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 85%. In 2022, 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 80%, and across counties in 2022 providers have documented contact with outpatient providers within 48 hours of inpatient admission 63% 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 76% of the time, with the established goal of 80%.
In 2022, appropriate referrals were made 71% of the time if a co-occurring disorder was identified during the Substance Use Disorder (SUD) Assessment, which falls below the goal of 80% 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 64% of the time in 2022, with the established goal of 80%.
To encourage exchange of information, Community Care:
- Requests individualized quality improvement plans from providers when rates fall below the goal.
- 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.
- Implementation of Pay for Performance projects with providers that focus on coordination of care.
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.