Managed Behavioral Health Care Organizations

Question 1

Key success factors of an ACO (4)

Answer 1

1. ) Ability to identify the population to manage
2. ) Ability to understand and manage cost
3. ) Ability to manage quality
4. ) Ability to integrate care

Question 2

Key success factors of a patient-centered medical home (7)

Answer 2

1. ) Improved quality of care
2. ) Improved status of comorbid conditions
3. ) Increased satisfaction of patients
4. ) Reduction of avoidable comorbid hospitalizations
5. ) Reduction of acute occurrences
6. ) Reduction of IP admissions
7. ) Reduction of LTC admissions

Question 3

Types of services delivered by behavioral health care networks (6)

Answer 3

1. ) IP services - highest level of skilled services. Involves 24-hour medical and nursing care in a psychiatric facility, general hospital, or detox unit in a hospital.
2. ) Residential treatment - services rendered in a 24 hour facility offering therapeutic services for patients with severe mental or substance-related disorders
3. ) Partial hospitalization - provides structured mental health or substance abuse therapeitic services for at least 4 hours a day and 3 days per week
4. ) Intensive OP program - provides structured therapeutic services for at least 2 hour per day and at least 3 days a week
5. ) OP treatment - includes individual, family, or group treatment rendered by a licensed professional
6. ) Employment assistance programs (EAPs) - EAP prof deliver short-term, problem-focused OP services for employees and their familities

Question 4

Types of behavioral health care services delivered by public sector networks (5)

Answer 4

1. ) Supervised living - includes community-based residential detox programs and rehab in halfway or quarter way houses
2. ) Programs for assertive community treatment - multidisciplinary teams deliver services directly in the community to people who demonstrate chronic symptoms and pattern of relapsing
3. ) Peer support - consumers who have recovered work under the supervision of a behavioral health provider that assists patients in building confidence and in improving life skills
4. ) Continuous treatment teams - multidisciplinary teams provide a range of services in an effort to prevent a child from needing to be removed from the home and placed in a more restrictive level of care
5. ) Community case management - workers coordinate care and social services delivered within the community

Question 5

Utilization management strategies to reduce IP behavioral health care cost (7)

Answer 5

1. ) Addressing psycho-social causes of admissions in order to get early treatment and avert need for admission
2. ) Increasing ambulatory follow up to help prevent unnecessary readmissions
3. ) Reducing readmissions through intensive interventions for at-risk patients
4. ) measuring and tracking clinical performance with a focus on outcomes and efficiency
5. ) Reducing relapse through effective aftercare planning and use of community and social supports
6. ) Coordinating services among multiple agencies and providers
7. ) Emphasizing the quality of services provided through supervision, analysis of complaints, satisfaction surveys, and staff training

Question 6

Delivery mechanisms for telemental health services (3)

Answer 6

1. ) Hub and spoke networks - these link large tertiary centers with outlying clinics
2. ) Health provider home connections - these link providers with single line phone video systems for interactive consults
3. ) Web based e-health patient service sites -these provide direct consumer outreach and services over the internet

Question 7

Challenges related to delivering telehealth care (4)

Answer 7

1. ) Technology infrastructure - technologies are constantly expanding
2. ) Cost - capital investment required may be too high
3. ) State licensing and regulation - must apply for separate license in each state
4. ) Payment - number of payers recently start covering telehealth and we visits

Question 8

Institute of Medicine definition of quality care

Answer 8

The degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Question 9

Institute of Medicine Aims or Properties of high quality care (6)

Answer 9

1. ) Safe -avoiding injuries to patients
2. ) Effective - provide services based on scientific knowledge and to those who could benefit
3. ) Patient centered - responsive and respectful to individual preference, needs and values
4. ) Timely - reducing waits and harmful delays
5. ) Efficient - reduce waste (equipment, supplies, ideas)
6. ) Equitable

Question 10

Data sources for behavioral health care performance metrics (8)

Answer 10

1. ) Administrative data - includes claims eligibility information, various coding sets
2. ) Treatment records - contains detailed clinical information
3. ) Survey data - from providers and consumers
4. ) Access data - review of provider appointment availability
5. ) Clinical assessments - involve consumer self-report and provider and caretaker observations
6. ) Utilization management data - include requests for care, non-authorizations, and appeals
7. ) Risk management data - include adverse events and medication errors
8. ) Predictive modeling data - derived from utilization data and population risk adjustment formulas

Question 11

MBHCO - tools to assess behavioral health (4)

Answer 11

1. ) Integrated home health and medical homes
2. ) DM to target specific conditions
3. ) motivational coaching
4. ) Internally developed health risk assessment tools