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BEHAVIORAL HEALTH - Overview |
Improving the quality of behavioral health care has been
a priority for NCQA since the early days of HEDIS, but
targeted efforts have certainly accelerated since the
launch of an accreditation program for managed behavioral
healthcare organizations. As we remarked in the first
edition of QUALITY PROFILES, behavioral health conditions
have a tremendous impact not only on those affected and
their families, but also on their productivity as employees.
Yet our health care system faces enormous challenges in
affecting meaningful improvements in this vital area.
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The Case Studies:
FOLLOW-UP AFTER HOSPITALIZATION FOR MAJOR AFFECTIVE
DISORDER - Establishing a Zero Defects Tracking
Process
Description: Studies had found that adequate
case management following discharge was effective
in reducing early re-hospitalization in depressed
patients. With this in mind, this health plan
developed and implemented hospital performance
standards and a behavioral health case management
process. These steps led to a 100 percent rate
of follow-up appointments.
FOLLOW-UP AFTER HOSPITALIZATION FOR MAJOR AFFECTIVE
DISORDER - Improving a Vendor's Discharge Planning
Description: Coordination with a vendor also
was critical to this plan's QI initiative, which began
with the implementation of a formal tracking system.
From there, the vendor focused on educational activities
for members and providers, including publishing articles
in the member and provider newsletters and hiring
additional case managers.
FOLLOW-UP AFTER HOSPITALIZATION FOR MAJOR AFFECTIVE
DISORDER - Planning and Communicating at the Time
of Discharge
Description: Improved communications were the
key to this plan's increased follow-up rate. Immediately
after each patient was discharged, the plan faxed
discharge summaries to the behavioral health department's
administrative office. Based on these summaries, the
plan installed a "tickler" system to monitor whether
patients were seen within 30 days after discharge.
MANAGEMENT OF MAJOR AFFECTIVE DISORDER - Working
With Vendors to Improve Coordination of Behavioral
Health Services
Description: On the advice of its behavioral
health advisory committee, this plan revised its policies
and procedures for communicating with members' primary
care physicians about behavioral health issues. In
response to access barriers, the plan's behavioral
health vendors increased psychiatric home-care services.
On the education front, the vendors taught behavioral
health providers how to coordinate care with members'
primary care physicians; the plan subsequently required
this coordination of care.
MEDICAL MANAGEMENT OF DEPRESSION - Disseminating
Guidelines to Improve Diagnosis and Treatment
Description: To increase the recognition of
depression, this plan designed and implemented a comprehensive
program of disseminating practice guidelines and educational
activities. The plan developed internal guidelines
with input from an advisory panel (which recommended
the initial set of draft standards) and public comment,
and distributed final standards to its provider network.
From there, the plan held educational seminars for
primary care providers and ran a detailed article
in the provider newsletter.
REDUCING INPATIENT MENTAL HEALTH READMISSIONS -
Reengineering Case Management
Description: This organization restructured
its case management program to reduce the rate of
readmission (within 90 days) for major affective disorders.
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