UTILIZATIONMANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare Quarters3& 4:July-December2015-SubmitedMarch1,2016

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1 UTILIZATIONMANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare Quarters& 4:July-December-SubmitedMarch,6

2 ByRobertW.Plant,Ph.D.withAnnPhelan, BonniHopkins,Ph.D.,LaurieVanDerHeide,Ph.D., SherieSharp,M.D.,LynneRinger,HeidiPugliese, ElenLivingston,JenniferKrom, JoeBernardi,IvanTheobalds,RebeccaNeal,JohnBroadwel, StelaNtate,andLindsayBetzendahl, aswelastheentirereporting,clinicalandqualitydepartments.

3 UTILIZATIONREPORTFORYOUTH MEMBERS Quarters& 4:July-December GeneralOverview Thisisthesecondreportthatreflectschangesinthetimingandformatoftheutilizationreview.Thesereportswilcontinuetocovertwoquartersandbecompleted semiannualy.thereviewofthedatawilcontinuetolookatquarters;theunderlyingreportsandgraphswilnotcombinethetwoquartersinto6-monthfigures.the formatwilcontinuetobedisplayedintableau,amoreinteractivedatavisualizationproduct. Onatleastasemiannualbasis,thereportsmutualyagreeduponinExhibitEoftheCTBHPcontractaresubmitedtotheStateforreview.Thisreportfocuseson theutilizationmanagementportionofthesereports,evidencedinthe4aseries,whichreviewsutilizationstatisticssuchasadmissionsper,members(admits/,),daysper,members(days/,),andaveragelengthofstay(alos). Asstatedinprevioussubmissions,resultsweregraphedonlyforbenefitgroupsthathadasuficientvolumeofmembersreceivingservicesineachlevelofcare (LOC).Theutilizationreportfocusesonlyonthoselevelsofcareinwhichthedatawarantedanalysisanddiscussionasevidencedbysignificantchangesand trendsorincaseswhenchangesandtrendsareunclearandadditionaldataisneeded.asaresult,thisreportoutlines/highlightstheareasofinterestrelatedto certainutilizationtrends,aswelastheunderlyingfactorswhichdrivethetrendandassociatedprogrammaticresponsestakenbybeaconhealthoptionstoimpact/mitigateorsupportthetrend.wealsopresentrecommendationstoaddressremainingchalengesandreportprogressrelatedtotheseplannedrecommendations.theareasoffocusforthisquarterarelistedonthefolowingpage. Methodology Theshifttosemiannualreportswasdesignedtominimizenoisecreatedbyquarter-to-quarterfluctuationsthatdonotreflectatruetrendinthedata.However,as agreed,thesesemiannualreportswilcontinuetoincludequarterlyleveldetailratherthanasimplerol-upof6-monthperiods.thisachievesthebalanceofmaking surethatsignificantandmeaningfulquarterlyfluctuationsarenotmissedwhilemaintainingafocusonmorepersistenttrends.theutilizationdatainthe4aand BseriesreportsareexclusivelybasedonauthorizationsenteredintotheBeaconConnectsystem.Insomecases,additionaldata,primarilydrawnfrom the ProviderAnalysisandReportingprogram (PAR),areincludedtoenhancetheunderstandingofthedriversoftheutilizationtrends.AnexampleofthisistheinclusionoftheInpatientchildPARdatathathelpstofurtherexplainhowchangesintheaveragelengthofstay(ALOS)forchildinpatienthospitalizationforagiven quarterareimpactedbyindividualhospitalperformance. Thedatafortheutilizationreportsarerefreshedineachsubsequentsetofreports.Asaresultofretrospectiveauthorizationsandchangesineligibility,theresults foreachquarteroftendiferfrom thepreviouslyreportedvalues.inmostcases,therefresheddatadoesnotresultinsignificantdiferencesinthepreviouslyreportedconclusions.however,onsomeoccasionsthereissuficientvariationthatthepreviousanalysisisnolongerrelevant.thisphenomenonhasbeenmuch morecommonforanalysesofadultutilization,asretrospectivemembershipvariationshavebeensignificantlylargerforadultsthanforyouth.foranyanalysisaffectedbythesevariations,weidentifyitinthenarativeanddescribetheimplications. Totalmembershipisbasedonuniquemembers.Thismeansthatevenifamemberchangesage,benefitgrouporDCFstatustheywilonlybecapturedoncein thatreportingperiod. Thelengthofstaycalculationisbasedonlyuponthosememberswhoweredischargedduringthereportingperiod.Themeasureincludesaldaysfrom thebeginningoftheauthorizationforthatlevelofcare,includingthosefrom previousreportingperiodsifapplicable.significancetestingwascalculatedforaveragelength ofstaybyusingamixedefectsmodelwithafixedterm. Thenumeratorforadmits/,anddays/,arebasedonthetotalnumberofmembersintheidentifiedgroup.Days/,includeservicedaysconsumed duringthereportingperiod.alper,calculations,exceptwherenoted,usethestatewideyouthpopulationasthedenominator.significancetestingforadmits wascalculatedusingachisquaretest.forthepurposesofthisreport,onlythosemeasuresthatarebothstatisticalysignificantandclinicalymeaningfulwilbe discussedandnotedasstatisticalysignificant.

4 ReportsUsedforYouthReport ReportsUsed 4A_TotalUniqueMembership 4A_TotalUniqueMembership:AlYouth(ages7andunder) 4A_MembershipYouth(ages7andunder)DCFMembers 4A_MembershipYouth(ages7andunder)Non-DCFMembersCompositionofDCFMembership; 4A_/4A_InpatientAdmits/,;AlYouth(ages7andunder);DCFvs.Non-DCFMembers 4A_/4A_InpatientDays/,;DCFvs.Non-DCFMembers(ages7andunder) 4A_/4A_InpatientAverageLengthofStay,DCFvs.Non-DCFMembers PARInpatientAverageLengthofStay(ALOS)andDischargesforIn-StatePediatricHospitals;AlYouth(ages-) PARInpatientAverageLengthofStay(ALOS)forIn-StatePediatricHospitals;Child(ages-)andAdolescent(ages-7),DCFvs.Non-DCF PARInpatientPediatricHospitalsAverageLengthofStay(ALOS)Comparison B_7InpatientPercentofDaysDelayed,DCFvs.Non-DCFMembers CTBH87InpatientDaysinDelaybyReasoncode(s) CTBH87InpatientSolnitCenterALOS;AlYouth,CourtOrderedandNonCourtOrdereddata B7InpatientSolnitCenterNumberofDaysDelayed CTBHInpatientSolnitCenterDaysinDelaybyReasonCode 4A_CommunityPRTFAdmissions;Youth(ages5 ),CommunityPRTFDays/,andPRTFAverageLengthofStay,Youth(ages5 ) B7CommunityPRTFNumberofDaysDelayed;Youth(ages5-),DischargeDelayDescriptions B4BPRTF(excludingSolnit)DischargeDelayReasonAwaitingPlacement 4A_SolnitCenterPRTFAdmissions;Youth(Ages 7) 4A_SolnitCenterPRTFDays/,;Youth(Ages 7) 4A_SolnitCenterPRTFNumberofDaysDelayed;Youth(Ages-7) CTBH5RTCLengthofStayAnalysis CTBH86OutpatientRegistration(OTP)TimelyReceiptofEvaluations,ECCProviders-AlMembers CTBH86COutpatientRegistration(OTP)TimelyReceiptofEvaluations,ECCProviders(Ages-7) CTBH78C_8DOutpatient(OTP)RegistrationTimelyReceiptofEvaluations,ExcludingECCs(Ages-7)

5 UTILIZATIONMANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare Quarters& 4:July-December-SubmitedMarch,6 AreasofFocus Membership TotalUnique DCF&Non-DCF CompositionofDCFMembership TableofContents SelectBookmarkIcontoView"AreasofFocus" AndGoDirectlytoSelectedPage InpatientFacilities Admits/,&Days/, AverageLengthofStay PARHospitals PercentofDaysDelayed DischargeDelayReasonCode(s) InpatientSolnitCenter AverageLengthofStay NumberofDaysDelayed DischargeDelayReasonCode(s) Community&SolnitPRTF Admissions&Days/, AverageLengthofStay TotalOverstayDays OverstayReasonCode(s) Autism Spectrum DisorderServices Admissions&Admits/, UtilizationProfile ProviderVolume Forthisreport,thefolowingutilizationdatapointshavebeenplaced intheappendixandarenotdiscussed: OutpatientEnhancedCareClinics(ECC) RegistrationVolume AccessStandards RTC Admissions& ALOS PHP,IOP,& EDT Admits/, ICAPS Admits/, Outpatient (OTP) Admits/,

6 PG YouthMedicaidMembership TotalMembershipVolume& DCFMembership Afterdecreasingforthreeconsecutivequarters,DCFmembershipincreasedinbothQ 5andQ4 5. DCFyouthcontinuetomakeupabout.5% ofthetotalyouthmembership. SelecttoCompareGroups Al 9K TotalUniqueMembership Adults/Youth Youth Non-DCF DCF SelecttoCompareDCFYouth Al CompositionofDCFYouth Commited Voluntary JuvenileJustice Dualy Commited FWSN Totalyouthmembershipslightlyincreased inq 5,butthendecreased.5% inq4 5.Thenon-DCFyouthcontinuetomake upabout98% ofthetotalyouthpopulation. Overview Thetotaluniquemembershipincreased slightlyinq 5andthendecreasedinQ4 5.Itappearsthat,evenwithrefreshed numbers,theremaybeadecreaseinmembershipforbothyouthandadultsinq4 5. TheQ 5refreshratewasatmorehistoricallevels(.55%).TheenrolmentdeadlinesfortheAfordableCareActimpacted ourmembershipdatainthefirstquarterof and,hencethelargerthanusual refreshrates(.8% and.7%,respectively).weshouldexpectthistooccuragain in6giventhejanuary,6open enrolmentdeadline.therefreshratescan befoundinthetableonpage. #ofmembers 8K 7K 6K 5K 4K #ofyouth 8K 7K 6K 5K 4K Afterdecreasingforthreeconsecutive quarters,dcfmembershipincreasedin bothq 5andQ4 5.DCFyouthcontinuetomakeupabout.5% ofthetotalyouth membership.andwithinthis.5%,thedcf Commitedcategorycontinuestobeabout 94% ofthegroup.afterdecreasingforthree consecutivequarters,thedcfcommited populationincreasedinbothq 5andQ4 5.Altheothercategoriesdecreasedin Q4 5,andthesedecreasescanbeseenif youdeselect"dcfcommited"from the graphdropdown. K K K K K K K K

7 PG YouthMedicaidMembershipTables TotalMembership,RefreshRate,& DCFMembership QuarterlyUniqueMembershipComposition ColumnswilnotadduptothetotalbecausememberscanmovebetweenDCFgroups. Q Q4 TotalMembership(IncAdults) 76,645 7,89 77, 796,79 88, 88,7 86,47 86,55 868,6 86,48 TotalYouthMembership 4,9 4,986,56 6,976,88 6,8 7,754 5, 6, 4,7 DCF 8,77 7,964 8,75 8,6 8,787 8,695 8,56 8,79 8,48 8,49 Non-DCF 97,88 98,545 4,797,59 6,4 9,,78 8,5 9,485 7,98 QuarterlyYouth(-7)MembershipDataRefresh Q Q4 Q Q Q OriginalMembership,88,5,77,99,844,54 9,7 9,85 4,4 RefreshOneQuarterLater,77 4,986,8 6,547,899 6,8 6,6 4,9 6, RefreshPercentChange.79%.8%.8%.%.64%.8%.7%.59%.55% QuarterlyYouth(-7)DCFMembershipComposition Q Q4 DCFCommited 7,76 7, 7,545 7,9 8,7 8,9 7,97 7,75 7,96 8,6 VoluntaryServices JuvenileJustice DualyCommited FamilywithServiceNeeds

8 PG YouthMembershipSummary Conclusions Thetotaluniquemembership(youthandadult)hasdecreased4% from Q 5toQ4 5(86,55to86,48).Individualy,boththeadultandyouthmembership havedecreased. Thetotalyouthmembershipdecreasedby% (5,to4,7)from Q 5toQ4 5.Thedriverofthisdecreasewasthenon-DCFpopulationwhichdecreased.%,incontrasttotheDCFmembershipwhichslightlyincreased.5% (8,79to8,49).ThedriveroftheincreasedDCFmembershipwasnotedinthe DCFcommitedpopulationwhichincreasedfrom 7,75inQ 5to8,6inQ4 5,a.% increase.thedcfvoluntaryservicemembershipdecreasedby6% andthejuvenilejusticepopulationdecreased%,reachingthelowestmembershipforbothgroupsoverthepasttenquarters. Overal,inQ4 5,youthaccountedfor8% (4,7of86,48)ofthetotalMedicaidpopulation.DCFcontinuestorepresentasmalpercentageofthetotal Medicaidmembership(%),whilenon-DCFcomprises7% (7,98of86,48)ofthetotalMedicaidmembership. WewilcontinuetomonitortheDCFpopulationforfurthertrending,specificaly,theDCFcommited,voluntaryandjuvenilejusticepopulationswhichhadnoted variations.

9 PG4 Inpatient:ExcludingSolnit Admits/,,Days/,& AverageLengthofStay At.9daysinQ4'5,theinpatientALOSforalyouthwasthe lowestithasbeenoverthepastquarters. SelecttoHighlightGroup DCF Non-DCF TotalYouth InpatientAdmits/,:Youth(-7) ExcludingSolnit InpatientDays/,:Youth(-7) ExcludingSolnit InpatientAverageLengthofStay:Youth(-7) ExcludingSolnit Admits/,.6.4 Days/, Avg.LengthofStay(days) Overview Thereareapproximatelypediatricin-stateinpatientpsychiatricbeds,plusadditionalout-of-statebedsatafewhospitals.Aftertrendingupwardsfortheprior threequarters,totaladmits/,decreasedinq 5thenwentbackupinQ4 5.ForthethirdstraightyeartherewasanincreaseinQ4,suggestingthismetric folowsaseasonaltrend.thesesametrendsoccuredforthenon-dcfyouth,whichisthedrivingforcebehindthetotal.forthedcfyouth,admits/,has trendedupwardsforthethirdconsecutivequarter.typicalyasadmits/,goup,alosgoesdownandviceversa,andweseethisoccurinqandq4of. Overal,ALOShascontinuedtotrenddownwardovertime.TheDCFyouthhavehadalongerALOSthenthenon-DCFyouthforeachofthelasttenquarters. However,inQ4 5,themagnitudeofthediferencewasthelowestacrossthissametimeperiod(.days). TherangeofALOSfortheDCFmemberswas 6days;forthenon-DCFmembersitwas 4daysacrossQ 5andQ4 5;however,the4LOSwasan outlier,asthenext-longestaloswas65days.days/,hasbeentrendingdownward,whichindicatesthatmembersareusingfewerdays.thenumberofcasesinq 5(664)wasthelowestnumberofcasesinthelasttwoyears,whichwasdrivenbyalargedecreaseinthenumberofnon-DCFcases,asthenumberof DCFcasesactualyincreasedinQ 5.

10 PG5 Inpatient:In-StatePediatricHospitals AverageLengthofStay IncludestheSevenIn-StatePediatricPARHospitals(Ages-7) Overview InQ 5,foryouthages-,DCFyouthhadalowerALOSthanthenon-DCFyouthforthefirsttimeineightquarters.InbothQ 5andQ4 5,theDCFgrouphadanALOSthatwasagaingreaterthanthenon-DCFALOS,whichhasbeentheusualtrend.For thedcfgroup,q4 5hadthehighestnumberofdischargesforCY.ThisalsooccuredinQ4 4,suggestingtherecouldbe someseasonalitytothismetric.thelengthofstayrangeforthedcf-yearoldswas 6dayswhiletherangeforthenon-DCF groupwas days;thedaystaywasanoutlier,asthenextlongestlengthofstaywas8days. Foryouthages-7,theDCFgroupcontinuestohavealongerALOSthanthenon-DCFgroup.SinceQ 4,boththeDCFand non-dcfaloshavemovedinthesamedirection;theyhavealternatedbetweendecreasingandincreasingeachofthelastseven quarters.thedcfaloshasmorevariabilityovertime.also,inq4 5,thesetwomeasuresdiferbyonly.days;thisisthe smalestdiferencebetweenthem inthelasttenquarters.forthe-7yearolds,therangeforthedcfgroupwas-5days,while therangeforthenon-dcfgroupwas-4days. SelectAge/DCFGroup(s) MultipleValues DCF,Ages- DCF,Ages-7 Non-DCF,Ages- Non-DCF,Ages-7 8 InpatientAverageLengthofStay;Ages-&Ages-7 DCF&Non-DCFMembers 4 InpatientTotalDischarges;Ages-&Ages-7 DCF&Non-DCFMembers Avg.LengthofStay(days) 8 6 Discharges

11 PG6 Inpatient:In-StatePediatricHospitals AverageLengthofStay& DischargeVolume IncludestheSevenIn-StatePediatricPARHospitals(Ages-7) TheALOSforthein-statepediatrichospitalshasremainedstableoverthepastquarters.Duringthistimeperiod, onaverage,64youtharedischargedeachquarter. In-StatePediatricHospitals Forthein-statepediatrichospitals,theALOShasremainedstableovertime.It increasedinq 5andthendecreasedinQ4 5tothelowestleveloverthe lasttenquarters(.days).thetopthreeprovidersbyvolumeareyalenew Haven,Hartford,andNatchaug.Sincetheyaccountfor7.% ofdischargesin QandQ4 5(84/discharges),theyarethelargestdriversofchangein thestatewidealos.thealosforhartford,manchesterandst.vincent sdecreasedfrom CY 4toCY 5,NatchaugandWaterburysawaslightincrease inalos,andst.francis andyalenewhaven salosremainedconstant. QuarterlyInpatientIn-StatePediatric(PAR)HospitalsAverageLengthof StayComparison ShowingQ4'5 HartfordHospital ManchesterHospital NatchaugHospital HighlightHospital StatewidePediatricHospitals QuarterlyIn-StatePediatric(PAR)HospitalsAverageLengthofStay HospitalComparison/SelectQuarter(point)toFilterBars St.FrancisHospital St.Vincent'sMedical Center WaterburyHospital YaleNewHavenHospital StatewidePediatric Hospitals Avg.LengthofStay 5 5 InpatientPARHospital:StatewidePediatricHospitals ALOSAlYouth(Ages-7) Avg.LengthofStay 5 Q' Avg.LengthofStay(days) Q'5 InpatientPARHospital:StatewidePediatricHospitals DischargeVolumeAlYouth(Ages-7) 4 Discharges 6 Q'4 Q'5

12 PG7 InpatientHospitals(AlandIn-State/PAR)Tables Admits/,,Admisions,Days/,,AverageLengthofStay& Discharges SelectMeasureforTable AverageLengthofStay(ALOS).6 7. Q QuarterlyInpatient(AlHospitals)AverageLengthofStay(ALOS):Youth(-7) ExcludingSolnit Q4 DCF Non-DCF TotalYouth SelectMeasureforPARTable AverageLengthofStay(ALOS) Ages- DCF QuarterlyInpatientIn-State(PAR)HospitalsAverageLengthofStay(ALOS):AlYouth(Ages-7) DCF&Non-DCFMembers Q 8. Q Non-DCF Ages-7 DCF Non-DCF Al TotalYouth QuarterlyInpatientIn-State(PAR)HospitalsAverageLengthofStay(ALOS):AlYouth(Ages-7). 8.5 Q Q4 HartfordHospital ManchesterHospital NatchaugHospital WaterburyHospital YaleNew HavenHospital St.FrancisHospital St.Vincent'sMedicalCenter StatewidePediatricHospitals

13 PG8 PediatricInpatientSummary ExcludingSolnit Conclusions From Q 5toQ4 5,therewasaslightincreaseinadmits/,,withadecreaseintheALOSfortheHUSKYyouthpopulation.TheALOSforalyouthdecreased.4% (.to.94)from Q 5toQ4 5.ThedecreaseintheALOSforDCF(down.5%)wasthemaindriverofthedecreasedALOSforalyouth. TheDCFadolescent(-7yearold)ALOSdecreasedthemost,by% (.7to.8)from Q 5toQ4 5.Thenon-DCF-yearoldALOSalsodecreased, whiletherewasaslightincreaseinthealosforthedcf-yearoldandthenon-dcf-7yearoldpopulations.although,thedcfaloshasremained higherthannon-dcf,ithasagaindecreasedfrom Q 5toQ4 5.TheALOSinQ4 5,forboththeDCFandnon-DCFgroups,wasthelowestoverthepastten quarters. Recommendations BeaconHealthOptionscontinuestorecommendthedevelopmentofapreventivemodelofintegratedcare,whichcanprovidefamilieseasyaccessandrapidconnectiontotreatmentservices.Thefolowingrecommendationsareopportunitiestoenhancethistypeofhealthcaredelivery..DevelopaninfrastructurewhichsupportseasyaccessandconnectiontotreatmentservicesforspecializedpopulationssuchasthosechildrenwithanAutism Spectrum Disorderdiagnosis(ASD):MostchildrenwithanASDdiagnosiswhorequireacutecareservicesutilizeout-of-statefacilitiesforacutestabilizationwhich oftenleadstolongerlengthsofstaysecondarytotheincreaseddistancefrom theirhomeandtheinabilityoffamiliestoparticipateinthetreatmentduetotransportationissues.youthwithanasddiagnosisoftenstaylongerininpatientcarethantheirnon-asdidentifiedpeerswhoutilizethesameservices. Update:BeaconhasauthorizedABAservicesforchildrenwithanAutism diagnosissincejanuary.thebeaconasdteam consistsofcaremanagers,care coordinatorsandpeerspecialists.duringthistime,beaconhascolaboratedwiththedepartmentofdevelopmentalservices,departmentofsocialservicesand thedepartmentofchildrenandfamiliesweeklytoreviewoperations,cases,andcontinuetobuildthemedicaidprovidernetworktoservethispopulation.beacon hasalsoworkedwiththestateagenciestocolaboratewiththehospitalofspecialcarewhichopenedaspecializedasd8-bedinpatientunit.thisunithasadmittedmedicaidmemberswithanasddiagnosistoprovidethespecializedlongerterm behavioralandclinicaltreatmentrequiredforstabilizationandtransition.a keycomponentoftheunit stherapeuticinterventionhasbeentheincreasedabilityforfamiliestoparticipatewithinthebehavioralplanduetotheinstatelocation. BeaconwilcontinuetocolaboratewithStatepartnersandtheHospitalofSpecialCaretoprovideutilizationreview,andcasecoordinationtothemembersadmittedtotheunittoensuresuccessfuloutcomes..IntegratebehavioralhealthservicesforyouthwithinaFamilyCareModelUrgentCareCenter:Thereisaneedtodevelopeasy,rapidaccesstobehavioral healthcaretreatmentinlocalcommunitiesasanalternativetoemergencydepartments.theadditionofbehavioralhealthserviceswithanalreadyestablishedurgentcarecentertoprovideintegratedcareinafamilycaremodelhasthepotentialtoreducebothbehavioralhealthandmedicalemergencydepartmentandinpatientutilization.therecommendationisunchangedfrom previousquarters. Update:TherearecurentlynourgentcarecentersinConnecticutwhichintegratebehavioralhealthserviceswithinaFamilyCaremodel.However,someclinics haveexpandedtheirservicestoincludebothprimarycareandbehavioralhealthcare.twoenhancedcareclinicsnowprovidebothbehavioralhealthandprimary medicalservices.intercommunityhealthcenteringlastonburyctandbridgesinmilfordhaveexpandedaccesstoincludebothmedicalandbehavioralhealthofferingurgentstatusappointmentswhendeemedclinicalynecessary.inaddition,cornelscotandcharteroakclinicscontinuetoserveasfqhcs(federaly QualifiedHealthCenters)whichprovidebothmedicalandbehavioralhealthcaretoMedicaidmembers.Beaconcontinuestorecommendexpansionoftheseexistingprogramstoincludeurgentcareandintegratingbehavioralhealthservicesforyouthwithinafamilycareurgentcarecenter. Recommendationscontinueonthenextpage.

14 PG9 PediatricInpatientSummary,continued ExcludingSolnit Recommendations,continuedfrom previouspage.continuetoexpandtheimplementationanddevelopmentofrapidresponsemodel:therapidresponsemodelfocusesonthecolaborationamongcommunity,stateagenciesandbeaconstaftoprovideemergencydepartmentssupportandcasemanagement.opportunitiesremaintoimplementarapidresponse modelinotheremergencydepartments(ed)withhighpediatricbehavioralhealthvolume. Update:TheRapidResponsemodelcontinuestoprovidesuccessfulcolaborationbetweenConnecticutChildren smedicalcenter(ccmc),thedepartmentof ChildrenandFamilies(DCF),EmergencyMobilePsychiatricServices(EMPS),andBeaconHealthOptions.Monthlymeetingsanddailyclinicalroundscontinue. IntensiveCaseManagerscontinuetocaleachinstateemergencydepartmentandtrackinpatientyouthbedavailabilitytoprovideefectivecasecoordination whenneededforhuskyyouthwhopresenttotheemergencydepartment.thereremainopportunitiestoexpandthismodeltootherhigh-volumeemergencydepartments. 4.Establish,ineachoftheregionalareas,acentralizedforum whichmeetsregularlytodiscussat-riskyouthwhohavehighutilizationofcrisisandbehavioral healthservices.beaconcontinuestorecommendtheestablishmentofacentralizedforum ineachregionalareatocoordinatecareforthoseyouthidentifiedasat riskforhighutilizationofinpatientandemergencydepartmentservices.thisforum wouldservetoengagecommunities,families,schools,andprovidersinthe planning,anddeliveryofbehavioralhealthservices. Update:TheIntegratedServiceSystem (ISS)meetinghasbeenestablishedineachregionalDCFareaofice.BeaconHealthOptions stafatendthesemeetings tosupportcoordinationofcareanddialoguetoengagecommunitiesintheplanninganddeliveryofbehavioralhealthservices.curently,beaconisworkingincollaborationwithdcfandseveralemergencydepartmentsandproviderstoscheduleregionalcommunitymeetingswhichfocusondiscussionofcrisisandemergencyservices.beaconcontinuestorecommendthistypeofforum tobuildapreventativebehavioralhealthcaresystem. 5.ContinuedStateAgencycolaborationwithBeaconHealthOptions:BeaconcontinuestorecommendongoingcolaborationwiththeStateAgenciesonmultiple levelstodevelopanintegrated,community-based,preventivehealthcaresystem.beaconanddcfwilcontinuetohaveweeklycomplexcaseroundstodiscuss alhuskyinpatientchildrenwhorequireadditionalescalationandcolaboration.thisprocessisdesignedtopromoteearlycoordinationofcareandcommunicationbetweenstateagenciesoncomplexcases. Update:BeaconHealthOptionscontinuestomeetwithStatepartnersonaweeklybasisinmultipleforums.TheDepartmentofDevelopmentalServices(DDS) hascontinuedtoparticipatewithdcf,andbeaconinweeklycomplexcasediscussionstoreviewhigh-riskchildrenwhorequireadditionalescalationandstate agencyintervention.inaddition,asdweeklymeetingswithdds,dssanddcfhavebeenestablished.thisprocesscontinuestoserveasapreventativemodel topromotetimelyescalationandcoordinationofcare.

15 PG InpatientDischargeDelay:ExcludingSolnit PercentDelayDays& DelaybyReason PercentofDaysDelayed Thepercentoftotaldelaydaysdecreased by.8percentagepointsto6.% inq 5andQ4 5.TheslightdecreaseinQ 5wasdrivenbynon-DCFmembers whosepercentofdelaydaysdecreasedby.percentagepointsto5.6%.total numberofcasesthatweredelayedincreasedby5casesfrom Q 5()toQ 5(8),butthendecreasedbycasesin Q4 5to5cases. DaysinDelaybyReason MembersthatweredelayedduetoawaitingaStateHospitalbedincreasedslightly inbothq 5andQ4 5.Membersthat weredelayedduetowaitingforprtfservicesdecreasedthelasttwoquarters,from inq 5to7inQ4 5.Totaldelay daysformemberswaitingforprtfdecreasedinq 5,thenincreasedslightly inq4 5.Membersthatweredelayeddue towaitingforsolnitprtfincreasedslightlyinq 5andthendecreasedslightlyin Q4 5,whilethetotaldelaydaysdidthe exactopposite. Note:TheReasonCode"AwaitingSolnitPRTF"wasnot implementeduntillate. AwaitingStateHospital AwaitingPRTF AwaitingSolnitPRTF AwaitingRTC/GH AwaitingDDSServices AwaitingFosterCare AwaitingOther 8 9 Q 6 4 % ofdaysdelayed Q4 QuarterlyInpatient(ExcludingSolnit)PercentofDays Delayed:AlYouth 5% % 5% % TheDCFpercentageofdaysdelayedwaslowerthannon-DCFforthefirst timeinq4'5.dcfalsohadthelowestnumberofchildrenindelayedstatus inthelasttenquarters. TotalYouth Non-DCF DCF QuarterlyInpatientDelayedDischargesbyReasonCode Hoverformoreinformationonavg.delayeddaysandtotaldelayeddays QuarterlyInpatientDischargeswithDelayedDays: AlYouth HovertoViewDelayedReason DelayedDischarges 7 Q'4 Q4'4 Q'5 Q4'

16 PG InpatientDischargeDelay:ExcludingSolnitTables PercentDelayDays& DelaybyReasonCode Q Q4 DCF % ofdaysdelayed CasesDelayed/inOverstay Non-DCF % ofdaysdelayed CasesDelayed/inOverstay TotalYouth % ofdaysdelayed CasesDelayed/inOverstay.4% 5.% 9 4.5% 9.5% 5 8.% 4.7% 5.6% 5 7.4% 7.%.4% 6.% 9.% 6 4.8% 5.% 9 5.9% 4.% 5 6.% 5.6% 6.8%.9% 4 8.% 57.% 5 7.% 4 7.8% % 5 5.9% 5 6.% 8 6.% 6.9% 4.% QuarterlyInpatient(ExcludingSolnit)Table(Ages-7) PercentofDaysDelayed&CasesDelayed Q Q4 AwaitingState Hospital DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingSolnitPRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingPRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingRTC DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingGH DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingFosterCare DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges QuarterlyInpatientDischargeswithDelayedDaysbyReasonCode DischargeDelayReason MultipleValues

17 PG InpatientDischargeDelaySummary ExcludingSolnit Conclusions Thepercentoftotaldaysdelayeddecreasedfrom 7.% to6.%,thelowestpercentageofdischargedelayinthelasttenquarters.quarter4 5wasthefirst quarterthedcfpercentageofdaysdelayed(5.6%)waslowerthannon-dcf(6.%).dcfalsohadthelowestnumberofchildrenindelayedstatusinthelast tenquarters(n=). MostofthechildrenindelayedstatuswereawaitingadmissionintoSolnitinpatient.Therewereatotalof9youth(QandQ4 5)waitingforSolnitinpatient.AlthoughlessthanQandQ 5(77days),theyouthwaitingforSolnitinpatientagainutilizedthemostinpatientdaysindelay,75totaldaysindelay.Therewere youthindelayedstatusawaitingprtflevelofcare.sevenofthoseyouthwereadolescentsawaitingsolnitprtfand6wereawaitingcommunityprtflevel ofcare.thoseawaitingsolnitprtfutilized8daysindelay,whilethoseawaitingcommunityprtfutilizeddays. Recommendations.ExpandPRTFcapacityanddevelopalternativesforthechildrenyearsandundertoincludecrisisstabilization. ThelimitednumberofPRTFbedscontinues tocausedelays.withincreasedlimitationsinaccesstootherlevelsofcare,thereislimitedcapacityforchildrenwithcomplexbehavioralhealthneeds.beacon continuestorecommendexpandingthecurentprtfcapacityandincreasingadditionalcommunityservicesforthosechildrenunderwithcomplex,highly acutebehaviors,includingthosechildrenwithdevelopmentaldelaysandautism. Update:PRTFcapacityhasremainedunchanged.TherearethreePRTFfacilities,oneofwhichisonlyabletoadmitboys,whichleavesagapforfemaleyouth yearsandunder.aserviceagreementwithatrainingcomponentisscheduledtobeginincolaborationwiththedepartmentofdevelopmentalservicesandaprivateprovidertooferspecializedtrainingstostafwhenchildrenwithanautism diagnosisareadmited.inaddition,beaconcontinuestosupporttimelydischarge planningwithcarecoordinationprovidedonseverallevels.theicm continuestoprovideclinicalcoordinationwithprovidersandstateagencies.carecoordination andpeerservicesoferedthroughtheasdandcaremanagemententity(cme)teamsprovidesupporttofamiliesbyidentifyingfamilyandclinicalneedsthatmay presentasbarierstodischarge..developcommunity-basedbehavioralhealthserviceswhichmeetthehigheracuitybehavioralhealthneedsofchild/adolescents,includingcrisisand WraparoundTeams,thatfolowchildrenthroughoutthelevelofcarecontinuum. Asthesystem movestowardscommunity-basedbehavioralhealthcare,with limitedoptionsregardingchildrens'placementincongregatecareandsolnit,thereisagreaterneedtodevelopbehavioralhealthservices.thoseservicescan providecoordinationofcare,familysupport,andclinicalservicestoaclinicalycomplexyouthcohort.thisactivityhasthepotentialtodecreaseemergencydepartmentutilization,inpatientlengthofstayanddischargedelay. Update:Beaconcurentlyprovidessupportofserviceswhichfolowchildrenthroughoutthelevelofcarecontinuum.Beacon'sIntensiveCareManagersprovide carecoordinationandassistwithclinicalfacilitationfrom theemergencydepartmentthroughinpatientthroughdischargeplanningintoanotherlevelofcareorthe community.thisisachievedonvariouslevelssuchasco-locationandcolaborationwithdcfandemps.inaddition,beacon'sasdandcmeteamsofercare coordinationandpeerserviceswhichfocusoncolaborationwithinthecommunity.

18 PG Inpatient:SolnitCenter AverageLengthofStay& DelayDays TheincreaseintheinpatientaveragelengthofstayatSolnitCenterhinderstimelyaccesstothis facilityforthosechildrenondischargedelayincommunityinpatientunitsandemergencyrooms. BenefitGroup Court-Ordered Non-Court-Ordered TotalYouth Overview Theaveragelengthofstay(ALOS)foralyouth placedinpatientatsolnitcentercontinuedits upwardtrend.thealosforthenon-court-orderedyouthdecreased.6% from QtoQ 5(7.4to4.5)andaccountedfortheoveraldecreaseinALOSatthattime,andthenincreasedinQ4 5by8.%.TheALOSforthe court-orderedyouthincreasedfrom.9daysin Q 5to5.5daysinQ 5,thenincreased slightlyinq4 5to45days.Therewere9total dischargesinq 5and6inQ4 5.InQ& Q4 5,thenon-court-orderedyouthcomprised 87.7% (n=57)ofthetotal,andthecourt-ordered comprised.% (n=8).thenon-court-ordered dischargesincreasedfrom 4inQ 5to7in Q 5,anddecreasedinQ4 5to.The court-ordereddischargesdecreasedfrom 5in Q 5toinQ 5,thenincreasedto6inQ4 5. ThenumberofinpatientdaysdelayedatSolnit Centerdecreasedby56.6% from QtoQ 5 (64to58),andthereweretwolessdischarges(7to5).Thenumberofdaysdelayed increasedslightlyinq4 5to88days,andthe numberofcasesremainedthesame. ForQ4 5,therewerethreedelayeddischarges:twoawaitingaResidentialTreatment Facility(RTC)with8delaydays,andone awaiting"other"with48delaydays.sincethere werefivecasesidentifiedondelayinq4 5, thismeansthattworemainingyoutharestilin delaystatusandhavenotyetdischarged,accountingfor6totaldelaydays. Avg.LengthofStay #ofdaysdelayed 5 5 QuarterlySolnitInpatientAverageLengthofStay Court-Ordered,Non-Court-Ordered,andTotal Q' Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 QuarterlySolnitInpatientNumberofDelayedDays TotalYouth Discharges QuarterlySolnitInpatientTotalDischarges Court-Ordered,Non-Court-Ordered,andTotal 5 4

19 Inpatient:SolnitCenterTables AverageLengthofStay& DelayDays Q Q4 Court-Ordered ALOS Discharges Non-Court-Ordered ALOS Discharges TotalYouth ALOS Discharges QuarterlyInpatientSolnitCenterAverageLengthofStay Court-Ordered,Non-Court-Ordered&TotalYouth Q Q4 TotalYouth #ofdaysdelayed/inoverstay CasesDelayed/inOverstay QuarterlyInpatientSolnitCenterInpatientNumberofDelayedDays TotalYouth Q Q4 AwaitingPRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingRTC DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingGroup Home DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingFoster Care DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges QuarterlyInpatientSolnitCenterDelayedDischargesbyReason PG4

20 PG5 Inpatient:SolnitCenterSummary Conclusions TheALOSforalyouthinpatientatSolnitCenterincreasedQ 5toQ4 5by5.5% (4.5to.).Thecourt-orderedpopulationwasthedriverofthisincreaseastheirALOSincreasedsignificantlyfrom.9daysinQ 5toanaverageof45daysinQ4 5.Incomparison,theALOSforthenon-court-ordered youthdecreased.6% from 7.4daysto4.5daysfrom Q 5toQ4 5. Theoveralnumberofdaysdelayedduringthistimehasdecreasedfrom 64daysdelayedto88totaldaysdelayedinQ4 5,a48.4% reduction.therewereonlyafewchildrenondelayedstatus(n=4).twowereawaitingresidentialplacement,onewasawaitingprtfandtheotherwaswaitingforagrouphome. Curently,alongerALOSatSolnitCenterinevitablyhinderstimelyaccesstotreatmentforthosechildrenondelayintheinpatientunitsandemergencydepartments.MostofthechildrenondelayedstatusontheinpatientunitsareawaitingadmissiontoSolnithospital.Thesechildrenutilizemoredelayeddayswaitingfor Solnitcomparedtoanyotherreasonfordelay. Recommendations.BeaconwilcontinuetocolaboratewithSolnitfacilitiesandStateagenciestoincreasetimelyaccessandefectivetreatmentanddischargeplanning. Update:BeaconhasincreasedcolaborationwithSolnitCentertosupporttimelyaccesstocareandefectivecareplanning.Beacon sicmsarecurentlyonsite dailytoprovideutilizationreviews,clinicalcasecoordination,triage,andparticipationwithinmultiplecaseconferenceforums.beacon'sicm team wilalsowork withcssdandthecourt-orderedpopulationtoassistwithappropriatelinkagetoservicesuponevaluationcompletionatsolnit.weeklyclinicalroundsandtriage hasbeenestablishedwiththeboy sprtfsolnitnorth,howevernotatthegirl sprtf.beaconrecommendsincreasedcolaborationinaforum suchas triage/clinicalroundswiththesolnitgirl sprtffacility.

21 PG6 CommunityPRTF:ExcludingSolnit(YouthAges5-) Admisions,Days/,& AverageLengthofStay Overview ThenumberofcommunityPRTFadmissionsdecreasedslightlyinQandQ4'5,toand, respectively.however,thenumberofadmissionsiswithintherangeofadmissionsrecorded overthepastninequarters. Days/,forcommunityPRTFessentialyremainedunchangedoverthepastninequarters. QuarterlyPRTF(ExcludingSolnit)Days/,:Youth5-4 From Q 5toQ 5,communityPRTFALOSdecreasedslightlyby.% (84.6to66.). From Q 5toQ4 5,communityPRTFALOSincreasedslightlyby7.% (66.to78.6). ThenumberofdischargesdecreasedtoinQ 5,thendecreasedtoinQ4 5. QuarterlyPRTF(ExcludingSolnit)Admissions:Youth5- Days/, Admissions QuarterlyPRTF(ExcludingSolnit)ALOS:Youth5- Q' Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 CommunityPRTF:ExcludingSolnitMeasures Q Q4 Admissions Avg.LengthofStay(days) 5 5 Days/, ALOS Discharges

22 PG7 CommunityPRTF:ExcludingSolnit(YouthAges5-) OverstayDays& OverstayReasons ThecommunityPRTFdaysinoverstaydecreasedthepasttwoquartersfrom 989inQ'5to594inQ4'5.The averagedaysinoverstayincreasedoveralbydaysduringthistimeperiod. NumberofOverstayDays ThecommunityPRTFdaysinoverstaydecreasedby4.9% from Q 5toQ 5(989to 644),anddecreasedagainby7.8% from Q 5 toq4 5(644to594).ThecommunityPRTF casesinoverstaydecreasedby6.% from Q 5toQ 5(9to4),anddecreasedagainby.4% from Q 5toQ4 5(4to).Theaveragedaysinoverstaydecreasedby6.days from Q 5toQ 5,andthenincreasedby 8.daysfrom Q 5toQ4 5,foranoveralincreaseof.daysinoverstayinQ-Q4 5. #ofdaysinoverstay QuarterlyPRTF(ExcludingSolnit)TotalOverstay Days(Ages5-) PRTFOverstayReason AwaitinggoinghomebecamethebiggestreasonforoverstayinQ 5,accountingfor4.9% 4 ofoverstayedcases(6outof4),whileawaiting goinghomeandawaitingfostercaretiedforthe largestreasonforoverstayinq4 5,bothaccountingfor45.5% ofoverstaycases(5outof foreachreason).awaitinggoinghomedecreasedfrom 6.% inq 5(5outof9)to 4.% inq 5(outof4),thendecreased againto9.% inq4 5(outof). 8 6 CasesinOverstay QuarterlyPRTF(ExcludingSolnit)TotalOverstay Cases 5 5 #ofdays Delayed/inOver. QuarterlyPRTF(ExcludingSolnit)Table Q 77 Q QuarterlyPRTFExSolnitPercentofOverstayDischargesbyTopReasonCode AwaitingGoing Home Q 4.% Q4.% 7.% 7.5% 44.4% 55.6%.% 6.8% 4.9% 45.5% CasesDelayed/in Overstay AwaitingFoster Care 85.7% 66.7% 6.6% 5.%.%.% 4.% 6.8% 4.9% 45.5% AverageDays Delayed/inOver AwaitingGH.%.% 9.%.5%.%.% 6.7% 6.% 4.% 9.%

23 PG8 CommunityPRTF(ExcludingSolnit)Summary Conclusions Thenumberofadmissions,ALOSanddischargesforcommunityPRTFhavealdecreasedfrom Q 5toQ4 5.Admissionsdecreasedby9% (6to)and thealosdecreasedslightlyby.% from 84.6to78.6.Inaddition,dischargesdroppedfrom 9to,a8% reduction. Mostchildreninoverstaywereawaitinggoinghomeorfostercareplacement.Mostchildrenwhowereidentifiedaswaitingtogohomewerewaitingforfamilywork andstabilizationorcommunityservicessuchaseducationalneedstobeabletomeetthechild sservicerequirementsupondischargehome. Therehasbeenashiftinoverstayreasonsoverthepastyearindicatinganincreaseinthosechildrenidentifiedasgoinghomeduetolackoffostercareresources andplacement.often,achangeindischargerecommendationhasoccuredduetonotfindingafostercarefamily.whenthisoccurs,efortsshifttoworktoprovidewraparoundservicestothefamily. Therecontinuestobealackofviableoptionsavailablefortheunder-twelveagegroupwhorequireadditionalstabilization.Itisnecessarytoincreasecommunity clinicalservicesandfostercareresourcesthatareabletoprovidesupportandmeettheneedsofthispopulation. Recommendations.ExpandPRTFscopeofservicestoincludeacontinuum ofcare,crisisstabilizationandcarecoordination.beaconcontinuestorecommendexpandingthe scopeofprtftoincludeanintegratedcontinuum ofservices,whichincludescrisisstabilizationandcoordinatedcare.withlimitedaccessfortheyoungerpopulationtocongregatecareandsolnitcenter'sinpatientunit,prtf-referedyouthareaclinicalycomplexpopulation.inadditiontothealreadyexistingclinicalservicesprovidedbyprtf,theadditionofmedicaidcoveredservicesforcrisisstabilizationaspartofacontinuum ofcaremodelisrecommended.thismodelwould includecarecoordinationtoprovideeducationandsupporttoparentswhileamemberisreceivingtreatment,andtocoordinatecareforthefamilywhenthechildis dischargedintothecommunity.itisalsorecommendedtheprtfsexpandcapacityandaddatrainedworkforcetoprovidetreatmenttothoseyouthwithdevelopmentaldisabilitiesorchildrenwithautism Spectrum Disorder. Update:TheseservicesarenotyetinplaceatthePRTFlevelofcare.ThiscontinuestobenecessaryasaninternalserviceoferedbythePRTF.Servicessuch asclinicalcarecoordinationarenecessarytoworkdirectlywiththefamilyandchildandfolowthem upondischargewithinthecommunity.services,whileofered, remainfragmentedandfrom diferentagencies.beaconcontinuestoprovidecarecoordinationoferedthroughicm clinicalcoordinationandfamilysupport throughtheasdandcmeteams.

24 PG9 PRTF:SolnitNorth& South(YouthAges-7) Admisions& Days/, QuarterlySolnitPRTFAdmissions(ages-7) 5.5 QuarterlySolnitPRTFDays/,(ages-7) Admissions 5 Days/, SolnitNorthPRTFopened//. SolnitNorthPRTFopened// Overview SolnitNorthPRTF,whichhasbedsandservesmales,openedonDecember,,addingtothealreadyestablished6femalebedsatSolnitSouthPRTF. Thisbed-capacityincreaseaccountsfortheriseinadmissions,days/,,andnumberofdaysoverstayedinthattimeperiod.SolnitNorthPRTFhasseenanincreaseinadmissionssinceitsopening,andtheyhavenowleveledoutandbecomefulyoperational. ThenumberofadmissionstoSolnitPRTFincreasedfrom Q 5toQ 5by.% (to7),thendecreasedfrom Q 5toQ4 5by48.6% (7to9).Solnit PRTFdays/,increasedslightlyfrom Q 5toQ 5(4.7to4.4),thenincreasedfrom Q 5toQ4 5(4.4to5.8).

25 PG PRTF:SolnitNorth& South(YouthAges-7) OverstayDays& NumberofYouthinOverstaybyReasonCode AwaitingresidentialorgrouphomeplacementwasthemainreasonforoverstayinQ 5(ofthe6casesoverstayed),andawaitingfostercarewasthemainreasoninQ4 5,with5ofthecasesinoverstaystatus. QuarterlySolnitPRTFOverstayDays(ages-7) Selecticonforoverstaycasesgraph NumberofOverstayDays InQ 5,thenumberofoverstaydaysdecreasedfrom Q 5by6.6% (64to4),then increasedby4.% inq4 5(4to75).The numberofcasesinoverstaypositivelycorelates withthenumberofoverstaydays,withcases inq 5,decreasingto6casesinQ 5,then increasinginq4 5tocases.Awaitingresidentialorgrouphomeplacementwasthemain reasonforoverstayinq 5(ofthe6cases overstayed),andawaitingfostercarewasthe mainreasoninq4 5,with5ofthecasesin overstaystatus. #ofdaysinoverstay SelectYeartoChangeChartBelow MultipleValues SolnitNorthPRTFopened// Q' Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 QuarterlySolnitPRTFNumberofYouthbyOverstayReasonCode(ages-7) AwaitingFosterCare 5 AwaitingOther AwaitingRTC/GH 4 AwaitingCommunity Services 5 4

26 PG PRTF:SolnitNorth& South(YouthAges-7)Tables Admisions,Days/,& OverstayDays Q Q4 Admissions Days/, ALOS Discharges #ofdaysdelayed/inoverstay CasesDelayed/inOverstay QuarterlySolnitPRTFMeasures(ages-7) Q Q4 AwaitingStateHospital AwaitingPRTF AwaitingRTC AwaitingGH AwaitingFosterCare AwaitingCommunityServices AwaitingOther EducationIssues FamilyIssues Other QuarterlySolnitPRTFNumberofYouthbyOverstayReasonCode(ages-7)

27 PG PRTF:SolnitNorth& SouthSummary Conclusions AdmissionstoSolnitPRTFdecreasedfrom Q 5toQ4 5by6.7% (to9).inaddition,adecreaseindischargesby6% (5to6),ilustratesdecreased throughputwithinthesystem forchildrenawaitingthislevelofcarewhileinpatient. Mostchildren,similartothecommunityPRTFs,wereinoverstaystatusawaitingfostercareplacement.Onlyfourwereawaitinggrouphomeandonewaswaiting forresidential.duetothelackofappropriatefosterhomesavailable,theutilizationofgrouphomeswhicharewithinthecommunityshouldbeconsideredwhen clinicalyappropriate.thisoferstheyouththeopportunitytostepdowntoacommunitysetingwithinastructuredenvironmentwhileawaitingtheidentificationof anappropriatefamily.italsoofersamorereasonabletimeframetocolaboratewiththefosterfamilytoensureservicesareinplace.thiswouldbebeneficialto theyouth,inadditiontopromotingthroughputanddecreasingrecidivism. Recommendations.ItisrecommendedthatBeaconmonitortheSolnitPRTFlevelofcareforadditionaltrending,andincludedatarelevanttodischargedelayreasoncodes, specificalyforsolnitnorthcampus.itisrecommendedthatweidentifythespecificdelayreasonsforthemalesatthesolnitnorthcampusandimplementincreaseddischargeplanningwithbeacon'sintensivecaremangers,dcfandsolnit.beaconcontinuestohaveweeklycarecoordinationmeetingstoreviewcurrenttreatmentanddischargeplanningwithbothfacilities. Update:BeaconhascontinuedtomonitortheSolnitPRTFlevelofcareindicatingspecificreasoncodesforoverstaystatus.Onsitecolaborationandutilizationreviewscontinueandareexpandingtoincludetriageofcases.ThereareopportunitiestoincludeBeacon'sIntensiveCaremanagerswithincaseconferences,inadditiontoworkingwithBeacon'sCMEteam toofergreatertimelyconnectiontowrapserviceswithinthecommunity.

28 PG Autism Spectrum DisorderServices Admisions& Admits/, Asexpected,admits/,andadmissionscontinuedtogrowoverthefirstyearoftheprogram. HoveroverPuzzlePieceforDefinitionofEachService ClassCorespondingBelow LevelofCare DiagnosticEvaluation BehaviorAssessment PlanofCare ServiceDelivery QuarterlyAutism Spectrum DisorderServicesAdmits/, YouthAges- QuarterlyAutism Spectrum DisorderServicesAdmissions YouthAges Admits/,.6.4 Admissions Q'5 Q'5 Q'5 Q4'5 Admissions&Admits/, Asexpected,admits/,andadmissionscontinuedtogrowoverthefirstyear oftheprogram.thismayalsobeduetotheincreaseinautism Spectrum Disorder(ASD)prevalenceratesduring.TheCentersforDiseaseControl (CDC)releasedNationalprevalencestatisticsinMarchofestimatingthat inevery68childrenisidentifiedashavingasd.resultsfrom thenational HealthInterviewSurvey(NHIS)werereleasedonNovember,.ReorderingsurveyquestionsregardingASDonthesurveyresultedinnewdata.Theresultsindicatedthatcurentlyasmanyasin45childrenarediagnosedwith ASD. Thebehaviorassessmentandplanofcareauthorizationsareoftengiventogetherandthereforethereiscloseoverlapinthemeasures.Selectthecoloron thelegendtohighlightoneoftheserviceclasses. Q'5 Q'5 Q'5 Q4'5 QuarterlyAutism Spectrum DisorderServiceAdmits/,&Admissions AuthorizationsBegan//5forthisLevelofService DiagnosticEvaluation BehaviorAssessment PlanofCare ServiceDelivery Admissions Admits/, Admissions Admits/, Admissions Admits/, Admissions Admits/,

29 PG4 Autism Spectrum DisorderServices UtilizationDemographics UtilizationProfile Therewere9uniqueyouththatwereauthorizedforAutism Spectrum DisorderServicesinCY.By-in-large,thepopulationwasmale(79%)and non-dcf(8%).thiswasconsistentfortheutilizationacrosstheservice classesaswel. Therewassomevarianceinserviceclassutilizationbyagegroupsandrace. Youthages-6accountedforthelargestvolumeofdiagnosticevaluations (57%).ThenewstatisticreleasedinNovemberincreasesthenational prevalencerateofasdfrom.5% to.4%.todate,thereisnoknown cure.whatisknownisthatearlyidentificationandinterventionarecritical. TotalYouthbyGender:CY Male Female.8% TotalYouthbyDCFStatus:CY Non-DCF Voluntary Commited 5.46%.6% Utilizationbyagegroupwasconsistentacrosstheotherserviceclasses. Eachagegroupmadeupapproximatelyathirdofalauthorizations,withthe exceptionofthe9-yearoldgroupwhichisexceptionalysmal.many youthinthisagegrouphavealreadyreceivedadiagnosisandaccessedservicesandcommunitysupportsthroughschoolorotherfundingsources. Again,forracialandethnicgroups,therewasadiferenceinthebreakdownof utilizationforthediagnosticevaluationserviceclasscomparedtotheremainingthreeservices.hispanicyouthhadalmost4% ofthediagnosticevaluationauthorizations,butconsistentlyaround% oftheotherserviceclasses. Blacks,too,hadahigherportionofthediagnosticevaluationauthorizations (9.4%)thantheydidintheotherserviceclasses. TotalYouthbyLevelofServiceandAge:CY -6yrsold 7-yrsold -8yrsold 9-yrsold 79.8% 8.94% Becausemembersmayhavemultipleauthorizationswithdiferencesin,specificaly,ageandDCFstatusatthe timeofadmission,demographicsarecapturedasofthelast/mostrecentauthorizationrecord.eachmemberis onlycountedonceinthiscalculation. TotalYouthbyLevelofServiceandRace:CY White Hispanic Black Asian Multi-racial DiagnosticEvaluation 57.% 4.% 7.7% 44.8% 4.7% 9.4% BehaviorAssessment.8% 5.4%.% 69.% 9.7% 6.6% PlanofCare.% 5.5%.% 69.% 9.8% 6.6% ServiceDelivery.4%.9% 4.7% 6.6%.% 9.% Thesevalueswilnotadduptothetotaluniqueyouthasyouthmayutilizemorethanoneservice.However,eachyouthisonlycountedonceineachdemograhiccategorywithineachserviceclass.

30 PG5 Autism Spectrum DisorderServices ProviderVolume ProviderEnrolment TheprovidernetworkexperiencedgrowthinQandQ4of.Anadditionaltwelveproviderswereaddedtothenetworkforavarietyofservices.Witha totalof4providersenroledasautism Serviceproviders,6providersare enroledtocompletediagnosticevaluations,8providersareenroledforbehavioralassessments,and6forplanofcaredevelopment.twenty-six providersareenroledfordirectservicedelivery. Additionalefortsforrecruitingareunderwayasarearevisionandupdateto theexistingstateasdguidelines.theseupdatesandguidelinerevisions, basedonproviderfeedback,wilpotentialyopenthenetworktoadditional Autism Servicesproviderswhohavepreviouslynotenroled.RecruitingoutreachtoregionalAppliedBehaviorAnalysis(ABA)associationsinConnecticut,RhodeIsland,NewYork,andMassachusetsareplannedtoinform practitionersandorganizationsabouttheneedforserviceswithinconnecticutand howtoaccessenrolment. AmonthlyseriesofLearningColaborativesforASDprovidershasexpanded theopportunityfornetworkingamongprovidersofthisnewserviceandhighlightedthetrendsandneedsacrossthenetwork.initialasdproviderorientationshavehelpedtostreamlinetheprocessofenrolment,maximizetheopportunitytohavefrequentlyaskedquestionsansweredandprovideeducation onaccessingauthorizations. Austism Spectrum DisorderServices:QuarterlyCumulativeProviderEnrolmentbyServiceClass:CY EnroledProviders Diagnostic Evaluation Theprovidernetworkexperiencedgrowthin QandQ4.Anadditionalproviderswere addedtothenetworkforavarietyofservices. Behavioral Assessment PlanofCare ServiceDelivery DiagnosticEvaluation BehavioralAssessment PlanofCare ASDProviderVolumeofAuthorizationsbyServiceClass Sortviafilterabove CONNECTICUTBEHAVIORALHEALTHLLC FOCUSCTRFORAUTISM INC FAMILYSTRONG CT SHORELINESOCIALLEARNING HOSPITALFORSPECIALCARE TRADING SPACESABA,LLC GROWING POTENTIALSERVICES ABLEHOMEHEALTHCARELLC BEHAVIORALHLTHCONSULTING SVCSL. EASTERSEALSCOASTAL,FAIRFIELDCN. ADELBROOKCOMM.SERVICEINC ABAOFCONNECTICUT,LLC ADVANCEDPSYCHOLOGICALSERVICES RUSSOLILLO,PATRICKJ STRON FOUNDATIONS INTERLOCKING CONNECTIONS,LLC ROSALES,MANUELJ ALTERNATIVESERVICESCTINC HULIEN,DEBORAHS ROGINSKY,BINA UNITEDSERVICESINC HILTONBEHAVIORTHERAPY KOZODOY,PAUL GREENWICHEDUCATIONGRP THESEEDCENTER TEMPPROVIDER 9 SelectServiceClasstoFilter Al ServiceDelivery ServiceDelivery PlanofCare BehaviorAssessment DiagnosticEvaluation NumberofAuthorizations Austism Spectrum DisorderServices:MonthlyCumulativeProviderEnrolment byserviceclass Note:Aprovidermayperform morethanoneservice

31 PG6 Autism Spectrum Disorder(ASD)ServicesSummary Conclusions TheASDprovidernetworkdevelopmentcontinuestobeaprimaryfocustoincreasememberaccesstoservices.Targetedoutreachandrecruitingefortsforenrolingservicedeliveryorganizationsisourpriority. Additionalassistancewilbeaccessedfrom NationalBeaconHealthOptionsasbestpracticemodelsaredevelopednationwideandcommunicatedtobehavioral serviceprovidersandstateabaorganizationsinaneforttoincreaseproviderenrolment. Relationshipswithareacoleges,universitiesandschoolsystemswilbefosteredtoincreaseprovideraccesstopotentialbehaviortechnicianstaflookingfor hoursandexperience.learningcolaborativeswilcontinuemonthlyasaplatform toprovideinformation,increaseoveralqualityofthenetworkandenrolpotentialnewasdproviders. Recommendations Feedbackhasbeengatheredfrom performingasdprovidersandincorporatedintoproposedchangestotheexistingstateasdregulations.itisanticipatedthat proposedchangestotheasdregulationsandadditionofseveralnewserviceclasseswilhaveanimpactonincreasingmemberaccesstoservices.theseproposedchangesareexpectedtobeapprovedandreleasedduringqorqof6. ColaborationwiththeDepartmentofDevelopmentalServices(DDS)continuesaschildrentransitionofoftheautism waiverprogramsandintomedicaidservices forasd.colaborationwiththedepartmentofchildren&families(dcf)andthedepartmentofmentalhealth&addictionservices(dmhas)continuesaschildrentransitionfrom USEandflexfundprogramsandyoungadultstransitiontoalternatementalhealthserviceswhenapplicable. NewpartnershipsandcolaborationshavebeenformedwithintheHispaniccommunitiesinrelationtoparentsofchildrenwithASDandaccesstoservices.Other partnershipswilbeexploredtoincreaseeducationandresourcesrelatedtoearlyaccesstoscreeninganddiagnosisforasd.

32 PG7 OutpatientRegistrationVolume AdultandYouth K TotalOutpatientRegistrationVolume:ECCandNon-ECC PercentofOutpatientRegistrationVolumeandTotalVolume:ECCand Non-ECC 8% OutpatientRegistrationVolume 5K K 5K K % ofoutpatientregistrationvolume 7% 6% 5% 4% % % 5K % % ECC Non-ECC Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 K Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 ECC Non-ECC 5,596 5,995 5,949 5,66 4,849 4,768 4,697 4,66 4,65 6,5 9,58 9,,9,578,54 5,54 4,9 4,6 Total,747 5,5 5,8 8,68 7,47 8,,8 9,59 8,74 RegistrationVolume The TotalOutpatientRegistrationVolume measurecapturestheoveralvolumeofnewlyregisteredmedicaidmembers,includingthoseevaluationsexcludedfrom meetingtheeccaccessstandards.from Q 5toQ 5,therewasa.4% decreaseintotaloutpatientregistrationvolume,andfrom Q 5toQ4 5 therewasa.9% decrease. TotalECCregistrationvolumehavebeentrendingdownwardandnon-ECCvol- umehavebeentrendingupwardsinceq4.thegapbetweeneccsandnon- ECCshasbeenexpandingoverthistime.ECCsaccountedforapproximately 6% ofthetotaloutpatientregistrationvolumeduringqandq4 5,whilenon- ECCsaccountedforapproximately84%.

33 PG8 YouthOutpatientRegistrationVolume EnhancedCareClinics(ECC)vs.Non-ECCProviders TypeofCare(Agegrp) YouthMeasures ECCYouth Non-ECCYouth TypeofCare ECCAdult ECCYouth TotalOutpatientRegistrationVolume:ECCYouth&Non-ECCYouth TotalOutpatientRegistrationVolume:ECCAdult&ECCYouth -ECCTotal 5K 6K 4K 5K OutpatientRegistrationVolume K K OutpatientRegistrationVolume 4K K K K K K K Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 Overview Non-ECCyouthregistrationshavebeentrendingupwardsinceQ4,andaccountedforapproximately6% oftotaloutpatientregistrationvolumeinqandq4 5.ECCyouthregistrationshavebeentrendingdownward,andaccountedforapproximately7% oftotaloutpatientregistrationvolumeinqandq4 5.

34 PG9 YouthOutpatientRegistrationVolume EnhancedCareClinic(ECC)vs.FreestandingClinics(FSC) Overview The RegistrationsRequiredtoMeetECCAccessStandards measurecapturesonlythoseevaluationsthatarerelevanttomeetingeccaccessstandards.outpatientclinicsareabletoidentifyandexcludefrom calculationthe exemptregistrations whichinclude:)thoseclientssteppingdownfrom ahigherlevelofcare withintheiragency;and/or)thoseclientswhohavebeenintreatmentattheeccbutwhoexperiencedachangeininsurancecoveragetomedicaid.theaccess measuresarebasedonlyonthetimelinessofappointmentsforthosememberswhoaretrulynewclientsintheeccs. Evaluationsneedingtomeettheaccessstandardsaccountedforalmost65% acrossqandq4 5.Thishasremainedfairlyconstantoverthereportingperiod. WhencomparingECCsvs.FSCsforyouth,ECCshaveconsistentlyhadahighernumberofevaluations,buttheyhavebeenslightlytrendingdownwardovertime. FSCshavebeenslightlytrendingupward. TotalOutpatientRegistrationVolume:VolumeofRegistrationsRequiredto MeetECCAccessStandardsandVolumeofExemptRegistrationsECC andnon-ecc SelectGroup YouthMeasures ECCYouth FSCYouth K OutpatientRegistrationVolume ExemptEvals TotalNumberofEvaluationsRequiredtoMeetECCAccessStandards: ECCandNon-ECCFreestandingClinics(FSC) OutpatientRegistrationVolume 5K K 5K K 5K #ofevalsrequiredtomeeteccaccessstandards 5 5 K Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5 Q4' Q'4 Q'4 Q'4 Q4'4 Q'5 Q'5 Q'5 Q4'5

35 PG YouthOutpatientECCAccesStandards Routine,UrgentandEmergentRegistrations AccessStandards EmergentevaluationsthatmettheECCaccessstandardsdeclinedinQ4 5belowthe95% accessstandard,to75% (outof8registrationsdidnotmeetthe standard).bothroutineandurgentevaluationsremainedconsistentlyabovethe95% accessstandard. ThepercentofoutpatientevaluationsoferedwithintheECCaccessstandardhavebeenconsistentlymetbyECCsforroutine,urgentandemergent.Bothroutine andurgenthavebeenconsistentlyunmetbyfscs,andemergentincreasedinq4 5backtomeetingthestandardafteradipbelowtheaccessstandardtheprevioustwoquarters. ECCEvaluationsthatMettheECCAccessStandards Youth(-7) PercentofRoutineOutpatientEvaluationsOferedwithintheECCAccess Standard:ECCandNon-ECCFreestandingClinics(FSC)-AlMembers % % % ofevaluationsthatmettheeccaccessstandard 95% 9% 85% 8% 75% 7% 65% 6% AccessStandard95% % ofotpevaluationsoferedwithinaccessstandard 95% 9% 85% 8% 75% 7% 65% 6% AccessStandard95% 55% 5% Routine Urgent Emergent 55% 5% Routine Urgent Emergent ECC FSC Q'4 Q'4 Q'5 Q'5 Q'4 Q'4 Q'5 Q'5

36 PG OutpatientEnhancedCareClinics Compliance QuarterlyOverview ProviderComplianceforQ 5&Q4 5: RoutineAccesscompliancewiththe4daystandardfortheECCsfelintothefolowingcategories:.Mettheaccessstandardof95%:9.ECCfalingbelowthe95% RoutineStandard:CatholicCharities(Norwich):9.6% inq 5and87.4% inq4 5 UrgentAccesscompliancewiththedaystandardfortheECCsfelintothefolowingcategories:.NumberofECCsthatreportedUrgentvolume:Q:8 Q4:5.Mettheaccessstandardofdays:9.ECCfalingbelowthe95% UrgentStandard:CatholicCharities(Norwich):.% inq 5 volumeof EmergentAccesscompliancewiththehourstandardfortheECCsfelintothefolowingcategories:.NumberofECCsthatreportedEmergentvolume:Q: Q4:8.Mettheaccessstandardofhours:9.ECCfalingbelowthe95% EmergentStandard:TheVilageforFamiliesandChildren:5% inq4 5 volumeof AnnualOverview Year-to-Date(YTD)ComplianceSummariesfrom January, December,: TheinformationbelowexcludesvolumeexemptionswhicharetobecompletedinMarch6. ECCsfalingbelow the95% RoutineStandard: CatholicCharities(Norwich):9.6% inq 5and87.4% inq4 5.YTD%:9.6%. ECCsfalingbelow the95% UrgentStandard: ClifordBeers(5.%)inQ 5 volumeof.ytd%:66.67%. CatholicCharities(Norwich):.% inq 5 volumeof.ytd%:.%. Bridges:% inq4 5 volumeof.ytd:.%. ECCsfalingbelow the95% EmergentStandard: TheVilageforFamiliesandChildren(5.%)inQ4 5 volumeof.ytd%:87.5%. YaleChildStudyCenter(.%)inQ4'5-volumeof.YTD%:.%

37 PG OutpatientEnhancedCareClinics Interventions& Activities InterventionsandActivities InterventionstoaddressECCperformanceonAccessStandards: Althoughtheformalmeasurementperiodhasbeenannualized,ECCscontinuetoreceivedataonaquarterlybasis.Thisincludesbothquarterlyandyear-to-date totalsforeachstandard.thoseagenciesbelow95% foranymeasurewilberequiredtosubmitacorectiveactionplan(cap). Throughthedataentryerorprocess,Mid-FairfieldChildGuidanceCenter(whichhadpreviouslybeenlistedat9.67% fortheurgentaccessstandard)wasableto makeacorectionandiscurentlyincompliance.theadjustmentisreflectedinthemostrecenteccreport. ClifordBeershasindicatedthatthe5% receivedinq 5wasadataentryerorandBridgeshasalsoindicatedthatthe.% receivedinq4 5wasadata eroraswel.assoonastheysendthepaperworktoshowtheentriesareerors,thiswilbepresentedatthefolowingeccoperationsmeetingforapprovalbeforehavingitprocessedandcorected. AlEC swhohavefalenbelowtheurgentandemergentaccessstandardswilberemindedoftheavailabledataentryerorprocess. MysteryShopperProgram: InQ 5,Bridges,CatholicCharities NewBritain,andWelmorewereshopped.CatholicCharities NewBritaindidnotpassduetonotreturningthecaland Welmoredidnotpassduetothelackoftriageorscreeningquestionsbeingaskedduringthecal.TheyweremysteryshoppedagaininQ4 5andpassedsuccessfuly.InQ4 5,CatholicCharities Norwich,FamilyandChildren said,andyalechildstudycenterwereshopped.familyandchildren saiddidnotpass duetonotreturningthecal.theywilbeshoppedagaininq 6. ECCOperations: ThemeetingmetregularlyanddiscussionswerearoundtheneedforpotentialadditionaladultECCsinidentifiedregionsanddevelopingtheRequestforAgreement(RFA). ECCProviderWorkgrouponCapacityandAccess: DidnotmeetinQ 5&Q4 5. ActivitiesGoingForward:.Continuemonitoringaccessdataonaquarterlybasiswithinthecontextofannualizedmethodology..ContinuetheMysteryShopperprogram toensureefectivetriageandscreening. AccessStandards Children: Onthechildside,theemergentevaluationsthatmettheECCstandardsdeclinedinQ4 5belowthe95% accessstandardto75%.thiscanbeexplainedbythe VilageforFamiliesandChildrenwhichontheemergentmeasureinQ4 5scored5% (volumeof)andyalechildstudycenterwhichscored.% (volumeof ).TheselowscoreshadanimpactontheoveralscoresfortheemergentaccessstandardinQ4 5.

38 QuarterlyAppendixGraphs ICAPS,MDFT,MST,FFT,PHP,IOP,EDT,& Outpatient, 4, 6, 8, Admissions QuarterlyAdmissionsforLowerLevelsofCare:AlYouth Admits/, QuarterlyAdmits/,forLowerLevelsofCare:AlYouth LevelofCare ICAPS PHP IOP EDT Outpatient FFT MDFT MST SelectVarious LevelsofCare Below ToView in Graphs Bydeselecting Outpatient(OTP) youcanview changesinthe otherlevelsof care. LevelofCare Al Q Q4 ICAPS Admits/, Admissions MDFT Admits/, Admissions MST Admits/, Admissions FFT Admits/, Admissions PHP Admits/, Admissions IOP Admits/, Admissions EDT Admits/, Admissions Outpatient Admits/, Admissions , 8.6 6, 7. 7, , , , , 9.6 7, , , QuarterlyAdmits/,&AdmissionsTableforLowerLevelsofCare:AlYouth PG

39 PG4 QuarterlyResidentialTreatmentFacility(RTC) Admisions& AverageLengthofStay QuarterlyResidentialTreatmentCenterAdmissions-PercentofTotal % In-State Out-of-State QuarterlyResidentialTreatmentCenterAverageLengthofStay(ALOS) 4 In-State Out-of-State % ofadmissions 8% 6% 4% % % QuarterlyResidentialTreatmentCenterDischarges-PercentofTotal In-State Out-of-State % Avg.LengthofStay(days) % ofdischarges 8% 6% 4% % % 4

40 PG5 QuarterlyResidentialTreatmentFacility Admisions& AverageLengthofStayTables % InstateAdmissions QuarterlyResidentialTreatmentCenter(RTC)Admissions In-Statevs.Out-of-State Q 94.% Q4 95.% 97.67% 97.9% 9.%.% 96.88% 97.67% 96.97% 9.% InStateAdmissions % OOSAdmissions 5.97% 5.%.%.8% 7.69%.%.%.%.% 6.67% OOSAdmits 4 In-StateALOS QuarterlyResidentialTreatmentCenter(RTC)AverageLengthofStay(ALOS)&Discharges In-Statevs.Out-of-State Q 55.6 Q In-StateDischarges Out-of-StateALOS, ,44.,4.5 8., Out-of-StateDischarges