ExecutiveSummary&AnalysisbyLevelofCare. Quarters1&2:January-June2017-SubmittedSeptember1,2017

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1 UTILIZATIONMANAGEMENT FORADULTMEMBERS ExecutiveSummary&AnalysisbyLevelofCare Quarters1&2:January-June2017-SubmittedSeptember1,2017

2 ByLynneRinger,ErikaSharilo,CarrieBourdon, HeidiPugliese,LindsayBetzendahl, RobertPlant,AnnPhelan,StelaNtate, StephanieShorey-Roca,andWalaceFarrel, aswelastheentirereporting,clinical,andquality Departments. Foranyinquiries,comments,orquestionsrelatedtotheuseofTableau,ortheinteractive featureswithinthisreport, ThisreportwascreatedbyBeaconHealthOptionsonbehalfoftheCTBehavioralHealthPartnership.Howevertheopinions, conclusions,andrecommendationscontainedhereinaresolelythoseofbeaconhealthoptions,andmaynotrepresentthoseofdss, DMHAS,andDCF.

3 UTILIZATIONREPORTFORADULTMEMBERS Quarters1&2:January-June2017 GeneralOverview Onatleastasemiannualbasis,thereportsmutualyagreeduponinExhibitEoftheCTBHPcontractaresubmittedto thestateforreview.theshifttosemiannualreportswasdesignedtominimizenoisecreatedbyquarter-to-quarter fluctuationsthatdonotreflectatruetrendinthedata.themarchdeliverableservesastheannualreportandcovers fourconsecutiveyearsofutilizationdata.theseptemberdeliverablecovers10consecutivequarterswithafocused analysisonthemostrecenttwoquarters,butmayincludethepastfourifthereisinformationnecessarytoreview thathadnotbeenanalyzedpreviously. Thisreportfocusesontheutilizationmanagementportionofthesereports,evidencedinthe4Aseries,whichreviews utilizationstatisticssuchasadmissionsper1,000members(),daysper1,000members(days/1,000), andaveragelengthofstay(alos). Withinthisinteractivereport,alutilizationdataisavailableviadrop-downfilters,butthenarrativehighlightsthe areasofinterestrelatedtocertainutilizationtrends.insomecases,demographicbreakoutsareavailabletoenhance theunderstandingofutilization.additionaly,thenarrativeidentifiestheunderlyingfactors,whichdrivethetrends andassociatedprogrammaticresponsestakenbybeaconhealthoptionstoimpact/mitigateorsupportthetrend. Beaconalsopresentsrecommendationstoaddressremainingchalengesandreportsprogressrelatedtothese plannedrecommendations.theareasoffocusforthisdeliverablearelistedonthefolowingpage. Methodology Thedatacontainedinthisreportarebasedonauthorizationadmissionsandarerefreshedforeachsubsequentsetof updatesduringtheyear.duetochangesineligibility,theresultsforeachquarteroryearmaychangefrom the previouslyreportedvalues.thereportsandanalysesforallevelsofcareareaffectedbythischange.pleasenote thatutilizationmetricsmaychangewiththerefreshofthedata.therefore,thereadershouldbecautiouswhen interpretingthelatestquarterofdata.thecontractorwilmonitorthepost-refreshchangesclosely.ifwarranted, methodologywilberevisited. Themethodologyformembershiptotalsremainsunchanged.FortheTotalMembershipcounts,eachmemberisonly countedonceperquarter,evenifhe/shechangeseligibilitygroupsorexperiencesgapsineligibility.forinstance,ifa memberchangesbenefitgroupswithinthequarter,thatmemberisincludedinthetotalsforeachbenefitgroup,but onlyonceforthetotalmembership.thismethodologyisreferredtointhegraphsas UniqueMembership".Forthe benefitgroups,membersarecountedineachgroupinwhichtheywereeligibleduringthetimeperiod(quarteror year).thismeansthattheindividualbenefitgroupmembershipcountscannotbeaddedtoobtainanoveraltotal sincememberscanshiftbetweenbenefitgroups. Themethodologyforcalculatingagehaschanged,resultinginaslightshiftinadultandyouthmembershiptotals. Previoustothisreport,countsforadultsandyouthwerebasedonifamembermetthatagecriteriaduringthetime period.thismeantthatyouthwhowereboth17and18yearsoldinaquarterwerecountedinboththeadultand youthtotals.inordertoalow forthedril-downofdemographicandageinformation,itwasrequiredthatmembers becountedinonlyonegroupduringatimeperiod.agegroupisnow basedontheagethatamemberwasforthe majorityofthetimeperiod(quarteroryear).otherdemographicssuchasgenderandrace/ethnicityarebasedonthe mostrecentlyupdatedeligibility.thesedemographicswilupdateasneededaswewanttoreportonthemost accurategenderorrace/ethnicitythatamemberidentifieswith. Additionaly,whileunchangedfrom previousreportingperiods,itisworthnotingthattheper1,000measures comparetheutilizationratesofthepopulationtothepopulation s membermonths.thismeansthatwhenviewing theofhuskydmemberstherateisbasedonthenumberofadmissionswithinthehuskydpopulation, nottheentireadultpopulation.thishelpstoanalyzewhichpopulationsarepotentialymorechronic,acute,orin need. Reports

4 EXECUTIVESUMMARYREPORTFORADULTMEMBERS Quarters1&2:January-June2017 TotalMembership InConnecticut,MedicaidmembershiphadbeenincreasingaftertheAffordableCareActwasimplementedinJanuary2014.However,in Q4 15overalMedicaidmembershipexperiencedthefirstlargedeclineduetoachangeineligibilitycriteriarelatedtoincomelevels, whichtookeffectonseptember1,2015.sincethatdecline,overalmembershiphasstabilizedoverthelastseveralquarters.adults continuetomakeupthemajorityofthemedicaidpopulationat59%. BenefitMembership Unfortunately,duetotheanomaliesdiscoveredintheMedicaideligibilityfile,wearenotabletoaccuratelyspeaktotrendsinthedata relatedtobenefitpackageorrace/ethnicityfrom Q4 16throughQ2 17.ForthisiterationoftheSemiannualUtilizationReportonly demographicsrelatedtoageandgenderwilbediscussedifrelevant. Asseeninprevioussubmissions,thefemalescontinuetomakeupthemajorityoftheadultMedicaidpopulationaround56%.Adults ages25-34arethelargestagegroupandafterdecreasingbetweenq3andq4 15,thenumberofmembershavesteadilyincreased quarter-over-quarterwithinthisagebracket.while35-44yearoldshadbeenthesecondlargest,inthepastthree(3)quarters,the 18-24populationgrew andsurpassedthesizeofthe35-44yearoldsinq4 16andmaintainedattheslightlyhigherpercentage(20%) duringq1andq2 17. InpatientPsychiatricHospitalUtilization Thenumberofdischargesfrom inpatientpsychiatrichospitalizationappeartobegeneralystableovertimeandq1andq2 17mirror similarvolumefrom thesamequarterslastyear.the25-34yearoldscontinuetoaccountforapproximately28% ofalinpatient psychiatrichospitaldischarges,whichisconsistentoverthelast10quarters. Theincreaseintheaveragelengthofstay(ALOS)seenbetweenCY2015(8.0)and2016(8.5)continuedthroughQ1 17(8.8).Thedropin Q2 17isconsistentwiththeseasonaltrendthathasbecomeevidentoverthelast10quarters,wherethereisadecreaseinQ2 folowingahighinq1.itshouldbenotedthatthealosforq1hasbeenincreasingslightlyeachyear 2015(8.2),2016(8.5)to2017 (8.8).WhilethetotalALOSforalmemberscamedowninQ2,iftrendsareconsistentwithlastyear,Q3andQ4arepredictedtoincrease andcy2017couldpossiblybehigherthancy2016.thisincreasemaybeduetoseveralchangesinthesystem (i.e.accesstoshelterbed processchangesandreductioninthestate-operatedinpatientbeds)contributingtocompoundingeffectsonthelengthofstay.with theadditionofanew MedicalDirector,Beaconlooksforwardtodevelopingnew strategiestoaddressalosandtimelydischargesfrom acuteinpatientsettingsbacktocommunityservices. WhiletheALOSforthe55+agegrouphasbeen longerthantheotheragegroups,thealosforthe 18-24yearoldsincreasedbyadaybetweenQ3 15 (8.1)toQ1 17(9.1).Thelongerlengthofstayfor theolderadultsmaybeaccountedforbythe severityoftheirilnessand/orchalengesrelated totheirdischargeplans,butreasonsforthe increaseinthealosfortheyoungadultsareless clear. Inordertobetterunderstandtheneedsofthe year-oldpopulation,Beaconisworkingona projectthatfocusesonthis transition age group.dataanalyseshavebeenconductedto determineiftheycontinuetoreceivethecarethat theyneedastheytransitionfrom theyouth mentalhealthsystem withthedepartmentof ChildrenandFamilies(DCF)totheadultmental healthsystem withthedepartmentofmental HealthandAddictionServices(DMHAS). Additionaly,Beaconisimplementingaproject regardingfirstepisodepsychosis,whichis targetedtothesameagecohortandhaspotential toimprovethequalityofcareandreducehospital utilizationandlengthofstay.

5 Pagei-ExecutiveSummary:Quarters1&2:January-June2017 Basedonthedatasharedwithin-statehospitalsviatheProviderandAnalysisReporting(PAR)Program,theacutelengthofstayhas trendedupsinceq2 16,withanincreaseofone-thirdofadaybyQ1 17.Whilemanyhospitalshadlowerthanaveragelengthofstays, thereweresix(6)in-statehospitalsthathadahigherthanaveragelengthofstayinq1 17andcontributedtotheincrease:Danbury Hospital,HospitalofCentralConnecticut,NatchaugHospital,ProspectWaterbury,StamfordHospital,andYaleNew HavenHospital. Whilealongerlengthofstaymayattimescontributetobetterhealthoutcomes,itisnotedthatNatchaughasahigherthanaverage 7-dayreadmitrateforfirsthalfofCY2017aswelasthelasthalfofCY2016.GriffinHospital,St.FrancisHospitalandSt.Vincent s MedicalCenteralsohadhigherthanaverage7-dayreadmitratesforboththelasthalfofCY2016andthefirsthalfofCY2017. Recommendation1:ContinueAdultInpatientPARProgram InQ1andQ2 17,theRegionalNetworkMangers(RNMs)andClinicalstaff metwithinpatientpsychiatrichospitalstoreview data, discusssystemicbarriers,andidentifypracticesthathaveproventobesuccessful,withappropriatefolow upasnecessary.duringthe PARmeetings,providersidentifiedhomelessness,accesstoresidentialrehabbedsandstateinpatientbeds,andconnectiontoa prescriberasfactorsimpactingtheiralosand/orreadmissionrates.asaresultofthelatter,beaconwilbeprovidingbaselinedatato thehospitalsonthepercentageofmemberswhofilaprescriptionwithin30daysofdischargefrom thehospital.hospital-specific and/orregionalstrategieswilbedevelopedbasedonperformance.inaddition,strategieshavebeenimplementedtotrytoimprovethe connectiontostatebedsformembershospitalizedatdanburyhospitalandwaterburyhospital.beaconwilcontinuetopartnerwith DMHASandthehospitalsinRegion5regardingthestatebedprocess. Recommendation2:ContinueInpatientBypassProgram Additionaly,inresponsetoproviderconcernsthatthereasonforincreased ALOSwasrelatedtooutliers,theBypassProgram wasreevaluatedandthetrim pointforwhowasremovedasanoutlierwasadjusted from 100daysto40daysorgreater.Thiswilalow BeacontobetterunderstandwhatiscontributingtotheoveralincreaseinALOS insteadoffocusingontheoutliersthatmaynotbeabletobeimpactedandorarenotdrivingtheoveralconsistentincreaseinthe ALOS.DuringtheinpatientprovidermeetingheldinQ2 17,therewaspositiveresponsefrom theparticipantsregardingthischange. TheAdultInpatientBypassProgram wilcontinueandtargetswilcontinuetobere-evaluatedtodetermineifchangesinthebehavioral healthservicesystem haveimpactedinpatienthospitaldatastatewideandifthetargetsshouldbeadjusted.

6 Page i-executivesummary:quarters1&2:january-june2017 InpatientDetoxification HospitalUtilization Afterincreasingoverthelastthree(3)years,duetoincreasedproviderawarenessaboutwhotheyneedtocontact(BeaconversesCHN) topre-certifythecare,theadmission/dischargevolumeforhospital-baseddetoxificationhasleveledoff andhasbeenfairlyconsistent overthepastfive(5)quarters.thetopthreeagegroupsusingthislevelofcarecontinuetobethegroupsfrom 35-64yearsold.Males continuetobeapproximately70% ofaldischargestothislevelofcare. TheALOSremainsunchangedfrom theannualincy2016at5.3days.alosisnotimpactedbygender asevidencedbythemalesand femalesareconsistentlystayingthesameamountoftime.ratesremainunchangedfor7-day(9%)and30-day(28%)readmissionbut remainhigherthanpsychiatricreadmissions.most(89%)ofthemembersthatarereadmittingareadmittingbacktodetoxification treatmentasopposedtopsychiatriccare. Recommendation3:ContinueHospital-basedDetoxificationPARProgram Beaconcontinuestomeetwiththehospital-baseddetoxificationproviderstoaddressreadmissionratesandanypatternsortrendsin thosethatreadmit.oneareaoffocuswastoincreasetheutilizationofmedicationassistedtreatment(mat),specificalyvivitrol,asan additionaltoolinaddressingchronicrelapseandrecidivism withinthislevelofcare.yalenew HavenHospitalreportedthattheywilbe offeringvivitroltoindividualsbeingtreatedfordetoxificationfrom alcoholandothersubstancesasindicated.beaconwilcontinueto engageandencourageotherhospitalprovidersregardingopportunitiesformatwithinthehospital-baseddetoxificationlevelofcare. Recommendation4:ContinuetoProvideEducationtoProviders TheClinicalSupervisors,ClinicalCareManagers(CCMs),andCo-ManagementCCMscontinuetoprovidecaseconsultationand differentialdiagnosissupporttoalhospital-baseddetoxificationprovidersindeterminingwhichadministrativeserviceorganization (ASO)isthecorrectASOtoauthorizethislevelofcare.Inaddition,theClinicalstaff andrnmshavemadeaconcertedeffortto encouragetheseproviderstoenterthedischargeform whichinitiatesbeacon sconnect-to-careprocessforalmembersdischarging from ahospital-baseddetoxification.afocusoftheupcomingparcycleinq3andq4 17isimprovingconnect-to-careeffortsand encouragingwarm transferstosubstanceabuseandrecoveryresourcesatdischarge. InpatientDetoxification FreestandingUtilization WhiletherewasanincreaseindischargevolumeinCY2016comparedtotheprioryear,thelastthree(3)quartershaveremainedstable andareontracktobeconsistentwith2016.itisanticipatedthattherecouldbeanincreaseinq3 17basedonseasonaltrendsseenin thepast.the25-34yearoldscontinuouslyaccountforapproximately38% ofalinpatientdetoxification-freestandingdischarges.the ratioofalagegroupsremainsconsistentoverthequarters.similartoinpatientdetoxification-hospital,malesaccountforover70% of aldischarges. ALOSremainsflatforthislevelofcareataround4.2days.TheALOSmaybe slightlydifferent/lowerifaltheprovidersconsistentlycompletedtheir dischargeform andprovidedtheactualdischargedate.mostproviders consistentlycompletethisinformationforbeaconbutmccaandstonington havestruggledtodoso.afteragreatdealofoutreachandsupport, improvementisalreadybeingseeninq3 17. Recommendation5:ContinueProviderWorkgroupMeetingsandPARProgram Beaconheldameetingwithalofthefreestandingdetoxificationproviderson May10,2017andhadrepresentationfrom fiveofthesevenfreestanding providers.beaconpresentedthemedicationassistedtreatment(mat) websitewhichincludedademonstrationofthematlocatormap.providers identifiedaneedforongoingeducationfortheirlinestaff aswelasmembers andfamilymembersoftheclientstheyserve.theprovidersindicatedthat theyhaveseenanincreaseinayoungadultpopulationandmanyhavefamily membersinvolvedintheirtreatment.theprovidersalsoindicatedalackof awarenessbythefamilymembersregardingmatservicesandattimesthese familymembershavediscouragedmedicationduetoalackofunderstandingof thebenefitsofmatinadditiontotraditionaltherapiesintreatingsubstance usedisorders.beaconwilcontinuetoholdmeetingswiththefreestanding inpatientdetoxificationprovider,inadditiontoparmeetings,toaddressthe needsinthispopulationwiththeultimategoalofsharingresourcesand creatingmateducationalmaterials.theconnect-to-caremeasurewilbe incorporatedintheparmeetingsinanefforttoimproveconnect-to-carerates andpotentialyreducereadmissionrates.additionaly,thernmswilcontinue topartnerwiththedmhasregionalmanagersaroundperformance improvementefforts.

7 Pageiv-ExecutiveSummary:Quarters1&2:January-June2017 HomeHealth HomehealthpromptingincreasedbetweenQ1 16andQ2 16buthasbeentreadingdownsincethen.Once-a-day(QD) medicationadministrationcontinuestotrendupwhile two-times-a-day(bid)administrationcontinuestotrend down.emergencydepartmentandinpatientratesremain flatoraretrendingslightlydownward. Recommendation6:ContinueHomeHealthBypassProgram BeaconhascontinuedtheBypassProgram forhomehealth agencies.thebypassprogram providesadministrative reliefforbothbeaconandhomehealthagencieswhile promotingpracticechangethatwilbenefitmembersand improvetheefficiencyofhomehealthservices.the agenciesonbypassareauthorizedforlongerperiodsof time,thusdecreasingthenumberofconcurrentreviews requiredforanepisodeofcare.thebypassprogram eligibilitycriteriaincludesachievementofabidmedication administrationtargetrate. Inaddition,BeaconhasestablishedaBypassPlusProgram thisyearwhichincludestheachievementofabidmedicationtargetrate andanemergencydepartment(ed)utilizationrate.thehomehealthagenciesprovidedpositivefeedbackregardingthisnewlyadded measureduringourlastalhomehealthagencystatewidemeeting. Beaconhascontinuedtoworkwithproviderstoachievethesegoals.Beaconhascontinuedtocolaboratewithprovidersregularlyto review andmonitortheirstatuswithinthebypassprogram anddiscussthetoolstosupportthereductionofthebidrate.thisyear, homehealthagencieshaveincreasedtheirutilizationofthehomehealthpromptingtoolwhichhassupportedthereductioninthebid rate. EnhanceCareClinics(ECCs) ThevolumeofECCoutpatientregistrations,foryouthandadults,continuestoclimbquarterafterquarter.Therecontinuetobe increasesinq1folowedbyadecreaseinq2,whichwasobservedin2016and2017.thepercentofeccvolumeoutofaloutpatient registrationswas14% inq1andq2 17. ECCscontinuetomeettheaccessstandardforroutinecare;however,inQ1 17theaccessforurgentregistrationfelbelow the95% accessstandardto88%.afterbeingbelow thestandardinq1 17,registrationinQ2 17mettheaccessstandardat98%.Thefolowing adulteccsdidnotmeetthe95% urgentaccessstandardinq1orq2: BHCareInc.Valey:75% inq1 17 CatholicCharities,Norwich:50% inq1 17 ConnecticutRenaissance,Bridgeport:33.33% inq1 17 MiddlesexHospital Adult:0% inq2 17 Alagenciesthatdidnotmeetthe95% accessstandardfortheurgentoremergentmeasureinq1 17wereaskedtoreview theirdatato verifywhetherthosefailuresweredataentryerrors.bhcareinc.valeyisstilreviewingtheirinformationandcatholiccharites Norwichindicatedthatthemeasuretheyfailedwasnotadataentryerror.ConnecticutRenaissance,Bridgeportstilhadaprovisional designationandasaresultwerenotrequiredtosubmitdataentryinformation.agenciesthatfailedtheurgentoremergentmeasurein Q2 17wilbeaskedshortlytoverifywhethertheurgentoremergentaccessstandardthattheydidnotmeetweredataentryerrors. Additionaly,duetotheincreaseinreporteddataentryerrorsoverthepasttwoyears,Beaconpresentedinformationondataentry errorsduringtheeccproviderworkgroupinmay2017includingremindersandtipsforminimizingerrors. Recommendation7:AssessECCinitiative TheECCprogram hasbeenoperatingunchangedformanyyears.recommendreviewingtheeccinitiativeregardingthechoiceand operationalizationofeccprogram metrics,acost-benefitanalysis,andopportunitiestoincorporatevaluebasedpayment methodologies.

8 UTILIZATIONMANAGEMENTFORADULTMEMBERS ExecutiveSummary&AnalysisbyLevelofCare Quarters1&2:January-June2017-SubmittedSeptember1,2017 AreasofFocus TableofContents Selecticontoview menuandjumptoselectedpage ExecutiveSummary Membership&Demographics InpatientPsychiatric Facilities DischargeVolume AverageLengthofStay &Days/1,000 InpatientDetoxification: Hospital-Based DischargeVolume AverageLengthofStay &Days/1,000 InpatientDetoxification: Freestanding DischargeVolume AverageLengthofStay &Days/1,000 HomeHealthServices MedicationAdministration Frequency UtilizationRates OutpatientEnhancedCare Clinics(ECC) RegistrationVolume AccessStandards Forthisreport,thefolowingutilizationdatapointscanbefoundintheLowerLevelsofCaretab: MentalHealthGroupHome,Days/1,000&AverageLengthofStay PartialHospitalizationProgram AmbulatoryDetox MethadoneMaintenance ABeaconHealthOptions-CTDashboard IntensiveOutpatient OutpatientServices

9 PG1 AdultMedicaidMembership TotalMembershipVolume SelectDate 2017Q2 ChooseMembershipType AlMemberswithoutDuals AlMemberswithDuals AlMemberswithoutDuals AdultMemberswithDuals AdultMemberswithoutDuals YouthMemberswithDuals YouthMemberswithoutDuals InQ2'17,therewasatotalof773,649 Medicaidmembers(excludingduals). AnnualTotalMedicaidMembership HoverforDetails AdultsmadeupthemajorityoftheAl MemberswithoutDualspopulationat59% (452,836). 800K Membersages3-12werethelargest singleagegroupat23% (181,663). FemalesmadeupthemajorityoftheAl MemberswithoutDualspopulationat53% (410,840). Members 600K 400K 200K Thelargestracial/ethnicgroupwas White,whichwas43% ofthepopulation (330,827). 0K ACAImplementation Q3'11 Q3'12 Q3'13 Q3'14 Q3'15 Q3'16 Q3'17 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 AlMembers AlMemberswithDuals AlMemberswithoutDuals AlMembersDualsOnly 869, ,430 78, , ,165 78, , ,041 78, , ,457 78, , ,021 78, , ,873 77, , ,402 77, , ,649 74,699 MembershipCount Methodology Adults AdultMemberswithDuals AdultMemberswithoutDuals 545, , , , , , , , , , , , , , , ,836 Youth AdultMembersDualsOnly YouthMemberswithDuals YouthMemberswithoutDuals 78, , ,424 78, , ,395 78, , ,598 78, , ,980 78, , ,044 77, , ,355 77, , ,207 74, , ,729 DualEligibility Information YouthMembersDualsOnly

10 AdultMedicaidMembership MembershipbyBenefitGroup PG2 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 HUSKYA(FamilySingle) HUSKYA(FamilyDual) HUSKYB HUSKYC(LTCSingle) HUSKYC(LTCDual) HUSKYC(ABD/OtherSingle) HUSKYC(ABD/OtherDual) HUSKYD(MLIA) AdultMemberswithDuals AdultMemberswithoutDuals AdultMembersDualsOnly AlMembers Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 0K 50K 100K 150K 200K #ofmembers/% ofmembers Adults-HUSKYBenefitGroups-TotalMembersbyNoDemographic(AlMembers) Important:Totalmembersshowstheraw countofmembersinthegroupselected.hoverformoreinformation ChooseView TotalMembers HUSKYA(FamilySingle) HUSKYB HUSKYC(ABD/OtherSingle) HUSKYC(LTCSingle) HUSKYD(MLIA) SelecttoAdd/RemoveBenefitTypes Al SelectGroupType SingleGroups ChooseDemographic NoDemographic(AlMembers) HUSKYA (FamilySingle) HUSKYC (ABD/Other Single) HUSKYC(LTC Single) HUSKYD (MLIA) AlMembers withoutduals InpatientPsychiatricFacility InpatientDetoxification:Hospital InpatientDetoxification:Freestanding PartialHospitalization(PHP) IntensiveOutpatient(IOP) AmbulatoryDetox MethadoneMaintenance Outpatient bylevelofcare Note:Forthetable,thelowerlevelsofcarearenotconducive tothedays/1,000andaveragelengthofstay(alos) measuresavailable.forexample,becauseoutpatient authorizationsaregivenforoneyearatatime,alosmaynot reflectthetruelengthoftimemembersstayinoutpatient. SelectTimePeriod Q2' SelectMeasure

11 PG3 InpatientPsychiatricFacility ServiceClass InpatientPsychiatricFacility ChooseDemographic NoDemographicBreakout Removedemographicgroups Al SelectMembershipType TotalsGroup AlMembers Changeto% ofdischarges(onlyifdemographicisselected) Discharges ChooseBenefitGroup(s) AlMemberswithoutDuals InpatientPsychiatricFacility(Excl.State)-Adults(18+) Discharges AlMemberswithoutDuals InpatientPsychiatricFacility(Excl.State)-Adults (18+) AlMemberswithoutDuals Discharges/% ofdischarges 2K 1K 2 1 0K 0 Q1'15 Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 InpatientPsychiatricFacility(Excl.State)-Adults(18+) AverageLengthofStay(ALOS) AlMemberswithoutDuals Q2'15 Q4'15 Q2'16 Q4'16 Q2'17 InpatientPsychiatricFacility(Excl.State)-Adults (18+) Days/1,000 AlMemberswithoutDuals AverageLengthofStay Days/1, Q1'15 Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 Q2'15 Q4'15 Q2'16 Q4'16 Q2'17

12 PG4 InpatientPsychiatricFacility Q3'16 Q1'17 Q4'16 Q2'17 BRIDGEPORTHOSPITALINC BRISTOLHOSPITALINC CHARLOTTEHUNGERFORDHOSPITAL DANBURYHOSPITAL DAYKIMBALLHOSPITAL GRIFFINHOSPITAL HARTFORDHOSPITAL HOSPITALOFCENTRALCT JOHNSONMEMORIALHOSPITAL LAWRENCE&MEMORIALHOSPITAL MIDDLESEXHOSPITAL NATCHAUGHOSPITALINC NORWALKHOSPITALASSOCIATION PROSPECTMANCHESTERHOSPINC PROSPECTWATERBURYINC STFRANCISHOSPITAL&MEDICALCTR STVINCENTSMEDICALCENTER ST.MARYSHOSPITAL STAMFORDHOSPITAL STATEOFCONNECTICUTJ.D.HOSPITAL WILLIAM BACKUSHOSPITAL,THE YALENEW HAVENHOSPITAL Statewide 2, , , , In-StateHospitalDischargeVolume Q3'16 Q4'16 Q1'17 Q2'17 BRIDGEPORTHOSPITALINC BRISTOLHOSPITALINC CHARLOTTEHUNGERFORDHOSPITAL DANBURYHOSPITAL DAYKIMBALLHOSPITAL GRIFFINHOSPITAL HARTFORDHOSPITAL HOSPITALOFCENTRALCT JOHNSONMEMORIALHOSPITAL LAWRENCE&MEMORIALHOSPITAL MIDDLESEXHOSPITAL NATCHAUGHOSPITALINC NORWALKHOSPITALASSOCIATION PROSPECTMANCHESTERHOSPINC PROSPECTWATERBURYINC STFRANCISHOSPITAL&MEDICALCTR STVINCENTSMEDICALCENTER ST.MARYSHOSPITAL STAMFORDHOSPITAL STATEOFCONNECTICUTJ.D.HOSPITAL WILLIAM BACKUSHOSPITAL,THE YALENEW HAVENHOSPITAL Statewide In-StateHospitalAverageLengthofStay AverageLengthofStay ServiceClass InpatientPsychiatricFacility Discharges Add/RemoveProviders Multiplevalues

13 PG Q1 Q2 Q3 Q Q1 Q2 Q3 Q Q1 Q2 InpatientPsychiatric Facility AlMemberswithDuals AlMemberswithoutDuals AlMembersDualsOnly HUSKYA(FamilySingle) HUSKYB HUSKYC(ABD/OtherSingle) HUSKYC(LTCSingle) HUSKYD(MLIA) ShowingAdult(18+)Medicaid InpatientHigherLevelsofCareTable Showing: Range How tousetheinteractivetables:1.the"levelofcare"filteralowsyoutocomparethethreehigherlevelsofcare(inpatientpsychiatric,inpatientdetox:hospital-based,and InpatientDetox:Freestanding).2.Changethe"SelectMeasure"filtertoseethedatainthetablebelow.AvailableMeasuresinclude,,Days/1,000, ALOS,andDischarges.3.Filtertoview andcomparethebenefitgrouptypes(totals,duals,singles).4.finaly,filterbybenefitgrouptoadjustthetable'soutput.notethatthe colorindicatestherangefrom lowestvalue(white)tohighestvalue(blue)withinthetable.thecorrespondinggraphscanbefoundonpage4.additionaly,somecelsmaybe blank,whichindicatesthattherewerenomembersinthatbenefitgroupthatutilizedthelevelofcareselected. 3.SelectGroupType(s) Multiplevalues 4.ChooseBenefitGroup(s) Al 1.LevelofCare InpatientPsychiatricFacility 2.SelectMeasure

14 PG6 HomeHealthServices & Q2'15 Q4'15 Q2'16 Q4'16 Q2' SkiledNursing-Adults Q2'15 Q4'15 Q2'16 Q4'16 Q2' SkiledNursing-Adults ServiceClass SkiledNursing GroupType AlMemberswithDuals HUSKYC(ABD/OtherSingle) HUSKYC(ABD/OtherDual) HUSKYD(MLIA) AlMembers withduals HUSKYC (ABD/Other Single) HUSKYC (ABD/Other Dual) HUSKYD (MLIA) SkiledNursing-Adults:Q2'17 ChooseBenefitGroups Multiplevalues SelectGroupType Al SelectTimePeriod Q2'17

15 PG7 HomeHealthServices MedicationAdministration&Utilization(ED/IP/OBS)Claims StatewideEmergencyDepartment,InpatientHospitalizationand 23-HourObservationBedUtilizationRates EDRate IPRate OBSRate MedicationAdministrationVolume Statewide HighVolumeProviders 5K 30% 4K Volume 3K 25% 2K % ofmemberswith1+visits/episodes 20% 15% 1K 0K 30% Q2'14 Q4'14 Q2'15 Q4'15 Q2'16 Q4'16 StatewideMedicationAdministrationQDvs.BIDRates QDRate BIDRate(thickline) 10% 20% 5% 10% 0% 0% Q2'14 Q4'14 Q2'15 Q4'15 Q2'16 Q4'16 Q2'14 Q4'14 Q2'15 Q4'15 Q2'16 Q4'16

16 PG8 Q2'15 Q4'15 Q2'16 Q4'16 Q2'17 0K 5K 10K 15K 20K 25K 30K LowerLevelsofCare-Adults Q2'15 Q4'15 Q2'16 Q4'16 Q2' LowerLevelsofCare-Adults ServiceClass PartialHospitalization(PHP) IntensiveOutpatient(IOP) AmbulatoryDetox MethadoneMaintenance MentalHealthGroupHome Outpatient SelectAgeGroup(s) Al SelectBenefitGroupType AlMemberswithoutDuals LowerLevelsofCare & Q1'15 Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 PartialHospitalization (PHP) IntensiveOutpatient (IOP) AmbulatoryDetox Methadone Maintenance MentalHealthGroup Home Outpatient 1,017 1, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,796 LowerLevelsofCare-Adults SelectLevel(s)ofCare Al

17 PG9 OutpatientRegistrationVolume AdultandYouth 40K TotalOutpatientRegistrationVolume:ECCandNon-ECC ECC Non-ECC PercentofOutpatientRegistrationVolume:ECCandNon-ECC ECC Non-ECC 90% 35K 80% OutpatientRegistrationVolume 30K 25K 20K 15K 10K 5K % ofoutpatientregistrationvolume 70% 60% 50% 40% 30% 0K Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 20% Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 ECC 4,729 4,687 4,787 5,416 4,911 5,575 4,975 5,665 5,198 10% Non-ECC 25,795 25,427 25,320 29,413 28,311 29,581 30,468 34,532 33,081 Total 30,524 30,114 30,107 34,829 33,222 35,156 35,443 40,197 38,279 0% Q3'15 Q1'16 Q3'16 Q1'17

18 PG10 AdultECCandNon-ECCOutpatientRegistrationVolume AgeGroup AdultMeasures ECCAdult Non-ECCAdult TotalOutpatientRegistrationVolume:ECCAdult&ECCYouth ECCTotal ECCYouth ECCAdult TotalOutpatientRegistrationVolume:ECCAdult&Non-ECCAdult 28,000 5,500 26,000 5,000 24,000 4,500 22,000 OutpatientRegistrationVolume 20,000 18,000 16,000 14,000 12,000 10,000 OutpatientRegistrationVolume 4,000 3,500 3,000 2,500 2,000 8,000 1,500 6,000 1,000 4,000 2, Q3'15 Q1'16 Q3'16 Q1'17 Q3'15 Q1'16 Q3'16 Q1'17

19 PG11 OutpatientRegistrationVolume OutpatientRegistrationVolume VolumeofRegistrationsRequiredtoMeetECCAccessStandardsand VolumeofExemptRegistrationsECCandNon-ECC 40K 30K 20K 10K 0K SelectGroup AdultMeasures #ofevalsrequiredtomeeteccaccessst. 6,000 4,000 2,000 0 OutpatientRegistrationVolume ExemptEvals Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Q4'16 Q1'17 Q2'17 ECCAdult FSCAdult TotalNumberofEvaluationsRequiredtoMeetECCAccessStandards: ECCandNon-ECCFreestandingClinics(FSC) % ofevaluationsthatmettheeccaccessstandard ECCEvaluationsthatMettheECCAccess Standards-Adult Routine Urgent Emergent 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% AccessStandard95% PercentofRoutineOutpatientEvaluations OfferedwithintheECCAccessStandard- AlMembers FSC ECC % ofotpevaluationsofferedwithinaccessstandard 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% AccessStandard95% Routine Urgent Emergent Q3'15 Q1'16 Q3'16 Q1'17 Q3'15 Q1'16 Q3'16 Q1'17 Q1'16 Q1'17

20 EnhancedCareClinics(ECC)AppendixSummaryPg1:Quarters1&2:January-June2017 Summaryincludesanalysisofbothadultsandyouth ProviderComplianceforQ1andQ22017 RoutineAccesscompliancewiththe14-daystandardforthe37ECCsfelintothefolowingcategories: 1.Mettheaccessstandardof95% inq1:35 2.Mettheaccessstandardof95% inq2:36 3.ECCfalingbelow the95% RoutineStandard: ChildandFamilyAgencyofSECT Essex:92.86% inq1 17 RecoveryNetworkofPrograms:94.85% inq1 17 CatholicCharities(Norwich):91.23% inq2 17 UrgentAccesscompliancewiththe2-daystandardforthe37ECCsfelintothefolowingcategories: 1.Mettheaccessstandardof95% inq1:33 2.Mettheaccessstandardof95% inq2:35 3.ECCfalingbelow the95% UrgentStandard: BHCareInc.Valey:75% inq1 17 CatholicCharities Norwich:50% inq1 17 ConnecticutRenaissance Bridgeport:33.33% inq1 17 TheVilageforFamiliesandChildren:83.33% inq1 17 FamilyandChildren said:50% inq2 17 MiddlesexHospital Adult:0% inq2 17 EmergentAccesscompliancewiththe2-hourstandardforthe37ECCsfelintothefolowingcategories: 1.Mettheaccessstandardof95% inq1:36 2.Mettheaccessstandardof95% inq2:36 3.ECCfalingbelow the95% EmergentStandard: MiddlesexHospital Child:93.75% inq1 17 MidFairfieldChildGuidanceCenter:50% inq2 17 InterventionsandActivities AnnualizedMeasure:Althoughtheformalmeasurementperiodhasbeenannualized,ECCscontinuetoreceivedataonaquarterlybasis. Thisincludesbothquarterlyandyeartodatetotalsforeachaccessstandard. 2017VolumeExemptions:Thevolumeexemptionfunctionlooksatwhichagencieshaveexperienceda20% ormoreincreaseinvolume whenquartersin2016arecomparedtoquartersin2017.thegoaloflookingatthe20% increaseinvolumeistoidentifywhichagencies qualifyforasuspensioninaccessmeasuresiftheydidnotmeettheroutinemeasureforthatquarter. ForQ1andQ2 17,therewerethree(3)agenciesthatdidnotmeettheroutinemeasure:RecoveryNetworkofPrograms,Childand FamilyAgencyofSECT-Essex,andCatholicCharitiesNorwich.RecoveryNetworkofProgramsstilhadaprovisionaldesignationsoa volumeexemptioncomparisoncouldnotbemadesincetheywerenotaneccin2016.childandfamilyagencyofsect-essexand CatholicCharitiesNorwichdidnotexperiencea20% increaseinvolumeinthequarterthattheyfailedtheroutinemeasureand thereforeavolumeexemptioncannotbeapplied. DataEntryErrors:Alagenciesthatdidnotmeetthe95% accessstandardfortheurgentoremergentmeasureinq1 17wereaskedto review theirdatatoverifywhetherthosefailuresweredataentryerrors.bhcareinc.valeyisstilreviewingtheirinformationand CatholicCharites Norwichindicatedthatthemeasuretheyfailedwasnotadataentryerror.Alotheragenciesthatfailedtheurgent oremergentmeasuresubmitteddataentryerrorinformationthatwaspresentedattheeccoperationsmeetingsandwasapprovedas dataentryerrors.correctionshavebeenmadeintheserviceconnectsystem andthe18ereportwilbererunshortlytoreflectthose corrections.agenciesthatfailedtheurgentoremergentmeasureinq2 17wilbeaskedshortlytoverifywhethertheurgentor emergentaccessstandardthattheydidnotmeetweredataentryerrors. 2017MysteryShopperProgram:ThefolowingagenciesweremysteryshoppedinQ1andQ2 17:BHCareShoreline,Welmore,Wheeler Clinic,Klingberg,ConnecticutRenaissance Bridgeport,andChildGuidanceClinicBridgeport.WiththeexceptionofChildGuidance ClinicBridgeport,everyotherclinicpassed.ChildGuidanceClinicBridgeportwasmysteryshoppedinQ2 17anddidnotpassbecause theydidnotcompletetherequiredscreeningforbothcalsonthesamedaythecalsweremadeasarticulatedinpb

21 EnhancedCareClinics(ECC)AppendixSummaryPg2:Quarters1&2:January-June2017 AgencyonProbationin2017:ChildGuidanceClinicBridgeportwasplacedonprobationforfailingtheirQ2 17MysteryShoppercals. TheywereinformedonFridayAugust4th,2017andmustsubmittheirCorrectiveActionPlan(CAP)byFridayAugust18th,2017.In addition,ameetingisnow scheduledforaugust17,2017todiscusstheirmysteryshopperresults.oncetheircaphasbeenapproved andanytrainingofstaff indicatedonthecaphasbeencompleted,theywilgothroughthemysteryshopperprocessagainbeforethe endofq4 17. New ECCActivity:Seven(7)new ECCscameonwithaprovisionaldesignationonJuly1,2016.Theprovisionaldesignationswereto remaininplaceuntiltheagenciespassedtheironsitesurveyprocess.theonsitesurveyprocesswascompletedonmarch1,2017.of theseven(7)new locations,recoverynetworkofprogramsandconnecticutrenaissance Bridgeportpassedanddidnotneedtogoon acap.theotherfive(5)locationswereaskedtosubmitacap.alcapsweresubmittedbythedeadlineofmay30th,2017.thecaps wereacceptedonthefolowingdateswiththeexpectationthatwithin60daysofbeingnotifiedoftheircapacceptance,theagency wouldsubmitchartsthatdemonstratedthechangesreferencedintheircap: Additionaly,supportwasgiventotheclinicsbytherespectiveRegionalNetworkManagersandtheAVPofQualityManagement. StatusofProvisional/PermanentDesignation:RecoveryNetworkofProgramsandConnecticutRenaissance Bridgeportwhichdidnot needtosubmitacapbothreceivedtheirpermanentdesignationsonapril27,2017.theothernew ECClocationscontinuetoremainon provisionaldesignationuntilthedemonstrationchartshavebeenreviewedandapproved. ECCInteractiveMap:InQ2 17,anECCInteractiveMapwascreatedasatransitionfrom thestaticpdfversionthatwaspostedonthe CTBHPwebsite.TheInteractiveMapwasupdatedtoincludeasearchfunctiontolocateECCswithOpenAccessandECCsthatprovide MedicationAssistedTreatment(MAT). 2017Meetings ECCOperations:Thestandardmonthlymeetingswereheldthroughouteachquarteraswelasmanyadditionalmeetingsinorderto adequatelyaddresstheprocessoftakingtheseven(7)new ECClocationsthroughtheOnsiteSurveyprocess,topreparefortheECC ProvidermeetingthatwasheldonMay18th,2017,andfortheECCOrientationfortheStatePartnersandtheRegionalNetwork Managers. ECCProviderWorkgrouponCapacityandAccess:AnECCprovidermeetingwasheldonMay18th,2017.Theagendacoveredthe folowingitems: AnnualMeasureTrends DataEntryErrors OpenAccessandanOpenAccessProviderSpotlightgivenbyWheelerClinicandIntercommunityontheirtransitiontoOpenAccess. TheECCInteractiveMap ChalengestoFolow UpVisitsandHow Folow UpVisitsareTracked Asafolow uptothemeeting,theregionalnetworkmanagerscontactedtheirrespectiveeccstogatherinformationaboutwhether theclinictrackedfolow upvisitsandifso,how theyweretracked,aswelasestimatesofhow manyvisitsmetthe14-dayturnaround time.thisinformationistobesharedwiththeclinicsatthenexteccprovidermeetingwhichwiloccuronoctober3rd,2017.