Continuity and Coordination of Care
Community Care routinely monitors the coordination of members' care and exchange of clinical information among providers in several different ways. We strongly encourage providers to coordinate care with other practitioners who are seeing the same member. Coordination is important for member safety, to avoid duplicate assessments, procedures, or testing, and to improve treatment outcomes. Data for these measures are collected during record reviews for multiple levels of care across all counties.
The goal for written evidence of exchange of information among behavioral health practitioners is 95%. In 2018, the rate across our counties averaged 75%, meaning that when it was appropriate to do so, providers exchanged information and documented that they did so an average of 75% of the time.
For contact with an outpatient provider within 48 hours of inpatient admission, the established goal is 85%, and across counties in 2018 providers have exceeded this goal and have documented contact with outpatient providers within 48 hours of inpatient admission 91% of the time.
Providers are also expected to provide notice to aftercare providers within one business day of inpatient discharge including information about discharge and medications. This was documented 92% of the time, exceeding the established goal of 85%.
In 2018, appropriate referrals were made 70% of the time if a co-occurring disorder was identified during the MISA Assessment, which falls below the goal of 85% across counties.
If the member is involved with outpatient/case management services prior to their admission into the inpatient hospital, the outpatient treatment team/case manager was a part of transition planning 89% of the time in 2018, which exceeds the established goal of 85%.
To encourage exchange of information, Community Care:
- Requests individualized quality improvement plans from providers when rates fall below the goal.
- Includes articles in our provider newsletter regarding the importance of coordinating care.
- Posted a revised Release of Information on our website.
- Posted an article for members regarding the importance of coordination of care on our website.
- Care Management prompts providers during Utilization Management (UM) reviews to coordinate care and exchange information with members' other providers.
If you have found other techniques that are effective in promoting coordination of care among behavioral health providers, we would appreciate hearing from you. Please call us at 1-888-251-2224 with your ideas and comments.