Committee Coordination of Care Work Group
May 25, @ 3 PM at DSS Hartford)
Sheila Amdur surveyed a small group of families regarding notification to primary care provider (PCP) of their family member’s BH services. The family responses supported:
ü Written consent to have the information conveyed to the PCP (versus automatic notification).
ü Consider building cross-consent into the administrative BH processes.
ü Families see the connection of medical & BH as a positive step in engaging families in health care.
Mark Schaefer stated the ASO contract does not require the ASO send BH service authorizations to the PCP; however it would be possible to:
· Identify current Hospital ED to MCO communication procedures for ED visits, how this may apply to ED BH visits with the ASO.
· Develop a work flow as part of the ASO authorization process to remind BH provider to ask for written consent to notify the patient’s PCP
· For hospital discharge, hospital would obtain family consent to coordinate discharge services with the PCP & identify the prescribing practitioner on discharge. PCPs noted that the actual hospital discharge summary may not reach them if the patient doesn’t identify the PCP and there is an average report receipt delay of 3-4 months.
· The ASO intensive case management process could include criteria for timely connection to aftercare provider. There is also a post discharge follow up in 1st 7 days for ‘connect to care’.
· Educate families, PCPs & BH providers to the importance of communication between medical & BH services and family consent to this.
The BH Oversight Committee asked the work group to look at the process. Karen Andersson (DCF) and Mark Schaefer (DSS) reviewed the flow charts. (To access click below on ICM workflows).
· The ASO intensive care management (ICM) will coordinate with the MCO for members with co-occurring diagnoses.
· The ASO ICM is strategic short-term intervention to help families navigate the BH system, assist members who are high risk and either not accessing BH services or the services they receive are not helping them.
· The ASO ICM would support the ongoing work of the DCF collaboratives, or DCF caseworkers or DCF Health Advocates who work with DCF committed children. Suggested the ASO bring the DCF member the ASO is involved with to the appropriate DCF health Advocate’s attention.
· The 14 ASO ICMs will be assigned a local geographic area defined by the 14 DCF regions.
· The ASO will recruit new providers (the state agencies will credential providers new to the system) to meet local gaps in the service system. (The DCF Advisory Work Group will further review & discuss coordination of the various levels of care coordination in the DCF system with the ASO).
DSS stated that three of the four MCOs have a formulary (Preferred One has a preferred drug list). Within the 3 MCOs, there are differences in that CHNCT has a process for an automatic override to provide a temporary drug supply (in previous Council reports, CHNCT had 100% temporary supply). The other two MCOs do not include an automatic override nor an electronic message to the pharmacist about the temporary supply for HUSKY but are now working on this at the DSS direction.
· The report provided on the temporary supplies does not include the total number of rejected scripts at the pharmacy. DSS will review the numbers, report back.
· The health plans (3) have their drug formularies on line. The Mercer pharmacy team reviewed the formularies in 2003 for adequacy of drugs within classes. Subsequent MCO formulary changes are reviewed by DCF & DSS.
· Providers may not be aware when formularies change & pharmacists may not know about the HUSKY temporary supply policy (hence the utility of the electronic ‘prompt’).
· The DSS noted that in 2004, before the BH Oversight Committee reconfiguration, the BH subcommittee had organized a pharmacy work group. This WG recommended streamlining the drug PA forms into one common form and development of a practitioner “quick look” guide to BH drugs requiring prior authorization (on & off formulary). It was suggested that these efforts be revisited.
· Council/Committee recommendations for the next MCO/DSS contract negotiations could include applying the automatic override for temporary supply, development of a common formulary among the HUSKY MCOs and streamlined PA forms, provider “quick-look” guide.
The MCOs are responsible for BH transportation. Although there have been anecdotal reports of transportation problems that can suggest trends, there is no quantifiable assessment of the scope of the problems. The INFOLINE reports do not show a problem trend in this area. The DSS would see what data exists from transportation vendor to the MCOs. The department noted that since DSS has worked with the MCOs to ensure adherence to the DSS regulations, access to transportation services may be less of a problem. The WG suggested that:
ü Transportation should be a focus area to monitor in the 1st year of the carve-out, as well as questions included in the member satisfaction surveys.
ü DCF Health Advocate will provide information from their clients related to transportation.
Next Work Group meeting is scheduled for May 25 3 PM at DSS Hartford. The agenda will include:
· Transportation information
· MCO Pharmacy denials of temporary drugs
· Refinement of DCF pharmacy data.
· Coordination of ED face sheet with PCP.