Concordia maintains strict standards for the number of psychiatrists, psychologists, masters-level therapists, and facilities per 1000 members. All members are within 30 minutes’ drive to a Concordia network provider, on average a member is within 5 minutes to a Concordia provider and 10 minutes to a hospital. Concordia regularly assesses the ability of the Practitioner Network to meet the linguistic, cultural and special needs and preferences of the membership. We add new practitioners on a regular basis to continue to meet our standards and the needs of the membership.
Concordia standards for accessibility to outpatient appointments are:
- Routine care within 10 business days for Commercial health plan members and within 7 business days for Medicare and Medicaid members.
- Urgent care within 48 hours for Commercial health plan members and within 24 hours for Medicare and Medicaid members.
- Non-life threatening emergency care within 6 hours.
- Medication evaluations by psychiatrists within 10 business days for Commercial members and within 7 business days for Medicare/Medicaid members.
- Psychiatric consults within 6 hours for stat consults and within 24 hours for routine consults.
- Psychological testing within 30 days for Commercial/Medicare/Medicaid members.
Members with urgent care needs and non life-threatening emergency care needs are tracked. The members who did not keep their appointments within the specified time frames frequently arranged times that were more convenient to them and were not at risk. Personal scheduling issues of the member (vacation, work schedules, etc.) were found most often to be the reason why members did not keep their appointments within time standards.
Concordia’s standard for the average time to answer the telephone is within 30 seconds. The Concordia standard for telephone call abandonment rate (the number of calls where the caller hangs up before reaching a live operator), is less that 5 percent. We also have staff and practitioners available to assist members in languages other than English, including Spanish, Creole, and French.
Concordia also has a TTY line available for the hearing impaired. The telephone number to access this service is 305-514-5399 or 1-855-276-7285.
Continuity and Coordination of Care
Concordia has many activities that focus on improving the coordination of care between behavioral health and medical care and also among all behavioral practitioners treating the same member. This is important for member safety. We encourage members to sign consent to release information to facilitate communications with primary care physicians (PCPs) and behavioral health practitioners.
The rate of communication between practitioners is tracked using practitioner surveys every quarter. Information regarding treatment coordination is also included in treatment record review.
Concordia has noted that one of the major barriers to improved coordination is refusal of the enrollees to sign the required release of authorize coordination with the PCPs. Concordia will continue to educate practitioners, CMHCs and enrollees about the importance of coordination of care through communication on the Concordia website and in the enrollee and practitioner newsletters.
Concordia began compiling an annual Practitioner Profile Report (Provider Report Card) in an effort to inform providers on their average episodes, average length of stay, and coordination rates compared to the network averages as an effort to increase coordination rates to standard level. The Provider Report Card is mailed annually to all practitioners.
Member satisfaction is very important to Concordia. A member satisfaction survey is conducted annually. More detailed information on the member satisfaction survey results can be accessed upon request.
Concordia considers complaints carefully. Complaints from members are reviewed individually as soon as they are received, and a thorough investigation of the issues surrounding the complaint is conducted. Although the time standard for resolving complaints is 30 days from receipt, Concordia strives to resolve all complaints within 24 hours. The member is notified of the resolution of the complaint and of the right to appeal the decision, if appropriate. Appeals of the proposed resolution of complaints are also carefully considered.
Annually, Concordia conducts the annual Practitioner Satisfaction Survey to practitioners who have seen at least five (5) enrollees in the past year. Recent results indicate that:
93 percent of practitioners agreed that the Concordia Member Services Department provided courteous customer service. 93 percent agreed that member services staff were knowledgeable about benefits and eligibility, and 94 percent agreed that member services staff answered questions promptly.
92 percent of practitioners agreed that the Concordia Claims Department provided courteous customer services. 86 percent agreed that the claims staff answered questions promptly, 72 percent agreed that claims were paid promptly, and 80 percent agreed that claims payments were accurate.
79 percent agreed that they were able to speak with a care manager in a timely manner when they had an immediate need. 93 percent agreed that the referrals were appropriate for their training and expertise. 90 percent agreed the referral process was satisfactory. 70 percent agreed that the number of outpatient authorizations was satisfactory and 93 percent agreed the authorization process was satisfactory.
Clinical Practice Guidelines
Concordia has adopted nine clinical practice guidelines. These guidelines have all been developed by medical specialty societies. The following six guidelines have been adopted from the American Psychiatric Association:
Two guidelines related to the treatment of children and adolescents have been adopted from the American Academy of Pediatrics:
- ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescent
- Management of Children With Autism Spectrum Disorders
One guideline has been adopted from the Academy of Psychosomatic Medicine:
Concordia measures adherence to the ADHD, MDD, and Schizophrenia clinical practice guidelines. Concordia also provides members with consumer relevant versions of the guidelines.
Clinical Quality Improvement Activities
Concordia has identified specific clinical quality improvement activities that affect a significant portion or high risk segments of the membership. Interventions have been implemented over time to successfully improve performance in these areas.
The rate of members who complete an initial outpatient appointment within 7 or30 days of discharge from inpatient care for a behavioral health condition is monitored on a quarterly basis.
Behavioral Health Screening Programs
Concordia has established two behavioral health screening programs that are designed for members with specific diagnoses. These programs are for Major Depressive Disorders (MDD), and Alcohol Use.Please see the Behavioral Health Screening Information Section for more information. Members who have used the programs tell us that the programs are very helpful.
Psychiatric Advance Directive (PAD)
A Psychiatric Advance Directive is a legal document written by a currently competent person who lives with a mental illness. It describes the person’s mental health treatment preferences, or names an agent to make treatment decisions for the individual, should he or she become unable to make such decisions due to psychiatric illness (NAMI, 2015)
Concordia encourages members to discuss Psychiatric Advance Directives with their Behavioral Health Practitioner and inquire on how to create one. There may come a time when you are unable to make your own treatment decisions. Be prepared.