GOBHI Gazette July 2018
Greetings! We here at GOBHI are working hard to support you in improving access, quality, and experience of care for all of our members. We would like to use this opportunity to familiarize you with programs that are available through GOBHI as well as ways that quality of care being measured, so that together we can find opportunities for improvement and track better care, better health and lower costs. We will also use this venue to share with you articles relevant to our works as providers on mental health in rural areas.
In this issue:
Did you know that OHSU has a free service for medical providers to consult with child psychiatrists on an as-needed basis during business hours? Please see the OPAL-K Handout for more information.
Unhealthy Alcohol Use
GOBHI in collaboration with the National Committee for Quality Assurance (NCQA), funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and FEi Systems, to improve quality of care and reporting of the Unhealthy Alcohol Use Screening and Follow Up measure through a three-year Learning Collaborative.
The collaborative goal is to improve quality of care through measure reporting and QI activities. The final output will be a change package on successful QI approaches, participant measure reporting and dissemination of findings. Our specific objectives for the three years are:
- Year 1: Plans set up systems for QI and report the measure rate at baseline.
- Year 2: Demonstrate reproducible rapid-cycle approaches to improving care quality.
- Year 3: Demonstrate reproducible rapid-cycle approaches to improving care quality; disseminate findings and lessons using NCQA/SAMHSA/CDC network of plans and providers.
Why focus on unhealthy alcohol use?
Unhealthy alcohol use is a common and serious issue, ranging from risky drinking to alcohol dependence1. About 30% of the U.S. population misuses alcohol, and 21% of adults report engaging in risky or hazardous drinking2. Alcohol misuse accounts for 1 out of 10 deaths in the United States3.
Intent: Alcohol misuse is a leading cause of illness, lost productivity and preventable death in the U.S. The U.S. Preventive Services Task Force (USPSTF) has a grade B recommendation that “clinicians should screen adults aged 18 and older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.” This measure seeks to assure appropriate screening.
If you have questions or concerns regarding alcohol use please contact your provider.
Counseling or Other Follow-up Care includes
An encounter lasting more than 5 minutes, which must include at least one of the following:
- Feedback on alcohol use and harms
- Identification on high-risk situations for drinking and coping strategies
- Increase the motivation to reduce drinking
- Development of a personal plan to reduce drinking
- Documentation of receiving misuse treatment
1 Jonas, Daniel E. et al., 2012. “Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force.” Annals of Internal Medicine 157:645–54.
2 Vinson, D.C., B.K. Manning, J.M. Galliher, L.M. Dickinson, W.D. Pace, B.J. Turner. 2010. “Alcohol and sleep problems in primary care patients: a report from the AAFP National Research Network.” Ann Fam Med 8(6):484-92
3 Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States. Prev Chronic Dis 2014;11:130293. DOI: http://dx.doi.org/10.5888/pcd11.130293
Complex Care Management Process
The Complex Care Management Program is voluntary and is provided at no cost to the Member. A member must give verbal and/or written consent for enrollment in this program. The program is most successful with the participation of the Member’s family, caregivers and/or other support systems.
The CCM Program will use a standardized Care management process for all of its assigned Members which consists of several key areas, including but not limited to:
- Comprehensive Initial Assessment of member’s health
- Development of an individualized care plan
- Facilitation of member referrals to resources
- Follow-up and communication with members
- Self-Management Plans
- Assessment of progress against Care Management plans for members
Care Managers provide ongoing Care Management for as long as the Member has identified needs and expresses willingness to receive support and services from the program.
Generally, Care managers provide the following to all Members enrolled in the program:
- Support Member adherence to care plans to improve health complexities
- Advocacy to ensure appropriate services and resources are received
- Education and promotion of self-management in order to empower Members to take a more active role in their health
- Coordinated and seamless integration of complex services and/or special needs
- Appropriate and timely communication with Members, practitioners, and hospitals systematic approach to assessing, planning and provision of Care Management services to improve health outcomes
- Referrals to appropriate medical, behavioral, social and community resources to address member needs
- Phones and/or replacement phone minutes to replace those used in the Care Management process
For more information, view our Complex Care Management page →
Do you know someone in your community who is isolated and lonely?
The American Association for Retired Persons (AARP) reports that isolation and loneliness in seniors is associated with higher rates of:
- Chronic health conditions, including heart disease
- Weakened immune system
- Depression and anxiety
- Dementia, including Alzheimer’s disease
- Admission to nursing homes
- Increased use of emergency services
There is a new program that can offer help to those dealing with the devastating effects of loneliness and isolation—The Oregon Senior Peer Outreach Line.
This program provides a free weekly telephone support call from a trained peer support specialists. This is what program participants are saying:
“I haven’t had anybody to share with for years”
“I look forward to weekly calls from my peer support specialist—I think of her as a friend”
“My Mondays are so much better because I look forward to my call”
“I have felt less depressed and my life is more full of light”
Isolation and loneliness can cause a person to become more withdrawn and less self-motivated to make or keep vital social connections in their lives. As you can imagine the more isolated an older adult is, the harder it is for us to find them to offer help. We encourage you to refer people in your community who might benefit from this program.
The referral process is simple—just call Todd Trautner at 541.760.0273 or 833.736.7646.
If you would like program postcards or business cards please let us know, we are happy to provide you with the resources you need to refer people to this program.
Spotlight Updates in Utilization Management
New Email Address!
We are excited to announce that we have a new email address for the Utilization Management Department. It is [email protected]. Please send all correspondence, including authorization requests to our new email. During this transition, emails that are sent to our old email address will be automatically forwarded to our new email account. We will also be updating GOBHI Utilization Management forms to include our new email address.
MCG 22nd Edition Changes!
GOBHI’s Utilization Management Department uses MCG evidence-based care guidelines for authorization decisions. MCG care guidelines are updated annually, which has led to changes for medical necessity criteria for detox authorizations in the new 22nd Edition of MCG. The old 21st Edition of MCG only required ASAM Dimensions 1 and 2 to be completed for detox authorizations in order to meet medical necessity criteria. However, the new 22nd Edition of MCG will require all 6 Dimensions on the ASAM to be completed in order to meet medical necessity for detox authorizations. This change will be effective on October 1, 2018.
- 21st MCG Edition (ASAM Dimensions 1 and 2 were required)
- 22nd MCG Edition (All 6 ASAM Dimensions will be required)
- Start date for change 10/1/2018!
Post-service/Retro Decision Timeframe Change!
As a NCQA accredited organization, GOBHI strives to promote improvement and quality in healthcare.
Due to new Standards and Guidelines for the Accreditation of Managed Behavioral Healthcare Organizations for NCQA, GOBHI Utilization Management Department is now reviewing and making decisions about post-service/retro authorization requests in 14 days versus 30 days effective July 1, 2018.
In the spring of 2018, GOBHI brought CPCCO credentialing in-house. GOBHI is now credentialing all licensed behavioral health practitioners in the CPCCO which includes:
- Medical Doctor
- Ph.D. Psychologist
- Doctor of Psychology (PsyD)
- Nurse Practitioner
- Registered Nurse (RN)
- Physician Assistant
- Licensed Professional Counselor (LPC)
- Licensed Clinical Social Worker (LCSW)
- Licensed Marriage and Family Therapist (LMFT)
What is credentialing?
Prior to allowing network participation, GOBHI verifies a practitioner’s credentials, including but not limited to a valid license to practice, education and training, and malpractice history. Information provided within the application will be verified through several entities including the Office of Inspector General, the National Practitioner Data Bank (NPDB) and the appropriate licensing and educational entities.
How do I submit my credentialing documents?
Credentialing documents can be submitted via secure drop box to https://gobhi.sharefile.com/remote/29d59227-b2e3-4b17-896e-023045c4b8dd or sent to secure e-mail at [email protected]. If the documents are submitted via e-mail, #SECURE# must be in subject line along with the appropriate practitioner’s name.
For more information, view GOBHI’s Credentialing page →