CHC Behavioral Health Data Febr brua uary y 13 13, , 20 2020 20 Abigail Coleman/Director Program Analytics Charles Klinger/Systems Division Director Office of Long-Term Living Office of Mental Health and Substance Department of Human Services Abuse Services Department of Human Services 1
OL OLTL TL and and OMH OMHSAS SAS Activities Activities ❑ Established OLTL/OMHSAS Monthly Meetings ❑ Coordinated Joint Meetings between CHC-MCOs, Dual Special Needs Plans (D-SNPs) and BH-MCOs ❑ CHC Performance Improvement Projects (PIPs) (CY 2020-2023) Clinical: Strengthening Care Coordination CHC Goal: Strengthen coordination of LTSS and other types of health care including all Medicare and Medicaid services for dual eligible individuals ▪ Involves and promotes coordinating care between CHC-MCOs and D-SNPs for nursing facility, acute care, behavioral health Non-Clinical: Transitioning from Nursing Facility to the Community CHC Goal: Enhance Community Based Living Opportunities • Promotes Coordinating care between CHC-MCOs and D-SNPs for nursing facility and behavioral health 2 2/14/2020
The he numbe number r of of Pr Projected ojected C CHC HC Par articipants w ticipants who ho had had a c a claim wit laim with h a primar a primary y BH BH dia diagno gnosis sis in 2017 in 2017 Total Primary BH Population Diagnosis Medicaid BH Encounters Only 35,757 17.22% FFS Medicare Claims Only 83,528 40.22% 207,685 Unduplicated Medicare and 89,227 42.96% Medicaid 3 2/14/2020
Medicaid Onl Medica id Only y Se Services vices • 7.87% of individuals enrolled in a Community HealthChoices Managed Care Organization (CHC-MCO) received a Medicaid Only service in 2018 • Mental Health Crisis Intervention • Methadone Maintenance • Mobile Mental Health • Peer Support Services • Targeted Case Management • In comparison to Behavioral Health (BH) HealthChoices 6.78% of individuals enrolled in a Behavioral Health Managed Care Organization (BH-MCO) in a Southwestern County received at least one of these services in 2018 4 2/14/2020
The he nu numbe mber r of of ind individua ividuals ls pe per 1,00 r 1,000 0 CHC CHC en enrolled olled by by CHC CHC Pop opula ulation tion Gr Grou oup p th that t rec eceiv eived ed a Med a Medicaid icaid Onl Only y Ser Service vice in 201 in 2018 8 (Sout (Southw hwes est t on only) y) Total number of Number of Individuals individuals that CHC Population Group per 1,000 enrolled by received the service CHC Population Group Nursing Facility Ineligible 6,294 66.12 (NFI) Home and Community Based 649 6.82 (HCBS) Duals Long Term Care (LTC) Duals 417 4.38 HCBS Non-duals 332 3.49 LTC Non-duals 136 1.43 5 2/14/2020
The he nu numbe mber r of of ind individua ividuals ls pe per 1,00 r 1,000 0 CHC CHC en enrolled olled by by CHC CHC MCO MCO th that t rec eceiv eived ed a Med a Medicaid icaid Onl Only y BH BH Ser Service vice in 201 in 2018 8 (Sout (Southw hwes est t on only) y) Total number of Number of individuals that Individuals per CHC MCO received the 1,000 enrolled service by CHC-MCO UPMC COMMUNITY 4,207 44.20 HEALTHCHOICES PA HEALTH AND 2,048 21.52 WELLNESS AMERIHEALTH CARITAS 1,593 16.74 6 2/14/2020
The he nu numbe mber r of of ind individua ividuals ls pe per 1,00 r 1,000 0 CHC CHC en enrolled olled rec eceiving eiving th the e follo ollowing se wing service vices s in 201 in 2018 8 (Sout (Southw hwes est t on only) y) Total number of Number of Individuals BH Service individuals that per 1,000 CHC received the service enrolled Mental Health Crisis 2,333 24.51 Intervention Methadone Maintenance 1,238 13.01 Mobile MH 361 3.79 Peer Support Services 926 9.73 Targeted Case Management 4,418 46.41 7 2/14/2020
QUESTIONS 8
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