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. 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. We strongly encourage providers to coordinate care with other practitioners who treat the same member.

Community Care monitors five performance measures related to providers’ exchange of information and coordination of care. Data for these measures is 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 the Inpatient Mental Health (IPMH) level of care.

For all levels of care, the goal for evidence of coordination of care with other behavioral health practitioners is 85%. In 2025, providers documented this coordination an average of 76% of the time, which did not meet the goal. In contrast, when a co-occurring Substance Use Disorder (SUD) was identified, appropriate referrals were made in 89% of cases, exceeding the performance target.  

For inpatient reviews across the contracts in 2025, inpatient facilities documented contact with outpatient providers within 48 hours of admission 63% 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 57% 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 77% of the time in 2025. All rates related to the inpatient reviews did not meet the goal of 80%; however, overall, four of the five measures demonstrated improvement from 2024 to 2025, with care coordination amongst behavioral health specialists being the only measure to decline. A primary barrier that remains with all coordination of care 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 has implemented the following actions:

• Beginning in 2025, the IPMH and PRTF Quality Improvement Activities (QIAs) were redesigned to broaden network participation by expanding the provider pool and updating review activities. The redesigned process also emphasized more meaningful provider engagement beyond traditional record reviews.
• 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.

Moving forward, Community Care will be modifying the three IPMH measures to align with revised standards, and the performance target will be adjusted to 80% for all measures. 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.