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 2024, providers exchanged and documented this coordination an average of 80% of the time. In 2024, appropriate referrals were made 77% of the time if a co-occurring Substance Use Disorder (SUD) was identified; the goal was 80%. Neither of these measures met their respective goals; however, both rates reflected increases when compared to 2023.

For inpatient reviews across the contracts in 2024, inpatient facilities documented contact with outpatient providers within 48 hours of admission 39% 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 38% 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 55% of the time in 2024. All rates related to the inpatient reviews did not meet the goal of 80%; however, one of the three inpatient measures (inpatient contact with outpatient providers) noted an increase from 2023. A primary barrier impacting all coordination of care rates, but particularly the inpatient rates, is the Quality Department’s focus on reviewing problem-prone providers or providers who have not recently been reviewed.

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

• In 2025, Community Care will begin activities for the redesign of the Inpatient Mental health Quality Improvement Activities (QIAs). These activities may now include a larger portion of the inpatient network, with less focus on solely the problem-prone providers. The newly designed QIA will review member records regarding COC.

Routine education and discussion occur with providers during wrap-up meetings after record reviews. Community Care views this as a unique opportunity for dialogue and discussion about the importance of COC. This education is a continual process, as new providers enter the network but also for providers who may not be following the standards. Community Care also notes in writing to the providers about the need for timely COC and emphasizes that COC may provide an opportunity to gain another perspective on the members’ course of treatment and help initiate the process of developing appropriate aftercare plans.

• Individualized Quality Improvement Plans (QIPs) may be requested of any provider who falls below the COC goal. The Quality Department monitors the receipt of each QIP and evaluates if the QIP’s interventions would meaningfully impact the rates. If needed, QIP monitoring updates are requested from providers, for example, the results of self-audits to determine the effectiveness of the QIP.
• Care Managers regularly prompt providers during Utilization Management (UM) reviews to coordinate care. Care Managers also participate in numerous interagency meetings and initiatives to facilitate coordination.
• Community Care implemented Pay for Performance (P4P) models. Providers participating in this project may earn rate enhancements if pre-established goals related to follow-up and readmission are met. These performance measures necessitate inpatient hospitals 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.