G5: Building a Community G5: Building a Community System of Care for Adults System of Care for Adults

with MH/AD Disorderswith MH/AD Disorders

DATA UPDATEDATA UPDATE

March 5, 2009

Focus• Review of data to see where we are

relative to hospital and community services– Original intent was to compare with August 2007 presentation– Limted FY07 data presented (Q1-Q3) and inconsistent

standardization of units made this difficult w/o re-running the FY07 results.

• Answer questions about the Game Plan• Identification of indicators to be tracked

to see how we’re doing w/ the transition

Desired Regional-Based System of Care Service Array

Single Point of Entry

Crisis and Acute Care•Mobile Crisis CSP•Acute care beds•23 hour obs

Basic Clinical Services• Physician Assessment• Diagnostic Assessment• Nursing Services• Counseling• Medication• Daily Living Skills Training

Evidence-Based Recovery Support Services• ACT• Intensive case management• Supported Housing/ITR• Supported Employment

Inpatient Treatment Extended care, facility-based

CRISIS SERVICES

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to regions based upon county of residence Why change or no change? Where is acute/crisis capacity needed or where should it

be better utilized?

Consumers Discharged from State Hospitals with LOS <= 3 Days, FY2007-08

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to areas based upon county of residence Where is acute/crisis capacity needed or where should it be better utilized?

Consumers Discharged from State Hospitals with LOS <= 3 Days, FY2008

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to regions based upon county of residence Where is acute/crisis capacity needed?

Consumers Discharged from State Hospitals with LOS <= 14 Days, FY2008

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to areas based upon county of residence Where is acute/crisis capacity needed?

Consumers Discharged from State Hospitals with LOS <= 14 Days, FY2008

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to regions based upon county of residence Why change or no change? Where is SA crisis capacity needed?

Consumers Discharged from State Hospitals with SA primary DX, FY2007-08

Non-court controlled consumers discharged from AMH and secure cost centers Discharged consumers assigned to areas based upon county of residence Where is SA crisis capacity needed?

Consumers Discharged from State Hospitals with SA primary DX, FY2007-08

Crisis Stabilization Programs (CSPs)

Name   (July 1, 2006) (July 1, 2007) (July, 1 2008) (December 1, 2008)

Pathways Region 1 12 12 12 12McIntosh Trail Region 1 16 10 10 10Highland Rivers-Cedartown Region 1 30 28 28 28Highland Rivers-Dalton Region 1 28 30 30 30Serenity Behavioral Health Systems Region 2 16 16 16 16Advantage Behavioral Health Systems Region 2 14 14 14 14Cobb Region 3 16 16 16 16DeKalb Region 3 42 42 42 42GRN Region 3 16 16 16 16River Edge Region 4 15 15 15 15Phoenix Center Region 4 14 14 14 14Oconee Region 4 14 14 0 0Albany Region 4 30 30 30 30Southwestern State Hospital Region 4 15 17 17 17CSB of Middle Georgia Region 4 16 16 16 16MHDDAD - WCGRH Region 4 0 0 25 45Pineland Region 5 12 12 12 12Gateway - Brunswick Region 5 8 8 8 8Gateway - Savannah Region 5 8 8 8 0Satilla Region 5 0 0 16 16MHDDAD - GRH-SAV Region 5 0 0 0 16

ADULT TOTAL   322 318 345 373

Most beds in Region 4 (117), followed by Region 1 (80) and Region 3 (74) Region 3 – on a per capita basis, low CSP utilization and very low numbers of short hospital stays

and SA discharges Region 1 – on per capita basis, high CSP utilization and low numbers of short hospital stays and SA

discharges Region 4 - on per capita basis, high CSP utilization and high numbers of short hospital stays and SA

discharges

CSP Adult Consumers Served (Encounters), FY2008

Compare with carts of state hospital LOS and SA discharges in state hospitals. Again, less than perfect relationship.

CSP Adult Consumers Served (Encounters), FY2008

In terms of consumers served, authorizations almost identical to encounters. Focusing on encounters rather than authorizations should not skew results.

CSP Adult Consumers Served (Authorizations), FY2008

Charts above allow the examination of array of crisis services (instead of just CSPs) by region

Services include CSP, ambulatory detox, residential detox, and crisis intervention For example, Region 1 depends almost exclusively on CSP beds

Crisis Services Adult Consumers Served (Claims & Encounters), FY2008

CORE SERVICES

On per capita basis, high utilization in South Georgia, less utilization in Metro Atlanta

Core Svcs Adult Consumers Served (Encounters), FY2008

Within regional boundaries, utilization can vary. See Region 2 (Gainesville) and Region 5 (Savannah).

Core Svcs Adult Consumers Served (Encounters), FY2008

DAY SERVICES

Day services include SA Day, Intensive Day (Partial Hosp), Peer Supports, and Psychosocial Rehab On a per capita basis, day services more heavily utilized in South Georgia. Regions 1-3 have similar distributions across services (except Region 3 relies more on PSR and SA

Day and less on peer supports) Regions 4-5 have a similar distribution of day services.

Day Services Adult Consumers Served (Claims & Encounters), FY2008

Day services include SA Day, Intensive Day (Partial Hosp), Peer Supports, and Psychosocial Rehab

Day Services Adult Consumers Served (Claims & Encounters), FY2008

SUPPORTED EMPLOYMENT

1,577 consumers statewide

Supported Employment Adult Consumers Served (Encounters), FY2008

SUMMARY BILLING DATA

Adult Units X Rates (Medicaid & State), FY2008

Per claims and encounters, Region 4 bills almost 2X the community services as Region 1.

Similar distribution across regions. Crisis=10%, core= 67%, day= 8%, community support = 15%. What is the proper distribution?

Adult Units X Rates (Medicaid & State), FY2008

Adult Units X Rates (Medicaid & State) – Per MH/AD Prevalence, FY2008

Based upon claims and encounters submitted, Region 3 and 4 outliers in terms of per capita utilization.

Adult Units X Rates (Medicaid & State) per MH/AD Prevalence, FY2008