ExecutiveSummary& AnalysisbyLevelofCare. CalendarYear2016:January-December2016-SubmitedMarch1,2017
|
|
|
- Gudrun Marcussen
- 4 år siden
- Visninger:
Transkript
1 UTILIZATION MANAGEMENTFORADULTMEMBERS ExecutiveSummary& AnalysisbyLevelofCare CalendarYear2016:January-December2016-SubmitedMarch1,2017
2 ByRobertPlant,PhD,withAnnPhelan,BonniHopkins,PhD, LaurieVanDerHeide,PhD,SherieSharp,MD, LynneRinger,ErikaSharilo,HeidiPugliese,CarieBourdon JoeBernardi,StelaNtate,StephanieShorey-Roca, WalaceFarel,andLindsayBetzendahl, aswelastheentirereporting,clinical,andqualitydepartments. Foranyinquiries,comments,orquestionsrelatedtotheuseofTableau,ortheinteractivefeatureswithinthisreport, ThisreportwascreatedbyBeaconHealthOptionsonbehalfoftheCTBehavioralHealthPartnership.Howevertheopinions,conclusions,andrecommendationscontainedhereinare solelythoseofbeaconhealthoptions,andmaynotrepresentthoseofdss,dmhas,anddcf.
3 UTILIZATION REPORTFORADULTMEMBERS CalendarYear2016:January-December2016 GeneralOverview Onatleastasemiannualbasis,thereportsmutualyagreeduponinExhibitEoftheCTBHPcontractaresubmitedtotheStateforreview.The shifttosemiannualreportswasdesignedtominimizenoisecreatedbyquarter-to-quarterfluctuationsthatdonotreflectatruetrendinthedata. TheMarchdeliverableservesastheannualreportandcoversfourconsecutiveyearsofutilizationdata.TheSeptemberdeliverablecovers10 consecutivequarterswithafocusedanalysisonthemostrecenttwoquarters,butmayincludethepastfourifthereisinformationnecessaryto reviewthathadnotbeenanalyzedpreviously. HoverforList ofreports Used Thisreportfocusesontheutilizationmanagementportionofthesereports,evidencedinthe4Aseries,whichreviewsutilizationstatisticssuchas admissionsper1,000members(),daysper1,000members(days/1,000),andaveragelengthofstay(alos). Withinthisinteractivereport,alutilizationdataisavailableviadrop-downfilters,butthenarativehighlightstheareasofinterestrelatedtocertain utilizationtrends.insomecases,demographicbreakoutsareavailabletoenhancetheunderstandingofutilization.additionaly,thenarative identifiestheunderlyingfactors,whichdrivethetrendsandassociatedprogrammaticresponsestakenbybeaconhealthoptionsto impact/mitigateorsupportthetrend.beaconalsopresentsrecommendationstoaddressremainingchalengesandreportsprogressrelatedto theseplannedrecommendations.theareasoffocusforthisdeliverablearelistedonthefolowingpage. Methodology Thedatacontainedinthisreportarebasedonauthorizationadmissionsandarerefreshedforeachsubsequentsetofupdatesduringtheyear.Duetochangesin eligibility,theresultsforeachquarteroryearmaychangefrom thepreviouslyreportedvalues.thereportsandanalysesforallevelsofcareareafectedbythis change.pleasenotethatutilizationmetricsmaychangewiththerefreshofthedata.therefore,thereadershouldbecautiouswheninterpretingthelatestquarter ofdata.thecontractorwilmonitorthepost-refreshchangesclosely.ifwaranted,methodologywilberevisited. Themethodologyformembershiptotalsremainsunchanged.FortheTotalMembershipcounts,eachmemberisonlycountedonceperquarter,evenifhe/she changeseligibilitygroupsorexperiencesgapsineligibility.forinstance,ifamemberchangesbenefitgroupswithinthequarter,thatmemberisincludedinthe totalsforeachbenefitgroup,butonlyonceforthetotalmembership.thismethodologyisreferedtointhegraphsas UniqueMembership".Forthebenefit groups,membersarecountedineachgroupinwhichtheywereeligibleduringthetimeperiod(quarteroryear).thismeansthattheindividualbenefitgroup membershipcountscannotbeaddedtoobtainanoveraltotalsincememberscanshiftbetweenbenefitgroups. Themethodologyforcalculatingagehaschanged,resultinginaslightshiftinadultandyouthmembershiptotals.Previoustothisreport,countsforadultsand youthwerebasedonifamembermetthatagecriteriaduringthetimeperiod.thismeantthatyouthwhowereboth17and18yearsoldinaquarterwerecounted inboththeadultandyouthtotals.inordertoalowforthedril-downofdemographicandageinformation,itwasrequiredthatmembersbecountedinonlyone groupduringatimeperiod.agegroupisnowbasedontheagethatamemberwasforthemajorityofthetimeperiod(quarteroryear).otherdemographicssuch asgenderandrace/ethnicityarebasedonthemostrecentlyupdatedeligibility.thesedemographicswilupdateasneededaswewanttoreportonthemost accurategenderorrace/ethnicitythatamemberidentifieswith. Additionaly,whileunchangedfrom previousreportingperiods,itisworthnotingthattheper1,000measurescomparetheutilizationratesofthepopulationtothe population s membermonths.thismeansthatwhenviewingtheofhuskydmemberstherateisbasedonthenumberofadmissionswithinthe HUSKYDpopulation,nottheentireadultpopulation.Thishelpstoanalyzewhichpopulationsarepotentialymorechronic,acute,orinneed.
4 UTILIZATION MANAGEMENTFORADULTMEMBERS ExecutiveSummary& AnalysisbyLevelofCare CalendarYear2016:January-December2016-SubmitedMarch1,2017 TableofContents SelectBookmarkIcontoView"AreasofFocus" andgodirectlytoselectedpage AreasofFocus Membership&Demographics InpatientFacilities Days/1,000 AverageLengthofStay InpatientDetoxification:Hospital-Based Days/1,000 AverageLengthofStay InpatientDetoxification:Freestanding Days/1,000 AverageLengthofStay HomeHealthServices MedicationAdministrationFrequency UtilizationRates OutpatientEnhancedCareClinics(ECC) RegistrationVolume AccessStandards Forthisreport,thefolowingutilizationdatapointshavebeen placedintheappendixandarenotdiscussed: MentalHealthGroupHome,Days/1,000&AverageLengthofStay PartialHospitalizationProgram IntensiveOutpatient AmbulatoryDetox MethadoneMaintenance OutpatientServices
5 PG1 AdultMedicaidMembership TotalMembershipVolume 1000K TotalUniqueMembership AlMemberswithDuals AlMemberswithoutDuals AdultMemberswithDuals AdultMemberswithoutDuals 800K SelecttoView Totals Multiplevalues Members 600K 400K SelecttoShowTableorText 200K MembershipCount Methodology DualEligibility Information 0K TotalMembership TotalMedicaidmembership(withduals)forCY2016declinedby1.74%.Thisisthefirstannualdeclineinmembershipsince2011.Infact,alfourmembership cohortsdisplayedinthechartaboveshowthissamedeclineinannualmembershipoverthelastyear. DataRefresh ThedatarefreshrateinQ2 16was 0.86% and0.80% inq3 16.Thisisthe thirdconsecutivequarterwherethe refreshratewasatorbelow0.86%.this perhapssignalsachangeinthe underlyingprocessingofadultmedicaid applications.thesearequarterlyrefresh rateslessthanhalfthemagnitudeof historicratesandmoreinlinewithyouth refreshrates.
6 AdultMedicaidMembership MembershipbyBenefitGroup PG K 100K 200K 300K 400K 500K Members TotalAdultMembershipbyBenefitGroup(18+) SelectIndividual BenefitTypes Multiplevalues SelectBenefit GroupType Al Overview Theadultmembershipcontinuestobecomprisedlargelybytwobenefit groups,huskyd(mlia)andhuskya(familysingle).whilethesetwo groupshadessentialythesamenumberofmembersattheendofcy2014, MLIAbecamethelargergroupduringCY2015andcontinuedtohaveabout 26,000moremembersthroughoutCY2016.Afterincreasingeachyearsince 2012,thiswasthefirstyearthatmembershipdeclinedforbothgroups. ThreeoftheHUSKYCbenefitgroups(ABD/OtherSingle,LTCSingle,LTC Dual)havedecreasedinsizeeachyearsince2013. InCY2016,useofOutpatientservicesincreasedforeverybenefitgroup comparedtocy2015.huskyc(abd/othersingle)continuestohavethe highestrateofinpatientpsychiatricservices(excluding State-run)whileHUSKYD(MLIA)hadthehighestofalother levelsofcare,exceptoutpatient. AdultMemberswithoutDuals HUSKYA(FamilySingle) HUSKYC(ABD/OtherSingle) HUSKYD(MLIA) SelectMeasure SelectTimePeriod CY'16 SelecttoShow TableorText Note:Forthetablebelow,thelowerlevelsofcarearenotconducivetotheDays/1,000andAverage LengthofStay(ALOS)measuresavailable.Forexample,becauseOutpatientauthorizationsaregiven foroneyearatatime,alosmaynotreflectthetruelengthoftimememberstendtostayinoutpatient. Inpatient Psychiatric Facility(Excl. State-Run) Inpatient Detoxification: Hospital Inpatient Detoxification: General Inpatient Detoxification: Freestanding Partial Hospitalization (PHP) Intensive Outpatient (IOP) Ambulatory Detox Methadone Maintenance Outpatient HUSKYA(FamilySingle) HUSKYC(ABD/OtherSingle) HUSKYC(LTCSingle) HUSKYD(MLIA) AlMemberswithoutDuals bylevelofcare
7 PG3 AdultMedicaidMembership DemographicCompositionbyBenefitGroup Overview InCY2016,alagegroupsdecreasedinsizeexceptthe55-64yearoldswhilethe65+groupremainedthe samesize.membersages25-34continuetobethelargestagegroupoftheadultmedicaidpopulation accountingfor27.5% oftheadultmemberswithoutdualsgroupincy2016. Bothmalesandfemalesdecreasedinsizein2016byabout5,000members.Femalescontinuetobethe majorityintheadultmemberswithoutdualspopulation.whitemembersarethemajorityofthispopulation (52%),folowedbyHispanicmembers(26%)andBlackmembers(17%). ChooseDemographic NoDemographicBreakout SelectGroupType TotalGroups SelectBenefitGroups Al DemographicSelection Al CompositionofAdultMembershipbyBenefitGroup NoDemographicBreakout AdultMemberswithDuals AdultMemberswithoutDuals AdultMembersDualsOnly 600K 500K 400K Members 300K 200K 100K 0K
8 PG4 InpatientPsychiatricFacility(Excl.State-Run) ClickforSummary GroupType AlMemberswithoutDuals HUSKYA(FamilySingle) HUSKYC(ABD/OtherSingle) HUSKYD(MLIA) ServiceClass SelectMembershipType InpatientPsychiatricFacility. Al ChooseDemographic NoDemographicBreakout ChooseBenefitGroups Multiplevalues AdmissionsorDischarges(chartbelow only) Admissions InpatientPsychiatricFacility(Excl.State-Run)-Adults(18+) AverageLengthofStay(ALOS) InpatientPsychiatricFacility(Excl.State-Run)-Adults(18+) Admissions AverageLengthofStay ,000 5, InpatientPsychiatricFacility(Excl.State-Run)-Adults(18+) Days/1,000 InpatientPsychiatricFacility(Excl.State-Run)-Adults(18+) 60 6 Days/1,
9 PG5 InpatientPsychiatricFacility Summary Overview:TheInpatientPsychiatricALOSincreasedby6.11% from CY2015toCY2016.TheALOSreachedafour-yearhighof8.47days,up0.49 daysfrom thepreviousyear.admissionstoinpatientpsychiatrichospitalsdecreasedforthefirsttimeinfouryears,down427admissions.while decreasedslightly,days/1,000increasedby0.64daysincy2016.alagegroups,exceptfor65+,experiencedanincreasedalos, andadultmembersages25-34hadthelargestpercentincreaseof8.7%,almost0.7days.also,thealosincreasewasmoresignificantforfemale members,whohadadecreaseinadmissionsfrom CY2015toCY2016.BlackandHispanicmembershadanincreaseinCY2016ofoverthree quartersofaday. Conclusions SincetheALOSincreasedby0.49days,onewouldexpectthetodecrease.ALOScontinuestobemonitoredbyUM stafandisafocusofpar meetings.themostsignificantincreaseinaloswasexperiencedbyadultmembersages25-34,whichwilbeafocusoffuturepardiscussionstobeter understandthefactorsrelatedtotheincreasedalos.duringthepreviousparcycleprovidersreportedhomelessnessandaccesstosubstanceusedisorder ResidentialTreatmentasabariertotimelydischarges. Recommendations 1.ContinuetheAdultInpatientBypassProgram DeterminationofBypassProgram parameterswilbeconductedannualy,andquarterlymonitoringwilbe conductedtobringinfacilitiesthathavemetthetargets.thoseproviderswhoearnedbypassstatusbutsubsequentlyfailtomeetthetargetswilbealowedtwo additionalquarterstomakeadjustmentsandmeettargetsbeforebeingremovedfrom thebypassprogram. Update QuarterlyupdatesofBypassstatuscontinuetobereviewedandanalyzedinternalytoinform UM strategy.incolaborationwiththeregionalnetwork Managers(RNMs),providersareupdatedmonthlyandquarterlyontheirperformanceontheBypasstargetmeasuresandwhatactionsarerequiredtomaintainor beincludedintheprogram.inq3 16NorwalkHospitallostBypassstatusduetothedischargeform completionrateinq1 16andforexceedingthe7-day readmissionratetargetinq2andq3 16.BristolHospitalmetalthreetargetsandearnedBypassstatusinQ3 16.InQ4 16,BridgeportHospital,GrifinHospital, andstateofconnecticut-j.d.hospitallostbypassstatusduetoconsistentlyexceedingthetargeted7-dayreadmissionrateof6.0%.whileinq4 16Bridgeport metthe7-dayreadmissionratetarget,theiraloswasgreaterthanthetargetof8.2days.norwalkhospitalwasabletomeetaltargetsandreturntobypass statusinq4 16.TheAdultInpatientBypassProgram wilcontinueandtargetswilbere-evaluatedtodetermineifchangesinthebehavioralhealthservicesystem haveimpactedinpatienthospitaldatastatewide. Continuedonnextpage.
10 PG6 InpatientPsychiatricFacility Summary,cont. Recommendations,continued 2.ContinueAdultPARProgram RegionalNetworkManagers(RNMs)wilcontinuetoassessgaps,bariers,andbestpracticesamongstthepsychiatric hospitals.theadultinpatientworkgrouppresentations/discussionswilbegintoincludeperformanceindicatorsbrokenoutbyproviderandbygeographicalregion. Forhospitalswhosedatahasbeenstableoverthelongterm,itmaynotbenecessarytomeetindividualy,butdatawilbereviewedandsharedelectronicaly. RNMswiltargetthesehospitalsforbestpractices.Thosehospitalswheredatahasbeeninconsistentorwheretrendsarenotedthatrequireaction, communicationwilbeonaregularbasisandmeetingswiloccurataminimum ofbiannualy. Update InQ3andQ42016,theRNMsmetwiththeinpatientpsychiatrichospitalprovidersinacontinuedeforttoimproveaccesstocareandqualityofcarefor Medicaidadults.ClinicalandMedicalAfairsstaffrom BeaconjoinedtheRNMswhenapplicabletoparticipateinPARdiscussions.DuringthePARmeetings,data wassharedonmeasuresincludingalos,7-dayand30-dayreadmissionrates,anddischargeform completionrates.newmeasuressuchasthelengthofstayfor membersawaitingstatebedsandhedisfolowupafterhospitalizationformentalilnesswerealsointroduced. TheRNMsandotherBeaconstafcontinuedtohavediscussionswithindividualhospitalsabouttheirperformance,includingbariersandbestpracticesfor achievingand/ormaintaininganeficientlengthofstay.theseconversationsprovideanopportunitytobeterunderstandthevariedclinicalphilosophiesand approachesofthetreatmentteamsacrosshospitalsandtofacilitateprogressbysharinghospitalcomparisonstothestatewidegroup.hospitalsoftencited homelessness,accesstoresidentialrehabbeds,andaccesstostatepsychiatricbedsasbarierstoareducedalos.thisbecamethefocusofthewinter2016 workgroup.asaresultofparticipatinginconversationsaboutclinicalbarierstocareprogression,beaconwasabletoworkwiththestatepartnersandhospitals, whenappropriate,toenhancecommunicationbetweencommunityentitiestofacilitaterelationshipsnecessarytoimprovesmoothdischargeplanning.
11 PG7 InpatientDetoxification:Hospital-Based Summary Conclusions BeaconcontinuestoworkwithInpatientHospitalDetoxificationproviderstoobtainauthorizationsformemberswhentheadmissionisprimarilyrelatedtodetox. Thismayaccountforthecontinuedincreasein.TheincreaseinALOSformembersage45-54istobeexpectedastotalyearsofusehasledtomore significanthealthissuesrequiringmedicalmanagement.theemergingadultsages18-24continuetobebestservedinnon-hospitalsetingsastheyareless medicalycompromisedandcanreceivetherapeuticserviceswhilewithdrawingfrom substances. Recommendations Overview:TheALOSforAlMemberswithoutDualsdecreasedforthesecondconsecutiveyear,reaching5.30daysinCY2016.TheALOSfor eachbenefitgrouptrendeddownexceptforhuskya(familysingle)whichincreasedslightlyincy2016.whilealosdecreased,admissions continuedtotrendupwards.days/1,000andfolowedsimilarupwardtrends. AlagegroupshadadeclineinALOSinCY2016exceptthe45-54-year-oldcohortwhichincreasedby0.25days.Admissionsincreasedby20% for AlMemberswithoutDuals.Days/1,000,andincreasedforalagecohortsexcepttheyoungadultsages18-24andmembers65+.In CY2016,theALOSincreasedforfemalesby0.29dayswhiledecreasingthesameamount(0.28days)formales.TheALOSistrendingdownward forwhiteandblackmemberswhileremainingflatforhispanicmembers. 1.IncreasecommunicationandcolaborationwithHospital-BasedDetoxificationproviders RNMsandclinicalsupervisorswilcontinuetoscheduleandatend meetingswiththehospital-basedinpatientdetoxificationproviders.initialmeetingswilbeusedtoclarifyprocessesandprotocolsrelatedtodetoxauthorizations andaftercareplanning.subsequentmeetingswilofertheopportunitytopromotereal-timeum processcommunication,reviewalosandreadmissiondata, deviseinnovativestrategiestoresolvebarierstodischarge,identifygapsinservicesandexpediteconnect-to-careinitiatives.meetingatendeeswilinclude BeaconRNM andclinicalmanager,inpatientdetoxificationhospital-basedadministration,directtreatmentproviders,dischargeplanners,andutilizationreview personnel(specifictoeachhospital).meetingswilbeoferedatleasttwiceayearforongoingdatareviewandcolaborationwithalhospitals. Update TheRegionalNetworkManagers(RNMs)andClinicalSupervisorscontinuedtomeetwiththeinpatientmedicaldetoxificationhospitalprovidersduring thesecondhalfof2016.measuresreviewedincludealos,dischargevolume,7-and30-dayreadmissionrates,anddischargecompletionrates.throughthepar meetings,theprovidersidentifiedseveralchalengesimpactingreadmissionrates.thesebariersincludealackoftimely,appropriateresourcesavailableat discharge,significantmedicalcomorbidities,lackoftransportationandindividualseitherleavingamaorrefusingservicesatdischarge.additionaly,theknowledge ofandrelationshipswithlocalcommunityprovidersvariesgreatlyacrossthemedicaldetoxproviders.asneeded,thernmsandclinicalsupervisorshave increasedproviderawarenessofavailabletraditionalandnon-traditionalcommunityresources,encouragedparticipationincctmeetingswhenappropriate,and facilitatedconnecttocaremeetingswhenbariersincontinuityofcarewereidentified.theclinicalsupervisorsemphasizedbeaconum stafs roletoassist providersindevelopingprimaryandsecondarydischargeplansaswelastheroleofclinicalliaisonsforaftercarefolowupoutreach.lastly,beaconstaf continuetoencouragethemedicaldetoxproviderstoenterdischargecompletionformstosupportbeacon sconnecttocareefortspostdischarge. Connect-to-carewilcontinuetobeafocusin2017.
12 PG8 InpatientDetoxification:Freestanding Summary Overview:TheALOSforFreestandingDetoxificationhasincreasedslightlyforthepastthreeyears,butremainsaroundfourdays.The25-34age groupcontinuestohavethelargestnumberofadmissions(up6% from CY2015)andthehighestDays/1,000andrateforthislevel ofcare(alsoupfrom CY2015).Malescontinuetohaveabouttwo-and-a-halftimesthenumberofadmissionsasfemales.Whitememberscontinue tomakeupthevastmajorityofadmissionstothislevelofcare. Conclusions Theseresultsaretobeexpectedgivenaprotocoldrivenserviceandnoincreaseinthebedcapacitywithinthislevelofcare.Somefreestandingprovidershave discussedtheneedforalongeropiatetreatmentprotocolforindividualswhoareusinghigherpotencyopiates.thealoswilcontinuedtobemonitoredtoseeif thechangestoprotocolforhighopioiddependencyleadstoanincreasedalos,areductioninreadmissionrates,and/orareductioninmembersleavingama. Recommendations 1.ColaboratewithfreestandingdetoxproviderstodevelopOTP/MATmaterials.Beaconwilholdmeetingswiththesevenfreestandingproviderstodevelopa curiculum fortheirstaftoeducatemembersonthemultiplepathwaystorecovery.thiswouldincluderesourcesavailableinthelocalcommunity.beaconwil presentthectbhpmatwebsiteandothermaterialsavailabletosupporttheprovidersonthisproject. Update Beaconstafmetindividualywithalsevenfreestandingprovidersandbegandiscussionsrelatedtomedicationassistedtreatment(MAT)andadesireto developacuriculum thatcanbesharedandoferedatalfreestandingdetoxificationfacilities.thiscuriculum wiloferconsistenteducationtomedicaid membersrelatedtomatservicesavailabletothem inadditiontotherapyandnontraditionalresources. Severaloftheprovidersoferedtoparticipateinthe developmentofsuchmaterialsandawilingnesstopartneronthisproject.overthenext6monthsbeaconwilholdinitialmeetingsandreviewcurentmaterialsin ordertodevelopauniversalcuriculum thatwilbeoferedtoalfreestandingproviders.beaconwasabletoinform providersofthectbhpmatwebsiteand severalprovidershaveutilizedthematmaplocatorandprovidedupdatesforthemaplocatortobeacontoaccuratelyreflectservicesprovidedattheirfacilities.
13 PG HUSKYA(FamilySingle) InpatientPsychiatricFacility(Excl.State-Run) HUSKYA(FamilyDual) InpatientPsychiatricFacility(Excl.State-Run) HUSKYB InpatientPsychiatricFacility(Excl.State-Run) HUSKYC(ABD/OtherSingle)InpatientPsychiatricFacility(Excl.State-Run) HUSKYC(ABD/OtherDual) InpatientPsychiatricFacility(Excl.State-Run) HUSKYC(LTCSingle) InpatientPsychiatricFacility(Excl.State-Run) HUSKYC(LTCDual) InpatientPsychiatricFacility(Excl.State-Run) HUSKYD(MLIA) InpatientPsychiatricFacility(Excl.State-Run) CharterOak InpatientPsychiatricFacility(Excl.State-Run) ShowingAdult(18+)Medicaid InpatientHigherLevelsofCareTable Showing: Range SelectMeasure How tousetheinteractivetables:1.the"levelofcare"filteralowsyoutocomparethethreehigherlevelsofcare(inpatientpsychiatric,inpatientdetox: Hospital-Based,andInpatientDetox:Freestanding).2.Changethe"SelectMeasure"filtertoseethedatainthetablebelow.AvailableMeasuresinclude,Admissions,Days/1,000,ALOS,andDischarges.3.Filtertoviewandcomparethebenefitgrouptypes(totals,duals,singles).4.Finaly,filterby benefitgrouptoadjustthetable'soutput.notethatthecolorindicatestherangefrom lowestvalue(white)tohighestvalue(blue)withinthetable.the corespondinggraphscanbefoundonpage4.additionaly,somecelsmaybeblank,whichindicatesthattherewerenomembersinthatbenefitgroupthat utilizedthelevelofcareselected. SelectGroupType Multiplevalues ChooseBenefitGroups Al LevelofCare InpatientPsychiatricFacility(Excl.S.
14 PG10 HomeHealthServices Admissions& SkiledNursing-Adults K 1K 2K Admissions SkiledNursing-Adults Admissions ServiceClass SkiledNursing GroupType AlMemberswithDuals HUSKYC(ABD/OtherSingle) HUSKYC(ABD/OtherDual) HUSKYD(MLIA) Al Members withduals HUSKYC (ABD/Other Single) HUSKYC (ABD/Other Dual) HUSKYD (MLIA) SkiledNursing-Adults:CY'16 Admissions ChooseBenefitGroups Multiplevalues SelectGroupType Al SelectTimePeriod CY'16 Overview:ForAlMemberswithDualstheforSkiledNursing trendeddownwardforthethirdconsecutiveyear.huskyc(abd/othersingle) andhuskyc(abd/otherdual)hadadecreaseincy2016ofjustoverten percent.totaladmissionsweredownslightlyincy2016.huskyd(mlia), however,hadanincreasedforthethirdconsecutiveyear,increasing56.9% since2013.formedicationadministration,andadmissionswere essentialyunchangedincy2016foralmemberswithduals.forhuskyd (MLIA)theadmissionvolumehasincreased58.0% since2013.
15 PG11 HomeHealthServices MedicationAdministration& Utilization(ED/IP/OBS)Claims Overview ThevolumeofmembersreceivingMedicationAdministrationserviceshas trendedupinq1 16andQ2 16forbothstatewideandthehighvolume providers.thebidratedecreasedforthefourthconsecutivequarterreaching 14.20% inq2 16. Thestatewideemergency(ED)andinpatient(IP)andobservationratesrose slightlyinq1 16andQ2 16reaching31.0%,10.1% and4.6%,respectively. 5K 4K MedicationAdministrationVolume Statewide HighVolumeProviders StatewideEmergencyDepartment,InpatientHospitalizationand23-Hour ObservationBedUtilizationRates EDRate IPRate OBSRate Volume 3K 2K 30% 1K 0K % ofmemberswith1+visits/episodes 25% 20% 15% 10% Rate 30% 20% Q2'14 Q4'14 Q2'15 Q4'15 Q2'16 StatewideMedicationAdministrationQDvs.BIDRates QDRate BIDRate(thickline) 5% 10% 0% 0% Q2'14 Q4'14 Q2'15 Q4'15 Q2'16 Q2'14 Q4'14 Q2'15 Q4'15 Q2'16
16 PG12 HomeHealthServices Summary Recommendations 1.Continueplannedfocusonclaimsdataanalysis BeaconwilcontinuetoprovideanalysisoftherelationshipbetweenreductioninMedicationAdministration frequency,re-hospitalizationrates,andconnectiontoothercommunityservicesformemberstoensurethatfurtherreductionsinmedicationadministration frequencyarenotcausinganincreaseinutilizationofthoseotherservices.beaconwilcontinuecohorttrackingofmembersreceivingbidmedication administrationservicetorefineourknowledgeandunderstandingofutilizationpaterns.beaconwilcontinuetoengageprovidersinexplorationofthevariancesin frequencyreductionratesandhospitalization/obsandedratesthroughsemiannualgroupandindividualmeetingswiththe13high-volumeproviders. Update BeaconhascontinuedtoutilizeaBypassProgram forhomehealthagencies.thebypassprogram providesadministrativereliefforbothbeaconand homehealthagencieswhilepromotingpracticechangethatwilbenefitmembersandimprovetheeficiencyofhomehealthservices.thebypasseligibilitycriteria includesachievementofabidmedicationadministrationtargetrate.thevolumeofagenciesonthebypassprogram hasincreasedthisyearasmoreagencies havemetthetargetbidutilizationrate.theagenciesonbypassareauthorizedforlongerperiodsoftime,thusdecreasingthenumberofconcurentreviews requiredforanepisodeofcare.beaconhascontinuedtoworkwiththoseprovidersnotmeetingthebypassstandardstoachievethisgoal. BeaconhascontinuedtocolaboratewithprovidersregularlytoreviewandmonitortheirstatuswithintheBypassProgram anddiscussthetoolstosupportthe reductionofthebidrate.thisyear,homehealthagencieshaveincreasedtheirutilizationofthehomehealthpromptingtoolwhichhassupportedthereductionin thebidrate. 2.IncreasedcolaborationwithCHN.TopromotetheeficientandappropriateuseofHomeHealthservices,itisnecessaryfortherespectiveAdministrative ServiceOrganizationstocolaborateonStateinitiativesandgoals. Update Beaconhascontinuedtomeetwithleadershipfrom CHNtodiscusshomehealthauthorizations,levelofcareguidelinesandcasestodevelopparalel eficienciesinoperationalprocess,communicationandcriteriaforhomehealthservices.thisrecommendationhasbeenachieved,isnowmonitoredonan ongoingbasis,andhasbecomestandardoperatingprocedure.thisrecommendationwilthereforebeconcluded. 3.Discussandreviewhomehealthagencydataandreviewerfindings,withafocusonproviderswhosefrequencyofvisitshasincreasedorremainsabovethe statewideaverage. Update InFebruary2016,theDepartmentofSocialServices(DSS),DepartmentofMentalHealthandAddictionServices(DMHAS),theDepartmentofPublic Health(DPH),Beacon,andCHNheldastatewideHomeHealthmeetingwiththegoaloffamiliarizingproviderswiththeaggregateutilizationandexpenditure trends,servicescoveredbymedicaidthathelpsupportmedicationadministrationreductions,themethodologytotrackfutureutilizationandcosttrendsandan encouragementtoproviderstoatendsmalgroupsessionsthatwouldbeheldatbeaconincolaborationwithchn.thesesmalergroupmeetingsaford providersanopportunitytoreviewtheirindividualagencyleveldataonutilizationandcosttrendsaswelastheopportunityforpeertopeersharingandlearning from thosewhohavealreadymadegreatstridesinmedicationadministrationdecreases. Thisrecommendationhasbeenachieved,isnowmonitoredonanongoingbasis,andhasbecomestandardoperatingprocedure.Thisrecommendationwil thereforebeconcluded. Continuedonnextpage.
17 PG13 HomeHealthServices Summary,continued Recommendations,continued 4.WorkwiththeDSStoimplementhomehealthaidemedicationprompting.Utilizationofcertifiedhomehealthaidestoperform medicationpromptingforacohort ofmedicaidmembershasthepotentialtobeaneficientprocesstoreduceoverdependenceonskilednursingforthesolepurposeofmedicationadministration. Update TheuseofHomeHealthAidePromptingMedicationAdministrationwasimplementedinQ3 15.Theutilizationofhomehealthpromptinghasincreased thisyearandhassupportedthereductionofthebidrate.inaddition,beaconhascontinuedtoofermedicationadministrationtraining(mat)tohomehealth agenciesandresidentialcarehomes.thegoalofthematprogram istotraincertifiedhomehealthaides(hsas)inmedicationparameterstodevelopa knowledgeableandsafeworkforcethatcomplimentsandsupportstheskilsofregisteredprofessionalnurses.tofurtherpromotemattrainingtohhas,beacon hasexpandedmattrainingtooferonsitetrainingtohomehealthandrchagencies.beaconwilcontinuetoprovidemattrainingandmonitorthevolumeof HomeHealthaidepromptingservices.Thisrecommendationhasbeenachieved,isnowmonitoredonanongoingbasis,andhasbecomestandardoperating procedure.thisrecommendationwilthereforebeconcluded.
18 PG14 InpatientPsychiatricFacility(Excl.State-Run) BenefitGroup AlMemberswithoutDuals HUSKYA(FamilySingle) HUSKYC(ABD/OtherSingle) HUSKYD(MLIA) ServiceClass Al SelectGroupType Multiplevalues ChooseAgeGroup Al ChooseBenefitGroups Multiplevalues Al-Adults:AgesAl AverageLengthofStay(ALOS) Al-Adults:AgesAl Admissions AverageLengthofStay Admissions 100K 50K 0 0K Al-Adults:AgesAl Days/1,000 Al-Adults:AgesAl 40 15K 30 Days/1,000 10K 20 5K 10 0K
19 PG15 MethadoneMaintenance Recommendations Recommendations Note:ThedataforMethadoneMaintenancecanbefoundintheLowerLevelofCareUtilizationgraphsonthepreviouspageviathedropdownfilter,alongwiththe otherlowerlevelsofcare. 1.IdentifymembersreceivingMethadoneMaintenancewhocanbenefitfrom servicesclosertotheirresidence.logisticareissendingtransportationrequestsfor memberswithcomplexneedsandwhoaretravelingmorethan15milesformethadonemaintenancetobeacon sclinicalstafforclinicalreviewand recommendations.stafproactivelyoutreachtoproviderstoassistintransferingmemberstotheclosestmethadoneprovidersothattreatmentisnotinterupted. Whentransferingtoacloserclinicisnotfeasible,alternativemodesoftransportationareexploredand/orprovidersareaskediftakehomedosescanbe considered. Update Beaconcontinuestoreceivereferalsfrom Logisticarewhenmembersaretravelinggreaterthan15milesvialiverytomethadonemaintenancetreatment toaddressanybariersinreceivingserviceswithintheirlocalcommunity.beaconmetwithseveralmethadoneclinicsforongoingcolaborationandtounderstand continuedchalengestheclinicsandourmedicaidmembersfacewhenthereisaneedforachangeinproviderortransportationmethod.beaconcontinuesto atendthedmhasmethadonedirectorsroundtableforongoingcolaborationandtobeinformedofanyregulationchangesand/orareasoffocusaspresentedby thestateopiatetreatmentauthority.
20 PG16 OutpatientRegistrationVolume AdultandYouth TotalOutpatientRegistrationVolume:ECCandNon-ECC PercentofOutpatientRegistrationVolume:ECCandNon-ECC 140K 80% OutpatientRegistrationVolume 120K 100K 80K 60K % ofoutpatientregistrationvolume 70% 60% 50% 40% 30% 20% 40K 20K 10% 0% ECC Non-ECC K ECC 18,783 21,486 22,725 21,959 Non-ECC 49,191 55,046 63,116 83,969 18,993 20, , ,773 Total 67,974 76,532 85, , , ,650 RegistrationVolume The TotalOutpatientRegistrationVolume measurecapturestheoveral volumeofnewlyregisteredmedicaidmembers,includingthoseevaluations excludedfrom meetingtheeccaccessstandards.from 2011to2016,thetotal outpatientregistrationvolumegreatlyincreasedfrom yeartoyear.most recently,thetotaloutpatientregistrationincreased16.51% from CY2015toCY Overthepastsixyears,thetotalECCregistrationvolumeremainedrather constant,whilenon-eccvolumecontinuedtoincrease,thereforeexpandingthe gapbetweeneccandnon-eccswitheachpassingyear.incy2016,eccs accountedforapproximately15% ofthetotaloutpatientregistrationvolume, whilenon-eccsaccountedforapproximately85%.
21 PG17 AdultECCandNon-ECCOutpatientRegistrationVolume TypeofCare(Agegrp) AdultMeasures ECCAdult Non-ECCAdult ECCAdult ECCYouth TotalOutpatientRegistrationVolume:ECCAdult&Non-ECCAdult TotalOutpatientRegistrationVolume:ECCAdult&ECCYouth -ECCTotal 100K 90K 22K 20K 80K 18K OutpatientRegistrationVolume 70K 60K 50K 40K 30K OutpatientRegistrationVolume 16K 14K 12K 10K 8K 6K 20K 4K 10K 2K 0K 0K Overview Non-ECCadultregistrationshavebeentrendingupwardsinceCY2012,andaccountedforapproximately89% ofadultoutpatientregistrationvolumeincy2016. ECCadultregistrationshaveremainedfairlyconsistentandaccountedforapproximately11% ofadultoutpatientregistrationvolumein2016.
22 PG18 OutpatientRegistrationVolume Overview The RegistrationsRequiredtoMeetECCAccessStandards measurecapturesonlythoseevaluationsthatarerelevanttomeetingeccaccessstandards. Outpatientclinicsareabletoidentifyandexcludefrom calculationthe exemptregistrations whichinclude:1)thoseclientssteppingdownfrom ahigherlevelof carewithintheiragency;and/or2)thoseclientswhohavebeenintreatmentattheeccbutwhoexperiencedachangeininsurancecoveragetomedicaid.the accessmeasuresarebasedonlyonthetimelinessofappointmentsforthosememberswhoaretrulynewclientsintheeccs.totalevaluationsneedingtomeet theaccessstandardsaccountedforapproximately61% in2016.thishasremainedfairlyconstantoverthereportingperiod,whilethetotaloutpatientregistration volumehasincreased.whencomparingeccsvs.fscsforadults,fscshaveconsistentlyhadahighernumberofevaluations,andhavebeenslightlytrending upwardovertime.eccshaveremainedconsistent. TotalOutpatientRegistrationVolume:VolumeofRegistrationsRequiredto MeetECCAccessStandardsandVolumeofExemptRegistrationsECC andnon-ecc SelectGroup AdultMeasures ECCAdult FSCAdult 140K OutpatientRegistrationVolume ExemptEvals TotalNumberofEvaluationsRequiredtoMeetECCAccessStandards: ECCandNon-ECCFreestandingClinics(FSC) 120K OutpatientRegistrationVolume 100K 80K 60K 40K 20K #ofevalsrequiredtomeeteccaccessstandards 20K 15K 10K 5K 0K K
23 PG19 AdultOutpatientECCAccessStandards Routine,UrgentandEmergentRegistrations AccessStandards Emergentevaluationsforadultswerebelowthe95% accessstandardincy2012,butincreasedthefolowingyearandremainedabovetheaccessstandardfrom 2013through2016.UrgentevaluationsforadultswerealsobelowtheaccessstandardinCYs2012and2013,butincreasedin2014andhasremainedabove 95%,althoughtrendingdownward.Routineevaluationshaveconsistentlyremainedabovetheaccessstandardfrom CY2012throughCY2016. ThepercentoftotaloutpatientevaluationsoferedwithintheECCaccessstandardhavebeenconsistentlymetbyECCsforroutineandemergent.From CY2013 tocy2014,totalurgentevaluationsincreasedandwasabletoriseabovethe95% accessstandard.urgentcontinuedtomeettheaccessstandardfrom CY2014 throughcy2016,althoughithasbeentrendingdownward. BothroutineandurgentevaluationshavebeenconsistentlyunmetbyFSCs,althoughurgentdramaticalyincreased22.5percentagepointsfrom 2015to2016. EmergentmettheaccessstandardinCY2014at95.2% butdippedbelowthe95% accessstandardthefolowingyearandcontinuedtotrenddownwardin2016. ECCEvaluationsthatMettheECCAccessStandards Adult PercentofRoutineOutpatientEvaluationsOferedwithintheECCAccess Standard:ECCandNon-ECCFreestandingClinics(FSC)-AlMembers % ofeccevaluationsthatmettheeccaccessstandards 100% 90% 80% 70% 60% 50% AccessStandard95% Routine Urgent Emergent % ofotpevaluationsoferedwithinaccessstandard 100% 90% 80% 70% 60% 50% AccessStandard95% ECC FSC Routine Urgent Emergent
24 PG20 OutpatientEnhancedCareClinics Compliance,Interventions,& Activities Compliance ProviderComplianceforCY'16 RoutineAccesscompliancewiththe14daystandardforthe38ECCsfelintothefolowingcategories: 1.Mettheaccessstandardof95%:35 2.ECCfalingbelowthe95% RoutineStandardforatleastonequarter: HartfordHospital(IOL):92.31% inq12016and94.12% inq2'16;cy2016:94.87% CatholicCharities(Torington):91.30% inq4'16;cy % ConnecticutRenaissance(Bridgeport):90.34% inq3'16and94.67% inq4'16;cy2016:92.54% UrgentAccesscompliancewiththe2daystandardfortheECCsfelintothefolowingcategories: 1.NumberofECCsthatreportedUrgentvolumeduringtheyear:33 2.Mettheaccessstandardof2days:27 3.ECCfalingbelowthe95% UrgentStandard: CharloteHungerford(Adult):50% inq12016(vol.of2);cy2016:88.89% ClifordBeers:33.33% inq12016(vol.of3);cy2016:33.33% CommunityHealthResources:33.33% inq22016(vol.of3);cy2016:25.00% CatholicCharities(Torington):75.00% inq32016(vol.of4);cy2016:83.33% ConnecticutRenaissance(Bridgeport):66.67% inq32016(vol.of3);cy2016:66.67% ConnecticutRenaissance(Norwalk):50.00% inq42016(vol.of2);cy2016:50.00% EmergentAccesscompliancewiththe2hourstandardfortheECCsfelintothefolowingcategories: 1.NumberofECCsthatreportedEmergentvolume:13 2.Mettheaccessstandardof2hours:9 3.ECCfalingbelowthe95% EmergentStandard: CentralCTChildGuidance:0% inq4 16(vol.of1);CY2016:0% FamilyandChildren said:0% inq4 16(vol.of1);CY2016:0% TheVilageforFamiliesandChildren:50.00% inq32016(vol.of2);cy2016:60.00% YaleChildStudy:0% inq2 16(vol.of1);CY2016:0% Continuedonthenextpage.
25 PG21 OutpatientEnhancedCareClinics Compliance,Interventions,& Activities InterventionsandActivities InterventionstoaddressECCperformanceonAccessStandards: Althoughtheformalmeasurementperiodhasbeenannualized,ECC scontinuetoreceivedataonaquarterlybasis.thisincludesbothquarterlyandyeartodate totalsforeachstandard.thoseagenciesbelow95% foranymeasurewilberequiredtosubmitacorectiveactionplan(cap)withoneexception.thesevennew ECClocationswilnotberequiredtosubmitaCAPsincetheycurentlyhaveaprovisionaldesignationandanyperformanceonaccessstandardsbelowthe95% iscurentlynotbeingcounteduntiltheirdesignationbecomespermanent. CommunityHealthResources,ClifordBeers,CharloteHungerfordandTheVilagehavealindicatedthatthepercentagesreceivedontheurgentoremergent measureswheretheydidnotmeetthe95% accessstandardwereadataentryerorandhavesentinpaperworkcurentlybeingreviewed.familyandchildren s AidandYaleChildStudyhavealsobeengiventheopportunitytopresentpaperworktosupporttheirmissingtheemergentmeasureinQ2andQ42016.Al paperworksubmitedwilbepresentedattheeccoperationsmeetingforreview. CatholicCharitiesNorwichwhichhadbeenonprobationfornotmeetingtheRoutineAccessstandardinQ32015andtheUrgentAccessstandardinQ42015 cameofprobationinq ActivityAroundNewECCLocationsinQ3 16andQ4 16: ThesevenECClocationshavebeengoingthroughanorientationprocessasfolows: On6/28/2016 thefirstorientationmeetingwasheldatctbhpandcoveredgeneralinformationaboutbeinganenhancedcareclinic. On10/11/2016 afolowuptotheinitialorientationmeetingwasheldandcoveredinformationaboutwhattoexpectaspartoftheprocessoftheonsitesurvey whichalnewecclocationswilgothroughasapartofmovingfrom aprovisionaldesignationtoapermanentdesignation.inaddition,clinicswereoferedthe opportunitytohaveanydocumentsthattheyhadreadyreviewed.connecticutrenaissanceandrecoverynetworkofprogramssubmiteddocumentsforreview. ClinicswerealsoinformedthattheOnsiteSurveyswouldoccurinQ InDecember2016,theclinicswereaskedtosubmitchartsforreviewthatcouldbeusedasapartoftheInter-raterReliabilityprocessinpreparationforthe OnsiteSurveys.ThosechartswerereviewedandeachclinicreceivedfeedbackinJanuary2017. *Welmorehadbeenapprovedasanadditionaladultlocationwithdrewjustbeforethe7/1/2016startdate. Continuedonthenextpage.
26 PG22 OutpatientEnhancedCareClinics Compliance,Interventions,& Activities,continued InterventionsandActivities,continued MysteryShopperProgram: InQ32016,CatholicCharities Torington,ConnecticutRenaissance Norwalk,andRecoveryNetworkofProgramsweremysteryshopped.Althreeagencies arepartofthesevennewecclocations.calsweremadeinbothspanishandenglishinq32016andtheresultswereasfolows: TherewereissueswithnoSpanishspeakingstafavailableinsomecasesandnoinitialcalsansweredorvoic srespondedtoovera24-hourperiod.This information/feedbackwascommunicatedtotheagenciesinoctober2017. InQ42016,CharloteHungerford(Adult),Intercommunity,andUnitedServicesweremysteryshopped.Althreeagenciesmetthemysteryshopperstandard.As afolowuptomysteryshoppercalsdoneinq22016withhartfordiol,ameetingwasheldonaugust17th,2016toaddresstheirtriagingprocess.sincethe initialmeeting,theclinichassubmitedseveraliterationsofatriagetreeandmorethanonephoneconferencehasbeenheldwiththeclinictoaddressthe modifications.theyhavenoweliminatedonestepoftheirinitialprocessandmodifiedtheirscreeningtooltomoreeasilyidentifyamemberincrisisatthe beginningofthetriageprocess.theirfinaliterationandtriageprotocolwereforwardedtothestatepartnerson2/9/2017. PercentageofMembersRequestingLaterAppointmentEvenThoughTheyHaveBeenOferedAppointmentWithinRequiredTimeFrame ThisinformationwassharedwithprovidersalongwiththeQ32016ECCresultsandclinicswerecontactedtotryandgetabeterunderstandingofthedata.In mostcasestheclinicsreportedthateventhoughmembersmayhaverequestedalaterappointmentthanwhatwasofered,theywereoftenstilseenwithinthe14 days.thisissupportedbythedatawhenwelookatwhatthestatewideaveragewasformembersreceivingappointmentsoutsideofthe14-daywindow;4.83% in bothq32016andq42016.(tableau Oferedvs.Accepted) ECCOperations:TherewereongoingmeetingsthroughoutQ3 16andQ4 16. ECCProviderWorkgrouponCapacityandAccess:DidnotmeetinQ3 16andQ4 16. ActivitiesGoingForward: 1.Continuemonitoringaccessdataonaquarterlybasiswithinthecontextofannualizedmethodology 2.ContinuetheMysteryShopperprogram toensureefectivetriageandscreening 3.CompletetheOnsiteSurveysofthesevennewECClocations
27 PG23 GlobalRecommendations Updates 1.SupportRegionsinthedevelopmentofCommunityCareTeam (CCT)Meetings RNMswilcontinuetosupporteachregion/hospitalintheplanning, developmentandcontinuationofestablishedccts.icmswilparticipateinfolow-upmeetingsandcontinuetofacilitatethecctswhileworkingwiththehospital andcommunityproviderstoidentifyadditionalstafingresources. Update TheRNMshavebeenactivelyinvolvedinsupportingtheongoingdevelopmentoftheCCTmeetingsatvarioushospitalsacrossthestate.Inpreparation fortherealocationofbeacon sicm andpeerresourcesfrom thefrequentvisitortothengainitiative,beaconstafworkedcolaborativelywiththehartfordand SouthCentralCCTsinthefalof2016todevelopandimplementCCTtransitionplans.Additionaly,theRNMscontinuedtoprovidesupport,technicalassistance, andhelpwithproviderengagementtoothercctsacrossthestate,includingtwonewlyestablishedcctsatthehospitalofcentralconnecticutandajointcct betweenwaterburyhospitalandst.mary shospital.theicmsandpeerscontinuetoparticipateincctsacrossthestatewhenmemberstheyareworkingwith aspartofthengainterventionarebeingdiscussed. 2.IncreasecoordinationwithCHN Clinicalmanagers/administratorsfrom CHNandBeaconmeetbiweeklytoreviewprotocolsandproceduresrelatedto authorizationsandsharedcases.aswemovetowardsanintegratedhealthmodelwewilfurtherdevelopcommunicationplansandmemberspecificinterventions thatreflectoursharedefortstoprovidequalitycareandsupportformedicaidmembers. Update BeaconandCHNcontinuetomeetwithMedicalDetoxificationproviderstoclarifyauthorizationprocesses.Thisjointefortwilcontinuetofurtherreduce duplicateauthorizationrequestsandincreasethehospitalsunderstandingoftheimportanceofdischargeplanningtosupportongoingrecoveryinthecommunity andareductionofrapidrecidivism.clinicalmanagementfrom BeaconHealthOptionsandCHNcontinuetomeetonamonthlybasistofurtherclarifyinpatient referalsforco-managementandhaverefinedthereferalcriteria.theweeklycomplexmembercolaborativemeetingcontinuesinadditiontothemonthly communitybasedcomanagementmeetingtoprovidememberupdatesandoferfeedbackandsuggestionsfornextsteps.beaconispartneringwiththemedical ASO inschedulingmeetingswithhospitaldetoxproviderstofurtherclarifyauthorizationproceduresandwhichaso shouldbecontactedbasedoncase presentation.theseefortswilcontinueasneeded. 3.EstablishanASO BehavioralHealthSystemsCommitee(ABH/DMHAS)wherebysystemsofcare(e.g.residentialrehab)thatfaloutsidethescopeofBeacon s existingprovidernetworkofcareworktogethertoidentify,problem solve,andaddresssystemicbariers.severalconnecttocaremeetingshavebeenheldinthe NewHavenareatodiscusscoordinationamongstinpatientproviders(IPDandIPF)andstatewideresidentialrehabilitationprograms.Thefolowing recommendationsforimprovedaccesswereidentified: a.examineresidentialrehabilitationlevelofcarecapacitytoadequatelyservethreedistinctpopulationsidentified1)sa2)co-occuring3)co-morbid b.examineutilizationofdmhasrecoveryhouses(e.g.step-upversusstep-down) c.examinethepotentialofdevelopingastandardizedreferalform andcentralizedaccess Update BeaconheldanInpatientWorkgroupmeetingwithfacilitiesandinvitedDMHAStopresentonresidentialrehabservicesavailabletomembers.Providers continuedtoquestiontheabilitytohaveacentralizedreferalform orprocess.onesuggestionwastopilotacentralizedprocessinaregiontodetermineifthat wouldhelpstreamlinethereferalprocessandincreaseaccesstoresidentialrehabservicesasthecurentprocesscanbelaborintensiveforthereferingparty. DMHASreportedunderutilizationofthisservicebasedoncensusdata,Providersquestionedwhethertherewasaneedforincreasedcapacityfordualydiagnosed individualsasthisisthepopulationmostoftenreferedfrom InpatientHospitaltoresidentialrehab.ThesetwoitemswilbebroughttotheSubstanceUseDisorder Workgroupfordiscussionandpotentialnextstepsasthegrouphasrepresentationfrom Beacon,DSS,DMHAS,ABH,CHNandDCF. Recommendationscontinueonthenextpage.
28 PG24 GlobalRecommendations Continued 4.DevelopacomprehensiveMedicationAssistedTreatmentcontinuum ofcare. a.identifycurentmatprovidersanddevelopaninclusivedocumentthatidentifieswhichmedicatedassistedtreatmentisavailablethroughspecific providers/facilities. b.identifycurentopenings/capacityfornewmedicaidreferalsintotheseprograms.developaproviderresourcelisttoencouragehigherlevelofcareprovidersto beginmatwithmembersknowingwhichprogramscanprovideongoingmatinthecommunity. Update BeaconcreatedaMedicationAssistedTreatment(MAT)webpagewhichhasproviderandmemberresourcesavailable.Beaconalsodevelopedan interactivemapthatlistsalknownmedicaidmatprovidersthatisavailableonthematwebpage.beacondevelopedamemberandprovidertoolkitthatwil includetwobrochures.onebrochurefocusesonmatforopiateusedisorderandtheotherfocusesonmatforalcoholusedisorder.thetoolkitshavebeen reviewedandarependingfinalapproval.onceapprovedtheywilbepostedtothematwebpageandincludedinmember/providerfoldersrelatedtothenational Governors Associationinitiative.BeaconwilalsopartnerwithCHNtohaveaproviderfocusgroupwithMedicalProviders.Thegoalwilbetoexpandthenetwork ofmatprescribersinct.
ExecutiveSummary&AnalysisbyLevelofCare. Quarters1&2:January-June2017-SubmittedSeptember1,2017
UTILIZATIONMANAGEMENT FORADULTMEMBERS ExecutiveSummary&AnalysisbyLevelofCare Quarters1&2:January-June2017-SubmittedSeptember1,2017 ByLynneRinger,ErikaSharilo,CarrieBourdon, HeidiPugliese,LindsayBetzendahl,
UTILIZATION MANAGEMENTFORYOUTH MEMBERS
UTILIZATION MANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare CalendarYear216:January-December216-SubmitedMarch1,217 ByRobertPlant,PhD,withAnnPhelan,BonniHopkins,PhD, LaurieVanDerHeide,PhD,SherieSharp,MD,
UTILIZATIONMANAGEMENTFORADULTMEMBERS Quarters1&2:January-June2015 ExecutiveSummary&AnalysisbyLevelofCare. Submited: September1,2015
UTILIZATIONMANAGEMENTFORADULTMEMBERS Quarters&:January-June ExecutiveSummary&AnalysisbyLevelofCare Submited: September, Authors: RobertW.Plant AnnPhelan LynneRinger ElizabethFeder LindsayBetzendahl Acknowledgements:
ExecutiveSummary&AnalysisbyLevelofCare. Quarters1&2:January-June2017-SubmittedSeptember1,2017
UTILIZATIONMANAGEMENT FORYOUTHMEMBERS ExecutiveSummary&AnalysisbyLevelofCare Quarters&:January-June-SubmittedSeptember, ByLindsayBetzendahl,HeidiPugliese, CarrieBourdon,LynneRinger, RobertPlant,AnnPhelan,
UTILIZATIONMANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare Quarters3& 4:July-December2015-SubmitedMarch1,2016
UTILIZATIONMANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare Quarters& 4:July-December-SubmitedMarch,6 ByRobertW.Plant,Ph.D.withAnnPhelan, BonniHopkins,Ph.D.,LaurieVanDerHeide,Ph.D., SherieSharp,M.D.,LynneRinger,HeidiPugliese,
ExecutiveSummary&AnalysisbyLevelofCare. CalendarYear2018:January-December2018-SubmittedMarch1,2019
UTILIZATIONMANAGEMENT FORADULTMEMBERS ExecutiveSummary&AnalysisbyLevelofCare CalendarYear2018:January-December2018-SubmittedMarch1,2019 Submittedby: LoriSzczygiel,ChiefExecutiveOfficer RobertPlant,PhD,SVPofAnalytics&Innovation
UTILIZATIONMANAGEMENT FORYOUTHMEMBERS
UTILIZATIONMANAGEMENT FORYOUTHMEMBERS ExecutiveSummary&AnalysisbyLevelofCare Quarters1&22018:January-June2018-SubmittedSeptember4,2018 Submittedby: LoriSzczygiel,ChiefExecutiveOfficer RobertPlant,PhD,SVPofAnalytics&Innovation
ExecutiveSummary&AnalysisbyLevelofCare. CalendarYear2018:January-December2018-SubmittedMarch1,2019
UTILIZATIONMANAGEMENT FORYOUTHMEMBERS ExecutiveSummary&AnalysisbyLevelofCare CalendarYear2018:January-December2018-SubmittedMarch1,2019 Submittedby: LoriSzczygiel,ChiefExecutiveOfficer RobertPlant,PhD,SVPofAnalytics&Innovation
HIV and Drug Prevention in Estonian Prisons
HIV and Drug Prevention in Estonian Prisons Maret Miljan The Division of Social Rehabilitation The Estonian Ministry of Justice Prisons in Estonia (3676 prisoners): Tallinn Prison ( 571 convicted male
SFY2019:July1,2018-June30,2019
ANNUALPROGRESSREPORT SFY019:July1,018-June30,019 ReportpreparedbyBeaconHealthOptionsfortheDepartmentofChildrenandFamilies SubmittedAugust6,019 Acknowledgements StateFiscalYear019:July1,018-June30,019 Submittedby:
Sand ell survey December/November 2009
Technical University of Denmark Danish Institute for Fisheries Research Survey Cruise leader Date of depart Date of arrival NS Sandeel-survey Dirk C. Tijssen 12/11-2009 05/12-2009 Sand ell survey December/November
Forensic Psychiatry in Denmark
Forensic Psychiatry in Denmark Current statement 8th-nsfp Forensic Psychiatry in Denmark Danish Legislation (short version) Numbers Research Trends and Challenges Forensic psychiatry in Denmark 1 Forensic
Quarters1&2ofSFY2019:July1,2018-December31,2018
SEMI-ANNUALPROGRESSREPORT Quarters&ofSFY09:July,08-December,08 ReportpreparedbyBeaconHealthOptionsfortheDepartmentofChildrenandFamilies SubmittedMarch,09 Acknowledgements Q&QSFY09:July,08-December,08 Submittedby:
System Management Principles Statement
System Management Principles Statement System Management Principles Statement Compliance report for July, August and September 212 Summary of balancing actions and breaches for July, August and September
APPENDIX E.3 SHADOW FLICKER CALCULATUIONS. 70 m TOWERS & 56 m BLADES
Grousemount Wind Farm, Co. Kerry Environmental Impact Statement - Volume 2 of 3 August 2015 APPENDIX E.3 SHADOW FLICKER CALCULATUIONS 70 m TOWERS & 56 m BLADES Appendix E: Shadow Flicker Assumptions for
Patienten i eget hjem. Solvejg Henneberg Pedersen Ledende overlæge Geriatrisk afdeling Roskilde
Patienten i eget hjem Solvejg Henneberg Pedersen Ledende overlæge Geriatrisk afdeling Roskilde Program for workshoppen 1. Hanna Vestenaa og Sara Fokdal, FUI projektet i Region Sjælland 2. Else Marie Damsgaard,
Figur trafik 1. Antal tilskadekomne behandlet på skadestuen, Figur trafik 2.
72 Figur trafik 1. Antal tilskadekomne behandlet på skadestuen, Odense Universitetshospital efter færdselsulykke i perioden 1978 til 23. 4 23 35 3 25 2 22 21 2 1999 1998 1997 1996 1995 1994 1993 1992 1991
CMS Support for Patient- Centered Medical Homes. Linda M. Magno Director, Medicare Demonstrations
CMS Support for Patient- Centered Medical Homes Linda M. Magno Director, Medicare Demonstrations Overview Congressional support for medical homes reflected in legislation since 2006 Administration support
Central Statistical Agency.
Central Statistical Agency www.csa.gov.et 1 Outline Introduction Characteristics of Construction Aim of the Survey Methodology Result Conclusion 2 Introduction Meaning of Construction Construction may
Medicinske komplikationer efter hofte- og knæalloplastik (THA and KA) med fokus på trombosekomplikationer. Alma B. Pedersen
Medicinske komplikationer efter hofte- og knæalloplastik (THA and KA) med fokus på trombosekomplikationer Alma B. Pedersen Outline Introduction to epidemiology of THA and KA Epidemiology of medical complications:
Admission criteria for the Danish Section For at blive optaget på Europaskolen skal du have aflagt Folkeskolens Adgangsprøve eller lignende.
KØBENHAVNS KOMMUNE Børne- og Ungdomsforvaltningen Center for Policy NOTAT 30. august 2018 Optagelseskriterier til uppersecondary S5-S7 (gymnasiet) på Europaskolen København Optagelseskriterierne til uppersecondary
Epidemiology of Headache
Epidemiology of Headache Birthe Krogh Rasmussen MD, DMSc Denmark Prevalences Distribution in the population Risk factors Consequences The thesis is based on the following publications: 1. Rasmussen BK,
College Insurance Program (CIP)
College Insurance Program (CIP) Pam Kogler Benefits Management, Division Manager Bureau of Benefits Email: pam.kogler@illinois.gov Phone: (217) 785-8051 Who s Responsible for What? The College Insurance
System Management Principles Statement
System Management Principles Statement Compliance report for March 213 Summary of balancing actions and breaches for March 213 Performance compared to last year Summary Report Mar 213 Total Number of Buy
System Management Principles Statement
System Management Principles Statement Compliance report for February 214 and March 214 Summary of balancing actions and breaches for February 214 March 214 Performance compared to last year Summary Report
ACTUM Project: Joint Activities and Travel of Household Members
ACTUM Project: Joint Activities and Travel of Household Members 1 (mt@transport.dtu.dk) Sigal Kaplan 1 (siga@transport.dtu.dk) Goran Vuk 2 (gjv@vd.dk) 1 Technical University of Denmark, Department of Transport
WindPRO version Nov 2013 Printed/Page :45 / 1. SHADOW - Main Result
SHADOW - Main Result Assumptions for shadow calculations Maximum distance for influence Calculate only when more than 20 % of sun is covered by the blade Please look in WTG table WindPRO version 2.9.269
Kalibrering af Vejeceller og Flowmålere i processen INSA 1 / 48
Kalibrering af Vejeceller og Flowmålere i processen INSA 1 / 48 INSA 2 / 48 Hvordan man bygger en flowvogn Målsætning: at udnytte tidligere erfaringer med bygning af flowvogne. Fokus på kompakt design
The effects of occupant behaviour on energy consumption in buildings
The effects of occupant behaviour on energy consumption in buildings Rune Vinther Andersen, Ph.D. International Centre for Indoor Environment and Energy Baggrund 40 % af USA's samlede energiforbrug sker
New Hospital & New Psychiatry Bispebjerg
The Bispebjerg Construction Project EUHPN, October 2012 Hospital plan for the Capital Region A major restructuring project of the Danish hospital structure is now taking place. Each of the 5 regions develops
Children s velomobility how cycling children are made and sustained
Children s velomobility how cycling children are made and sustained Trine Agervig Carstensen, tac@ign.ku.dk Anton Stahl Olafsson, asol@ign.ku.dk Thomas Sick Nielsen, thnie@transport.dtu.dk Trafikdage i
Farmakoepidemiologi Den grimme ælling
Farmakoepidemiologi Den grimme ælling Jesper Hallas Professor i klinisk farmakologi Syddansk Universitet DSKFs jubilæumsmøde April 2016 Outline Datakilder i Danmark Anvendelser DKs position Hvilke ændringer
Trolling Master Bornholm 2016 Nyhedsbrev nr. 3
Trolling Master Bornholm 2016 Nyhedsbrev nr. 3 English version further down Fremragende vejr og laks hele vejen rundt om øen Weekendens fremragende vejr (se selv de bare arme) lokkede mange bornholmske
DANMARKS NATIONALBANK
DANMARKS NATIONALBANK PRODUCTIVITY IN DANISH FIRMS Mark Strøm Kristoffersen, Sune Malthe-Thagaard og Morten Spange 13. januar 218 Views and conclusions expressed are those of the author and do not necessarily
Sport for the elderly
Sport for the elderly - Teenagers of the future Play the Game 2013 Aarhus, 29 October 2013 Ditte Toft Danish Institute for Sports Studies +45 3266 1037 ditte.toft@idan.dk A growing group in the population
Reexam questions in Statistics and Evidence-based medicine, august sem. Medis/Medicin, Modul 2.4.
Reexam questions in Statistics and Evidence-based medicine, august 2013 2. sem. Medis/Medicin, Modul 2.4. Statistics : ESSAY-TYPE QUESTION 1. Intelligence tests are constructed such that the average score
The RESNET Rating Quality Assurance Monitoring Challenge
The RESNET Rating Quality Assurance Monitoring Challenge A Rating Industry Roundtable Presented by Ben Adams, MaGrann Associates Steve Baden, RESNET Daran Wastchak, D.R. Wastchak, LLC February 16, 2009
TRANSCODINGCHOICES FOR24x7x365LINEARVIDEO
TRANSCODINGCHOICES FOR24x7x365LINEARVIDEO ATECHNOLOGYCOMPARISONBETWEENHARDWARE-BASED VIDEOCOMPRESSIONSYSTEMSANDSOFTWARE-BASED VIRTUALIZEDSERVERMODELS RICHARDPESKE VICEPRESIDENTOFVIDEOCOMPRESSION ANDPROCESSINGPRODUCTS
ARRISPKICenter SanDiego,USA PKIS:END-TO-END PKIPROVISIONING SYSTEM
ARRISPKICenter SanDiego,USA PKIS:END-TO-END PKIPROVISIONING SYSTEM TABLEOFCONTENTS INTRODUCTION END-TO-ENDPKIPROVISIONINGSYSTEM OVERVIEW SYSTEM SECURITYFEATURES PKIDATATYPES THEARRISPKISERVER(PKIS) GLOBALSYSTEM
DAO BUSINESS ApS. Howitzvej 50, st mf 2000 Frederiksberg. Årsrapport 1. januar december 2016
DAO BUSINESS ApS Howitzvej 50, st mf 2000 Frederiksberg Årsrapport 1. januar 2016-31. december 2016 Årsrapporten er fremlagt og godkendt på selskabets ordinære generalforsamling den 02/05/2017 Yan Yang
The use of instrumented gait analysis in interdisciplinary interventions for children with cerebral palsy
PhD thesis The use of instrumented gait analysis in interdisciplinary interventions for children with cerebral palsy Helle Mätzke Rasmussen Department of Clinical Research Faculty of Health Sciences University
7764/11 RR/dk 1 DG H 3A
COUNCIL OF THE EUROPEAN UNION Brussels, 17 March 2011 7764/11 ENFOPOL 63 NOTE From: To: Subject: CEPOL Law Enforcement Working Party CEPOL five-year report 1. Articles 21(1) and 21(3) of the Council Decision
From innovation to market
Nupark Accelerace From innovation to market Public money Accelerace VC Private Equity Stock market Available capital BA 2 What is Nupark Accelerace Hands-on investment and business developmentprograms
BrandIndex Webinar: 2011 Super Bowl Results February 17, 2011
BrandIndex Webinar: 2011 Super Bowl Results February 17, 2011 Ted Marzilli Global Managing Director, BrandIndex Ph: 646-723-4646 E: ted.marzilli@yougov.com Lance Fraenkel Manager, Client Services Ph: 646-723-4647
Trolling Master Bornholm 2012
Trolling Master Bornholm 1 (English version further down) Tak for denne gang Det var en fornøjelse især jo også fordi vejret var med os. Så heldig har vi aldrig været før. Vi skal evaluere 1, og I må meget
Peter Emmerich Hansen
Peter Emmerich Hansen Udviklingen på sundhedsområdet med omlægning af sygehusstrukturen, medfører at kommuner, regioner og almen praksis skal forholde sig til en ny virkelighed med bl.a. kortere indlæggelser
Erfaringer med EUTR / Due Diligence 02/
Erfaringer med EUTR / Due Diligence 02/12-2014 Proces og konsekvens EUTR Due Diligence Virksomheder, som bringer træ og træprodukter i omsætning for første gang på det indre marked, bør på grundlag af
ESG reporting meeting investors needs
ESG reporting meeting investors needs Carina Ohm Nordic Head of Climate Change and Sustainability Services, EY DIRF dagen, 24 September 2019 Investors have growing focus on ESG EY Investor Survey 2018
The Green Power Plant Seahorn Energy
The Green Power Plant Seahorn Energy Agenda Seahorn Energy Hvorfor lagring? The Green Power Plant (GPP) Økonomien i GPP Fremtidige aspekter 25/06/2013 SEAHORN ENERGY Aps 2 Seahorn Energy Lille dansk virksomhed
Childhood motor performance as predictor of physical activity and physical activity related injuries
Childhood motor performance as predictor of physical activity and physical activity related injuries The Childhood Health, Activity and Motor Performance School Study- DK The CHAMPS Study- DK Lisbeth Runge
EA evaluering af DANAK Maj Erik Øhlenschlæger, DANAK april 2016
EA evaluering af DANAK Maj 2016 Erik Øhlenschlæger, DANAK april 2016 1 Omfang af peer evaluering for laboratorieområdet - 2 prøvningslaboratorier (1 aflyst pga. sygdom) - 2 kalibreringslaboratorier - 1
DANSKE MÆNDS SÆDKVALITET - EN OPDATERING
DANSKE MÆNDS SÆDKVALITET - EN OPDATERING Niels Jørgensen Afdeling for Vækst og Reproduktion Rigshospitalet Sædkvalitet Lavere end 2-3 generationer siden I Europæiske lande Kun 25% har optimal sædkvalitet
Bookingmuligheder for professionelle brugere i Dansehallerne 2015-16
Bookingmuligheder for professionelle brugere i Dansehallerne 2015-16 Modtager man økonomisk støtte til et danseprojekt, har en premieredato og er professionel bruger af Dansehallerne har man mulighed for
Agenda Subject Time Status Annex Comments
Board Meeting - Draft Agenda Wednesday, January, 30 th From 15.00 to 20.00 19.30: Dinner Agenda 1, Annex 01 Agenda Subject Time Status Annex Comments 1. Welcome and approval of the agenda 15.00 15.10 01
Energy!Matters! The!Social!Construction!of!Energy!! !!!! Danish!title:!Energi!og!betydningsforhold.!Den!Sociale!Konstruktion!af!Energi!
EnergyMatters TheSocialConstructionofEnergy Danishtitle:Energiogbetydningsforhold.DenSocialeKonstruktionafEnergi Numberofcharacters:181.136(79.6pages) Submissiondate:21.December2012 Nameofsupervisor:DanKärreman
How much energy does this operation use?
Tom Manning How much energy does this operation use? How much energy does this operation use? Why? How much energy does this operation use? Why? What steps will reduce energy consumption? Compilation
Laerdal Resuscitation User Network. Guideline 2015 og update om 10 steps to improve survival
Laerdal Resuscitation User Network Guideline 2015 og update om 10 steps to improve survival Freddy Lippert, Akutberedskabet Region Hovedstaden Dansk Hjertestop Register Emergency Medical Services, Copenhagen,
KALK- OG TEGLVÆRKSFORENINGEN. CPR Sustainable Construction
CPR Sustainable Construction 1 Tommy Bisgaard - Direktør i Kalk- og Teglværksforeningen - Formand for DS 417 (CEN TC350 & 351) - Formand for miljøkomiteen i TBE & CU (keramiske industrier i Europa) - Medlem
DRAFTBROCHUREFORCOMPLIANCEINSTITUTE
DRAFTBROCHUREFORCOMPLIANCEINSTITUTE Contents 1.0 Introduction 2.0 Vision 3.0 Mission 4.0 AimsandObjectivesoftheInstitute 5.0 Governance 6.0 Membership 7.0 Curiculum 8.0 KeyInitiatives 9.0 ProfileofMembersoftheInstituteBoardofTrustees
Brystkræftscreening og overdiagnostik hvordan forstår vi stigningen i incidens?
Brystkræftscreening og overdiagnostik hvordan forstår vi stigningen i incidens? Henrik Støvring stovring@ph.au.dk 1. December 2016 Institut for Folkesundhed, AU Institutseminar, Vingsted Screening forskningsområdet
Databaserne, indikatorer og forskning
Databaserne, indikatorer og forskning 28. Februar 2017 Søren Paaske Johnsen Overlæge, klinisk lektor, ph.d. Klinisk Epidemiologisk Afdeling Aarhus Universitetshospital Indhold Sammenhænge mellem struktur,
Netværks analyser af regionale udbrud
Netværks analyser af regionale udbrud erfaringer fra ESCMID workshop i Groningen, Holland Camilla Holten Møller Læge og ph.d studerende Afdeling for infektionsepidemiologi og forebyggelse Statens Serum
Søvnapnø, type II diabetes og tabt arbejdsmarkedsfortjeneste - et sundhedsøkonomisk perspektiv
Søvnapnø, type II diabetes og tabt arbejdsmarkedsfortjeneste - et sundhedsøkonomisk perspektiv Mads Nordentoft Kandidatstuderende i Folkesundhedsvidenskab mads.nordentoft@gmail.com Dias 1 Introduktion
Task Force on European Standard Population. Eurostat, Unit F5 Monica Pace
Task Force on European Standard Population Eurostat, Unit F5 Monica Pace Background Current "Standard population" in use by Eurostat: WHO 'Standard population' of 1976 Main use is of that standard population:
Vandramme Direktivet implementering i EU
Vandramme Direktivet implementering i EU Henriette Faergemann Team Leader Directorate General for Environment European Commission Konteksten - The Water Blueprint Report on 2009 Report on on 2009 2009
SURVEYS BLANDT INDVANDRERE OG ETNISKE MINORITETER
Troels Fage Hedegaard Postdoc, Aalborg Universitet Institut for Statskundskab SURVEYS BLANDT INDVANDRERE OG ETNISKE MINORITETER 1 Oversigt Hvem er jeg og hvorfor taler jeg i dag? Hvad vil jeg sige noget
Fertilitetsrådgivning koncept og resultater efter de første 5 år
Rigshospitalet Fertilitetsrådgivning koncept og resultater efter de første 5 år Overlæge, Phd Målet for fertilitetsrådgivning Nedsætte antallet af fertilitetsbehandlinger At hjælpe mænd og kvinder med
Market overview 17 December 2018
Market overview 7 December Equity Ticker Price Volume Past performance (ISK m.) YTD W M 3M M OMXI 33., -.%.% -.9%.%.3% OMXIGI 9..%.% -.9%.%.% Marel 3.,33 9.3% -.7%.% -.7% 3.3% Icelandair.,3 -.3%.% -3.%
The purpose of our Homepage is to allow external access to pictures and videos taken/made by the Gunnarsson family.
General The purpose of our Homepage is to allow external access to pictures and videos taken/made by the Gunnarsson family. Formålet med vores hjemmesiden er at gøre billeder og video som vi (Gunnarsson)
DDD is STILL better than VVI
DDD is STILL better than VVI 가톨릭의대 노태호 VVI(R) 의장점 하나의 lead 시술이용이 시술관련문제발생이적고 가격이저렴, 긴수명 운동시심박출량증가효과가우수 그러나문제는 - absent AV synchrony AV synchrony blood pressure Wu RC and Reynolds DW from Cardiac Pacing.
Vælg layout/design Nyt dias Fremhæv et eller flere ord i overskriften Bold Vis hjælpelinjer som hjælp ved placering af objekter
Knud Juel Causes of social inequality Determinants of illness 80 Life expectancy in Denmark (years) 70 60 Women Men 50 40 30 1845 1855 1865 1875 1885 1895 1905 1915 1925 1935 1945 1955 1965 1975 1985 1995
Drømmer du om en karriere i USA?
Drømmer du om en karriere i USA? Pernille Wichmann Christensen, Formand, DJØF New York DJØF København, torsdag den 5. maj, 2011 OVERSIGT Pernilles vej til USA - Den personlige historie Adgang til USA?
En varm velkomst til. Poul Melbye Analysechef, Politiken
En varm velkomst til Poul Melbye Analysechef, Politiken Fra fiasko til succes Poul Melbye, Analysechef, Politiken Politiken Første udgave: 1. oktober 1884 3 ansatte Oplag på 2000 STØT FALDENDE OPLAG 150.000
Overview of education statistics in Denmark
Overview of education statistics in Denmark Christian Vittrup Peter Bohnstedt Anan Hansen Education Statistics Statistics Denmark A simple model Basic information on the students Who Where What When Okt.
Age Standardized Incidence Rate-ASR GLOBOCAN ASR ASR.
p [ ] Age Standardized Incidence Rate-ASR ASR - ASR - GLOBOCAN C B - email: Amiralmasi@arakmu.ac.ir - p< ICD-O C22 Cochran-Armitage WinPepi 2.1 CI ± ± ± ± ± ± ± ± ± References 1. Etemadi A, Sadjadi A,
Susan E. Moore, Director Chris Harper, Work First Program Manager
Susan E. Moore, Director Chris Harper, Work First Program Manager September 19, 2011 1995 Executive Order of Governor Jim Hunt. Set 2-year time limit Placed emphasis on going to work 1997 Temporary Assistance
Mission and Vision. ISPE Nordic PAT COP Marts Jesper Wagner, AN GROUP A/S, Mejeribakken 8, 3540 Lynge, Denmark
Mission and Vision ISPE Nordic PAT COP Marts 2007 Mission Statement To provide a professional technical group to support all levels of competence of Process Analytical Technology within the Scandinavian
Velkommen til IFF QA erfa møde d. 15. marts Erfaringer med miljømonitorering og tolkning af nyt anneks 1.
Velkommen til IFF QA erfa møde d. 15. marts 2018 Erfaringer med miljømonitorering og tolkning af nyt anneks 1. 1 Fast agenda kl.16.30-18.00 1. Nyt fra kurser, seminarer, myndighedsinspektioner, audit som
Håndhygiejne: Nye løsninger på et gammelt problem?
Håndhygiejne: Nye løsninger på et gammelt problem? v/ Professor, overlæge dr.med. Jens Kjølseth Møller Klinisk mikrobiologisk afdeling, Sygehus Lillebælt, Vejle Sygehus Hvad ved vi om Håndhygiejne og Adfærd?
Udledninger fra brændeovne og effekten på sundhed
ENVS Seminar April 19, 2016 Udledninger fra brændeovne og effekten på sundhed DCE s rådgivningspanel 6. juni 2016 Jørgen Brandt, Steen Solvang Jensen, Mikael Skou Andersen, Marlene Schmidt Plejdrup, Ole-Kenneth
Cohort of HBV and HCV Patients
Cohort of HBV and HCV Patients Emanuel K. Manesis, MD Professor of Medicine In 2003 the Hellenic Center for Disease Prevention & Control (HCDPC) started a cohort study of chronic HBV, HDV and HCV infection
3. Arbejdskraft, alder og uddannelse Labour force, age and education
27 3. Arbejdskraft, alder og uddannelse Labour force, age and education A. Brugers alder Ved den årlige landbrugs- og gartneritælling indhenter Danmarks Statistik oplysninger om fødselsdato, måned og år
Husstande og familier. Households and families
Husstande og familier Households and families 172 - Husstande og familier Tabel 87. Husstande 1. januar 1980-2000 Households 1 January 1980-2000 En enlig mand med/uden En enlig kvinde med/uden Husstande
CombiningToolsYouCanUsewith SecurityYouCanTrust
COMPLIANCE CLOUD CombiningToolsYouCanUsewith SecurityYouCanTrust Youalreadyknowthat123FormBuilderdeliverspowerful form buildingtools.with123formbuildercompliance Cloud,youcantakethecapabilitiesandsecurityofyour
Husstande og familier
Husstande og familier Households and families ((Side 169)) 170 - Husstande og familier Tabel 89. Husstande 1. januar 1980-1998 Households 1 January 1980-1998 En enlig mand En enlig kvinde Husstande med
Guidelines. Lederkursus, Middelfart 27. april 2012
Guidelines Ulrik Becker Overlæge, dr. med. Gastroenheden, Hvidovre Hospital Adjungeret professor, Statens Institut for Folkesundhed mobil 23 39 17 28 Ulrik.becker@hvh.regionh.dk Lederkursus, Middelfart
Roskilde Universitet Jeanette Lindholm PHD-.student
Roskilde Universitet Jeanette Lindholm PHD-.student jeaneli@ruc.dk Recognition of Prior Learning in Health Educations JEANETTE LINDHOLM PHD-STUDENT Research question How do RPL students experience themselves
FINDINSIDE TABLEOFCONTENTS. ErinMilsYouthCentresupportsandempowersyouth toadvocateforthemselvesandtheircommunityin ordertocreateabrighterfuture.
FINDINSIDE TABLEOFCONTENTS OurMision ErinMilsYouthCentresupportsandempowersyouth toadvocateforthemselvesandtheircommunityin ordertocreateabrighterfuture. p.1 Execu vedirectormesagereport p.2 BoardMembersReport
Using SL-RAT to Reduce SSOs
Using SL-RAT to Reduce SSOs Daniel R. Murphy, P.E. Lindsey L. Donbavand November 17, 2016 Presentation Outline Background Overview of Acoustic Inspection Approach Results Conclusion 2 Background Sanitary
Alfa-1-antitrysin mangel hos børn. Elisabeth Stenbøg, Afd.læge, PhD Børneafd. A, AUH
Alfa-1-antitrysin mangel hos børn Elisabeth Stenbøg, Afd.læge, PhD Børneafd. A, AUH Hvad er det? Alfa-1-antitrypsin Proteinstof Produceres i leveren Fungerer i lungerne Regulerer neutrofil elastase balancen
Engelsk G Opgaveark. Maj 2011. Dato Prøveafholdende institution Tilsynsførende
Engelsk G Opgaveark Maj 2011 Eksaminandens navn Nummer Dato Prøveafholdende institution Tilsynsførende Jeg bekræfter herved med min underskrift, at opgavebesvarelsen er udarbejdet af mig. Jeg har ikke
Forskning og udvikling i almindelighed og drivkraften i særdeleshed Bindslev, Henrik
Syddansk Universitet Forskning og udvikling i almindelighed og drivkraften i særdeleshed Bindslev, Henrik Publication date: 2009 Document version Final published version Citation for pulished version (APA):
Vejledning om den relevante kapacitetsudnyttelsesfaktor ved ansøgning om kvotetildeling for produktionsenheder omfattet af EU s kvoteordning
VEJLE D NI NG OM DE N RE LEV AN T E KAP AC I T ETS- U D N YTTELSESFAK T O R VED AN S ØGNINGER OM K VOTETILDE LI NG UN- D E R EU S KVOTEORDNIN G 28. maj 2015 Ref. DM/MHJ Center for Erhverv Vejledning om
Celebrating10Yearsof ServingOurCommunity!
Celebrating10Yearsof ServingOurCommunity! Aswecelebrateour10thanniversaryhereatATLAS,wearesothankfulfortheopportunitywehavetoserve thiscommunity.manyofyouhavesupportedourgoodworksinthecommunitythroughyourdonationsor
Rentemarkedet. Markedskommentarer og prognose. Kilde, afdækning Dato 12. august 2014
Rentemarkedet Markedskommentarer og prognose Kilde, afdækning Dato 12. august 2014 Rentemarkedet DKK siden august og fremover 2.5 2 1.5 1 0.5 August 2013 NU Vores forventning til renteniveauet om 1 år
Brug af logbog i undervisning. Karen Lauterbach Center for Afrikastudier Adjunktpædagogikum 19. Juni 2013
Brug af logbog i undervisning Karen Lauterbach Center for Afrikastudier Adjunktpædagogikum 19. Juni 2013 Motivation og projektidé Modsætning mellem undervisningsideal (deltagende og reflekterende studerende
INOPS Survey data report for Denmark Lindholst, Andrej Christian; Hansen, Morten Balle; Østergaard, Jeppe
Aalborg Universitet INOPS Survey data report for Denmark Lindholst, Andrej Christian; Hansen, Morten Balle; Østergaard, Jeppe Publication date: 2017 Document Version Publisher's PDF, also known as Version
IDA National energiplan Elsystemer
IDA National energiplan Elsystemer 2. jan 29 Ingeniørhuset Kbh. Betina Knudsen, Vattenfall Nordic Agenda Vattenfalls klima målsætning Initiativer for at nå klima målsætning Største udfordringer 2 The Investment
Vigtigheden af Information Management nu og i fremtiden
Dorte Madsen 1 Vigtigheden af Information Management nu og i fremtiden Dorte Madsen, phd Institut for Informatik, Copenhagen Business School E-mail: dorte@cbs.dk Studieleder BA in Information Management
Reviews 1997 1998 1999 2002 2002 2003 2008;
Reviews Rinck GC, van den Bos GA, Kleijnen J et al. Methodologic issues in effectiveness research on palliative cancer care: a systematic review. J Clin Oncol 1997; 15: 1697-1707. Smeenk FW, van Haastregt