Continuity and Coordination of Care

Community Care actively supports Coordination of Care, or COC, to ensure members are supported in their behavioral health and substance use treatment. We strongly encourage providers to coordinate care with other practitioners who are seeing the same member. Coordination is important to avoid duplicate assessments, procedures, or testing as well as to improve treatment outcomes. Coordination of care activities also have inherent member safety implications.

Community Care monitors five performance measures related to providers’ exchange of information and coordination of care. Data for these measures are collected during ad hoc and routine record reviews with providers; these reviews are across multiple levels of care in each contract. Two measures reflect reviews completed within all levels of care, while three measures are only relevant to inpatient levels of care.

For all levels of care, the goal for written evidence of exchange of information among behavioral health practitioners is 85%. In 2023, providers exchanged and documented, when it was appropriate to do so, an average of 69% of the time. In 2023, appropriate referrals were made 72% of the time if a co-occurring disorder was identified during the Substance Use Disorder (SUD) Assessment; the goal was 80%. Neither of these measures met their respective goals.

For inpatient reviews across the counties in 2023, inpatient facilities documented contact with outpatient providers within 48 hours of admission 35% of the time. Inpatient facilities are also expected to provide notice to aftercare providers within one business day of an inpatient discharge including information about discharge and medications. This was documented 61% of the time. Furthermore, 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 57% of the time in 2023. All rates related to the inpatient reviews did not meet the goal of 80%.

To encourage exchange of information, Community Care has implemented the following actions:

Created and updated a universal release of information, which is posted on our website.

Hold wrap-up meetings after record reviews to provide education on performance standards and expectations; Community Care views this as a unique opportunity for dialogue and discussion with a provider about the importance of COC.

• Requests individualized Quality Improvement Plans (QIPs) from any provider who falls below the performance goal.
• Regularly prompts providers during Care Management/Utilization Management (UM) reviews to coordinate care. Clinical staff and Care Managers also participate in numerous interagency meetings, trainings, and initiatives to facilitate coordination with other agencies.
• Permanently implemented select protocols associated with pre-certification and authorization processes from the 1135 waiver for certain levels of care. This intervention should relieve administrative burdens so that providers have more time and staff available to perform the required coordination of care.
• Maintains an article on our website for members regarding the importance of COC.
• Implemented Pay for Performance (P4P) models; providers participating in this project may earn rate enhancements if pre-established goals related to follow up are met. The performance measures, which typically focus on follow-up appointments and readmission rates, necessitate inpatient facilities to coordinate with aftercare 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.