 2007 2008 3Q2009 Adams 24.0% 25.8% 25.5% 32.1% Allegheny 33.0% 35.9% 36.7% 39.7% Bedford 37.5% Berks 27.0% 34.0% 29.3% 33.9% Bucks 33.2% 28.8% 32.4% 39.1% Carbon 22.4% Chester 22.0% 23.2% 20.1% 25.3% Clinton 20.8% Delaware 37.7% 47.3% 46.1% 42.4% Lehigh 27.2% 26.6% 30.5% 34.7% Lackawanna 18.9% 27.2% 35.6% Luzerne 23.7% 30.4% 28.1% Lycoming 34.2% Monroe 33.6% Northampton 32.4% 26.5% 33.1% 44.6% Philadelphia 30.4% 35.9% 37.1% 36.8% Pike 39.7% Somerset 38.5% Susquehanna 29.1% 36.7% 27.6% Wyoming 20.5% 28.6% 40.0% York 29.0% 24.7% 27.9% 25.9% NCSO 33.1% 35.3% OMHSAS Average 29.7% 30.9% 31.6% 34.0%
ADULT INVOLUNTARY ADMISSIONS Rational for Measure: Voluntary treatment is preferred to involuntary treatment. Clients treated involuntarily lose some of their right to choose treatments that best suit their needs and can be adversely affected by the experience. Involuntary treatment is a breakdown of the treatment alliance between consumers and service providers. Goal: Involuntary admissions decrease over time. Increased Involuntary Admissions: A county s rate of involuntary admissions was considered increased if the rate of involuntary admissions increased more than 20% compared to the average of the prior four quarters. Counties with increased rates of involuntary admissions in two successive quarters were noted. Decreased Involuntary Admissions: A county s rate of involuntary admissions was considered decreased if the rate of involuntary admissions decreased more than 20% compared to the average of the prior four quarters. Counties with decreased rates of involuntary admissions in two successive quarters were noted. Established HealthChoices Counties: Current Status: For all 67 HealthChoices Counties there were 2,594 involuntary admissions in the quarter, a rate of 3.2 per 1000 adult members. HealthChoices - Adult Involuntary Admisssions per 1000Eligibles 6.0 5.0 4.0 3.0 HealthChoices Rate 2.0 1.0 0.0 SE SW LC NE NCSO NCCO 18
HealthChoices - Adult Involuntary Admissions per 1000 Eligibles 6.0 5.0 4.0 3.0 2.0 4q 2009 1.0 0.0 SE SW LC NE NCSO NCCO Trends: The number of involuntary admissions, 2,594 was within the range of the last eight quarters but the rate of admissions was down from the previous quarter. SE Region: Current Status: In Philadelphia 5.6 per 1000 adults were hospitalized involuntarily. The rates for the four suburban counties were: Bucks 2.5, Chester 1.5, Delaware 4.9 and Montgomery 4.9 per 1000 adults. HealthChoices SE - Adult Involuntary Admissions per 1000 Eligibles 7.0 6.0 5.0 4.0 3.0 Established HealthChoices Rate 2.0 1.0 0.0 BU CH DE MO PH 19
HealthChoices SE - Adult Involuntary Admissions per 1000 Eligibles 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 BU CH DE MO PH Trends: Comparison to prior four quarters: Southeast Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters CH County Philadelphia: Philadelphia had 1,168 Involuntary Admissions, within the range of the prior four quarters. Philadelphia has been an outlier with a high rate of involuntary admissions in all eight measured quarters. Decreasing the rate of involuntary commitments toward the state s average represents a continuing challenge for the county. Bucks, Delaware, Chester, and Montgomery Counties: Delaware County and Montgomery County have also had high involuntary admission rates for eight successive quarters. Lowering the rate represents a challenge to these counties. Bucks County and Chester County involuntary admission rates are significantly lower. SW Region: Current Status: In Allegheny County, 3.2 per 1000 adults were hospitalized involuntarily. The rates for the Suburban SW counties were: Armstrong 1.5, Beaver 3.1, Butler 3.0, Fayette 1.8, Greene 0.5, Indiana 1.3, Lawrence 3,2, Washington 0.6, Westmoreland - 2.6 per 1000 adults. 20
HealthChoices SW - Adult Involuntary Admissions per 1000 Eligibles 3.5 3.0 HealthChoices 2.5 2.0 1.5 1.0 0.5 0.0 AL AR BE BT FA GR IN LW WS WE HealthChoices SW - Adult Involuntary Admissions per 1000 Eligibles 6.0 5.0 4.0 3.0 2.0 1.0 0.0 AL AR BE BT FA GR IN LW WS WE Trends: Comparison to prior four quarters: Southwest Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters 21 GR, WS GR AR, LW AR County
L/C Region: Current Status: The county rates for adult involuntary hospitalization were: Adams 2.6, Berks 2.6, Cumberland 0.9, Dauphin 1.3, Lancaster 2.2, Lebanon 2.7, Lehigh 1.3, Northampton 2.2, Perry 2.6, York 3.6 per 1000 adults. HealthChoices - Adult Involuntary Admissions per 1000 Eligibles 4.0 3.5 3.0 HealthChoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 AD BK CU DA LA LB LE NH PE YO HealthChoice L/C - Adult Involuntary Admissions per 1000 Eligibles 6 5 4 3 2 1 0 AD BK CU DA LA LB LE NH PE YO Trends: Comparison to prior four quarters: Lehigh/Capital 22 County
Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters AD, BK, LA, LB, LE. PE,YO Capital Five Counties (Cumberland, Dauphin, Lancaster, Lebanon and Perry): Cumberland, Dauphin, Lebanon, Lancaster, and Perry Counties had their highest rate for adult involuntary admissions in the last four quarters. Lebanon, Lancaster, and Perry Counties increased by more than 20%, compared to the average of the prior four quarters. York, Adams, Lehigh, Berks, and Northampton Counties: York, Adams, Lehigh, and Berks involuntary admissions increased by more than 20%, compared to the average of the prior four quarters. NE Region Current Status: The county rates for adult involuntary hospitalization were: Lackawanna 2.5, Luzerne 1.4, Susquehanna 1.6, Wyoming 0.0 involuntary admissions per 1000 adult members. HealthChoices NE - Adult Involuntary Admissions per 1000 Eligibles 3.5 3.0 HealthChoice s Rate 2.5 2.0 1.5 1.0 0.5 0.0 LK LU SQ WY 23
NE Adult Involuntary Admissions per 1000 Eligibles 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 LK LU SQ WY Total Trends: Comparison to prior four quarters: Northeast Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters WY SQ SQ County Susquehanna County had an increased rate of involuntary admissions in each of the last four quarters. Please note the low number of admissions, less than ten for some counties, may have affected the findings. North Central State Option There were 114 Involuntary Admissions in the quarter and 108 in the prior quarter. The rate for the NCSO region was 1.6 per 1000 adult members, which was below the mean of 3.2 per 1000 members for all HealthChoices Counties in the same quarter. Region 1 State College (Huntingdon/Mifflin/Juniata and Centre Counties): In Centre County the rate of involuntary admissions decreased by more than 20%, compared to the average of the prior four quarters. In Huntingdon, Juniata, and Mifflin Counties the rate of involuntary admissions increased by more than 20% compared to the average of the prior four quarters. Region 2 Dubois (Clarion, Clearfield and Jefferson Counties): In Clarion and Jefferson Counties the rate of involuntary admissions decreased by more than 20%, compared to the average of the prior four quarters. 24
Region 3 Dubois (McKean, Potter, Forest, Warren Cameron, and Elk Counties): Warren and Cameron Counties has had no involuntary admissions in the last quarter. The rate of involuntary admissions in Cameron, McKean, Potter, and Warren Counties decreased by more than 20% compared to the average of the prior four quarters, in each of the last four quarters. The rate of involuntary admissions in Forrest County increased by more than 20% compared to the average of the prior four quarters, in each of the last four quarters. Region 4 Moosic (Columbia, Montour, Snyder, Union, Northumberland and Schuylkill): The rates for Columbia and Northumberland Counties increased by more than 20%, compared to the average of the prior four quarters. The rates for Montour and Union Counties decreased by more than 20%, compared to the average of the prior four quarters. Region 5 Moosic (Bradford, Sullivan, Tioga, and Wayne Counties): Sullivan County had no involuntary admissions in the last eight quarters. The rates for Bradford and Wayne Counties increased by more than 20%, compared to the average of the prior four quarters. The rates for Tioga County decreased by more than 20%, compared to the average of the prior four quarters. Please note the low number of admissions, less than ten, may have affected the reliability of the findings. NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 1 4.0 3.5 3.0 HealthChoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Centre Huntingdon Juniata Mifflin 25
NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 1 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Centre Huntingdon Juniata Mifflin TOTAL NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 2 4.0 3.5 3.0 HealthChoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Clarion Clearfield Jefferson 26
NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 2 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Clarion Clearfield Jefferson Total NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 3 3.5 3.0 HealthChoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Cameron Elk Forest McKean Potter Warren 27
NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 3 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Cameron Elk Forest McKean Potter Warren TOTAL NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 4 4.0 3.5 3.0 HealthChoices 2.5 2.0 1.5 1.0 0.5 0.0 Columbia Montour Northumberland Schuylkill Snyder Union 28
NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 4 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Columbia Montour Northumberland Schuylkill Snyder Union Total NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 5 4.0 3.5 3.0 HealthChoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Bradford Sullivan Tioga Wayne 29
NCSO Adult Involuntary Admissions per 1000 Eligibles - Region 5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Bradford Sullivan Tioga Wayne TOTAL Trends: Comparison to prior four quarters: North/Central State Option Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters County CE, CL, JE, CA, MC, PO, WA, MT, UN, TI CL HU, JU, MI, CO, NU, BR, WA HU, BR, WA North Central County Option There were 185 Involuntary Admissions in the Quarter and 191 in the prior quarter. The rate for the NCCO region was 1.7 per 1000 adult members, which was less than the mean for all HealthChoices Counties in the same quarter, 3.2 per 1000 adult members. The rates for all of the counties except Bedford and Pike Counties were below the mean of the HealthChoices counties for this quarter. These are positive findings. The rate for Somerset, Clinton, Carbon, and Crawford Counties decreased more than 20%, compared to the average of the prior four quarters, in the last quarter. The rate for Bedford, Blair, Fulton, and Pike Counties increased more than 20%, compared to the average of the prior four quarters, in the last quarter. 30
NCCO Adult Involuntary Admissions per 1000 Eligibles - CBHNP 4.5 4.0 3.5 3.0 Established Healthchoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Bedford Somerset Blair Franklin Fulton Clinton Lycoming NCCO Adult Involuntary Admissions per 1000 Eligibles - CBHNP 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Bedford Somerset Blair Franklin Fulton Clinton Lycoming Total 31
NCCO Adult Involunary Admissions per 1000 Eligibles - CCBH 4.0 3.5 3.0 Establihed Healthchoice s Rate 2.5 2.0 1.5 1.0 0.5 0.0 Carbon Monroe Pike NCCO Adult Involuntary Admissions per 1000 Eligibles - CCBH 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Carbon Monroe Pike Total 32
VBH Adult Involuntary Admissions per 1000 Eligibles - VBH 3.5 3.0 Established Healthchoices Rate 2.5 2.0 1.5 1.0 0.5 0.0 Cambria Erie Crawford Mercer Venango NCCO Adult Involuntary Admissions per 1000 Eligibles - VBH 4.5 4.0 3.5 3.0 2.5 2.0 1.5 4Q 2009 1.0 0.5 0.0 Cambria Erie Crawford Mercer Venango Total 33
Trends: Comparison to prior four quarters: North/Central County Option Decreased Involuntary Admissions Decreased Involuntary Admissions 2 successive quarters Increased Involuntary Admissions Increased Involuntary Admissions 2 successive quarters County SO, CT, CB, CW BL, BD, FU, PI Discussion: For all Established HealthChoices Counties taken together, the number of involuntary admissions, 2,594 was within the range of the last four quarters Lebanon, Lancaster, and Perry Counties had their highest rate for adult involuntary admissions in the last four quarters. Philadelphia, Delaware and Montgomery Counties have also had high involuntary admission rates for eight successive quarters. Susquehanna County had an increased rate of involuntary admissions in each of the last four quarters These findings represent challenges to the above counties. Wyoming had a decreased rate of involuntary admissions in the last quarter. The rates for all of the NCCO counties, except Bedford and Pike Counties, were below the mean of the HealthChoices counties for this quarter. 34
ADULT INVOLUNTARY ADMISSIONS Erie Warren McKean Potter Tioga Bradford Susquehanna Crawford Wayne Forest Cameron Venango Mercer Clarion Jefferson Lawrence Clearfield Butler Armstrong Beaver Indiana Cambria Clinton Centre Sullivan Lycoming Wyoming Lackawanna Luzerne Columbia Union Montour Carbon Northumberland Snyder Schuylkill Pike Monroe Northampton Allegheny Blair Berks Bucks Washington Westmoreland Huntingdon Montgomery Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Philadelphia Delaware INCREASE IN ADULT INVOLUNTARY ADMISSIONS DECREASE IN ADULT INVOLUNTARY ADMISSIONS
30 DAY INPATIENT PSYCHIATRIC READMISSIONS Rational for Measure: Persons who stabilize during hospitalization and access community resources are less likely to need rehospitalization. Goal: Less than 10% of hospitalized patients readmitted within 30 days. Trends: Counties will be compared to themselves over time. CHILDREN Increased Readmissions: Counties readmissions were considered increased if the percentage of members discharged from an inpatient unit readmitted within 30 days increased more than 20% compared to the average percentage of members readmitted in the prior four quarters. Counties with an increased percentage of readmissions in two successive quarters were noted. Decreased Readmissions: Counties percentages of members discharged from an inpatient unit readmitted within 30 days were considered decreased if the percentage of readmitted members decreased more than 20% compared to the average of the prior four quarters. Counties with a decreased percentage of readmissions in two successive quarters were noted. Please note that the number of readmissions for many counties is low, particularly for children s hospitalizations. The low number may affect the reliability of the results. Established HealthChoices Counties: Current Status: Eleven percent (11%) of children in all HealthChoices Counties were readmitted to Inpatient Psychiatric Unit within 30 days of a Psychiatric Hospital discharge. HealthChoices - Children's 30 Day Readmission Rate 18% 16% 14% 12% 10% OMHSAS 10% Goal 8% 6% 4% 2% 0% SE SW LC NE NCSO NCCO HC
Trend: The percent of children readmitted to inpatient services was 1% less than the prior quarter. SE Region: The percentage of children readmitted in Philadelphia County was 10% and 13% in the Suburban SE Counties. HealthChoices SE - Children's 30 Day Readmission Rate 18% 16% 14% 12% 10% OMHSAS 10% Goal 8% 6% 4% 2% 0% BU CH DE MO PH Trends: Counties with more than 10% readmitted: Chester 15%, Philadelphia 11% County % Readmitted Number Readmitted County % Readmitted Number Readmitted Chester 16% 9 Montgomery 13% 9 Comparison to prior four quarters: Southeast Decreased Readmissions Decreased Readmissions 2 successive quarters Increased Readmissions Increased Readmissions 2 successive quarters County BU CH,MO CH,MO Philadelphia: Philadelphia County reached the state goal of 10%. Bucks, Delaware, Montgomery: Delaware met the state s goal in each of the last seven quarters, as well as Bucks in the last three quarters. These counties are commended. Montgomery exceeded the state goal for the first time in seven quarters. Chester County: Chester County exceeded the state goal. SW Region: The percentage of children readmitted in Allegheny County was 10% and the average for the Suburban SW Counties was 13%. 37
HealthChoices SW - Children's 30 Day Readmission Rate 35% 30% 25% 20% 15% 10% OMHSAS 10% Goal 5% 0% AL AR BE BT FA GR IN LW WS WE Trends: Counties with more than 10% readmitted: County % Readmitted Number Readmitted County % Readmitted Number Readmitted Lawrence 14% 2 Indiana 13% 1 Beaver 11% 4 Westmoreland 26% 18 Fayette 12% 4 Comparison to prior four quarters: Southwest Decreased Readmissions Decreased Readmissions 2 successive quarters Increased Readmissions Increased Readmissions 2 successive quarters County AL, WS, GR WS LW, WE Allegheny County: Allegheny County met the state goal. Suburban SW Counties: Washington County had decreased readmissions in the last two quarters. This is to be commended. Lawrence and Westmoreland had increased readmissions in this quarter. The low number of readmissions, between one and four, for several of the counties with more than 10% readmissions may have influenced the reliability of the findings. L/C Region: Fourteen percent (14%) of all children in the region were readmitted. 38
HealthChoices L/C - Children's 30 Day Readmission Rate 45% 40% 35% 30% 25% 20% 15% 10% OMHSAS 10% Goal 5% 0% AD BK CU DA LA LB LE NH PE YO Trends: Capital Five Counties (Cumberland, Dauphin, Lancaster, Lebanon and Perry): Cumberland County had no admissions in the last quarter. This is a positive finding. Dauphin County had increased readmissions in the last quarter. Adams, Berks and York Counties: York County has met the state s goal in the last quarter. Adams County had increased readmissions in the last quarter. Lehigh and Northampton Counties: Northampton County had increased readmissions in the last quarter. Counties with more than 10% readmitted: County % Readmitted Number Readmitted County % Readmitted Number Readmitted Adams 25% 5 Berks 15% 13 Lancaster 20% 10 Northampton 13% 7 Lebanon 13% 3 Perry 13% 1 Lehigh 13% 10 Dauphin 20% 7 Comparison to prior four quarters LC- Capital Decreased Readmissions Decreased Readmissions 2 successive quarters Increased Readmissions Increased Readmissions 2 successive quarters County CU, LB, YO LB, CU AD, DA, LE, NH, PE AD, LE, PE NE Region Thirteen percent (13%) of the children in the region were readmitted within 30 days. 39
Northeast Children's 30 Day Readmission Percentage 35% 30% 25% 20% 15% 10% OMHSAS 10% Goal 5% 0% LK LU SQ WY Total Trends: Luzerne, Susquehanna, Wyoming Counties have met the state s goal for the last quarter. This is a positive finding. Counties with more than 10% readmitted: County % Readmitted Number Readmitted County % Readmitted Lackawanna 14% 11 Comparison to prior four quarters LC- Capital Decreased Readmissions Decreased Readmissions 2 successive quarters Increased Readmissions Increased Readmissions 2 successive quarters Number Readmitted County SQ, WY LU, LK LU North Central State Option An average of 9% of children were readmitted within 30 days for the NCSO counties, a decrease from 13% in the prior quarter. Region 1 State College (Huntingdon, Mifflin, Juniata. and Centre Counties): An average of 8% of children were readmitted in the current quarter, a decrease from 13% in the prior quarter. No children in Juniata County were readmitted in the last five quarters and no children in Huntingdon County were readmitted in the current quarter. Mifflin County had an increase in the last quarter. Centre and Huntingdon Counties had a decrease. 40
Region 2 Dubois (Clarion, Clearfield and Jefferson Counties): An average of 14% of children were readmitted in the current quarter, a increase from 10% in the prior quarter. Clarion and Clearfield Counties had an increase in the last quarter. Jefferson County had a decrease in the last quarter. Region 3 Dubois (McKean, Potter, Forest, Warren, Cameron, and Elk Counties): An average of 4% of children were readmitted, an decrease from 11% in the prior quarter. No children were readmitted in Cameron and Forest Counties during each of the last eleven quarters, McKean County in the last three quarters and Potter in the last quarter. Warren County also met the state s goal in each of the last seven quarters and McKean County in each of the last five quarters, and Elk in the last quarter. These counties are commended. Warren had an increase in the last quarter. Elk, McKean, and Potter had decreases. Region 4 Moosic (Columbia, Montour, Snyder, Union, Schuylkill and Northumberland): An average of 11% of children were readmitted in the current quarter, an decrease from 14% in the prior quarters. No children in Montour County were readmitted in the last four quarters and Union in the last quarter. Northumberland and Snyder Counties had increases in the last quarter. Columbia, Montour, and Union had decreases. Region 5 Moosic (Bradford, Sullivan, Tioga and Wayne Counties): An average of 4% was readmitted in the current quarter, a decrease from 13% in the prior quarter. No children in Sullivan County were readmitted in each of the last eleven quarters and Tioga County in the last four quarters. These counties are commended. Wayne had a decrease in the last quarter and met the state s goal of 10%. NCSO Children's 30 Day Readmission Percentage - Region 1 35% 30% 25% 20% 15% 10% OMHSAS 10% Goal 5% 0% Centre Huntingdon Juniata Mifflin Total 41