LeYeO Rf CaUe Quarters 1 & 2: January-June 2015 ......UTILIZATION MANAGEMENT FOR YOUTH MEMBERS...

$: LeYeO Rf CaUe Quarters 1 & 2: January-June 2015 ......UTILIZATION MANAGEMENT FOR YOUTH MEMBERS Quarters 1 & 2: January-June 2015 E[ecXWiYe SXPPaU\ & AQaO\ViV b\ LeYeO Rf CaUe Submitted:$
UTILIZATION MANAGEMENT FOR YOUTH MEMBERSQuarters 1 & 2: January-June 2015

Executive Summary & Analysis by Level of Care

Submitted:September 1, 2015

Authors:Robert W. Plant Ann Phelan Lynne Ringer Heidi Pugliese Ellen Livingston Lindsay Betzendahl

Acknowledgements:The authors would like to acknowledge the important contributions of the Quality Analyst Team lead by JosephBernardi (Rebecca Neal, Ivan Theobolds, John Broadwell, Kate Powers, Stephanie Shorey-Roca, Shweta Tiwari,and Melissa Williams) and the Reporting Analyst Team lead by Ray Rocchetti (Susan Donavon, Mike Barron, Sarah

Brdar, Wally Farrell, Jim Greer, Lonnie Madeux, and Bill Owen).

For any inquiries, comments, or questions related to the use of Tableau please contact Lindsay Betzendahl at [email protected].

UTILIZATION REPORT FOR YOUTH MEMBERSQuarters 1 & 2: January-June 2015

MethodologyThe shift to semiannual reports was designed to minimize noise created by quarter-to-quarter fluctuations that do not reflect a true trend in the data. However, asagreed, these semiannual reports will continue to include quarterly level detail rather than a simple roll-up of 6-month periods. This achieves the balance of makingsure that significant and meaningful quarterly fluctuations are not missed while maintaining a focus on more persistent trends. The utilization data in the 4A and10B series reports are exclusively based on authorizations entered into the Beacon Connect system. In some cases, additional data, primarily drawn from theProvider Analysis and Reporting program (PAR), are included to enhance the understanding of the drivers of the utilization trends. An example of this is the inclu-sion of the Inpatient child PAR data that helps to further explain how changes in the average length of stay (ALOS) for child inpatient hospitalization for a givenquarter are impacted by individual hospital performance.

The data for the utilization reports are refreshed in each subsequent set of reports. As a result of retrospective authorizations and changes in eligibility, the resultsfor each quarter often differ from the previously-reported values. In most cases, the refreshed data does not result in significant differences in the previously re-ported conclusions. However, on some occasions there is sufficient variation that the previous analysis is no longer relevant. This phenomenon has been muchmore common for analyses of adult utilization, as retrospective membership variations have been significantly larger for adults than for youth. For any analysis af-fected by these variations, we identify it in the narrative and describe the implications.

Total membership is based on unique members. This means that even if a member changes age, benefit group or DCF status they will only be captured once inthat reporting period.

The length of stay calculation is based only upon those members who were discharged during the reporting period. The measure includes all days from the begin-ning of the authorization for that level of care, including those from previous reporting periods if applicable. Significance testing was calculated for average lengthof stay by using a mixed effects model with a fixed term.

The numerator for admits/1,000 and days/1,000 are based on the total number of members in the identified group. Days/1,000 include service days consumed during the reporting period. All per 1,000 calculations, except where noted, use the statewide youth population as the denominator. Significance testing for admitswas calculated using a chi square test. For the purposes of this report, only those measures that are both statistically significant and clinically meaningful will bediscussed and noted as statistically significant.

General OverviewThis is the first report to reflect changes in the timing and format of the utilization review. First, these reports will now cover two quarters and be completed semi-annually. The review of the data will continue to look at quarters; the underlying reports and graphs will not combine the two quarters into 6-month figures. Sec-ond, the format will change to Tableau, a more interactive data visualization product.

On at least a semiannual basis, the reports mutually agreed upon in Exhibit E of the CT BHP contract are submitted to the State for review. This report focuses onthe utilization management portion of these reports, evidenced in the 4A series which reviews utilization statistics such as admissions per 1,000 members (ad-mits/1,000), days per 1,000 members (days/1,000), and average length of stay (ALOS).

As stated in previous submissions, results were graphed only for benefit groups that had a sufficient volume of members receiving services in each level of care(LOC). The utilization report focuses only on those levels of care in which the data warranted analysis and discussion as evidenced by significant changes andtrends or in cases when changes and trends are unclear and additional data is needed. As a result, this report outlines/highlights the areas of interest related tocertain utilization trends, as well as the underlying factors which drive the trend and associated programmatic responses taken by Beacon Health Options to im-pact/mitigate or support the trend. We also present recommendations to address remaining challenges and report progress related to these planned recommen-dations. The areas of focus for this quarter are listed on the following page.

Reports Used for Youth Report

Reports Used4A_2 Total Unique Membership4A_2 Total Unique Membership: All Youth (ages 17 and under)4A_1 Membership Youth (ages 17 and under) DCF Members4A_1 Membership Youth (ages 17 and under) Non-DCF Members Composition of DCF Membership; 2012 – 20144A_1/4A_2 Inpatient Admits/1,000; All Youth (ages 17 and under); DCF vs. Non-DCF Members4A_1/4A_2 Inpatient Days/1,000; DCF vs. Non-DCF Members (ages 17 and under)4A_1/4A_2 Inpatient Average Length of Stay, DCF vs. Non-DCF MembersPAR Inpatient Average Length of Stay (ALOS) and Discharges for In-State Pediatric Hospitals; All Youth (ages 3-12)PAR Inpatient Average Length of Stay (ALOS) for In-State Pediatric Hospitals; Child (ages 3-12) and Adolescent (ages 13-17), DCF vs. Non-DCFPAR Inpatient Pediatric Hospitals Average Length of Stay (ALOS) Comparison10B_7 Inpatient Percent of Days Delayed , DCF vs. Non-DCF MembersCTBH12087 Inpatient Days in Delay by Reason code(s) CTBH12087 Inpatient Solnit Center ALOS; All Youth, Court Ordered and Non Court Ordered data10B7 Inpatient Solnit Center Number of Days DelayedCTBH12212 Inpatient Solnit Center Days in Delay by Reason Code4A_2 Community PRTF Admissions; Youth (ages 5 – 13), Community PRTF Days/1,000 and PRTF Average Length of Stay, Youth (ages 5 – 13) 10B7 Community PRTF Number of Days Delayed; Youth (ages 5- 13), Discharge Delay Descriptions10B4B PRTF (excluding Solnit) Discharge Delay Reason Awaiting Placement4A_2 Solnit Center PRTF Admissions; Youth (Ages 13 – 17)4A_2 Solnit Center PRTF Days/1,000; Youth (Ages 13 – 17)4A_2 Solnit Center PRTF Number of Days Delayed; Youth (Ages 13-17) CTBH10035 RTC Length of Stay Analysis

UTILIZATION MANAGEMENT FOR YOUTH MEMBERSQuarters 1 & 2: January-June 2015

Executive Summary & Analysis by Level of CareSubmitted: September 1, 2015

Areas of Focus

MembershipTotal UniqueDCF & Non-DCF

Composition of DCF Membership

Inpatient FacilitiesAdmits/1,000 & Days/1,000Average Length of Stay

PAR HospitalsPercent of Days Delayed

Discharge Delay Reason Code(s)

Inpatient Solnit CenterAverage Length of StayNumber of Days Delayed


Community & Solnit PRTFAdmissions & Days/1,000Average Length of StayTotal Days Delayed


Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

Utilization ProfileProvider Volume

Residential Treatment Center

In-State/Out-of-State Percent of AdmissionsAverage Length of Stay

For this report, the following utilization data points havebeen placed in the Appendix and are not discussed:

Table of ContentsSelect Microscope to View "Areas of Focus"

And Go Directly to Selected Page

→

PHP, IOP, & EDTAdmits/1,000

IICAPSAdmits/1,000

Outpatient (OTP)Admits/1,000

Youth Medicaid MembershipTotal Membership

Total Unique Membership The total population (youth and adult) fluctuated over the last two quarters (Q1 ’15 and Q2 ’15) increasing by 18,011 members, a 2.15% increase from Q4 ’14(838,273) members to Q1 ‘15 (856,284 members), then decreasing by 13,776 members from Q1 ’15 to Q2 ’15. Total membership for Q2 ’15 will likely increaseonce the data refreshes.

All Youth (Ages 17 and Under) The total youth population also fluctuated increasing slightly by 218 members, from Q4 ’14 (326,108 members) to Q1 ’15 (326,326 members), then decreasing by6,521 members from Q1 ’15 to Q2 ’15 (319,805). Non-DCF members made up 98% of total youth population in Q2 ’15.

2013 Q1 2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2

0K

200K

400K

600K

800K

# of Members

Total Unique Membership

■ All Members (Incl. Adults) ■ Total Youth

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1

Original Membership

Refresh One Quarter Later

Refresh Percent Change 0.82%

304,986

302,500

0.79%

303,770

301,388

0.53%

301,878

300,293

0.54%

300,372

298,752

0.80%

326,108

323,534

0.64%

322,899

320,844

1.10%

316,547

313,099

2.18%

310,381

303,773

2.07%

326,326

319,721

Quarterly Youth (0-17) Membership Data Refresh

2013 Q2 2013 Q4 2014 Q2 2014 Q4

0.0%

1.0%

2.0%

% Change (Refresh)

Quarterly Youth Refresh RateAll Benefit Groups, Duals Removed (0-17)

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

Total Membership (IncAdults)

Total Youth Membership 304,986

710,829

304,190

706,645

302,070

702,786

300,594

696,241

326,108

838,273

323,188

818,021

316,976

796,792

311,516

772,321

319,805

842,508

326,326

856,284

Quarterly Total Unique Membership

The refresh rate more than doubledover the last quarter to 2.07% whichcould be a result of the open enroll-ment ending in Q4 ’14.

PG 1

Youth Medicaid MembershipMembership by DCF & Non-DCF

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0K

50K

100K

150K

200K

250K

300K

# of Youth

Quarterly Membership Growth■ Total Youth ■ Non-DCF ■ DCF

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0K

1K

2K

3K

4K

5K

6K

7K

8K

# of Youth

Composition of DCF Youth■ Committed ■ Voluntary ■ Juvenile Justice ■ Dually Committed

■ Family With Service Needs

Select to Compare DCF YouthDeselect Committed to see smaller ch..Multiple Values

Totals may not match due to member move-ment between groups.For the third consecutive quarter the total DCF population has decreased. The Dually

Committed is the only population which did not decrease. DCF Committed populationis the main driver of the total DCF population.

Select GroupAll

PG 2

Youth Medicaid Membership TablesMembership by DCF & Non-DCF

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

DCF Committed

Voluntary Services

Juvenile Justice

Dually Committed

Family with Service Needs 24

32

237

500

7,213

19

29

232

552

7,376

17

28

230

593

7,383

15

32

240

603

7,648

10

29

213

402

8,009

15

31

224

458

8,071

17

31

221

478

7,912

21

30

226

475

7,545

4

33

171

336

7,634

7

26

199

380

7,914

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

DCF

Non-DCF

Total Youth Membership 304,986

298,545

7,964

304,190

297,828

8,177

302,070

295,693

8,231

300,594

293,889

8,505

326,108

319,030

8,695

323,188

316,142

8,787

316,976

310,059

8,613

311,516

304,797

8,275

319,805

313,119

8,159

326,326

319,298

8,498

PG 3

ConclusionsThe total unique membership (youth and adult) has increased from Q4 '14 to Q2 '15 (838,273 to 842,508). The driver of this increase has been the adult populationas the total youth membership has decreased in both non-DCF and DCF. The DCF Voluntary service membership decreased 16% and the Juvenile Justice de-creased 19%, reaching the lowest membership for each over the past ten quarters. The DCF Committed membership decreased only slightly by 5% (8,009 to7,634) from Q4 '14 to Q2 '15 remaining the main driver for the total DCF population. The Dually Committed was the only DCF population which did not decrease inmembership. DCF continues to represent a small percentage of the Medicaid youth membership (2%) as non-DCF comprises 98% of total youth membership. Wewill continue to monitor the DCF population for further trending or changes.

Youth Membership Summary PG 4

Inpatient: Excluding SolnitAdmits/1,000, Days/1,000 & Average Length of Stay

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Admits/1,000

Quarterly Inpatient Admits/1,000: Youth (0-17)Excluding Solnit

Admits/1,000The total admits/1,000 increased by 7.4% from Q1’15 to Q2 ’15 (0.68 to 0.73) after decreasing slightlyby 1.4% from Q4 ’14 to Q1 ’15. Non-DCF ad-mits/1,000 remained fairly constant over the lastthree quarters. Non-DCF involved youth made up82.4% of total admissions over the last two quarters(Q1 and Q2 ’15), a 3.1% increase from Q4 ’14. DCFadmissions are generally decreasing over the lastyear, down 21.3% from one year ago.

Days/1,000Total days/1,000 decreased by 5.5% from Q1 '15 to Q2'15 which is the second consecutive quarterly decrease(8.66 to 8.18) after increasing by 10.4% from Q3 ’14 toQ4 ’14. Total number of cases increased by 9.1% cas-es to 777 from Q1 ’15 to Q2 ’15 after decreasing by6.1% from the previous quarter. Non-DCF membersare responsible for driving the increase as they ac-counted for 82% of the additional cases.

Average Length of Stay (ALOS)After remaining fairly constant over the last 3 quarters, total ALOS decreased to 11.2 days in Q2’15, the lowest ALOS in the last 2 years. Overall,the DCF youth population continues to have alonger ALOS than the non-DCF youth populationby approximately 3 days. Range of LOS for DCFyouth was 1-122 days. Range of LOS for non-DCFyouth was 1-334 days.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

2

4

6

8

10

Days/1,000

Quarterly Inpatient Days/1,000: Youth (0-17)Excluding Solnit

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

2

4

6

8

10

12

14

16

18

Avg. Length of Stay (days)

Quarterly Inpatient Average Length of Stay:Youth (0-17)Excluding Solnit

Total ALOS decreased to 11.2 days in Q2 ’15, the lowest ALOS in the last 2 years.

Select to Highlight GroupDCFNon-DCFTotal Youth

PG 5

Inpatient: Excluding Solnit TablesAdmits/1,000, Days/1,000 & Average Length of Stay

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

DCF Admits/1,000

Admissions

Non-DCF Admits/1,000

Admissions

Total Youth Admits/1,000

Admissions

175

0.20

172

0.19

169

0.19

161

0.18

136

0.14

149

0.16

150

0.16

136

0.15

118

0.13

115

0.12

525

0.60

447

0.51

545

0.62

508

0.58

521

0.55

468

0.50

552

0.59

541

0.60

562

0.61

526

0.56

701

0.79

619

0.70

714

0.81

669

0.76

657

0.69

617

0.65

702

0.76

677

0.75

680

0.73

641

0.68

Quarterly Inpatient Admits/1,000: Youth (0-17)Excluding Solnit

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

DCF Days/1,000

Cases

Non-DCF Days/1,000

Cases

Total Youth Days/1,000

Cases

206

2.8

203

3.2

205

3.2

182

2.7

162

2.3

175

2.5

169

2.4

155

2.4

140

1.6

133

1.9

593

7.0

515

6.2

622

7.1

555

6.7

596

6.6

543

5.5

635

6.9

580

6.4

637

6.6

579

6.7

799

9.8

718

9.4

827

10.3

737

9.4

758

8.9

718

8.1

804

9.2

735

8.8

777

8.2

712

8.7

Quarterly Inpatient Days/1,000: Youth (0-17)Excluding Solnit

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

DCF ALOS

Discharges

Non-DCF ALOS

Discharges

Total Youth ALOS

Discharges

187.0

14.0

172.0

17.1

174.0

16.1

146.0

14.9

144.0

15.3

149.0

15.8

143.0

13.9

136.0

17.2

123.0

13.4

111.0

15.4

554.0

11.5

448.0

13.2

554.0

11.2

478.0

11.5

543.0

12.1

468.0

11.3

560.0

10.9

497.0

10.6

583.0

10.8

504.0

11.8

741.0

12.1

620.0

14.3

728.0

12.3

624.0

12.3

687.0

12.8

617.0

12.4

703.0

11.5

633.0

12.0

706.0

11.2

615.0

12.4

Quarterly Inpatient Average Length of Stay (ALOS): Youth (0-17)Excluding Solnit

PG 6

Inpatient: PAR HospitalsAverage Length of Stay

Includes the Seven In-State Pediatric Hospitals (Ages 3-17)

Youth Ages 3-12The DCF 3-12 year-olds’ ALOS de-creased by 1.8 days to 12.3 days from Q1’15 to Q2 ’15, continuing the decreasingtrend over the last 5 quarters and the lowest ALOS in the last two years. TheDCF 3-12 year-olds’ discharges fluctuat-ed over the last two quarters decreasingby 34.1% to 29 discharges in Q1 ’15 thenincreasing back to more historic levels of43 discharges in Q2 ’15. Range of LOSfor DCF youth was 1-104 days. The non-DCF 3-12 year-olds’ ALOS increased by0.9 days from Q1 ’14 to Q2 ’15 to 12.9days, after a 0.4 day decrease from Q4’14 to Q1 ’15. This is the first time non-DCF 3-12 year olds members had alonger ALOS than DCF 3-12 year oldmembers. Range of LOS for non-DCFyouth was 1-134 days.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

5

10

15

20


Quarterly Inpatient Average Length of Stay; Child (Ages 3-12)DCF & Non-DCF Members

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

5

10

15

20


Quarterly Inpatient Average Length of Stay; Child (Ages 13-17)DCF & Non-DCF Members

Youth Ages 13-17For the DCF 13-17 year-olds, the ALOSremained fairly constant over the last twoquarters. Range of LOS for DCF youthwas 1-112 days. For the non-DCF 13-17year-olds, the ALOS decreased by 1.1days, and Q2 ‘15 is the lowest ALOSrecorded in the reporting period. The number of discharges increased by 46, a13.9% increase after decreasing by 29discharges, a 8.0% decrease from Q4 ’14to Q1 ’15. Range of LOS for non-DCFyouth was 1-96 days.

For the first time, the non-DCF involved youth ages 3-12 had a longer average length of stay (12.9) thanthe DCF 3-12 year-olds (12.3) by 0.6 days.

Ages 3-12 Ages 13-17

DCF Non-DCF DCF Non-DCF

164

43

378

78

Quarterly Inpatient DischargesDCF vs. Non-DCF Members withAge Breakout - Showing Q2 '15

Quarter Q2 '15

PG 7

Inpatient: PAR HospitalsAverage Length of Stay

Includes the Seven In-State Pediatric Hospitals (Ages 3-17)

As a group, the Big Seven pediatric hospitals have been demonstrating a slight downward trend in ALOS since Q2of '13 to Q2 '15 (from 12.0 to 10.8 days).

Pediatric PAR HospitalsIn-state pediatric hospitals ALOS decreased by 0.7 days from Q1 ’14 to Q2 ’15.Three in-state pediatric hospitals (Hartford Hospital, St. Vincent’s Medical Cen-ter, and Yale New Haven Hospital) had a decrease in ALOS from Q1 ’14 to Q2’15, with St. Vincent’s Medical Center having the largest decrease of 3.9 days.After a decrease of 74 discharges, an 11.6% decrease from Q4 ’14 to Q1 ’15,discharges increased by 101 cases, an 18.0% increase from Q1 ’15 to Q2 ’15.

0 2 4 6 8 10 12 14 16 18Avg. Length of Stay (days)

Hartford Hospital

St. Francis Hospital

Natchaug Hospital

Yale New Haven Hospital

Waterbury Hospital

Manchester Hospital

St. Vincent's Medical Center

Big Seven Pediatric Hospitals

15.60

11.30

12.00

10.60

10.80

11.50

6.70

7.60

Quarterly Inpatient PAR Hospitals Average Length of Stay ComparisonShowing Q1 '15Select to Change:

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

2

4

6

8

10

12


0

100

200

300

400

500

600

700

Discharges

Quarterly Inpatient Big Seven PAR Hospitals: All Youth (Ages 3-17)Dual Axis Comparison

■ ALOS ■ Discharge Volume

Select Quarter to View ALOS Comparison Above and Use Ctrl to Select More than One Hos-pital Above for ALOS Comparison Over Time Below

Q1 '15

PG 8

Inpatient: PAR Hospitals TablesAverage Length of Stay & Discharges

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Ages 3-12 DCF ALOSDischarges

Non-DCF ALOSDischarges

Ages 13-17 DCF ALOSDischarges

Non-DCF ALOSDischarges

All Total Youth ALOSDischarges

5714.80

5018.30

6817.20

4115.60

4415.20

3915.60

4016.50

3517.20

4312.30

2914.10

12914.00

13812.90

16311.90

12611.60

14012.40

13011.20

16411.80

12011.80

16412.90

12712.00

12112.70

11716.10

10215.00

9414.60

9113.60

10215.60

9512.40

8815.30

7813.70

7414.60

37110.20

27510.20

34110.10

31610.90

36110.20

30010.30

3489.50

3449.60

3789.20

33210.30

67811.80

58012.70

67412.00

57712.00

63611.50

57111.80

64710.90

58711.30

66310.80

56211.50

Quarterly Inpatient Average Length of Stay (ALOS): All Youth (Ages 3-17)DCF & Non-DCF Members

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Hartford Hospital ALOS

Discharges

Manchester Hospital ALOS

Discharges

Natchaug Hospital ALOS

Discharges

St. Francis Hospital ALOS

Discharges

St. Vincent's MedicalCenter

ALOS

Discharges

Waterbury Hospital ALOS

Discharges

Yale New Haven Hospital ALOS

Discharges

Big Seven PediatricHospitals

ALOS

Discharges

100

13.00

91

14.80

91

15.20

77

15.60

84

18.50

98

14.20

92

14.40

72

16.20

99

14.20

93

15.60

37

10.20

31

7.00

47

6.20

31

6.50

35

10.10

19

13.60

35

7.10

48

7.10

32

8.60

38

7.60

123

11.60

117

13.70

117

13.40

114

14.70

118

11.60

120

11.40

137

11.20

117

11.80

128

12.40

98

12.00

67

11.60

63

13.70

78

11.70

74

10.20

79

9.50

76

11.10

47

14.90

58

11.80

65

12.50

60

11.30

89

8.80

72

13.10

78

11.40

69

9.90

80

10.10

63

9.20

81

9.00

79

9.50

109

6.90

74

10.80

25

9.10

26

9.50

36

8.30

38

5.90

26

10.80

12

8.30

35

7.60

14

9.00

25

8.80

19

6.70

237

13.00

180

12.10

227

12.10

174

12.50

214

10.40

183

11.90

220

10.30

199

11.10

205

10.40

180

10.60

678

11.80

580

12.70

674

12.00

577

12.00

636

11.50

571

11.80

647

10.90

587

11.30

663

10.80

562

11.50

Quarterly Inpatient PAR Hospitals Average Length of Stay (ALOS) and Total Discharges: All Youth (Ages 3-17)

PG 9

Pediatric Inpatient SummaryExcluding Solnit

ConclusionsFrom Q4 '14 to Q2 '15, there has been an increase in the admits/1,000, with a decrease in the days/1,000 and the ALOS for the HUSKY youth population. Thenon-DCF youth continue to utilize more Inpatient days with greater admissions than the DCF youth. Most likely, this continues to be related to the greater volumeof non-DCF members compared to DCF involved members. Overall, DCF youth continue to have longer lengths of stays, but less Inpatient admits/1,000 anddays/1,000 compared to the non-DCF youth. Although the ALOS for the DCF youth has remained higher than non-DCF, it has decreased from Q4 '14 to Q2 '15 and was the lowest DCF ALOS in the past twoyears. The decreased ALOS was noted in both DCF and non-DCF. For the first time, the non-DCF youth ages 3-12 had a longer ALOS (12.9) than DCF youth(12.3). This could be related to DCF children already having connection to care, while the non-DCF are not as of yet receiving services. Beacon will continue tomonitor this population and follow-up connection to care for all youth. St. Francis Hospital and Natchaug Hospital were the only two hospitals whose ALOS in-creased from Q4 '14 to Q2 '15.

RecommendationsBeacon continues to recommend the development of a preventive model of integrated care, which can provide families easy access and rapid connection to treat-ment services. The following recommendations are opportunities to enhance this type of healthcare delivery. 1. Develop an infrastructure which supports easy access and connection to treatment services for specialized populations such as those children with an AutismSpectrum Disorder diagnosis (ASD): Most children with an ASD diagnosis who require acute care services utilize out-of-state facilities for acute stabilization whichoften leads to longer lengths of stay secondary to the increased distance from their home and the inability of families to participate in the treatment due to trans-portation issues. Youth with an ASD diagnosis often stay longer in inpatient care than their non ASD identified peers who utilize the same services. Currently, thereare no designated inpatient beds for this population. Update: Beacon began to authorize ABA services for children with an Autism diagnosis in January 2015. Three Clinical Care Managers have provided authoriza-tions for ABA services and Peers and Care Coordinators dedicated to the ASD team, have assisted individuals and families in the navigation of the behavioralhealth system. Beacon has met with the Department of Developmental Services, Department of Social Services and the Department of Children and Familiesweekly to review operations, cases, and current efforts to expand the Provider network. Beacon continues to recommend building an infrastructure, including in-state inpatient capacity, and a continued expansion of the Medicaid provider network to serve this specialized population. 2. Integrate behavioral health services for youth within a Family Care Model Urgent Care Center: There is a need to develop easy, rapid access to behavioralhealth care treatment in local communities as an alternative to emergency departments. The addition of behavioral health services with an already established ur-gent care center to provide integrated care in a family care model has the potential to reduce both behavioral health and medical emergency department and inpa-tient utilization. The recommendation is unchanged from previous quarters. Update: Discussions continue at the State Agency(s) to consider creating community-based treatment centers. Beacon continues to recommend integrating be-havioral health services for youth within a family care urgent care center. Recommendations continue on the next page.

PG 10

Pediatric Inpatient Summary, continuedExcluding Solnit

Recommendations, continued from previous page3. Continue to expand the implementation and development of Rapid Response model: The Rapid Response model focuses on the collaboration among commu-nity, State agencies and Beacon staff to provide emergency departments support and case management. Opportunities remain to implement a Rapid Responsemodel in other emergency departments (ED) with high pediatric behavioral health volume. Update: Daily Rapid Response interventions continue with the Connecticut Children’s Medical Center (CCMC) in Hartford and Saint Mary’s Hospital in Waterbury.Representatives from DCF, Emergency Mobile Psychiatric Services (EMPS), the hospital EDs and Beacon continue to meet monthly to discuss issues, barriersand the status of the Rapid Response model. The agencies have implemented a communication protocol that outlines process when a DCF Committed statuschild is “stuck” in the CCMC ED. Models similar to Rapid Response have expanded into other emergency departments. Bristol Hospital now utilizes EMPS (Wheeler Clinic) to staff their emergency department and Yale New Haven Hospital ED has collaborated with Clifford Beers EMPS for evaluations. Opportunitiesremain to expand this model to other high volume emergency departments. 4. Establish, in each of the Regional areas, a centralized forum which meets regularly to discuss at-risk youth who have high utilization of crisis and behavioralhealth services. Beacon continue to recommend the establishment of a centralized forum in each Regional area to coordinate care for those youth identified as atrisk for high utilization of inpatient and emergency department services. This forum would serve to engage communities, families, schools, and providers in theplanning, and delivery of behavioral health services. Update: Each Regional DCF area has begun the process of establishing an Integrated Service System meeting (ISS). Beacon has met with several of the DCFarea office leadership teams to discuss the organization, attendees, content and process of these meetings. It is the continued recommendation this forum wouldserve to engage communities in healthcare delivery. 5. Continued State Agency collaboration with Beacon Health Options: Beacon continues to recommend ongoing collaboration with the State Agencies on multiplelevels to develop an integrated, community-based, preventive healthcare system. A. Continued participation in the implementation and development of recommendations from PA-13-178, the Children’s Behavioral Health Plan for the State of Connecticut. B. Beacon and DCF will continue to have weekly Complex Case rounds to discuss all HUSKY inpatient children who require additional escalation and collabora-tion. This process is designed to promote early coordination of care and communication between State Agencies on complex cases. Update: Beacon continues to meet with State Agencies on a weekly basis. Part A of the recommendation has been put on hold secondary to the State budget.This part of the recommendation will no longer be included. Beacon continues to meet on a weekly basis with DDS, DCF-CT BHP Director, the DCF-CT BHP Pro-gram Manager, the Beacon Child Psychiatrist/Medical Director, and Clinical Director to discuss high-risk children who require additional escalation, collaborationand potential intervention from other State Agencies. This process continues to serve as a preventative model to promote timely escalation and coordination ofcare.

PG 11

Inpatient Discharge Delay: Excluding SolnitPercent Delay Days & Delay by Reason

The average number of delay days for discharged individuals awaiting State Hospital and PRTF levels of carehave been trending upward since Q1 of 2014.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

% of Days Delayed

Quarterly Inpatient (Excluding Solnit) Percent of Days Delayed: All Youth

■ Total Youth ■ Non-DCF ■ DCF

2014Q1 Q2 Q3 Q4

2015Q1 Q2

AwaitingStateHospital

Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

AwaitingPRTF


AwaitingSolnit PRTF


29.01746

25.633313

17.41227

13.6685

27.933512

31.838212

15.820513

16.022414

12.327122

13.322617

27.335513

16.01127

29.0582

9.0273

Quarterly Inpatient Discharges with Delayed Days by Reason CodeOnly Select Three Reasons are Shown (Hover in Graph Above to See All)

2014 Q2 2014 Q4 2015 Q2

0

10

20

30

Delayed Discharges

Quarterly Inpatient Discharges with De-layed Days: All Youth

Hover to View Delayed Reason

Percent of Days DelayedThe percent of total days delayed decreased by 4.3 percentage points to 7.0%in Q2 ’15, returning to more historic levels after increasing to 11.3% in Q1 ’15from Q4 ’15, the highest quarter in the last two years. This fluctuation was drivenby non-DCF members whose percent of days delayed increased by 6.2 per-centage points (more than double) to 11.0% in Q1 ’15 from Q4’ 14 (4.8%), anddecreased 4.1 percentage points to 6.9% in Q2 ’15. Total number of cases de-layed increased by 8 cases from Q4 ’14 (35) to Q1 ’15 (43), but then decreasedby 10 cases in Q2 ’15 to 33 cases, the lowest in the last two years. Similarly,this fluctuation was driven by non-DCF members whose number of delayed cas-es nearly doubled from Q4 ’14 (16) to Q1 ’15 (30), and decreased by 8 cases to22 delayed cases in Q2 ’15.

Days in Delay by ReasonMembers delayed awaiting StateHospital doubled from Q4 ’14 (6)to Q1 ’15 (12), but then remainedconstant at 12 members from Q1‘15 to Q2 ’15. Members delayedawaiting PRTF fluctuated over thelast two quarters (Q1 ’15 and Q2’15) decreasing by 6 membersfrom Q4 ’14 to Q1 ’15, then in-creasing by 6 members from Q1’15 to Q2 ’15. Similarly, total delaydays for discharges fluctuatedover the last two quarters (Q1 ’15and Q2 ’15); however, the fluctu-ations were much larger decreas-ing by 93 days, a 45.4% decreasefrom Q4 ’14 to Q1 ’15, then in-creasing by 243, a 217% increasefrom Q1 ’15 to Q2 ’15.

Note: The Reason Code "Awaiting Solnit PRTF" was not implemented until late 2014.

PG 12

Inpatient Discharge Delay: Excluding Solnit TablesPercent Delay Days & Delay by Reason Code

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

DCF % of Days DelayedCases Delayed

Non-DCF % of Days DelayedCases Delayed

Total Youth% of Days DelayedCases Delayed

2212.40%

2512.00%

1810.60%

1810.90%

1914.50%

1913.50%

158.10%

2114.70%

117.40%

1312.50%

216.10%

329.20%

286.50%

236.60%

164.80%

225.20%

295.90%

142.30%

226.90%

3011.00%

438.00%

5710.20%

467.80%

417.80%

357.30%

417.80%

446.50%

355.90%

337.00%

4311.30%

Quarterly Inpatient (Excluding Solnit) Table (Ages 0-17)Percent of Days Delayed & Cases Delayed

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Awaiting StateHospital


Awaiting PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting RTC Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting GH Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Foster Care Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Other Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Comm ServDDS


Awaiting DDS Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Solnit PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

20.320310

26.02088

23.62129

24.21215

29.01746

25.633313

17.41227

13.6685

27.933512

31.838212

26.336814

22.257726

16.629818

14.119814

15.820513

16.022414

12.327122

13.322617

27.335513

16.01127

23.3703

14.2856

10.3727

22.11557

20.0201

9.0273

12.0242

43.71313

0.000

17.0171

20.0201

29.3883

21.0211

30.0602

0.000

0.000

5.0102

22.5452

4.041

0.000

8.0162

1.011

0.000

25.5512

0.001

7.071

0.000

11.0222

0.000

16.0483

2.783

84.02523

53.51072

0.000

11.0222

0.000

0.000

10.0202

0.000

0.000

63.0631

9.091

0.000

0.000

29.0582

9.0273

Quarterly Inpatient Discharges with Delayed Days by Reason Code

PG 13

Inpatient Discharge Delay SummaryExcluding Solnit

ConclusionsAfter a slight increase in the percentage of days delayed in Q1 ‘15, the percent of discharge delay days for all youth decreased from Q4 ’14 to Q2 ‘15 (7.3% to7.0%). This was driven by the decrease in the DCF percentage of discharge delay (14.5% to 7.40%) while the non-DCF percentage of discharge delay increased(4.8% to 6.9%). Most of the children on delay were awaiting admission into Solnit Inpatient. There was a total of 24 youth (Q1 ‘15 and Q2 ’15) waiting for Solnit Inpatient. The youthwho were awaiting Solnit level of care utilized the most inpatient days in delay, 717 total days in delayed status. This was followed by those youth awaiting PRTFlevel of care (20 youth) who utilized 467 total days in delays. This was a noted change from Q4 ‘14, when most of the children in delay were awaiting PRTF level ofcare. The number of cases on delay remains very low with only one case during the first two quarters of 2015.

Recommendations1. Expand PRTF capacity and develop alternatives for the children 12 years and under to include crisis stabilization. – The limited number of PRTF beds continuesto cause delays. With increased limitations in access to other levels of care, there is limited capacity for children with complex behavioral health needs. Currentlythere are only three PRTF facilities, of which one is only able to admit males. Beacon continues to recommend expanding the current PRTF capacity and increas-ing additional community services for those children under 12 with complex, highly acute behaviors, including those children with developmental delays andautism. Update: PRTF bed capacity has not increased. Children continue to remain inpatient on delayed status awaiting this level of care. The S-FIT (Short-Term FamilyIntegrated Treatment Program) will begin implementation during the second half of this year. This is a family stabilization service with a respite component for theyouth wherein the child can reside up to 14 days and then transition home. This service was created to provide crisis stabilization for a child at risk for inpatient orfor those youth transitioning out of inpatient. Many providers and families are unaware of this service as a DCF referral continues to be required. Beacon has de-veloped an Autism Spectrum Disorder (ASD) team which began in January of 2015. ASD Care Managers are able to provide Medicaid authorization for servicesassociated with children diagnosed with Autism. Peer and Care Coordinator staff will support connection to care in the community. These Beacon services will support timely connection to care from inpatient to the community, but there is still an identified need for highly acute youth. Beacon continues to recommend theexpansion of PRTF bed capacity to manage children with complex behavioral health needs, including those children with developmental delays and autism. 2. Develop community-based behavioral health services which meet the higher acuity behavioral health needs of child/adolescents, including crisis andWraparound Teams, that follow children throughout the level of care continuum. – As the system moves towards community-based behavioral health care, withlimited options regarding children’s placement in congregate care and Solnit, there is a greater need to develop behavioral health services. Those services can provide coordination of care, family support, and clinical services to a clinically complex youth cohort. This activity has the potential to decrease emergency depart-ment utilization, Inpatient length of stay and discharge delay. Update: Beacon has continued to collaborate with State Agencies to develop care coordination efforts to meet the complex behavioral health needs of children.This is accomplished on various levels such as working with EMPS agencies to collaborate with emergency departments, referrals to care coordination, and co-lo-cation of Intensive Care Managers within DCF area offices. These steps provide increased opportunities to follow children throughout the level of care continuum.Beacon has collaborated with DCF in the development of a Care Management Entity (CME) to achieve the goal of reducing and diverting youth from congregatecare settings. Beacon currently has a CME team which consists of Care Coordinators, Peers, and Network of Care Managers. A Supervisor and Director provideoversight and management of the team. In addition, Beacon has developed the ASD team which also provides care coordination, peer services and authorizationsfor ABA services to those children diagnosed with Autism.

PG 14

The increase in average length of stay at Solnit Inpatient hinders timely access to this facility forthose children on discharge delay in community inpatient units and emergency rooms.

Inpatient: Solnit CenterAverage Length of Stay & Delay Days

Benefit GroupCourt-Ordered

Non-Court-Ordered

Total Youth

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

50

100

150

Avg. Length of Stay

Quarterly Solnit Inpatient Average Length of StayCourt-Ordered, Non-Court-Ordered, and Total

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

100

200

300

400

# of Days Delayed

Quarterly Solnit Inpatient Number of Delayed DaysTotal Youth

Average Length of StayThe average length of stay (ALOS) for all youth placed at Solnit Inpatient increased by 14.6% from Q1 to Q2 ‘15 (101.8 to 116.7). The ALOS for the non-court-or-dered youth increased 71.9% from Q1 to Q2 ’15 (110.1 to 189.3) and accounted for the overall increase in ALOS. The ALOS for the court-ordered youth de-creased 32.8% (40.3 to 27.1), by comparison. There were 25 total discharges in Q1 ’15 and 38 in Q2 ’15. In Q2 ’15, the non-court-ordered youth comprised 55.3%(N=21) of the total, and the court-ordered comprised 44.7% (N=17). The non-court-ordered discharges decreased from 31 in Q4 ’15 to 22 in Q1 ’15, and de-creased slightly in Q2 ’15 to 21. The court-ordered discharges decreased from 7 in Q4 ’14 to 3 in Q1 ’15, then increased to 17 in Q2 ’15. Number of Days Delayed The number of days delayed at Solnit Inpatient increased by 17.4% this quarter (310 to 364), and there was one less discharge (8 to 7). The number of days de-layed at Solnit has been increasing since Q3 ’14. Q1 ’15 increased by 45.5% from Q4 ’14 (213 to 310), and Q2 ’15 increased by 17.4% from Q1 ’15 (310 to 364). Days in Delay by Reason For the last two quarters, there was only one delayed discharge (for awaiting Group Home), which was delayed 96 days. Since there were 7 total cases identifiedon delay in Q2, this means that six remaining youth are still in delay status and have not yet discharged.

PG 15

Inpatient: Solnit Center TablesAverage Length of Stay & Delay Days

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Court-Ordered ALOS

Discharges

Non-Court-Ordered ALOS

Discharges

Total Youth ALOS

Discharges

3.0

40.3

5.0

90.0

11.0

87.0

9.0

69.3

7.0

57.9

8.0

42.8

17.0

62.7

12.0

78.8

17.0

27.1

3.0

40.3

24.0

136.8

30.0

84.6

37.0

123.1

29.0

133.3

31.0

107.6

23.0

116.1

31.0

106.7

24.0

134.8

21.0

189.3

22.0

110.1

27.0

126.1

35.0

85.4

48.0

114.8

38.0

118.2

38.0

98.4

31.0

97.2

48.0

91.1

36.0

116.1

38.0

116.7

25.0

101.8

Quarterly Solnit Inpatient Average Length of StayCourt-Ordered, Non-Court-Ordered & Total Youth

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Total Youth # of Days Delayed

Cases Delayed 5

160.0

3

169.0

6

281.0

8

401.0

9

213.0

6

127.0

7

251.0

9

205.0

7

364.0

8

310.0

Quarterly Solnit Inpatient Number of Delayed DaysTotal Youth

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Awaiting PRTF Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

Awaiting RTC Delayed Discharges



Awaiting GroupHome

Delayed Discharges



Awaiting FosterCare

Delayed Discharges



37.0

37

1

0.0

0

0

0.0

0

0

0.0

0

0

29.5

59

2

0.0

0

0

0.0

0

0

23.0

23

1

0.0

0

0

0.0

0

0

0.0

0

0

49.0

49

1

0.0

0

0

0.0

0

0

0.0

0

0

27.0

27

1

23.0

23

1

13.0

13

1

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

35.0

35

1

0.0

0

0

37.0

37

1

86.0

86

1

49.5

99

2

96.0

96

1

0.0

0

0

118.0

118

1

0.0

0

0

69.0

69

1

73.0

73

1

0.0

0

0

119.0

119

1

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

Quarterly Solnit Inpatient Delayed Discharges by Reason

PG 16

Inpatient: Solnit Center Summary

ConclusionsThe overall ALOS for youth inpatient at Solnit Inpatient has increased during Q1 and Q2 ‘15. The primary driver of this increase was the non-court-ordered youthwhose ALOS increased from Q4 ‘14 (107.6) to Q2 15 (189.3). The ALOS for the court-ordered youth decreased. The number of days delayed at Solnit have beenincreasing since Q3 ‘14 to Q2 ‘15 (127 to 364). For the last two quarters, there was one delayed discharge (awaiting group home) delayed for 96 days. There arecurrently six remaining youth on delay. This increased ALOS hinders timely access to Solnit for those children on delay in the community inpatient units and emergency departments. The Inpatient (Ex-cluding Solnit) data for Q1 ‘15 and Q2 ‘15 indicated most children on delay were awaiting admission into Solnit Inpatient.

RecommendationsBeacon has continued to support triage and coordination efforts with the State Agencies and Solnit Center, both the inpatient and PRTF units. We will continue tomeet weekly with all Solnit units for the purpose of care coordination and discharge planning.

PG 17

Community PRTF: Excluding Solnit (Youth Ages 5-13)Admissions, Days/1,000 & Average Length of Stay

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

10

20

30

Admissions

Quarterly PRTF (Excluding Solnit) Admissions: Youth 5-13

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

2

4

Days/1,000

Quarterly PRTF (Excluding Solnit) Days/1,000: Youth 5-13

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

50

100

150

200


Quarterly PRTF (Excluding Solnit) ALOS: Youth 5-13

Admissions The number of Community PRTF admissions decreased by 50.0% from Q4 ’14to Q1 ’15 (30 to 15) and then increased by 73.3% from Q1 ’15 to Q2 ’15 (15 to26). However, the number of admissions is within the range of admissionsrecorded over the past nine quarters. Days/1,000 Days/1,000 for Community PRTF essentially remained unchanged over the pastnine quarters. Average Length of Stay (ALOS)From Q4 ’14 to Q1 ’15, Community PRTF ALOS decreased slightly by 3.8%(182.8 to 175.8). From Q1 ’15 to Q2 ’15, Community PRTF ALOS increasedslightly by 5.2% (175.8 to 185). The number of discharges decreased to 13 inQ1 ‘15, which was the lowest number of discharges reported in all ten quarters.However, this number increased in Q2 ’15 to 29 which is more consistent withprevious quarters.

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

Admissions

Days/1,000

ALOS

Discharges 23

124.6

4.5

21

28

143.4

4.6

29

27

171.9

4.6

24

20

149.3

4.5

19

24

182.8

4.2

30

24

146.7

4.3

21

28

183.7

4.2

29

23

168.3

4.1

23

29

185.0

4.2

26

13

175.8

4.3

15

The numbers of admis-sions, days/1,000 and average length of stayhave remained consistentover the reporting period.

PG 18

Community PRTF: Excluding Solnit (Youth Ages 5-13)Delay Days & Discharge Delay Reasons

Number of Days Delayed The Community PRTF days delayed increased by 65.4% from Q4 ’14 to Q1 ’15(384 to 635), and increased again by 48.5% from Q1 ’15 to Q2 ’15 (635 to 943).The Community PRTF cases delayed increased by 40.0% from Q4 ’14 to Q1 ’15(10 to 14), and increased again by 28.6% from Q1 ’15 to Q2 ’15 (14 to 18). Theaverage days delayed increased by 7.0 days from Q4 ’14 to Q1 ’15, and in-creased by 7.0 days from Q1 ’15 to Q2 ’15, for a total increase of 13.2 days de-layed in Q1-Q2 ’15.

Community PRTF Discharge Delay Days increased significantly over the reporting period.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

200

400

600

800

# of Days Delayed

Quarterly PRTF (Excluding Solnit) Total Days Delayed (Ages 5-13)

Discharge Delay Reason2013

Q1 Q2 Q3 Q42014

Q1 Q2 Q3 Q42015

Q1 Q2

Awaiting Going Home

Awaiting Foster Care

Awaiting GH

Awaiting Other

Awaiting RTC 0.00%

22.22%

11.11%

66.67%

0.00%

0.00%

0.00%

0.00%

85.71%

14.29%

0.00%

0.00%

0.00%

83.33%

16.67%

28.57%

0.00%

0.00%

57.14%

14.29%

0.00%

0.00%

22.22%

22.22%

55.56%

0.00%

0.00%

22.22%

33.33%

44.44%

0.00%

0.00%

12.50%

50.00%

37.50%

0.00%

0.00%

9.09%

63.64%

27.27%

0.00%

0.00%

22.22%

44.44%

33.33%

0.00%

0.00%

21.43%

50.00%

28.57%

Quarterly PRTF (Excluding Solnit) Percent of Delayed Discharges by Reason Code (Ages 5-13) PRTF Discharge Delay Reason Awaiting foster care continued to bethe biggest reason for discharge de-lay, accounting for 50% of delayedcases in Q1 ’15 (7 out of 14) and44.4% in Q2 ’15 (8 out of 18). Await-ing going home decreased from43.5% in Q4 ’14 (10 out of 23) to28.6% in Q1 ’15 (4 out of 14), then increased slightly to 33.3% in Q2 ’15(6 out of 18).

2013 Q4 2014 Q4

0

5

10

15

20

Cases Delayed Avg. of 11.9 delayed

Quarterly PRTF (Excluding Solnit) TotalDelayed Cases

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

# of Days Delayed

Cases Delayed

Average DaysDelayed 54.1

11

595

27.7

10

277

42.9

15

643

28.6

8

229

38.4

10

384

43.8

10

438

47.2

10

472

64.9

13

844

52.4

18

943

45.4

14

635

Quarterly PRTF (Excluding Solnit) Table

PG 19

Community PRTF (Excluding Solnit) Summary

ConclusionsThe numbers of admissions, days/1,000 and ALOS have remained consistent. The number of days delayed increased, more than doubling, from Q4 ‘14 to Q2 ‘15(384.0 to 943.0). There were eighteen (18) children in discharge delay in Q2 ’15, the most children in the past two years. Most children in delay were awaiting a foster home placement, followed by those awaiting services going home and awaiting Group Home. This trend continues toresult most likely because there were no available foster care families, and/or the discharge plan changed during the delay to return children home to their familieswith wrap-around services. The increase in delay awaiting Group Home is likely a result of this as well. There continues to be limited options for the under-12 agegroup who require additional stabilization. It continues to be necessary to increase community resources, foster care resources, and services that are capable ofmeeting the complex needs of this population.

Recommendations1. Expand PRTF scope of services to include a continuum of care, crisis stabilization and Care Coordination. Beacon continues to recommend expanding thescope of PRTF to include an integrated continuum of services, which includes crisis stabilization and coordinated care. With limited access for the younger popula-tion to congregate care and Solnit Inpatient, PRTF-referred youth are a clinically complex population. In addition to the already existing clinical services providedby PRTF, the addition of Medicaid covered services for crisis stabilization as part of a continuum of care model is recommended. This model would include CareCoordination to provide education and support to parents while a member is receiving treatment, and to coordinate care for the family when the child is dischargedinto the community. It is also recommended the PRTFs expand capacity and add a trained workforce to provide treatment to those youth with developmental dis-abilities or children with Autism. Update: These services are not yet in place in the PRTF level of care. However, Beacon has collaborated with DCF to develop a Care Management Entity (CME)to achieve the goal of reducing and diverting youth from congregate care settings and enhance care coordination efforts through a wraparound model expansion.Beacon currently has a Care Management Entity (team) which consists of Care Coordinators, Peers, and Network of Care Managers. A Supervisor and Directorprovide oversight and management of the team. This team will begin the second half of this year to provide care coordination within the community. In addition, theS-FIT (Short-Term Family Integrated Treatment Program) will begin implementation and expansion this year. This is a family stabilization service with a respitecomponent for the youth wherein the child can reside up to 14 days and then transition home. This service was created to provide crisis stabilization for a child atrisk for inpatient or for those youth transitioning out of inpatient. However, currently not all S-FIT programs have been implemented and are not available for chil-dren transitioning out of Inpatient. Many providers and families are also unaware of this service as a DCF referral continues to be required. Beacon has also devel-oped the ASD team that provides care coordination, peer services, and authorizations for ABA services to those children diagnosed with Autism. Beacon continuesto recommend expansion of PRTF bed capacity which includes these services as children remain in delay both inpatient and at the PRTF level of care.

PG 20

PRTF: Solnit (Youth Ages 13-17)Admissions, Days/1,000 & Delay Days

After a period of expected increases following the opening of services in 2013, admissions and days/1,000 at Solnit North PRTF have begun to level off.

OverviewSolnit North PRTF opened on December 1, 2013, which accounts for the rise inadmissions, days/1,000, and number of days delayed in that time period. SolnitNorth PRTF has been ramping up since its opening, and they have now leveledout and become fully operational.

AdmissionsThe number of admissions to Solnit PRTF decreased from Q4 ’14 to Q1 ’15 by44.1% (34 to 19), then increased from Q1 ’15 to Q2 ’15 by 63.2% (19 to 31). Days/1,000 PRTF days/1,000 decreased slightly from Q4 ’14 to Q1 ’15 (4.65 to 4.33), thenincreased slightly from Q1 ’15 to Q2 ’15 (4.33 to 4.46). The number of admis-sions positively correlates with the days/1,000 in both quarters.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

10

20

30

40

Admissions

Solnit North PRTF opened 12/1/13

Quarterly Solnit PRTF Admissions (ages 13-17)

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Days/1,000


Quarterly Solnit PRTF Days/1,000 (ages 13-17)

PG 21

PRTF: Solnit (Youth Ages 13-17)Delay Days & Number of Delayed Youth by Reason Code

The number of days delayed at Solnit PRTF increased by 29.2% (497 to 642) from Q4 ’14 to Q2 ’15.

Number of Days Delayed The number of days delayed had been increasing since Q4 ’13, and Q1 ’15saw an increase of 82.5% from Q4 ’14 (497 to 907). However, Q2 ’15 saw adecrease from Q1 ’15 of 29.2% (907 to 642). The number of cases delayedincreased from 13 cases in Q4 ’14 to 17 cases in Q1 ’15, which was the highest number reported in the ten reported quarters; however, Q2 ’15 de-creased back down to 12 cases. Awaiting Group Home was the main reasonfor discharge delay in Q1 ‘15, accounting for 6 of the 17 delayed cases.Awaiting Group Home and awaiting Community Services tied for the mainreason for discharge delay in Q2 ’15, each with 4 of the 12 cases delayed.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

200

400

600

800

# of Days Delayed


Quarterly Solnit PRTF Discharge Delay Days (ages 13-17)

Select Year to Change Chart BelowAll

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Awaiting RTC

Awaiting GH


Awaiting Community Services

Awaiting Other

Education Issues

2

1

1

3

2

2

1

3

2

2

6

4

1

1

1 5

6

4

1

1

3

4

4

1

Quarterly Solnit PRTF Number of Delayed Youth by Discharge Delay Reason Code (ages 13-17)

PG 22

PRTF: Solnit (Youth Ages 13-17) TablesAdmissions, Days/1,000 & Delay Days

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Admissions

Days/1,000

ALOS

Discharges

# of Days Delayed

Cases Delayed 4

96.0

12

113.4

1.8

24

2

29.0

13

103.9

1.6

16

1

78.0

7

224.3

1.5

8

1

90.0

10

150.1

0.9

13

13

497.0

33

122.1

4.7

34

7

256.0

29

103.1

4.5

28

8

221.0

39

107.3

4.8

41

4

157.0

14

113.4

3.8

37

12

642.0

25

177.1

4.5

31

17

907.0

26

171.3

4.3

19

Quarterly Solnit PRTF Admissions (ages 13-17)

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

Awaiting State Hospital

Awaiting PRTF

Awaiting RTC

Awaiting GH


Awaiting Community Services

Awaiting Other

Education Issues

Family Issues

Other 0

0

1

0

0

0

3

0

0

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

4

1

1

6

1

0

0

0

0

0

0

2

2

3

0

0

0

0

0

0

1

2

2

3

0

0

0

0

0

0

1

0

1

2

0

0

0

0

0

0

1

4

3

4

0

0

0

0

0

1

4

5

0

6

1

0

0

Quarterly Solnit PRTF Number of Delayed Youth by Discharge Delay Reason Code (ages 13-17)

PG 23

PRTF: Solnit Summary

ConclusionsSolnit PRTF's admissions, days/1,000 and discharges have decreased from Q4 ‘14 to Q2 ‘15. The number of days delayed at Solnit PRTFs increased by 29.2%(497.0 to 642.0) from Q4 ‘14 to Q2 ‘15. There were a total of 29 cases in discharge delay in the Solnit PRTF level of care for adolescents, and most of the adoles-cents in delay (11 of 29) were awaiting congregate care. Nine children (9 of 29) were awaiting community services, one (1 of 29) was awaiting educational place-ment, while the remaining eight (8 of 29) were awaiting foster care and other services.

RecommendationsIt is recommended that Beacon monitor the Solnit PRTF level of care for additional trending, and include data relevant to discharge delay reason codes, specifical-ly for Solnit North campus. It is recommended that we identify the specific delay reasons for the males at the Solnit North campus and implement increased dis-charge planning with Beacon Intensive Care Mangers, DCF and Solnit. Beacon continues to have weekly care coordination meetings to review current treatmentand discharge planning with both facilities. Update: Beacon has continued weekly rounds with both Solnit North and South. Beacon has met the recommendation and has fully implemented electronic refer-ral tracking and monitoring of discharge delay reasons for this population. Most of the adolescents continue to await congregate care. Beacon will be implementingthe Care Management Entity (CME) for DCF. There are opportunities to decrease the number of children awaiting congregate care through the CME activity. Uti-lizing the Wraparound Milwaukee model, Peers and Care Coordination will divert children from congregate care and build supports in the child’s community.

PG 24

Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

After the initial rollout, Autism Spectrum Disorder Services saw a significant increase in Behavior Assessment ad-missions during Q2 ’15.

Q1 Q2

0

10

20

30

40

Admissions

Quarterly Autism Spectrum Disorder Services AdmissionsYouth Ages 0-20

Q1 Q2

0.000

0.005

0.010

0.015

0.020

Admits/1,000

Quarterly Autism Spectrum Disorder Services Admits/1,000Youth Ages 0-20

OverviewThe Autism Spectrum Disorder Services program began authorizing services on January 2, 2015, subsequent to the Centers for Medi-care & Medicaid Services (CMS) announcement that habilitation services would be covered under Medicaid’s Early and Periodic Screen-ing, Diagnosis and Treatment (EPSDT) child health option. Previously, individuals with an Autism Spectrum Diagnosis (ASD) were ableto receive services from independent behavioral health providers who were compensated through either the Department of Developmen-tal Services (DDS) waiver funds, or the Department of Children and Families (DCF) flex funds, or other sources.

Level of CareDiagnostic EvaluationBehavior AssessmentPlan of CareService Delivery

2015Q1 Q2

Diagnostic Evaluation AdmissionsAdmits/1,000

Behavior Assessment AdmissionsAdmits/1,000

Plan of Care AdmissionsAdmits/1,000

Service Delivery AdmissionsAdmits/1,000

0.0112

0.0115

0.0243

0.0114

0.0244

0.0112

0.0130

0.001

Quarterly Autism Spectrum Disorder Service Admits/1,000& Admissions

Authorizations Began 1/1/15 for this Level of Service

Admissions & Admits/1,000As of June 30, 171 prior authorizations have been accessed by partic-ipating providers and 84 unduplicated members have accessed Diag-nostic Evaluation, Behavior Assessment, Plan of Care or Service De-livery in support of a member with an Autism Spectrum Disorder diag-nosis. Behavior Assessment, Plan of Care, and Service Delivery levels of service had dramatic increases in admissions or service authorizationsfrom Q1 ’15 to Q2 ’15 while Diagnostic Evaluation level of service de-creased slightly from Q1 ’15 to Q2 ’15. This trend was also consistentwith admits/1,000 as the Autism Spectrum Disorder Services programcommenced in Q1 ’15 and was enrolling new providers during this early development period.

Hover for Additional Au-thorization Details

Q1 & Q2 '15

PG 25

Level of Care Female MaleDiagnostic EvaluationBehavior AssessmentPlan of CareService Delivery 26

414223

515154

Total Youth by Level of Service and Gender

Level of Care 0-6 (yrs) 7-12 (yrs) 13-18 (yrs)19-20 (yrs)Diagnostic EvaluationBehavior AssessmentPlan of CareService Delivery 0

000

1115150

1120213

9212124

Total Youth by Level of Service and Age Group

Level of Care Asian Black Caucasian Hispanic MultiDiagnostic EvaluationBehavior AssessmentPlan of CareService Delivery 0

110

5111112

20363712

3442

3441

Total Youth by Level of Service and Race

Level of Care DCF Committed Non DCF Voluntary ServicesDiagnostic EvaluationBehavior AssessmentPlan of CareService Delivery 4

450

22484824

5443

Total Youth by Level of Service and DCF Involvement

Utilization ProfileEighty-four (84) unique members have accessed Autism Services in Q1 ’15 andQ2 ’15 through this new Medicaid program implementation. Male members more than doubled female members in every level of service (Diagnostic Evaluation, Behavior Assessment, Plan of Care, and Service Deliv-ery) accounting for 77% of admissions/service authorizations. The age group 0-6 years accounted for 44% of admissions/service authorizations while agegroups 7-12 years and 13-18 years, accounted for 32% and 24% respectively.Age group 19-20 years had no admissions/service authorizations. Caucasianmembers accounted for 61% of admissions/service authorizations while Hispan-ic members made up 23% of admissions/service authorizations. Non-DCF members made up 83% of admissions/service authorizations while DCF Com-mitted and Voluntary Service accounted for 9% and 8% of admissions/serviceauthorizations respectively. About 1 in 68 children has been identified with autism spectrum disorder (ASD)according to estimates from CDC's Autism and Developmental Disabilities Moni-toring (ADDM) Network. ASD is reported to occur in all racial, ethnic, and so-cioeconomic groups. ASD is almost 5 times more common among boys (1 in 42)than among girls (1 in 189). This demographic statistic from the Centers for Disease Control (CDC) could account for the larger ratio of male members to fe-male members accessing services. The 0-6 age group accounts for the great-est number of admissions due in part to the transition of DDS Early ChildhoodAutism Waiver children ages 3 to 4.6 years of age over to Medicaid as new waiver acceptance for children is discontinued.

Autism Spectrum Disorder ServicesUtilization Demographics

Eighty-four (84) unique members have accessed Autism Services in Q1 ’15 and Q2 ’15 through this new Medicaidprogram implementation.

Total Youth (January - June 2015) Receiving Authorized Autism Spectrum Disorder Services by Various Demographic IndicatorsGender, Age, Race, and DCF-Involvement

These values will not add up to the total unique youth as youth may utilize more than one service. However,each youth is only counted once in each demograhic category.

PG 26

Autism Spectrum Disorder ServicesProvider Volume

Autism Spectrum Disorder Services have experienced challenges in finding qualified providers willing to enroll asa Medicaid provider.

Hover over Puzzle Piece for Definition of Each Service Class Correspond-ing Above

DiagnosticEvaluation

BehavioralAssessment

Plan of Care Service Delivery0

5

10

15

Enrolled Providers

Austism Spectrum Disorder Services: Quarterly Cumulative Provider En-rollment by Service Class Year to Date

As of June 30, 2015

Provider Enrollment:The provider network has grown from six providers in January to 24 providers asof June 30 with six additional providers in the process of enrolling. The currentprovider network consists of individual providers and/or organizations who varyregarding the licensure of their staff. Of the 24 providers currently enrolled, 11providers are enrolled to complete Diagnostic Evaluations, 19 providers are en-rolled to offer Behavior Assessments, 19 providers are enrolled to provide Planof Care and 19 providers are enrolled to proceed to Service Delivery. With the rollout of these new services, the Connecticut Behavioral Health Part-nership (CTBHP) conducted a series of provider and family forums in addition tocommunity meetings in order to educate providers and the public regarding ser-vices now accessible to Medicaid beneficiaries with an Autisum Spectrum Disor-der diagnosis under HUSKY A, C, or D. The original policy transmittal and pre-sentations from the provider and family forums highlighted the services now cov-ered and how to access them. This documentation continues to be shared withproviders and the public. One-page member handouts have been created (in English and Spanish) and are utilized to disseminate information provided in aninformational folder including: important contact numbers, websites, andbrochures that detail Peer and Family Support Services and describe theCTBHP.

Q1January February March

Q2April June

Diagnostic Evaluation

Behavioral Assessment

Plan of Care

Service Delivery 13

12

12

8

6

6

6

5

4

4

4

5

19

19

19

11

15

15

15

11

Austism Spectrum Disorder Services: Monthly Cumulative Provider En-rollment by Service Class

Note: A provider may perform more than one service.There were no new providers in May.

PG 27

Autism Spectrum Disorder (ASD) Services Summary

SummaryOverall the Autism Spectrum Disorder Services program has been growing steadily from Q1 to Q2. The number of admissions jumped significantly and theProvider Network has more than tripled. As Peer Specialists and Clinical Care Coordinators for Autism Spectrum Disorder Services have outreached to memberfamilies and connected with DCF and DDS referrals, access to services will continue to increase. Providers enrolled for each service class have started to experi-ence an influx of members connecting with services and have begun to establish waitlists for those members looking to connect. Additional providers need to beadded to the network to accommodate the increase in members accessing these home and community-based services.

PG 28

Quarterly Residential Treatment Facility (RTC)Admissions & Average Length of Stay

AdmissionsAdmissions to out-of-state RTC facilities increased markedly in the first two quarters of 2015. The percent of out of state admissions increased to 13.9 per-cent in Q1 ’15 and was 9.3 percent in Q2 ’15; these are the highest values inthe last 9 quarters. This is due to a decrease in the number of RTC beds avail-able in the state as DCF has moved to limit the number of adolescents in such asetting. Given this change there may be an increase in S-FIT (Short-term Fami-ly Integrated Treatment) admissions.

Average Length of Stay (ALOS)The in-state average length of stay increased by 14.0 days from Q4 ’14 to Q1’15 (268.6 to 282.6) and increased an additional 31.0 days in Q2 ’15 (282.6 to313.6). The out-of-state average length of stay decreased by 540.0 days fromQ4 ’14 to Q1 ’15 (1.343.5 to 803.0). Out-of-state ALOS continues to remain sub-stantially higher than in-state ALOS, as well as more variable over time.

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% of Admissions

Quarterly Residential Treatment Center Admissions - Percent of Total

■ In-State ■ Out-of-State

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

200

400

600

800

1000

1200

1400


Quarterly Residential Treatment Center Average Length of Stay (ALOS)

■ In-State ■ Out-of-State

PG 29

Quarterly Residential Treatment FacilityAdmissions & Average Length of Stay Tables

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

In-State ALOS

In-State Discharges

Out-of-State ALOS

Out-of-State Discharges 4

652.75

55

215.07

12

1,120.58

75

255.60

12

830.00

90

228.46

25

843.64

102

209.95

2

1,343.50

32

268.56

5

1,044.00

53

237.91

3

695.00

56

278.32

7

590.86

44

282.52

2

928.00

37

313.62

3

803.00

45

282.62

Quarterly Residential Treatment Center (RTC) Average Length of Stay (ALOS) & DischargesIn-State vs. Out-of-State

2013Q1 Q2 Q3 Q4

2014Q1 Q2 Q3 Q4

2015Q1 Q2

% Instate Admissions

In State Admissions

% OOS Admissions

OOS Admits 3

5.00%

57

95.00%

4

5.97%

63

94.03%

1

1.43%

69

98.57%

0

0.00%

72

100.00%

0

0.00%

36

100.00%

3

7.14%

39

92.86%

1

2.04%

48

97.96%

1

2.27%

43

97.73%

4

9.30%

39

90.70%

5

13.89%

31

86.11%

Quarterly Residential Treatment Center (RTC) AdmissionsIn-State vs. Out-of-State

PG 30

Global Recommendations

Recommendations:This section documents activity since the previous quarterly report. 1. Establish a preventive model of behavioral health care and crisis intervention: Update: Beacon has continued to collaborate with State agencies, providers and the community at multiple levels to promote an integrated care network. Exam-ples of this are Intensive Case Mangers on site at DCF area offices, inpatient rounds, emergency departments, CHN and State Agency meetings regarding the im-plementation of various state plans and goals. 2. Increase collaboration with CHN to establish preventative integrated care: Update: Collaborative efforts with CHN have continued. Beacon co-management team continues to coordinate with CHN on shared cases for both the adult andchild co–occurring population. CHN has participated within ISS/MSS and System of Care meetings, as well as the established Medical Care Collaborative meetingin the Hartford region. There are additional opportunities to expand collaboration with CHN in both the adult and child inpatient units, EDs, and Home Health services for members withboth a medical and behavioral health diagnosis. The goal of collaboration with CHN is to work together to reduce system fragmentation and provide a seamless experience to the Providers and HUSKY members.

PG 31

Quarterly Appendix GraphsIICAPS, PHP, IOP, EDT, Outpatient

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0K

1K

2K

3K

4K

5K

6K

7K

8K

Admissions

Quarterly Admissions for Lower Levels of Care: All Youth

2013 Q2 2013 Q4 2014 Q2 2014 Q4 2015 Q2

0

2

4

6

8

Admits/1,000

Quarterly Admits/1,000 for Lower Levels of Care: All Youth Level of CareIICAPS

PHP

IOP

EDT

Outpatient

Select VariousLevels of CareBelow To Viewin Graphs

By deselectingOutpatient (OTP)you can viewchanges in theother levels of

care.

Level of CareAll

2013

Q1 Q2 Q3 Q4

2014

Q1 Q2 Q3 Q4

2015

Q1 Q2

IICAPS Admits/1,000

Admissions

PHP Admits/1,000

Admissions

IOP Admits/1,000

Admissions

EDT Admits/1,000

Admissions

Outpatient Admits/1,000

Admissions

530

0.60

553

0.63

620

0.70

563

0.64

568

0.60

560

0.59

571

0.62

575

0.63

544

0.59

552

0.59

322

0.36

271

0.31

320

0.36

280

0.32

351

0.37

273

0.29

324

0.35

294

0.32

334

0.36

316

0.34

481

0.54

410

0.46

508

0.58

480

0.55

445

0.47

398

0.42

489

0.53

429

0.47

475

0.51

408

0.43

158

0.18

197

0.22

160

0.18

195

0.22

227

0.24

176

0.19

234

0.25

166

0.18

203

0.22

177

0.19

7,120

8.06

6,212

7.03

7,079

8.05

7,107

8.11

7,827

8.25

7,017

7.44

7,624

8.22

7,367

8.12

7,829

8.45

7,964

8.46

Quarterly Admits/1,000 & Admissions Table for Lower Levels of Care: All Youth

PG 32

LeYeO Rf CaUe Quarters 1 & 2: January-June 2015 ......UTILIZATION MANAGEMENT FOR YOUTH MEMBERS...

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