Behavioral Health Partnership Oversight Council Coordination of Care Subcommittee
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
Meeting Summary: September 13, 2006
Chair: Sheila Amdur
Next meeting dates: Nov. 1, and Dec. 6, 2006 @ 9:30 AM at the LOB
Sheila Amdur, Subcommittee (SC) Chair, outlined two major issues for SC focus; pharmacy access and coordination of mental health services with primary care. Ms. Amdur invites family organizations and primary providers to participate in the SC.
Issue: HUSKY members that leave the pharmacy without the script filled, and no temporary drug supply is provided by the pharmacy, especially when the prescribing provider has not requested the required prior authorization (PA).
• Data was requested on:
o The number of scripts denied because of lack of PA;
o Percentage of these members that received a temporary supply;
o The percentage that received a medication in the same therapeutic class within 30 days.
DSS stated that gathering this information is costly and beyond the MCO current contract regarding pharmacy reports. Sheila pointed out that the data on the first two issues were supposed to be provided in October, 2005.
• In Fee-for-service (FFS), if a PA is not adjudicated within 2 hours, the pharmacy calls the company managing the program for approval/payment of a 5-day supply of the drug. The FFS turn around time is shorter than the federal requirements.
• DSS raised the question of how important this area is in relation to other pressing quality areas within the current budget. The Chair noted that it is difficult to evaluate the need for ongoing reports until baseline data is produced.
Outcome of Discussion
By the next meeting:
• DSS will consider the feasibility of providing the data requested.
• DSS will propose a study concept related to this issue, getting this out to the subcommittee prior to the next meeting.
• S. Amdur will ask advocacy groups for information on their members' experience with prescriptions.
• Each MCO was requested to provide their policies regarding prior authorization and temporary supplies. DSS also was asked to provide their written policy regarding MCO's requirements on these issues.
• Subcommittee can consider adding questions about member satisfaction with pharmacy in the next BHP consumer satisfaction survey, since it is not covered in the current survey.
Coordination of HUSKY Primary Care & Mental Health Services
The BHP Enhanced Care Clinic (ECC) RFP encourages (does not mandate in this RFP) that clinics interested in applying for ECC acceptance consider establishing a collaborative relationship with primary care practice sites.
Issue: The Subcommittee discussion centered on integration and collaboration of primary care practices and BH practices in HUSKY beyond the ECC proposal.
• National data looks at MH care delivered in primary care (PC) settings. Do we have data for the HUSKY program? Dr. Schaefer (DSS) stated information is in the encounter data that has come in since Jan 2006, the start of the BHP. The BHP will report on an analysis of BH/PC at the November meeting.
• Primary care providers are reluctant to code diagnosis (primary) as BH because of managed care & private insurer rejections. It is understandable that the PCP would want to maximize their revenue by using codes that are usually accepted (i.e. a primary medical diagnostic code).
There has been significant focus on this issue beyond the ECCs during the planning and implementation of the BHP program. Some activities to date include:
• MCO/ASO coordination is outlined in the HUSKY contracts and the ASO/MCO memorandum of understanding.
• Integration of Primary Care and BH practice can flow in two directions:
o The Primary Care provider would prescribe psychotropic drugs for some patients and may request psychiatric medication consultation.
o The patient is stable on psychotropic medications and could, with intermittent psychiatric evaluations, have the Primary Care provider follow the patient along with their medical management.
• Currently ASO's role in integration of PC & BH:
o Collaborative intensive case management with the member's MCO for those members with co-morbidities.
o Free consultation with the VOI psychiatrist and PC practitioners (which so far is rarely accessed by primary care providers).
o VOI has created a Physician Advisory Council that has broad representation from various practitioner types that will address policy needs.
• The Child Health & Development Institute (CHDI) has multiple BH/MH activities to achieve the CHDI strategic goal of effectively addressing BH concerns of children and their families in pediatric and primary care practices. (See CHDI handout below).
• State agency initiatives include DMHAS steering committee on life span issues with dollars appropriated in 2006 budget and DMHAS also has a transformation grant that involves multiple agencies.
• Unclear where adult HUSKY members fit into integrated care initiatives, especially with recent research identifying the impact of untreated parental MH problems on development of the child's MH problems. The MCO/VOI intensive case management process applies to children and adults.
Outcome of discussion
1. DSS will provide contractual requirements with MCO's on coordination of care, once the contracts are finalized.
2. Sheila Amdur will discuss with BHP & CHDI how the coordination SC and CHDI can work more closely together on integrated care in the HUSKY program.