Our Commitment to Quality
The mission of Concordia’s Quality Improvement Program is to monitor, manage, evaluate and improve the quality and safety of clinical care and service provided to Concordia members within a managed care system. In essence we work with our practitioners and providers and our Health Plan and medical delivery system partners to ensure accessible, appropriate and effective care.
Some of the goals of our QI Program in 2014 included increasing coordination of care among Behavioral Healthcare Practitioners and between those Practitioners and Primary Care Physicians (PCPs), improving follow-up care for members who are discharged from inpatient care, enhancing how we manage Member and Provider complaints and compliments as well as monitoring the consistency and thoroughness of the care delivered to our Members.
Annual Medical Record Reviews
Each year Concordia conducts Medical Record Review of our Practitioners’ medical records. This is done to make sure they are abiding by privacy and medical record keeping standards. Safety and effectiveness of the care delivered is assess through medical records reviews as well. In 2014, overall results for each Practitioner audited met or exceeded the goal of 80% using a standardized medical record review tool.
Concordia standards for the number of psychiatrists, psychologists, masters-level therapists, and facilities per 1000 members were met and exceeded in 2014. Also, the driving distances between members and each type of practitioner and facility were found to be appropriate in 2014. All members are within a 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 and facilities 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. In 2014, both of these standards were met. 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
For member care to be seamless, continuous and appropriate Behavioral Healthcare Practitioners are required to contact PCP’s and other BH Practitioners when they share in the care of a member. Patient safety and quality care can only occur when there is communication about treatment and medications with the member and amongst the healthcare professionals caring for that member. Member consent for this communication is required and vital for coordination of care to be successful. The rate of communication between practitioners is tracked using medical record audit review. In 2014 Concordia assessed how well our network of providers did with coordination of care; overall there was an 80.9% rate for PCP coordination, and an 83.2% rate for behavioral health coordination.
Continuity of Care
Concordia is committed to a smooth transition for members from a hospitalization to follow-up care in the community. Concordia expects members to receive care through a practitioner in the community within 7 days and 30 days of being discharged from the hospital. This level of follow-up care can prevent a member from having to be readmitted to an acute level of care. We monitor these outcomes on a monthly basis. In 2014, members were seen for a 7 day follow-up appointment 25% of the time. However, 67% of members discharged from a hospital were seen within 30 days.
Member and Provider Satisfaction
Concordia conducts satisfaction surveys of its members and providers at least once a year. Concordia also tracks and analyses member and provider complaints, grievances and appeals and compliments. The results and information are used to identify areas for improvement in the care our providers deliver and in the services Concordia provides.
In 2014 all complaints and appeals were resolved within required timeframes and results of satisfactions surveys were shared with our Health Plan partners, Providers and Concordia staff. Overall Member Satisfaction in 2014 was 86.2%. Areas for improvement include getting access to treatment in a more timely manner, being more involved in treatment goals and being informed about treatment alternatives based in the community (like support groups). Providers reported in 2014, 90% or higher satisfaction with Concordia’s processes for credentialing and provider education, getting an authorization or placing a complaint. Providers expressed less satisfaction, between 72 and 83%, with processes related to claims submission and payment.
Clinical Practice Guidelines
Concordia has adopted seven clinical practice guidelines. These guidelines have all been developed by medical specialty societies. The following five guidelines have been adopted from the American Psychiatric Association:
- Major Depression Disorder in Adults
- Treatment of Patients with Panic Disorder
- Treatment of Patients with Bipolar Disorder
- Treatment of Patients with Substance Abuse Disorders: Alcohol, Cocaine, Opioids
- Assessment and Treatment of Patients with Suicidal Behaviors
- Treating Schizophrenia
The seventh guideline has been adopted from the American Academy of Pediatrics:
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 30 days of discharge from inpatient care for a behavioral health condition is monitored on a quarterly basis.
Behavioral Health Screening Programs
Concordia has two established behavioral screening programs that are designed for members with specific diagnoses. These programs are for Alcohol Use and Major Depressive Disorders (MDD). Please see the Behavioral Health Screening Section for more information. Members who have used the programs tell us that the programs are very helpful.
If you would like more information about, or paper copies of materials, please contact the Concordia QI Department at 305-514-5300 option 2, option 2, or send an e-mail to firstname.lastname@example.org. We welcome your comments and ideas about how we can improve our care and services.
Complex Case Management Program
Through its Integrated Care Coordination Department, Concordia offers the Prevention and Recovery Program (PRP). The program is available to Concordia’s entire member population that meet the program’s entry criteria. The Preventions and Recovery Program offers complex case management services to members who have experienced a critical event or diagnosis that requires extensive use of resources and who need help navigating the system to facilitate delivery of care or services. The Prevention and Recovery Program is an opt-out program meaning members have the right to participate or to decline participation. The goals of the program are to:
* Improve the quality of life for Members
* Improve functional capacity of Members
* Increase Member self-care
* Enhance access to appropriate health care resources
The Program entry criteria are:
* Members with an SPMI diagnosis and severely impaired functioning
* Members with a history of psychiatric re-admissions within 30 days or more than 2 admissions in a 6 month period
* Members with an SPMI diagnosis and 3 or more complex medical conditions
* Members who have a history of being discharged from a State Hospital [identified from claims data and/or data collected through the UM process].
* Members with an SPMI Diagnosis and diagnosed with a comorbid Substance Abuse Disorder with more than 2 admissions in a 6 month period.
* Members admitted to A Statewide Inpatient Psychiatric Facility (SIPP)
If you are a member, member caregiver or provider and believe that a member meets the criteria for the program, please contact Concordia at 855.541.5300, option 2, option 1, and specify that you would like to make a referral to the PRP Program. You may also click here to enroll electronically.
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 our practitioners to discuss Psychiatric Advance Directives with their patients and document such discussion in the clinical record. Concordia is providing the following links and documents to assist practitioners and patients when considering preparing a PAD.
More Information about Psychiatric Advance Directive (PAD)
Advance Directive for MH
Advance Directives – Forms Proxies
Advance Directives – Personal Safety Plan
Click this link for information on PAD from the National Alliance on Mental Illness (NAMI)