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Since 1996, PBH has periodically provided its Provider Feedback Helps Evaluate
high volume individual and group outpatient few of the issues raised by providers are providers with objective feedback on key The ALERT System: Early Results
Neurofeedback in the Treatment
Profiling system. In 1999 PacifiCare Behavioral numbers that are different than the number Health implemented a completely redesigned Effective Treatment Planning
profile. This new profile includes nine quality The Dilemma of Delirium
indicators, plus several descriptive measures, Preliminary Results for 1999
Member Satisfaction
including a summary of the severity of the within 90 days of the date of service.
Substance Abuse Reporting and
provider’s case-mix. The following are highlights Treatment
Coordination of Care
Academy Free Membership Offer
● Profiles were distributed to nearly 1300 Northwest Staff Introduction
individual practitioners and over 80 group 12 or younger with at least one family visit practices. These providers saw approximately Celexa® Added to Formulary
Meeting Special Needs
indicated they meet with the family of their younger patients, but do not submit claims ● In the six-month period from October 1998 PBH Management
& Staff
met PBH’s target of having a complaint rate encourages providers to use these codes at Alan Savitz, M.D.
least once during a treatment episode with members under the age of 12, when the family ● During this same six-month period, only Jerome Vaccaro, M.D.
when a patient was receiving psychotropic The percentage of referred patients not seen Jeff Meyerhoff, M.D.
within 30 days seems high. Several providers pointed out that members often choose not to pursue treatment immediately, and that they Jack Costello, MS, MBA
cannot control this. PBH recognizes that many Director, Northwest Regional Operations members voluntarily choose to delay the initia- Edward R. Jones, Ph.D.
indicators is challenging, and PBH recognizes tion of treatment. An internal analysis showed that the interpretation of any individual indi- that a typical “no show” rate is about 30%; a Jack Pauley, LCSW
cator for a given provider can be influenced by persistently higher rate over time may indicate many factors. The profiling system is intended that accessibility is problematic. In light of Christy Beaudin, Ph.D., LCSW,
to be one tool among many that evaluates the the concerns raised by providers, PBH will re- evaluate the appropriateness of this measure care and service provided to members by PBH provider partners. To continually improve this Alice Kuchinskas, MFCC
quality measurement tool, the initial profile mailings have been accompanied by a question- Jan Cunningham, CSW
Provider Network Development
plan started with data collection at each of its Preferred Group Practices and then PBH has developed a unique system for measuring clinical outcomes. This new program, ALERT (Algorithms for Effective Reporting and Treatment), emphasizes the impor- show that PBH is delivering on its tance of guiding patients and practitioners along the course of a treatment episode. Unlike other outcomes pro- grams, the PBH program provides more than a snapshot of a patient’s change before and after treatment. It is treatment shows an effect size (statistical designed to monitor how the patient is changing during an episode of care, thereby assisting the provider in changing The ALERT System is based on information provided directly by the patient. While other outcomes manage- ment programs tend to rely on data submitted by the treating practitioner, PBH has developed a system that relies on patient self-report data. Powerful new tools have been developed for this purpose in consultation with lead- ing researchers in the field. The Life Status Questionnaire (LSQ) and the Youth Life Status Questionnaire (YLSQ) are patient self-report instruments jointly owned by PBH and American Professional Consulting Services (APCS).
Drs. Michael Lambert and Gary Burlingame, Professors of Psychology at Brigham Young University and principals of APCS, are two of the nation’s leading experts in the field The ALERT System is an efficient, user-friendly system ized, controlled clinical trials does not for collecting, analyzing and reporting clinical informa- tion. The LSQ and YLSQ are 30-item instruments that patients/parents complete in 5 minutes or less. They are administered prior to the first, third and fifth sessions and faxed to PBH by the treating practitioner. The LSQ and YLSQ have been developed in a unique software applica- tion that automatically enters the faxed information into a clinical database. This same fax-based technology is used for submitting the provider’s assessment of the patient, the Provider Assessment Report (PAR). The ALERT System quickly analyzes the clinical data submitted by both patient and provider, and generates reports that tell the clinician which patients are doing well and which patients are most at risk. The types of risk identified relate to suicidal behavior, chemical dependency, and premature dropout from treatment due to poor response. The ALERT System was implemented in 1999 through- out California, and PBH plans to roll it out to all of its regions during the next year. The PBH implementation PACIFICARE BEHAVIORAL HEALTH NETWORK DEVELOPMENT
one problem statement based on the infor- for achieving those goals. The goals are the In the last edition of Networknews the issue of mation gathered from the assessment. This “big picture”, while the objectives are the the “clinical assessment” was addressed. An may or may not be the patient’s presenting small, measurable targets that are established accurate assessment is the cornerstone of a to help identify whether or not the goals are clinician’s treatment plan. The treatment plan salient treatment issue identified. Each issue is a roadmap that aids the mental health should be clearly stated and numbered for have been set the clinician should list the practitioner in staying focused through the easier reference. It should contain informa- treatment episode. Without a solid, clearly tion about why the patient has entered treat- defined treatment plan the patient’s care can ment at this time, what changes in life-role should include the type, modality and fre- become aimless and meandering, and in many symptoms exist that help define the problem.
An effective treatment plan should contain Next, the practitioner should formulate the for adjunct treatment and/or possible refer- the following elements. It should have at least goals for treatment and set up the objectives rals, such as medication evaluations, support ventions are a way for practitioners to frame patient to learn and do, and approximately Psychiatric hospitals are adept at treating interactive process with the patient. Setting patients with psychiatric conditions, but they goals with the patient can engage them in are not the best place for the medically ill.
the treatment process from the initial ses- However, a number of acute medical problems inpatient level of care, will such care be can present with altered mental status as the should be discussed with the patient so they have a clear understanding of what to expect example of this is the clinical picture called Association’s Guideline on the Treatment from treatment, as well as the opportunity delirium in the DSM-IV. Because the behav- to either agree or disagree with the proposed ioral problems are so apparent, some harried emergency physicians give these patients only the patient’s involvement and understanding the most cursory of examinations before refer- ring them to psychiatric units. And because either make a notation on the plan that it not all evaluators in psychiatric facilities are was discussed with the patient, or they can medically trained, the very thought that what actually has a brain tumor or the failure they are seeing isn’t an acute psychiatric disor- der doesn’t occur to them. The result is the A treatment plan is dynamic in nature.
mislabeling and inappropriate placement of the It will likely change as the patient pro- patient, followed by inadequate medical follow- gresses, and should be reviewed and updated can also be cruel places for the medically up and unnecessary psychiatric treatment.
during the course of treatment. It should Elderly patients, especially those with a pre- also be re-evaluated if the patient does not existing dementia, are particularly at risk. show progress. Hence, the treatment plan is patient’s bladder infection is treated with an essential tool that should continually be PBH has recently implemented a new policy referred to during the course of treatment.
to address this problem. When a patient’s his- tory and clinical presentation strongly suggest a delirium as opposed to a purely psychiatric dis- sample treatment planning form, please call order, PBH is now requiring that he or she first appropriate, necessary care and recognize receive a thorough medical evaluation and appropriate medical treatment on a medical or PACIFICARE BEHAVIORAL HEALTH NETWORK DEVELOPMENT
with recent inpatient or residential treat- ment on a quarterly basis using mail sur- PacifiCare Behavioral Health monitors member satisfac- tion with the quality of care and service they receive by the mailed survey in the first six months conducting telephone surveys throughout the year.
Random samples of members who have recently called were satisfied with the process of obtain- PBH to access outpatient services are asked about their experiences with PBH and the provider to whom they were referred. Approximately 10% of members who access services are surveyed. In the first nine months of 1999, a total of 5124 members participated in the survey. the overall care (inpatient and outpatient) The 1999 results so far are generally very positive. The vast majority of members (85%) were satisfied overall with the services they received through PBH. Overall member dissatisfaction with services received has declined from over 9% in 1998 to less than 8% in the first nine months of 1999. Other survey highlights include: ● Members are highly satisfied with the degree to which the PBH customer service staff is caring and courteous. Ongoing customer service training for PBH staff, a new telephone system, and increased staffing have helped PBH reduce the percentage of members reporting that ● Nine out of ten members are satisfied with their PBH high as 50%. It appears that there may stance abuse disorders to outpatient provider availability for appointments.
How satisfied are you with.
On your initial call to PBH.
* Question only asked from October 1998 onward. PACIFICARE BEHAVIORAL HEALTH NETWORK DEVELOPMENT
Coordination of behavioral health care with ● An article was published in the 1999 primary care physicians and other practi- edition of Member Outlook, the PBH tioners is a standard of care endorsed by member newsletter, to increase members’ PacifiCare Behavioral Health. Not only is it awareness about the importance of coordi- less than optimal practice to treat a patient within a vacuum, but it may also endanger your patient’s health or introduce unnecessary ● PBH recognizes that coordination of care barriers to the treatment plan. PBH has the expectation that (1) care should be routinely to increase Primary Care Physicians’ aware- coordinated with the PCP for all patients, and ness and to provide them with more acces- (2) care should be coordinated in specific cases ● In an effort directed toward primary care PBH has implemented several strategies to Consultation Service, a toll-free, telephonic make coordination easier for all behavioral health practitioners involved in a patient’s care: ● The one-page Health Care Coordination ● PCS provides timely access to a behavioral capture practitioners’ coordination efforts.
health specialist for assistance with behav- nating care with the PCP in routine cases.
● In cooperation with the National Mental national organization of health care providers ● PBH’s clinical practice guideline on announced that it is offering free general fications by PacifiCare Health Systems for membership to all MCO panel providers.
use by its affiliated physicians in primary This offer extends through the first quarter of 2000. The only cost to providers is the ● PBH has led corporate-wide efforts at numerous benefits to its members and also treatment of depression in primary care.
awards Diplomate status to providers with Interventions have included special reports compliance by their patients, as well as a MCOs are beginning to use Diplomate status program offering education and telephonic PBH believes that effective coordination of care among the patient’s practitioners provides is published by PacifiCare Behavioral Health for its participating providers a dividend of improved quality of care for the Eve Lievonen, LCSW
Raeleen Marquez
patient. This makes it a goal worth the extra NORTHWEST REGION
Bill feels communication with providers is one of the best ways to We would like to introduce you to Bill Osborne, a member of maintain the quality of care for patients and he encourages our the PBH clinical staff in the Northwest office. Bill has been providers to call when concerns arise. “We are very interested in build- with PacifiCare Behavioral Health since the Northwest office ing good relationships with our providers and it is helpful to clear up opened in October 1996. He is a licensed social worker in the misunderstandings and answer questions as they come up. Often having state of Oregon. Many of you have spoken with Bill on the a discussion early on can prevent problems down the road,” says Bill. ■ phone, especially if you work with our Secure Horizons popula- tion. Because of his lengthy experience working with the elderly, Bill serves as the primary inpatient case manager and point per- son for Secure Horizons case management.
Bill graduated from Rutgers University with a Masters degree in Social Work, specializing in medical social work. He moved to Prescription Solutions reviews its prescription formulary on a regular the Northwest and began working with the Area Agency on basis. Sheela Andrews, Pharm.D., Director, Pharmacy Services for Aging, doing outreach and crisis work with the elderly. Bill went Prescription Solutions notes that there is a recent addition to the on to work with a Home Health and Hospice agency in the state of Washington, doing counseling, crisis intervention, and ● Celexa® is indicated for treatment of depression.
bereavement treatment with physically ill patients and their ● Efficacy has been shown to be similar between Prozac®, Zoloft®, families. After logging over 60,000 miles on his car in three years, Bill left this job to assume a supervisory position with a geriatric day hospital program. In that position, Bill ran groups ● No clinically significant drug interactions are associated with and did assessment and discharge planning. He also spoke to Celexa®, as it is not a potent inhibitor of P450 isoenzymes.
various organizations about identifying depression in the elderly ● Side effects with Celexa® (dry mouth, nausea, somnolence, and differentiating between dementia and depression. After that increased sweating, and tremor) tend to be less frequent and Bill is pleased with PacifiCare’s commitment to stand behind ● Celexa® is available as a scored tablet. ■ its goal of continuous improvement. “I think that we are always looking for better ways to assist people. It’s a constantly changing field that tends to ask a lot from the people that work within it.
The people I work with are constantly looking at and sharing new research regarding better ways to treat people.” In order to better meet the needs of our membership, especially in the He states that one of the key factors for patient health is the Portland area, PacifiCare Behavioral Health would like to ask your coordination of care. “An important part of our job is ensuring assistance. If you know of licensed practitioners who are bilingual or that there is appropriate follow-up when a member is discharged bilingual-bicultural, especially with respect to Asian or Hispanic popul- from the hospital. This can be a challenge because members ations, please encourage them to call us at the Lake Oswego office in often do not take the initiative to make a follow-up appointment regard to joining the PBH network. We all know that there are cases in in a timely manner.” Bill says the burden often falls on the which cultural or language barriers can impede progress in therapy or providers to notify PBH when a patient has been released from discourage a patient from participating in treatment. Increasing the a hospital. That communication is important to ensure that number of therapists in our network with different cultural backgrounds members get the follow-up care they need.
can help us to reduce these barriers. ■


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