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HomeMy WebLinkAboutAgenda - 03-13-2007-9cORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: March 13, 2007 Action Agenda Item No. q " G SUBJECT: Adoption of the Orange Person Chatham (OPC) Local Business Plan 2007- 2010 DEPARTMENT: County Manager's Office PUBLIC HEARING: (YIN) No ATTACHMENT(S): Under Separate Cover 1. Executive Summary 2. Draft Local Business Plan 2007- 2010 INFORMATION CONTACT Gwen Harvey, Asst Co. Mgr, 245 -2307 Judy Truitt, OPC/LME Director, 913-4037 PURPOSE: To adopt the draft Local Business Plan 2007-2010 for the Orange Person Chatham (OPC) Mental Health, Developmental Disabilities and Substance Abuse Authority. BACKGROUND: The N.C. Division of Mental Health has required that each area authority prepare and submit for approval a new local business plan to replace the original plan which expired in December 2006. The new Plan as developed by OPC administration provides specific information about OPC and its current operations, resource allocation, strategic objectives, and business rules in the areas of governance and administration, business management and information systems, provider relations and development, customer service and community planning, care management, and quality management. OPC administration held extensive stakeholder meetings and staff reviews as precursor to finalizing a draft Plan for public presentation. The new Plan is due to the state by March 31, 2007. The OPC Area Board and the three county commissions must review and authorize the Plan prior to submittal. Attachments 1 and 2 are an Executive Summary and the Draft Local Business Plan in its entirety. FINANCIAL IMPACT: There is no direct fiscal impact in the adoption of the draft Plan. OPC will continue to submit its request for Maintenance of Effort funds for each fiscal year as part of the normal budget process for the county. RECOMMENDATION(S): The Manager recommends that the Board adopt the draft Local Business Plan 2007-2010 for the Orange Person Chatham Area Authority. 2 Orange Person Chatham Mental Health, Developmental Disabilities and Substance Abuse Authority Local Business Plan 2007 - 2010 In December 2002 OPC Area Program developed and submitted a local business plan (LBP) that outlined how mental health, developmental disability and substance abuse services would be restructured as part of the state-wide mental health reform efforts. This first plan was atime-limited document that expired in December 2006. Its principle purpose was to define how OPC Area Program would divest itself of direct service delivery, create a comprehensive provider community, and begin development of the new "local management entity" or LME. In October 2006 the Division of Mental Health released the template for preparation of the new local business plan. which is expected to span the time period 2007 through 2010. The template, which DMH continued to revise until early January 2007, created the format under which each area program would develop and submit their new plan on or before March 31, 2007. The primary focus of the new plans will be the design and implementation of the local management entity for each catchment area. The new plans are limited to no more than 50 pages and are expected to contain specific information regarding the six local management functions of 1. Governance & Administration 2. Business Management & Information Management 3. Provider Relations & Development 4. Customer Service & Community Planning 5. Care Management 6~. Quality Management For each function OPC's plan will provide the following specific information: • Mission statement -each function within the LME is expected to define how their operations will support the overall mission of the agency. • Purchaser standards -the .Division of Mental Health, identified as the "purchaser" .of management functions from each area program, has multiple standards that area authorities are expected to meet. The plan is expected to address compliance with all identified standards. • Current operations -describes how the specific activities and responsibilities within the function are currently implemented in the organization. • Strategic objectives -are the specific tasks that the area authority will be undertaking .over the next three years, with responsible parties and stakeholders identified. • Resource allocation -describes how the current resource allocation supports the function of the LME. • Business rules -identifies rules or practices that both enhance and inhibit the agency's ability to operate efficienfily and effectively. Orange Person Chatham Mental Health, Developmental Disabilities and Substance Abuse Authority Local Business Plan 2007 - 2010 Executive Summary Since submitting its original local business plan (LBP) in December 2002, Orange Person Chatham (OPC) Area Program has undergone a series of significant changes in order to position itself as a strong Local Management En#iy;,(LME) in North Carolina. OPC has divested its service programs and reorganized-'its internal structure to fulfill the primary functions of an LME as outlined in North Carolina` General Statute § 122C- <,.. 115.4. OPC is now a manager of services for the catchment area; arid, our primary goal is to assure the provision of quality public mental health, developmenfial disability and substance abuse services to the residents of our communities. ~`~ -__,_,~~ OPC Area Program is comprised of Orange, Person, and Chatham Counties, which has a combined population of 219,384 residents. OPC's three counties are culturally, economically, and geographically diverse as described below. In Orange County, Chapel Hill, home of the University of North Carolina, is a university town with extensive medical and research faeil~ties.,. Although highly educated and above average in income, the commurnty~, is very socio-economically different. Rural northern and western Orange, while containing many ~Cfiapel Hill oriented people, also houses farming and working class communities. As is true in the other two counties, transportation obstacles make community services difficult. Orange County continues to have a growing permanent Latino population that is underrepresented in the utilization of mental health, developmental disabilities and/or substance abuse services. Person~Gounty is the lowest of the three counties on most socio-economic indicators and ,is largely rural. , Its~.are large town, Roxboro, is centrally located and serves as the hub`~fo~`~most services in the county. Person County .has a large African-American community~,vvith special needs requiring a high level of cultural competence. Person County has f~vver privater~agencies than our other counties, but county government is strong, as is the presence of Person Memorial Hospital. The Latino community .is underrepresented in the service system, but is also more migrant in nature and harder to reach. G Chatham County is geographically the largest county, very diverse on most measures, and difficult to serve efFiciently. Northern Chatham is considered an extension of Chapel Hill, with upper-income retirement communities, while western Chatham is more working class with an agricultural and small scale manufacturing economy. Western Chatham is politically and socially different than eastern Chatham, and in eastern Chatham, the north and south are distinctly different. Pittsbaro in the east and Siler City ` OPC currently operates a TASC program and provides regional Deaf Services. 4 in the west are the main population centers. Around Siler City resides a very large and rapidly growing permanent Latino population. This sub-community does not make use of public mental health, developmental disabilities and/or substance abuse services in numbers proportionate to its size. OPC has a strong administrative infrastructure that efficiently .uses its resources to manage its internal programs.. We are also fortunate to have experienced administrative and professional clinical staff members who carry out the requirements of the LME and address the needs of the community at large. Other strengths include the following: • 24/7/365 screening, triage and referral (STR) capacity with live bilingual voice response to all those who need it and an on-call back up system to support after- hours STR • a provider community comprised of over 240 gences and individual clinicians who provide over 100 different services, including~.all seven, best practice models • a hospital liaison who is able to provide <(mmedate response to consumers who are hospitalized • a .care review system in all three counties that,: has been successful in keeping consumers in their home communities ~~~, ` ~= • active participation by LME staff in over 30 community, groups and committees, including three Community Collaboratives for children • a strong housing program that includes crisis apartments and other housing initiatives •3 a large percentage,~of:{icerised LME staff available to provide technical assistance and clinical consultation to.providers • an approved training,.,, program which enables the LME to offer continuing education units to licensed clinicians, 6oth~for providers and staff • a strong customer service department-that provides timely response to complaints from consumers and providers ~- • an endorsement and monitoring process that is collaborative and provides technical assistance to improve the quality gf'services • a Gonsumer and Family Advisory Committee with a diverse and active membership While OPC has many strengths, it also faces multiple challenges to successful functioning as an LME for our community. These challenges include the following: • stabilization of OPC's financial health to ensure continued viability of the LME • a business system that is in its infancy • the need for a sophisticated system to fully automate the claims, STR, authorizations, and customer service functions • increasing hospitalization rates • staff turnover and recruitment issues • the need for a comprehensive public relations approach to educating the community about available services and the LME's role in obtaining those services • the need to increase communication and collaboration with community hospitals 4 5 • the need to expand and stabilize crisis services through mobile crisis and/or crisis centers • on-going communication with a large community of providers, especially those that may not be technologically advanced OPC's focal Business Plan 2007 - 2010 will outline how our agency will build on our existing strengths, while confronting and resolving the challenges we face to ensure a strong local management entity for our community. ".. _.: l - ~ ~ : ; ~, c~~ s 6 Chapter I Governance and Administration Mission Statement The mission of the Governance and Administration function of OPC is to provide oversight and management of administrative operations; to promote efficient and effective utilization of staff and resources; to implement agency~policy and protocols as established by the Area Board, and to create on-going opportunities,for full stakeholder ~, involvement. ~~` '~ Purchaser Standards ~ ~~ ~`~ ~~ OPC Area Program is currently in compliance with all applicable local; `state and federal statutes and rules, or will dedicate resources to the correction of any known,,orridentified deficiencies. ~ ~~~~, ~'~~~ Current Operations Area Board OPC's Area Board serves as the comprehensive "planning, budgeting, implementation, and monitoring body for community base~~_menfal health, -~tlevelopmental disability, and substance abuse services (mh/dd/sa),in the three county area. The nineteen member Board is appointed to serve as the governing body by the three Boards of County Commissioners pursuant to the provisions `~of ,Chapter 122C of the North Carolina General Statutes. The Board currently has six vacancies, for which the three Boards of Commissionecs_,are actively recruiting members. The Area Board operates under the guidance af~general by-laws, which were most recently revised on January 6, 2007 to include.~the requirements outlined in House Bill 2077. At the January Board retreat, OPC=s Mission Statemenf'and Code of Ethics were also.revised as part of our planning activities: Orientation, ~`uvnich is provided by the Area Director to all new Board members; is'~also being revised to reflect the changes that have occurred in the public mental health system. ;The Board meets at least ten times per year, conducting business under parliamentary procedures as described in Roberts Rules of Order. Officers of the Board include a Chairperson, Vice-Chairperson and Secretary who are elected for aone-year'term in January of each year. OPC's Area Board has standing committees for finance, personnel, client rights, and CFAC, as well as a nominating committee that convenes annually to compile the slate of nominees for Area Board officers. The Board has three. disability subcommittees, which are currently under review to determine the appropriate role and function of these committees within the structure of the local management entity. All committees, with the exception of the nominating committee, meet monthly and report activities to the full Board at the regular meetings. Written materials are distributed to Area Board members, county managers and other stakeholders one-week prior to the meeting each month. In October 2006, a 6 7 42-page agency-wide work plan was provided to the Board for review and approval. In addition, the Board is provided monthly financial update reports, the annual audit report, and the agency's quarterly report on quality management activities. Finally, all quarterly performance reports from the Division of Mental Health are also distributed to the Area Board. Area Director The OPC Board appoints the Area Director, who serves at the pleasure of the Board. OPC's current director, Judy R. Truitt, meets the qualifications of an executive director as outlined in NC General Statute § 122C-121, having a Master's Degree in Social Work, as well as over 25 years of both clinical and increasingly responsible administrative experience. /- The current governance and administration function `'rs organized around the Area Director's office. The Area Director is responsible fo~~ the appointment of all staff, implementation of policy established by the~Boartl; nand the.oversight and management of administrative operations to include supervision of all seri~or management staff. This includes the Medical Director, Chief Financial Officer, and the Director(s) of Care Management, Quality Improvement, Human Resources,, as,well as the service manager for OPC's Treatment. Accountability for Safer Communities and„regional Deaf Service programs. While Human Resources is located under the'Busiriess Management and Information Management section of the Local Business Plar~~ OPC has chosen to place these duties and responsibilities under the Governance and Administration functions. The Area Director meets;:indiridually with each members of senior management on a regular schedule, as-well as~ chairs weekly management team meetings. ~:: < ,- The Area Director is considered,.fihe primary agent of OPC in all contacts with local government officials and ~ state rep.[esentatives. As amulti-county area program OPC maintains close relationships with all IacaF~government entities, including local human service agencies. The Area Director meets with county management staff on a routine basis and provides updates to fu{1;-Boards of County Commissioners upon request. Staff members from OPC are currently .involved with over 30 community boards and committees. As one of the original pilot sites for System of Care, OPC has a long- standing history of community-based child and family teams and collaboration around the service system. The Area Director's office manages the contract with DHHS and monitors compliance with all applicable policies and regulations. In addition, the Area Director's office manages the contracts related to legal consultation, administrative office space, and general administrative services. Finally, it is noted that the Area Director also serves as public agent guardian for eighteen individuals who have been adjudicated incompetent in all three counties. Consumer and Family Advocacy Committee The OPC Consumer and Family Advisory Committee (CFAC) was established in 2002 and has from the start been an independent group, self- organized, and active in OPC's system reform ,planning. The CFAC has 30 seats, and currently includes 22 active members. This is one of the largest CFACs in the state according to the MH/DD/SAS Community .Systems. Progress Indicators First Quarter Report. The membership includes representatives from all three counties and disability groups, though Person and Chatham Counties are underrepresented (as are family members/consumers of developmental disability and substance abuse services). The CFAC will continue to focus recruitment efforts throughout 2007 within these geographic and disability areas. OPC provides financial and administrative support to the CFAC. All members are eligible for stipends and travel reimbursement related~~to attendance at meetings of the CFAC and its sub-committees. ;~.; ,.; ;; `< l ., Strategic Objectives: ``, F _ • Stabilize OPC's financial situation to ensure°continued viability of the LME. Target Date: On-going ,, Responsible Parties and Stakeholders: OPC Area Board-and Senior Management ~` • Establish a corAprehensive public relations approach to educating the community ,regarding rr-ental health, developmental disabilities and/or substance abuse services, while also increasing stakeholder involvement in the service system.,% _ ... Target Date: December2007, and ongoing Responsible Parties and .Stakeholders: OPC Management, Area Board and C"FAC ~ ~" ~~ `~. :• Formalize an annual strategic planning process to gather sfakeholder input in system designanal implementation Target~`D~ate: January 2008 and annually thereafter Responsible>.Parties;and Stakeholders: OPC Area Board, Management and staff, CFAC, community partners and DMH liaison • Achieve national accreditation for management functions. Target Date: June 2009 Responsible Parties and Stakeholders: OPC Management and Staff, Area Board • OPC will meet or exceed statewide averages on key indicators of an effective and responsive service system as defined by the goals of North Carolina's system transformation efforts and future initiatives. 9 Target Date: On-going Responsible Parties and Stakeholders: OPC Management and Staff, Provider Community, CFAC, Area Board • Finalize a comprehensive review, revision and implementation of local management entity policy and procedures. Target Date: June 2008 Responsible Parties and Stakeholders: OPC Management and Staff, CFAC, Area Board, community stakeholders ~~~ • Formalize annual gap analysis to facilitate resource allocation, as well as provider recruitment and training. Target Date: Second Quarter SFY 07-08 and annually thereafter Responsible Parties and Stakeholders: OPC Care~\llanagement and Community Planning: unit, Senior Management; CFAC, Area Board -; • Actively recruit qualified candidates with the necessary clinical and/or professional and technical experience and licenses or certification needed to work within the LME. Target Date: December 31, 200.7 and on-going Responsible Parties and Stakeholders: Human Resources staff, current and potential LME employees; provitle~s andttconsumers ,, • Revise existing Performance Appraisal and Step Level Review processes to more comprehensively reflect'tioth the expected and actual performance of staff at all levels. Target Date: June 30, 2007 and on-going,,. Responsible Parties and Stakeholders: !:NR staff workgroup, Senior Management • Develop a, c'~omprehensive staff development program which will provide opportunities fc-r training to enhance the professional and/or clinical skill set of LME employees, both professionally and personally. This plan will include the provision of Continuing Education Units (CEUs) for licensed clinicians on-site.~~~ Target~:D'ate: August 30, 2007 and on-going Responsible.. Parties and Stakeholders: Human Resources staff, Clinical Specialist, Nletlical' Director, LME employees, providers, and consumers • Continuously monitor and evaluate the benefit package which is offered to staff to ensure that it is cost effective and meets the needs of both the LME and the staff. Target Date: September 30, 2007 and annually thereafter Responsible Parties and Stakeholders: Human Resources staff, LME employees, Senior Management, Area Board 9 io -:• Review all Position Descriptions to ensure that they include requirements for continuous quality improvement and, where applicable, clinical standards. Target Date: June 30, 2007 and annually thereafter Responsible Parties and Stakeholders: Human Resources staff, OPC Management staff, MME employees • On-going review and monitoring of the LME's compliance with the Fair Labor Standards Act and other federal antl state regulations. Target Date: September 30, 2007 and on-going Responsible Parties and Stakeholders: Human Resources staff, LME employees, Senior Management, Area Board • Develop a training program for healthy 'ME staff .which addresses the physical and emotional health of employees. `` Target Date: June 2007 and on-going Responsible Parties and Stakeholders: LME employees • Review and make improvements as needed n~ any of the above objectives as a part of a continuous quality improvement:. plan. Target Date: June 30, 2010 ,, Responsible Parties and Stakeholders: Senior Management ~`, Resource Allocation ~; The Governance! and ;-Admiriisti-ation function positions: - ,% - .,. Area Director/Chief Executive~~Officer~~ ~~ ~ 1' FTE Medical Director .6 FTE Executive Assistant - ~ 1 FTE Switchboard/Receptionist 1 FTE HR Director 1 FTE HR Generalist 1 FTE of OPC has the followirig identified Also included in the Governance and Administration section of the agency's organizational chart are 3.3 FTEs, representing physicians retained as OPC employees who provide direct services under contract with a provider agency in the community. These physicians are provided administrative supervision and clinical consultation by OPC's Medical Director, but full personnel costs are covered under contract with the private provider. During the planning process for divestiture, OPC's Board chose to contract with four of the divesting programs to permit staff that were within three years of reaching early or full retirement to continue working with OPC. Personnel costs for these staff are io 11 covered under contract with provider agencies in the community. A total of six employees were initially a part of the Professional Employee Organization (PEO), however, in November of 2006, two of the employees retired. The Organization Chart for OPC is provided to show the positions and location of duties and responsibilities within the LME. Business Rules The following business rules enhance OPC's abilities as an LME: -:• OPC's Area Director and senior management have increased oversight of financial processes. ~: -. OPC Management has created a comprehensive financial management plan that is designed to closely monitor our current ~financial~3status, while identifying and referring for resolution any problems. ~~Three, committees have been revamped and/or created to track various aspects of our financial health. OPC's Utilization Management (UM) Committee, chaired by our~`IV,ledcal Director, is responsible for service utilization review, monitoring the flow of'`seivice dollars .into our system, allocations to providers, and requests for additional funding throughout the year. In the future the UM Committee will incorporate data regarding consumer outcomes and provider pertormance into this decision-making process. A second committee, chaired by our Business Systems Manager, focuses on the design and implementation of our new business system. A third committee, chaired by our Quality Improvement Director, was just established to review and resolve billing and reimbursement issues with our provider community. In addition, the Area Director reviews all payments under. $5000, while the Chief Financial Officer reviews all payments: over $5000; Senior Management receives weekly banking and financial updates`ar-d tracks, all open provider invoices within our system. Finally, it is noted that~Management Team made the decision to increase staffing in the Finance Department, as well 'as hire consultant services to resolve pending billing and `reimt~ursement issues! • Involvement,of Area Board enhances agency stability. OPC's Area Board has significantly increased its oversight and participation in the establishment of~ the local management entity. Board agendas include both state and local information relevant to LME functions, and Board members are frequently asked to engage with community partners in design of the system. The Area Board has increased Board membership on the Finance Committee and, on a monthly basis receives detailed reports regarding the agency's financial status. 11 12 •:~ The Area Director actively participates in community partnerships. OPC's Area Director is actively involved in multiple community and human. service collaboratives. Participation in these initiatives provides the LME an active voice in analysis of service needs, opportunities for partnerships, and the ability to receive community feedback on system design and consumer needs. The following business rules inhibit OPC's ability to successfully .function as a management entity for our community. `~;, /' • OPC's priority is to resolve financial issues with providers, which is critical, but has inhibited our ability to move forward irk. strategic' planning, design and full implementation of LME functions. • ~~~ .,~ • Clarification of business rules regarding licensure of clinical staff~~n LME. Recruitment and retention of licensed staff in all disability areas continues to be problematic, particularly in `developmental disability and substance abuse services. .~ ~, ~, F. , ,, 12 13 ~,, ,~,~ w~. e RecapNonist -~.w~a or.eo~rn a.~vron w..~..:i varwp...~.d~ne m mr ~..i ,.e.c.mm+: -,,G~e.wev x~.. -~~I>-.,.. - ~m~. ucr~ . ~'iw aa~.. ~ s~hev ~+~o-.m a.. v...y~..io. ~ .. „ ~~r.~+ea, o.h ti.aYev ~....u.+r~ cam ~w~~xn cveo,..~~a r:aw.~~~~.n ~- ~v- uc~ d.a,. m~MVn~w~vm. moo.. `VS j .'._... r~o ~ i.m..~ T,~tin ~_ } ` . '~3 r..nv n.,w~gc.r~ ose n.,. ... n~a.w..mw mss.... ,rte vfo nu~~~ t....m.~r~,ayn .,.a w.c~s „mQ ~..st.d,a r-_u~p. ~~vi..n..Y ~,,,~~ J ~,.o iri.~~~~ r~.~,w. :~V~+~ r v u...s ~mAnuwv !~' .:.. uy~.w.4ce ~w`.a, o,-r ~ac.aaenP*d.. ! mnr,,.yic..,.~- o < . ~• . mnM ap.~,nb cam. c.,olu,.e.~ ~ nm:s. r.r -s t<.b wu o,hrr:.~~a - .sa r-.: wa.ww oo ~.~.z.a,,, m. ~.a 13 14 CHAPTER 2 BUSINESS MANAGEMENT AND INFORMATION MANAGEMENT Mission Our mission is to ensure the financial viability of the LME to support management functions, the provider community and ultimately our consumers., We will perform. all fiscal duties in the areas of accounting, claims processing, reimbursement, funding, and reporting. The Information Technology area will support the infrastructure, data, and reporting resources necessary for all areas of the LME~ ,,~~~;, Purchaser Standards ~'~~. ~, <~" ;~~ OPC Area Program is currently in compliance with, all_applicable local, state and federal statutes and rules, or will dedicate resources to the`correction of any known or identified deficiencies. `" _ ~° Current Operations ~. Business and Information Management, currently, :tapes place in two separate departments at OPC; the Finance Department and the,:Human Resources Department. The Finance Department is organized'-} into four basic areas; Accounting, Contracts/Claims Adjudication, Business Systems,. and Network Management. Accounting The accounting segment of the department is responsible for all standard general ledger ..accounting functions. These functions include producing monthly financial reports`'to \the Area Board, senior management and county and State authorities. The department also providesinformation that is necessary for the planning of the authority. Revenues are. separated ~y type -federal, state and county governments and other. Expenses for services are'tracked by disability and by department. All purchases are ~ processed through one general fund account controlled by the accounts payable department. The accounts payable clerk reviews invoices for proper authorization that is controlled by purchase orders, service contracts, expense reports and budget authorizations. Costs are allocated to individual departments for management tracking and budget control. Non-Unit Cost Reimbursement expenditures are separately identified and accounted by the coding in accounts payable. The purchasing area employs a system that requires a purchase order created from a purchase request. The person responsible for this function also consolidates office 14 15 supply purchases and allocates costs monthly to the various departments. Purchase of services is controlled by annual contracts established by the Contracts area in conjunction with the Provider Relations Department. Payroll is processed by ADPTM, a private payroll services company. All employees are established in a "home" department. The payroll system also tracks leave and sick leave accrual and use within the ADPT"" software. Payroll checks are direct deposited to employees' bank accounts to save on costs. Use of ADPT"" allows for the separation of duties from Human Resources as required by accounting principles. - __ "` Contracts and Claims Adjudication i' In July of 2006, OPC implemented Phase I of a new business system for Screening Triage and Referral (STR) and client registration. Billing aid reimbursement continue to be processed by our old system. Shortly after implementation of Phase I, the agency experienced significant staff turnover. These factors when coupled with `~the,~Pcreased volume of claims impacted the claims adjudication process, and resulted ,in delays in timely processing of provider billing. ~,`. Claims adjudication receives appro~cimately 82% of claims electronically submitted. by providers. The adjudicator reviews-: the--.invoice far accuracy in coding, invoice completeness and authorization. Once theclaim is reviewed, it is uploaded for billing through the State Integrated Payment Reporting System (IPRS) or Medicaid system. ~ :~ However, this remains a manual process, pending-full ~rnplementation of OPC's. new business system. Denials will be compiefetl and serf back to the providers for any claims that cannot be billed. These denia{s:, may come from the claims adjudication process or the billing process. '';.._ ,~ '~~~ The reimbursement department reviews any claims that are denied payment through the State>or Medicaid~corriputer edits. Any internal processing errors are corrected and denials'wit be sent to the providers for the claims that need their attention. Information~Technology Network administration-is'responsible for both the computers and phone systems of the agency. The network administrator handles all hardware, wiring and interface issues. This includes the telephone system and printers as well as the computer system. Currently there are thirteen servers, -fifty-six personal computers and a telephone system. The agency uses Microsoft Officer"" software for general office computing, Unicare's Pro-FilerT"' software to track consumer billing and reporting, and Blackbaud's Financial Edger"' software for the accounting systems. Additionally, the network administrator acts as the web master for OPC's Internet and Intranet websites. is 16 There is one staff person who is primarily responsible for helpdesk .response. This person assures that staffs' computer issues are promptly addressed. The questions may involve software issues, connectivity issues with the server and printer issues. Response times are monitored on a monthly basis. This staff person is also responsible for the backup of data in the system. Business Systems The business systems area is responsible for implementing new projects and report writing. The manager is primarily responsible for implementing all new software conversions and implementations. Currently, emphasis is on implementation and development of Pro-FilerT"'. This position deals directly with the vendor and manages the project implementation. During the implementation phase OPC is closely coordinating efforts with Five County and Cumberland~who are the other two LME's also implementing Pro-FilerT"' The business systems~:a~ea `is responsible for implementing new projects, maintaining the business system data gathering and analysis, and report generation. The manager leads new .projects in conjunction with all effected departments in the LME. The Electronic Data `Informatiorti~(EDI) Specialist maintains Pro-FilerT"', does testing, and applies upgrades.. The ED1 specialist also manages the electronic transfer of data, particularly submission of billing from providers and sending data to outside agencies, e.g., Client Data Warehouse.` Tlie\Data Analyst is primarily responsible for data gathering and analysis, and the generatici and auditing of reports to all departments within the LME. ~: Risk Management _~ ~~ OPC conducts a comprehensive 'risk management protocol survey. Insurance coverage is reviewed and updated has appropriate for all areas. Full professional liability, property, worker's compensation,~`arid~.`vehicle,°~ insurance are maintained. Contracts are pre- audited and verified as such by the' Chief Financial Officer. OPC abides by the appropriate state, local and/orbfederal laws governing public records, open meetings, medical records, and employmei~f records. ., Strategic Objectives • The finance department will implement the Pro-FilerT'" billing module to expedite payment to the providers with less redundancy in information handling. Target Date: July 1, 2007 Responsible Parties and Stakeholders: Finance, Accounting, Business Systems, Provider Community • Create a budget that will allow for continued growth in fund balance during the fiscal year budgeting cycle. Target Date: July 1, 2007 and on-going 16 17 Responsible Parties and Stakeholders: Finance, Senior Management, CFAC, Area Board • Implement a new system/report to estimate encumbrances for state funded services for use in the Care Management department. Target Date: September 30, 2007 Responsible Parties and Stakeholders: Finance, Business Systems, Care Management • The website will be revised to allow better communication and education to consumers, providers and the community. Target Date: September 30, 2007 Responsible Parties and Stakeholders: Information Technology (IT), LME staff, Provider Community, Consumers • Establish a database of Pro-FilerT'" reports accessible to LME management and staff. Target Date: December 31, 2007 Responsible Parties and Stakeholders: Finance, Business Systems, IT, Management Staff, LME staff`~~-~,,.. • Implement electronic receipt.,and, posting of person centered plans, and crisis information in the Pro-FilerT'" f<l~ of the consumer. Target Date: December 31, 2007 _ Responsible Parties and Stakeholders: Finance, Business Systems, Care Management, Provider Community, P~rotoCall, consumers ,~_..f~ • Input 100% of the person centered; plans and crisis plans into the Pro- FilerT"!,_System. `~ Targe#~Date:;June 30, 2008 Responsible.Parties and Stakeholders: Finance, Business Systems, Care Management, PrptaCall ~~ - • Investigate and ~r~plement electronic solutions for exchanging data between`providers and LME departments. Target Date:,June,3~0~, 2009 and on-going Responsitile~ Partjes and Stakeholders: Finance, IT, Provider Relations, Provider Community, ProfoCall • Increase participation of providers' electronic submission of invoices from 82% to 95%+. Target Date: June 30, 2009 Responsible Parties and Stakeholders: Finance, IT, Provider Relations, Provider Community, consumers 17 18 •:- Review and make improvements as needed in any of the above objectives as a part of a continuous quality improvement plan. Target Date: June 30, 2010 . Responsible Parties and Stakeholders: Senior Management Resource Allocation The total FTEs budgeted to operate Information Systems are 16.25, whic county funds. This compares to 1 difference is the Human Resources Administration. the departments of Business Management and h includes a .5 FTE ,property manager funded by 8.1 as identified iri he, ~ Cost Model. The major function at OPC , is located ,in Governance and ~, `: Business Rules The following business rules enhance OPC's ability to successfully function as a management entity for our community ' ~,,,__ • There is communication from, the :Division of Mental Health (DMH) regarding the performance of the~OPCLME~~n~~r~lationship to other ~MEs. This communication allows the organization to concentrate on designated trouble ~; areas, and obtain assistance from others to,implement required changes. • The finance staff in DMH has been very helpful in providing interpretation of in#o~maton, and assistance in navigating changes for the local financial s~s~ems. ~" ~ The longevity of ~the~ staff has provided historical context for those at the local level„who are new to the State system. At the same time they have been able to provide; some input,~as to the potential initiatives being discussed at the Division. This has sometimes. prevented the LME from wasting resources on projects that may soon 6e ("relevant. The following business rules inhibit OPC's ability to successfully function as a management entity for our community. • Several of the current staff have moved into Finance from other departments within as a result of divesture and downsizing and are required to perform new duties. 18 19 Many of these staff have minimal experience with the software they currently use. In particular, most of the retained staff need additional training in soffinrare programs used for claims adjudication and reimbursement. This barrier can be addressed by increased formal training of staff in the software programs on an on-going basis. While staff new to the Finance Department are in need of training, many of the staff who were in the department will also be attending trainings on various software programs to enhance their skill set. • As~ the system is being rolled out, UniCare/Pro-FilerT"" is developing software to support the required accounting of system reform in North Carolina. The manner in which North Carolina is operaf ng and reports the use of funds is unique. Software that is working for managetl care systems in other states must be reprogrammed to fit the reporting needs of the State of North Carolina. This causes delays in implementation <and, inefficiencies on many levels. The reduction in the amount of reporting chariges~ coming~~from the State level could positively affect this barrier. ~~~ ~~ • Limited funding does not allow for separate` implementation teams to be hired for computer projects. ~'< Currently operations _tend to fall behind as staff work on new programs and trainings along ~vfh their current work. The situation causes frustration and position turnover as staff are unable to do quality work on two fronts. This barrier could be reduced by allowing for special funding of computer implementations over and above the normal LME allocation. __ • A portion of the`' .Provider Community does not have the computer infrastructure that would ,allow for easier transmission of data, reports and payments. As we switch to allowing the providers to electronically submit data, many will not have the resources or training required to support a consistent application across the Provider Community. This barrier could be resolved by requiring minimum computer capability in the standardized state contract. 19 20 CHAPTER 3 PROVIDER RELATIONS AND DEVELOPMENT Mission Statement The mission of the Provider Relations function of OPC LME is',to`de~elop and maintain a comprehensive provider community and to offer all necessary information and support to that community in order to facilitate the shared,!goal, of. improving consumer outcomes. Purchaser Standards OPC Area Program is currently in compliance with all applicable local, state and federal statutes and rules, or will dedicate resources to the correction of any known or identified deficiencies. Current Ouerations ~t The Provider Relations function of OPC is carried. out~~ by staff members of the Quality Improvement/Provider Relations Department In addition to performing the Quality Management function (see Chapter 6), this department focuses on provider community development and management, including technical assistance, accreditation, credentialing,: _endorsement, and oversight and monitoring of all external contract and catchment area providers. ;, Pro`viderDe elopment ~~` ,~ For many yews,.,, prior to, divestiture, OPC maintained a large network of contract providers to complement%~the services provided by the Area Program. In fact, prior to divestiture up to '4~7%, of OPC's annual budget was dedicated to provider contracts. However, with the advent of divestiture and the introduction of new service definitions and endorsement tSrocedures, OPC has seen an exponential growth in the provider community. OPC is fortunate to have a comprehensive community of providers that provide over 100 different services, including all seven best practice models. These include; Assertive Community Treatment Team, Community Support/Community Support Team, Psycho-Social Rehabilitation, Intensive In-Home, Multi-Systemic Therapy, Substance Abuse Intensive Out-Patient and Substance Abuse Comprehensive Out-Patient Treatment. Even so, OPC continues to monitor community needs to gauge unmet needs. Provider Relations staff work in conjunction with the 20 21 Community Planning section of the Care Management Department to identify gaps in services and potential providers of any needed services. Technical Assistance OPC strives to provide timely, and reasonable technical assistance regarding new and existing local, State or Federal initiatives or requirements. Provider Relations representatives are available by phone, a-mail and in person to assist providers with questions regarding policies and procedures; endorsement, billing, documentation, etc. The Provider Community Manager also maintains multiple pro~ider~e-mail lists so that any new information received from DMH or other community groups can be quickly forwarded to the provider community. ~ : ~; _ Technical assistance may also be offered and/or required by OPG `in conjunction with any quantitative/qualitative review findings; as a result of a monitoring or endorsement site visit; andJor in conjunction with any plan of correction that may be ~equred;~after any local, state or federal audit or license review. Providers may request technical assistance through their assigned Provider Relations Representative. (Requests are fulfilled based on the availability of resources within OPC. <<.., Communication Communication with providers is an on-going daily, activity. As mentioned above, Provider Relations Representatives are availa6le~by.phone, a-mail and in person, and the Provider Community Manager maintairis~~multiple~e=mail lists to communicate with providers. In the event a need arises for.., focused communication OPC maintains separate lists for IPRS contract providers, Community Support providers, CAP MR/DD providers, and providers in the catchment areal ~`` w: Website and:~Newsletter ~` OPC's Website has a page dedicated to providers which contains contact information, forms, `training information and a listing of providers and services in the area. Soon to be added~`to the website 'is a page for news and announcements which will include all communicatio~ns~ sent out iby Provider Relations staff as well as the monthly provider newsletter, The Quality Times. The newsletter is another means of communication and is designed to be~aresource for providers and a way to relay current information. Provider Meetings OPC also holds a monthly meeting for Community Support agencies and larger provider meetings at least quarterly or more often if needed. These meetings not only serve as an opportunity for the LME to collaborate with the providers, but they are also an opportunity for providers to collaborate with each. other. Information is provided on a wide variety of topics (e.g. System of Care, North Carolina-Treatment Outcomes and Program Performance System (NC-TOPPS), available crisis services and transition 21 22 planning), and the agendas are based upon issues identified by the providers or by LME staff in consultation with providers. Training A specialized form of technical assistance is the training provided by OPC. While in its early stages of development, OPC is offering approximately two trainings each month based on needs determined by providers and LME staff. Current offerings include: Diagnostic and Statistical Manual, Fourth Edition, Text Revision (D3M IV-TR), Ethics of Clinical Boundaries, Suicide Prevention, Understanding the Role and Purpose of Child and Family Teams, Transition Planning, Client Rights and Confidentiality and Client Outcomes Initiative (COI)/NC-TOPPS. Through a recent collaboration with the Greensboro Area Health Education Center, (AHEC) OPC will now be able to offer Continuing Education Units for several of the trainin fs~it provides. OPC is also involved with the Training Partners, a collaborative effort that includes representatives from the. NC Division of<'MHIDD/SAS; NC Council of Community Programs, Duke University Department of Psychiatry, Duke3 Addictions Program, the Guilford Center LME, the UNC School .of Social Work, and the Wake, Eastern, and Mountain AHECs. OPC will continue to meet with this group to address the widespread need for quality MH/DD/SA training around the state. _ ,; Provider Monitoring OPC maintains a monitoring ...team staffed by a Monitoring Team Leader, Clinical Specialist, Accred#~ation and'`: Credentialing Specialist and Provider Relations Representative(s) as needed. This team is responsible for local monitoring according to SB 163, as well as unlicensed Alternative Family Living (AFL) reviews and sub-recipient monitoring of those providers~~receivi`n'g ~~Sub'stance Abuse Prevention and Treatment Block Grant (SAPTBG) funds;>.. Themonitoring team also participates in client rights complaint investigations and monitors providers following any Level III incident. In addition to utilizing the provider`mo`ni~oring tool check-sheet during these reviews, the Clinical Specialist also conducts clinical interviews with consumers and both direct care staff as well as program managers. The team conducts monitoring of the provider community to promote: • compliance with all state, federal and accreditation standards • compliance with personnel requirements including privileging, Credentialing and review of core competencies for all staff • compliance with medical record documentation requirements • adherence to best practice protocols and applicable standards of clinical practice • the development and implementation of required corrective action plans to alleviate any problems in the service system identified through the monitoring process. 22 23 Endorsement In order to promote the provision of quality services and supports from agencies that comply with State and Federal laws and regulations, OPC endorses providers in accordance with the policy and procedures outlined in Communication Bulletin #44 and subsequent directives. Technical assistance is provided at;.each point during the endorsement process, including the application phase and'; ubsequent site visits. Whenever possible, endorsement is coordinated with monitoring activities to minimize disruptions to a program. ' '` Complaint Resolution ` ,; Complaints from providers regarding endorsement, monitoring or any other function of the LME are managed by the Provider Relations representatives. Every; attempt is made to resolve the issue informally and in a reasonable and timely mariner. In the event informal resolution is unsuccessful or inappropriate, OPC follows its internal complaint procedures and the process as outlined in GS §122C-151.4. Strategic Objectives: _ -- • Develop and implement a standai~dizEd and-~ "equitable process that can objectively evaluate the provideP. community and allow for informed consumer choice. Target Date: January 2008 ~ ~ ~'f~ Responsible Parties and Stakeholders: all LME Departments, Area Quality Management~Committee, CFAC 'Although OPC has~.,implemented an Annual Provider Self-Report that requests information on several quality indicators, there is still a need to produce a report containing objective measures of quality services. CFAC and other community groupstave expressed an interest in obtaining such a report to offer consumers enough information' oallow for informed choice. Over the next several months, OPC will be reviewing all sources of provider data such as monitoring results, progress towards national accreditation, number and types of complaints and incidents, fidelity to Evidence-Based Practice (EBP) models and collaborating with its stakeholders to determine the most effective and, consumer-friendly way to present this information. • Facilitate the creation of a Provider Council. Target Date: July 2007 Responsible Parties and Stakeholders: Quality Improvement and Provider Relations (QI/PR) Department, Provider Community 23 24 As mentioned earlier, OPC is fortunate to have a comprehensive provider community. OPC relies upon these providers to serve the LME's catchment area, and recognizes the .need for a mechanism to assure the opportunity for meaningful involvement by community providers in the OPC LME consumer service delivery system. We envision that the goal of the Provider Council will be to work in partnership with the LME through system reform to promote a strong system of high quality services for consumers with MH/DD/SA needs. Through,eollaboration with OPC, the Council will foster practices that support consumer" access with appropriate choices and high quality outcomes, ar~d within.!available resources, in a community-based system of care. ' ~_- • Expand provider training programs to include service specific trainings on enhanced benefit services and on Evidence-Based Practices; Additionally, the LME will offer specialized trainings based on community .identified needs. Target Date: On-going ~' Responsible Parties and Stakeholders: QI/PR Department, Human Resources Department, CFAC, Provider~Community Since implementing OPC's Training`,,;Pi~ogram, it has become readily apparent that our provider community is`~~nterested in .and willing to seek specialized trainings. Through our provider ;;monitoring process, it has become equally apparent that this training is greatly `reetled. We would like to expand our current training program to be able to offer service specific trainings and host Evidence- Based Practices training so that providershave local access to these resources. By offering these trainings, we will also ~be better able to monitor the quality of the training .received by the staff who will actually be providing the services. • Participate in the on-going evaluation of the IPRS contracting process to assure that state funds are allocated to quality providers that. are achieving positive outcomes for consumers. Target Date: On-going Responsible Parties and Stakeholders: OPC Utilization Management (UM) Committee, Area Quality Management Committee (AQMC), Senior Management, CFAC, Area Board As part of our comprehensive financial management plan, OPC's UM Committee has identified criteria for resource allocation through the IPRS contracting process. The criteria are as follows: Are there funds available? Does the new or increased service fit with DMH's priorities of serving the most severely impaired individuals first? 24 25 ^ How much money is already being spent on this service and on this population? ^ What are the unmet needs in the community? ^ Is the service considered best practice or evidence-based practice? Is the service considered a promising practice (in other words, a new service that has shown good outcomes in early use)? If this request for an increase in service to specific individuals, has the Care Management Department reviewed the request 'and confirmed that it meets the medical necessity criteria? ^ If this is a request from a provider for an increase in the contract, does this provider have a record of showing good outcomes and complying with monitoring requirements? • Expand provider monitoring to include ^ 'a targeted review of Person Centered Plans (PCP) and Crisis P/ar-s "''~s well as first responder capabilities. , `' ~. Target Date: July 1, 2007 and on-goir'ig~ ~~~ ~ ~_~, Responsible Parties and Stakeholders: Q.l/PR Department, Care Management Department, Provider Community, CFAC, Community Collaboratives As OPC continues to develop and improve its providermanitoring processes, we will incorporate reviews of PCPs, Crisis Plans and first responder capabilities to promote the basic goals of system reform. • Review and make_ -nprovements as needed in any of the above objectives as a part of a continuous quality improvement plan. Target Date:-June 30, 2010 Responsible Parties, and' Stakeholders: Senior Management _ , Resource Allocation ~ ~' ,, The entire Quality Improvement/P.rovider Relations Department consists of 7.9 FTEs, 6.15 of which are devoted to the Provider Relations function. These positions are broken down as follows: • Director - .5 FTE • Provider Community Manager -1 FTE • Provider Relations Representative - 2 FTEs (1 position filled, 1 posted) • Provider Monitoring Team Leader - .4 FTE • Accreditation and Credentialing Specialist -1 FTE • Clinical Specialist -1 FTE • Administrative Assistant - .25 FTE According to the cost model, OPC would be allowed 8.4 FTEs to fulfill this function. The variation from fihe cost model is mainly due to the relocation of the contracting function 2s 26 to the Finance Department beginning with Fiscal Year 06-07 and the inclusion of the Gap Analysis function in the Care Management Department. Business Rules Rules that enhance the efficient and effective operations of the QM/PR Department function: ~~ .. • A monitoring and endorsement process that is collaborative and provides technical assistance at every step during the process. i OPC prides itself on the detailed technical assistance ~it offers providers participating in the monitoring and endorsement processes.. Letters written to pro~itlers in response to endorsement applications or after monitoring or endorsement site visits'contain detailed information regarding positive impressions, suggestions or recommendations for improvement, and any deficiencies noted. Providers are encouraged to seek~technical assistance from OPC, as we have the shared goal of promoting qualitji'services for consumers. ~.. • A comprehensive provider community comprised of over 240 agencies and individual clinicians who provide: a~eP~--1 Q0 different services, including all seven best practice models. •3 OPC has a large percentage of professional and 'licensed LME staff available to provide technical assistance and clinical consultation. Six of the eight employees in the Quality Ma`nagement/Provider Relations Department have Master's_.Degrees, and three hold current clinical licenses. The Provider Relations Representative position that is currently vacant is expected to be filled by a licensed individual:' Within the LME there are a total of 23 Masters bevel staff, with an additional two stafflrnembers who.will receive their Masters Degrees by June of this year. Fifteen are currently licensed arid'.one will be provisionally licensed after receipt of the Masters degree in`June. ''° Rules that inhibit' he efficient and effective operations of the Provider Relations and Development function>= c~ • The proliferation of Medicaid providers and the LME's inability to limit the community. OPC recognizes and appreciates the concept of "any willing provider" as a means to provide consumer choice. However, as more and more providers receive endorsement and request MOAs with the LME, we are concerned that the stability of the system is being threatened. Our population can only support a limited number of specialized services (e.g. ACTT and PSR) and continuing to 26 27 add providers who are "willing" may jeopardize funding for these programs. OPC strongly supports DMH's priority strategic objective to right-size and stabilize a highly qualified provider system. • The inability to respond quickly and consistently to the provider community about system changes. With so many competing priorities at both the local and state level, it is often difficult to dedicate the necessary resources to analyze information received from the Division of MH/DD/SAS before forwarding it to the~p~ovder community. The LME must often choose between forwarding information in a timely manner or taking the time necessary to examine its impacfi on internal processes and external providers. When information is sent without this'`'level of analysis, the ~ a result is often confusion and a lack of message consistency; The LME also recognizes the volume of information that is transmitted and wN';collaborate with our provider community to identify more efficient ways to communicate.,~~ • Disparate internal systems to track provider information. ~'. Currently OPC maintains separate databases to track provider demographic information, incidents, complairts;._ billing and reimbursement.. With full implementation of the Pro-FilerT"'system, OPC will be able to reduce the separate databases and consolidate ;all ''-pertinent information in order to effectively evaluate the provides community,; a~r~ perform other necessary functions of the LME ~ ` ;_~ 27 28 Chapter 4 CUSTOMER SERVICE AND COMMUNITY PLANNING Mission The mission of the Customer Service function of the LME is to provide information, assistance and connections for individuals to resources within the community. Community Planning's mission is to focus on community capacity issues such as capacity development, strategic planning, community need assessments, analysis and collaboration, consumer and public relations and to promote the development of additional resources and connections to meet consumer needs. ~`=,- ~': Purchaser Standards / , l ` ~' .`\_ OPC Area Program is currently in compliance with all applicable local, state and federal statutes and rules, or will dedicate resources to the correction of any known or identified deficiencies. . ~: Current Ouerations ,.,~ Customer Services and. _Gommunity Planning is a part of the ,Care Management Department. Customer~Services~,and Community Planners (CS/CPs) promote an open and consumer-ce~ttered,culture ire the LME. Customer Service and Co~riplants ~~ ~~ CS/CPs are responsible for answering OPC's customer service line, responding to complaints, concerns and informafron requests. The OPC LME is committed to providing a timely response to complaints. OPC prides itself in successful resolutions of consumer and stakeholder concerns and has had very few formal complaints filed.. CS/CPs also aid individuals in navigating the local mental health system and provide public information about services and the LME. Community Collaboration Staff from this unit facilitates local disability interest groups and Community Collaboratives. OPC currently provides staff for an Interagency Committee for Developmental Disabilities and Community Collaboratives in each of our three counties. CS/CPs staff OPC's disability committees of the LME Board. It is through this collaboration with stakeholders and consumer groups that we evaluate service gaps and plan for expansion of services. Customer Service Community Planners also focus on strategic planning and consumer and public relations. 28 29 Housing The LME housing initiatives are managed by this Unit. This includes management of Housing and Urban Development (HUD) funded programs, chairing the Orange County Continuum of Care, serving as the lead agency for new housing initiatives, participation. in the Orange County Ten Year Plan to End Homelessness, and working collaboratively with other community partners to develop affordable housing for persons with disabilities. Service System Collaboration /`': _ This unit is responsible for development and oversight`af~ OPC's Crisis Service System, management of the System of Care initiative for children and adolescents, management of DD service funds and Community Alternative Programs for individuals with Mental Retardation/Developmental Disabilities (CAP-MR/DD) waiver and DD;~initiatves, and liaisons to disability specific providers. Staff in this unit manage the admission and discharge process for consumers in OPC's Crisis apartments. Department of Social Services/Department of Juvenile Justice (DSS/DJJ) Liaison OPC employs aDSS/DJJ Liaison funded by°~~Qrange County DSS and Orange and Chatham Counties Juvenile Justice who' performs face to face STR in the community. This liaison is a Licensed Professional~~~.Counseior~~(LPG)~ who provides consultation specific to youth involved with one of the above named~;agencies. Strategic Objectives ~;' • Expand-staffing to ensure adequate Customer Service capacity and ability td answer 50! df Customer Service calls with a live voice. ,'Target Date: July, 2007-July 2008 ` Responsible Parties and Stakeholders: Customer Service Manager, Customer Service/Community Planners, Senior Management, Area Board • Develop agency cultural competency plan and provide technical assistance to providers in.-this area Target Date: January 2008-July 2008 Responsible Parties and Stakeholders: Senior Management, Care Management Director, System of Care Liaison, .Area Board • Expand crisis services continuum including implementation of Mobile Crisis Service Target Date: February'2007-July 2008 Responsible Parties and Stakeholders: Customer Service and Community Planning, Provider Community, CFAC 29 30 • Revise and expand agency Disaster Preparedness Plan Target Date: September 2007 and on-going Responsible Parties and Stakeholders: Customer Service Community Planning Unit, Medical Director, Disaster Preparedness Team, Senior Management, Area Board • Conduct a minimum of two community awareness/public relations events .annually ,,-, Targef Date: May 2007 and on-going Responsible Parties and Stakeholders: Customer Service Community Planning Unit ~ ,. .,,\ • Develop community capacity plan that directly,. impacts~;and reduces the use of state psychiatric beds.. - Target Date: On-going .___,~, Responsible Parties and Stakeholders: Community Service/Commu,nity Planning, Provider Community, Utilization Management Committee~'Senior Management, Area Board • Develop long-term options for management and operation of the five OPC Crisis Apartments. Target Date: December 2007 Responsible Parties and Stakeholders: Customer Service/Community Planning Unit ~:'~ _ ,- • Increase affordable housing resources available in our community for people with tlisabilities._ _by collaborating with partners (e.g. Chrysalis Foundation for'~~Mental.,l~ii~alth,Orange County Coalition to End Homelessness, etc) 'to evaluate and apply for funding and housing initiatives as appropriate: -_ (e.g. Housing 400 Initiative) Target Date: March 2007=~J~uly 2010 Responsible Parties and Stakeholders: Customer Service Community Planner/Housing, Provider~Community, Senior Management, CFAC, Area Board • The Customer Service/Community Planner who is responsible for housing initiatives will pursue training through the Federal Emergency Management Agency to become a Disaster Response Worker. Target Date: July 2008 Responsible Parties and Stakeholders: Customer Service Community Planning Unit • Maintain an effective complaint resolution process by refining the procedures and protocols, tracking mechanisms and identifying responsible individuals for each stage of the denial process Target Date: September 2007 and on-going 30 31 Responsible Parties and Stakeholders: Customer Service/Community Planning Manager, Senior Management • Continue to reduce out of home placements for children by requiring provider participation in care review process. Target Date: On-going Responsible Parties and Stakeholders: System of Care Goordinator, Provider Community, Community Collaboratives • Develop an evaluation tool to monitor providers to assure their facilitation of monthly Child and Family Teams which includes the participation of all key stakeholders Target Date: September 2007 Responsible Parties and Stakeholders: System of Care Coordinator, OPC Monitoring Team, Community Collaboratives, Provider Community ~_ • Implement aweb-based community ,resource:>._directory, which can be accessed by consumers, stakeholders, providers`and LME staff. Target Date: July 2008 Responsible Parties and Stakeholders: Customer Service Community Planning Unit, Business Systems Manager, Information Technologystaff, CFAC, Provider Community ~< • In order to assure appropriate continuity of care, enhanced service providers wtll be eXpected to submit electronic crisis plans on all consumers who are~ideatified as "high risk" at least annually or more often if changes-occur in the consumer's life or plan. Target Date: July ,2008, Responsible Parties arid' Stakeholders."°Custc~mer Service Community Planning Unit, BusinessSystems` tall, Provider Community • Review and make improvements as needed in any of the above objectives as a part of a continuous~quality improvement plan. Target Date: June 30, 2010 Responsible Parties and Stakeholders: Senior Management Resource Allocation In July 2006, OPC combined customer service and community planning. Currently there is a System of Care Coordinator and 3.6 Customer Service/Planner positions, one of which is vacant. One of the CS/CPs oversees housing initiatives, one is responsible for Crisis and one (vacant position) will be primarily responsible for consumer affairs and community awareness initiatives and other community capacity building activities. One individual who is dedicated to Community Planning as .6 FTE is a licensed addictions 31 32 specialist. The three remaining staff currently assigned to these functions are Licensed Clinical Social Workers. The unit manager is a Qualified Developmental Disabilities Professional (QDDP). OPC currently has 6.5 FTEs dedicated to Customer Service Community Planning. OPC's FTEs for Customer Service/Community Planning varies from the Cost Model because of the grouping of some functions within OPC: • The service management activity of Community Collaboration has been paired with Customer Service % ` ` ~= • Some consumer affairs activities are performed in the Quality Improvement/Provider Relations department. The,CFAC and Client Rights liaison position is located within the QI department • The Medical Director, who performs some ,customer` service activities (responding to complaints and denial decisions) is located\\n Governance and Administration >„ , The System of Care Coordinator position is located within the Customer'~Service and Planning section; it should be noted that this FTE is funded outside of the Cost Model for ~MEs. `;.~"~ -_ Business Rules '~;--_ --= f The following business rules enhance tiie~ effectiveness and efficiency of Customer Service and Community Planning • All consumers requiring out of home placement must be reviewed by a local Care.-.Review Team. {` ;- - Over;the past ~ fiew 'years OPC, in partnership with Community Collaboratives in Orar-ge, Person and Chatham counties, .has prioritized keeping children in their homes'or as close to`~ho~me as possible. A care review process was instituted which requires, all. earns seekir`g out of home placement for a child to obtain prior approval from local Gare Review teams. The Care Review Teams are made up of professionals,, from OPC, Department of Social Services (DSS), Department of Juvenile Justice \(DdJ), local schools and family advocates. This intervention has resulted in a shift in community norms and expectations about children remaining in their home, or the least restrictive level possible. OPC's data in November 2006 shows that: • that at least 73% of children who are receiving services are living at home • the use of bevel III homes continues to be less than 8% in all counties, and; • 8-13% of the children are living in therapeutic foster homes. 32 33 • OPC values consumer, community and stakeholder input into system design, monitoring and evaluation.. Customer Service Community Planners and other LME .staff attend over 30 community groups and committees, including the three Community Collaboratives for children. Customer Service Community Planners facilitate many of these meetings and are viewed as well informed community partners. Consumers participate in many of these committees, especially the Community Collaboratives and subcommittees to the local Area Board. OPC has awell=documented history of soliciting consumer input via satisfaction surveys, publicfiarurras and focus group meetings. Currently OPC has aweb-based consumer,.satisfaction survey which is consistently used. During this local business planning process, OPC developed a survey, which was used by consumers, family members, community partners and community providers to inform them of the process arid; to allow tti~e.m the opportunity to submit recommendations for the local business plan. ~~~ ~ ~ The following business rules inhibit the effecti~~ness and efFciency of the' Customer Service Community Planning function. ~ ~ ~~~~ ~~" `, • OPC's current limited resources result in customer service calls being answered with a live voice approximately 25%of he time. OPC believes that consumers and stakeholders desire, timely responses to their questions and concerns. The current live voice response often requires that consumers leave a.-vocemail message. Although messages are returned within 24 hours, the response is not as timely as OPC or the consumer desires and if the consumer is not-available when the call is returned this results in "telephone tag" that can 6e frustrating to all parties_~nvolved. OPC has identified a strategic objective to double the number of calls`that.receive live3voice response within the next year. `~ - - - .. • Information on customer service calls and community resources is stored in multiple databases anc!/or~Microsoft Word TM documents depending on how the call comes into the LIME. Telephone requests for information come into the LME via STR and Customer Service lines. Currently Pro-FilerT"", OPC's information system, allows entry of information and referral calls, but is not structured to accept information necessary for tracking complaints. OPC's Customer Service and Community Planning Unit has identified a strategic objective to implement aweb-based resource directory that can be accessed by consumers, providers and LME staff. Data related to complaints and their resolution, as well as information on community resources is maintained in a Microsoft AccessT"' database. With full implementation of the Pro-FilerT"'' system, OPC will be able to reduce the separate databases and consolidate all pertinent information in order to effectively evaluate the provider community and perform other necessary functions of the LME. 33 34 • OPC's after hours STR provider, ProtoCall, has electronic access to crisis plans and alerts filed in their system. OPC's primary crisis provider, Freedom House, does not, have access to electronic or written information, crisis plans or alerts fora consumer. Providers submit information voluntarily. These agencies have no knowledge other than by verbal report of whether the consumer is already receiving services or has a clinical home. OPC is committed to supporting crisis providers' access to information necessary to deliver the most appropriate crisis service to .consumers. During a crisis a consumer already assigned to a clinical home provider should receive a response first from that provider. Access to appropriate diagnostic and treatment information, as well as crisis plans will support a more effective and"`efficient crisis .system. OPC has identified a strategic objective to address this,issue. "' ;: ,. ~~ ~, __~:~ ~r // L ,- , ` ~ \ f~ - _ F 34 35 CHAPTER 5 CARE MANAGEMENT Mission The mission of Care Management is to provide access to services 24/7/365; review service requests and make decisions regarding medical necessity. to promote the use of services which meet standards of quality and best practice. ~'~ -` ,' ;~ Purchaser Standards ~ '` ~! OPC Area Program is currently in compliance with all applicable local state and federal statutes and rules, or will dedicate resources to the correction of any known or identified deficiencies. ~`~ ~~~~>..,~ Current Operations ~ ~' Care Management includes the service management functions of Screening, Triage, Access and Referral, Authorizations and.'Care Coordination. Screening, Triage, Access and Referral `,, ' ,~ Screening, Triage, Access and Referral (STR) is available to consumers 24/7/365 via toll free telephone lines which allows prompt~_and easy access to needed services and supports from a provider of their choice within~,a130-minute/30 mile commute from their home. In accordance with Enhanced Services ,Implementation Update #14 providers of enhanced services may perform screening, triage and referrals. Telephone calls are answered y with'in` -„ five rings or 30-seconds. Additionally, Tele Typewriter/Telecommuriications Device for the Deaf (l-fY/TDD) or language interpretation services,. are available in accordance with Title VI guidelines. STR administrative staff receive 'consumer registrations from providers of enhanced services and enter this°information`info OPC's information system. `\ STR/Authorizations,,:for Developmental Disabilities Community ~ ,~ . _ - OPC employs five.:;..; staff to perform STR and Authorizations functions One STAR/Authorizer h`as expertise in developmental disabilities and is a Qualified Developmental Disabilities Professional. This person authorizes services for individuals with developmental disabilities including developmental day and developmental therapy. Most screenings for individuals with DD are conducted face to face; however, there are instances where it is necessary to conduct telephonic screenings. Additionally this person maintains the CAP prioritization tool, updates it, notifies families when selected, and explains the process for getting a case manager. This staff person receives MR2s (an assessment tool used to determine whether an ICF/MR ((Intermediate Care Facility 35 36 for individuals with Mental Retardation)) level of care is appropriate) and disseminates those to DSS and the targeted case manager, notifying DMH as to who is being placed onto the waiver. Utilization Review/Utilization Management (UR/UM) STR clinicians perform both STR and UR/UM on state funded services. STR/Authorizers authorize utilization of state funded psychiatric beds and Alcohol and Drug Abuse Treatment Centers (ADATC). Currently all admissions from Chatham and Person counties require prior authorization from STR/Authorizations to document attempts to locate community placements or other diversion options. UR/UM monitors the allocation of resources. from a consumer and community perspective and reviews state funded services. Person Centered Plans (PCPs) for Medicaid and state funded enhanced services recipients are routinely reviewed'`:Analysis of the above data is used to both monitor the effectiveness of service provision and assist Community Planning in identifying gaps in the service continuum. .~~ ,~ The program manager, in collaboration with the \Authanzations Workgroup, developed a Benefits Package for state funded services which is used to guide decisions about the amount and type of services authorized for consumers in various age/disability groups. Care Coordination ~, Care Coordinators link consumers who have complex needs (and/or who do not have an identified treatment.-provider) with needed services and supports. Care Coordination occurs through telephonic and fiace-to-face contacts with consumers and/or providers. Hospital Liaison ;activities are: included in Care Coordination and every consumer admitted to a state `psychiatric-..hospital is assigned a Care Coordinator. Clinical consultation is available`~or high risk`and -difficult to serve consumers. OPC currently has many adult consumers ,who are discharged on outpatient commitment. OPC Care Coordinators spend a great ;deal of time locating these individuals, encouraging involvement with a service provider end when appropriate terminating the commitment order. ,, Strategic Objectives • Improve efficiency of STR process including implementation of the Automatic Call Distributor (ACD) Target Date: August 2007 Responsible Parties and Stakeholders: STR/Authorization Manager, Care Management Department Director, Information Technology staff • OPC will collaborate with identified providers to transition their appointment schedules into the Pro-FilerT'" system. Target Date: January 2008 36 37 Responsible Parties and Stakeholders: Business Systems Manager, STR/Authorization Manager, Information Technology staff, Provider Community • Support implementation of new and expansion of existing evidence-based and best practice services in OPC's catchment area. Target Date: On-going Responsible Parties and Stakeholders: Care Management Department, Service and Community Planning and Authorizations Unit, Utilization Management Committee, Authorizations Workgroup, Provider Relations Unit, Senior Management, CFAC, Area Board • Develop Comprehensive UM Plan which incorporates feedback from consumers and stakeholders and identifies OPC's priorities related to continuity of care and treated prevalence.•~ " . Target Date: Annually following Area Board Retreat Responsible Parties and Stakeholders:Care Management Director, UM Committee, Senior Management, CFAC,.Area Board. -~ • Generate and routinely review appropriate .data to drive modification of IPRS Benefits Plan Target Date: February 2007 and on-going ,:> Responsible Parties and Stakeholders: Business Systerims manager, STR/Authorization Manager, UM Committee, Senior Management, QIlPR Department • Improve pen~tratio-i rates for underserved population groups e.g. Latinos, Severely Barad '' Persis'tantly Mentally 111 (SPMI), children with Severe Emotional Disturbance.. (SED), etc, by increasing IPRS funds to agencies serving these populafions . , w -- ~~~ Target Date: On-going ' ,, Responsible Parties arid; Stakeholders: Care Management Director, UM Committee, STR/Authorization;Manager . ~'' , • Expand the list of IPRS services which are authorized by OPC, to include, but not be limited to DD services Target Date: July 2007 Responsible Parties and Stakeholders: STR/Authorization Manager, Provider Community • Increase the number of reviews of PCPs for IPRS funded enhanced services to reach DMH's identified goal of 25% and 10% for Medicaid enhanced funded services. This will also include follow-up with 15% of consumers for whom a .PCP is not received within 45 days following a referral to an enhanced benefit provider 37 38 Target Date: On-going Responsible Parties and Stakeholders: STR/Authorization Manager, QI/PR Department, Provider Community • Expand the consumers' choice of providers available to deliver state funded assessment and treatment services by adding up to two additional providers Target Date: October 2007 Responsible Parties and Stakeholders: UM Committee, Provider Relations, Finance Department, CFAC, Provider Community ,:';: = --~ ,< • Use data obtained through coordination with providers of enhanced and crisis services to better identify high risk, high .cost consumers Target Date: On-going Responsible Parties and Stakeholders: Business Systems Manager, Lead Clinical Care Coordinator, Provider Community ~.__ ~, • Decrease the utilization of bed days at state psychiatric facilities by OPC consumers Target Date: On-going ~` Responsible Parties and `; ,Stakeholders: Clinical Care Coordinator, STR/Authorizations Manager ;_ • Review and make improvements as needed ri any of the above objectives as a part of a continuous quality irriprovement plan. Target Date: June 30, 2010 Responsible Parties and Stakeholders:~Seraior Management Resourcefa location ,, OPC~currently has 12:6 FTEs assigned to the Service Management function including STR, lJR/UM and Care Coordination. One STR/Authorizer is a registered nurse with over 20 years experience in adult mental health. ~~ ~ '~,_ :~~ Another STR/Autho~izer is a Qualified Mental Health Professional (QMHP) who is bi- lingual and has expertise in adult mental health. This individual will receive a Master's degree in Social Work in May 2007 and will seek provisional licensure as a Licensed Clinical Social Worker (LCSW). Additionally, this staff member is currently working towards becoming a Licensed Clinical Addictions Specialist. The STR/Authorizer with child mental health expertise is a licensed school counselor. 38 39 There is a vacant STR/Authorizer position for which OPC is actively recruiting for a licensed or provisionally licensed clinician. The manager of STR and UM/UR is a Licensed Clinical Social Worker with experience in adult and child mental health and child residential services. The Clinical Care Coordinator is a LCSW who provides care coordination to children and supervises two Care Coordinator positions, one of which is vacant. The current Care Coordinator is a registered nurse with decades of experience working with adults with SPMI especially those in need of ACTT. The cost model allows 19.1 FTEs for Service Management. OPC's FTEs for Service Management varies from the cost model, by having 12.6, because: • OPC contracts for after-hours STR and those FTEs are not counted in the total of LME staff. • Over the last two years as part of our overall_'fnancial management plan, OPC has combined a variety of duties and responsibilities within the Care Management Department. As we move forv~ard we will be investigating opportunities to increase staffing. E ~ ~. ,\ Business Rules ~~;` '~ _. ,, The following business rule enhance the Service Management-function •'• Enhanced Services implementation Update #14 provided clarification and • guidance, as weli~as standardization regarding the role of STR. -,\ OPC's STR is; conducted as';efficiently and effectively as possible. STR is a brief inquiry to determine -need and to facilitate access to a more intensive clinical service. We identify the nature'~of;the p~esentng_,MH/DD/SA problem, clarify the severity of need and facilitate referral'to a provider of choice. With this implementation update, we can be assured thafiour providers are conducting screenings in the same manner. ~ ' -< • A Care Coordinator is assigned to any consumer admitted to a state psychiatric facility. OPC has prioritized a reduction in the use of state psychiatric beds. One Care Coordinator is dedicated to monitoring high-risk consumers and ensuring referrals of those individuals to an appropriate clinical home. Additionally, a.system exists for tracking which consumers are admitted and discharged from state psychiatric institutions. This system allows all Care Coordinators, Supervisors and Department managers to review the specifics around the admission, projected discharge, and out-patient commitment status of consumers and to ensure timely and appropriate response. The following business rules inhibit the effectiveness and efficiency of the Care Management function 39 40 • OPC does not maintain schedules for IPRS or Medicaid service providers. Three way calls are used to schedule assessment appointments for all consumers. The lack of schedules maintained in Pro-FilerT"'' means that a STAR clinician must call the .provider and schedule the appointment over the phone. This business rule limits the actual hours we can make referrals for consumers to providers to the operating hours of the providers. We have created a strategic objective to address this issue. • Indigent consumers needing a routine mental health or substance abuse assessment (other than Driving While under the Influence) are referred to the same provider in Orange, Person and:.Ctiatham counties. =s;~ / `~~ OPC currently refers new consumers requiring an assessment for. a mental health condition to one provider in Oranges Person and Chatham counties. During divestiture, OPC released an RFP for comprehersive service agencies to deliver the services previously delivered by OPC to indigenf consumers and incorporate the then "new" service definitions. After a thorough review process only one provider was chosen as a Comprehensive Service Agency. This, decision created one "safety net" organization to receive the IPRS funds for assessmenfi'ard treatment of indigent consumers. At the time this decision focused on system iatability during the transition year. Over the past eight months, the capacity of this provider to perform the assessments within~''the; timelines, especially for urgent or emergent consumers, varies a great deal across the region. OPG acknowledges that inadequate IPRS funds limits flexibility; howeue~, we feel choice of providers for indigent consumers is too limited. A strategic objective .is listed to address the issue. ,; ~ - - ~._<. __. • OPC :uses a.._ paper system to receive and distribute authorization requests/approvals, STR forms and Person Centered Plans. -- OPGs~goal is to have,a'paper~ess~or virtually paperless system. Presently, providers of IPRS:,services submit a paper authorization form, which we enter into Pro-FilerT"' Authorization .,,requests: are printed and faxed to .providers. A process which allows providers to~,receive and submit forms electronically would reduce cost, and save time for both``providers and the LME. Full implementation of electronic capacity would correct this issue. ~~' • In order to provide services to a greater number of consumers, OPC has chosen to limit its IPRS Benefit Plan. Insufficient IPRS funds result in limited authorizations that are not always sufficient to meet the needs of the consumers. As system reform has progressed and our system has transitioned, many consumers were already engaged in traditional treatments and therapy. It takes time to transition people out of services while 40 41 ensuring access to new consumers coming into treatment. Therefore OPC continues to authorize small amounts of services to more people. As funding becomes available, OPC adjusts the Benefits Plan to allow for a larger volume of services which can be covered by a target population budget group. ,~~. ,~ _~ ~' ", '~ r~ .. ,:, .,,. '1 v '~~ , `, i' ,' <" _. ~ , ,, ~~ ~' - f' ;. 41 42 CHAPTER 6 QUALITY MANAGEMENT Mission Statement The Quality Management function of OPC LME is designed to provide continual assessment and improvement of the service delivery system with active participation of all interested stakeholders. Purchaser Standards ', ... OPC Area Program is currently in compliance with~'all applicable local, state and federal statutes and rules, or will dedicate resources to~the correction of any known or identified deficiencies. ~ ~ ' ~. <~ Current Ouerations ~~ Quality improvement activities within OPC are designed to enhance the system's ability to fulfill the mission statement through continual assessment ;and improvement of the service delivery system. Continuous quality improvement; is both an individual and systemic concern that is an integral part of routine business and is defined as the means through which ;`service providers, with active participation of all. interested stakeholders, can identify, analyze and solve problems within the service system. ~' - ;; The Quality Management function. of OPC is carried out by staff members of the Quality Improvement/Provider Relations Departrnent~ In addition to perForming the Provider Relations and Developmerif~function (see-Chapter 3), this department is responsible for management of all issues related.,, to consumer rights, confidentiality, incident review, consumer outcome assessments, research and evaluation review, maintenance of all policy and procedure manuals, coordination of the guardianship function for the LME, accreditation of the LME and coordination of HIPAA and Title VI compliance. Quality Improvement and Assurance For decades, OPC has supported an Area Quality Management Committee (AQMC). This committee exists to foster a systemic climate of quality management wherein providers, consumers, and family members are active members of the system. The focus of the committee is on improving processes, systems and outcomes, as well as providing stakeholders the data and tools they need 'in order to make good quality management decisions at the local level. The committee ensures the continual assessment of the system of care and is designed to support the goal of providing the highest quality of care possible within available resources, while meeting all state, federal, and local requirements. 42 43 The Quality Improvement/Provider Relations Department, in collaboration with the AQMC, fulfills the following quality management functions, which are included in the ME's Quality Management Plan: Oversees a comprehensive qualitative monitoring system that incorporates any or all of the following: • data from consumer satisfaction surveys. • reports related to accreditation and/or licensure and applicable self-reporting requirements. • reports related to service access and timeliness of treatment. • reports from external reviews by agencies responsible for system oversight. • results of monitorings, including local, CAP, ar%tl~,=,endorsement site visits. • feedback from consumers and families"'related to participation in treatment planning. _ ~~ • issues identified through community collaboration and needs assessments. • issues related to best practice standards and other, applicable standards of clinical practice • review of personal and aggregate outcomes' <.to guide recommendations for clinical decision-making and policy development. `'°~`'~' ., • identification, documentation, reporting and investigation' of individual incidents and complaints as well as any identified aggregate trends. Additionally, the Quality Management Department is~ responsible to: • Oversee/monitor risk management function to include review of .incidents, complaints and appeals, use of restrictive interventions, and any changes or events ...which could have an impact on continued service provision, and the repai=fing.of such events to appropriate authorities. • Oversee the review, revision, and distribution of applicable policy ~ and /procedures. ~'~ Monitor the implementation of a client rights program that ensures the health, safety'and welfare';of~ all persons served, protects the rights of consumers, and maximizes,the opportunity for stakeholder input and timely response to individual complaints,~'and/or,,appeals. • Facilitate \and°>er'isure CFAC involvement in the LME's quality improvement process. ~,.'~~ • Monitor the implementation of a utilization review system that ensures continuity of care, establishment of best practice guidelines, equitable distribution of funding, and an effective and efficient use of available resources. Incident Review and Reporting The Client Rights Coordinator manages the LME's Incident Reporting and Review function. This staff member is responsible for reviewing all reported incidents and 43 44 preparing reports for OPC's Incident Review Committee, which meets monthly. The Committee reviews all incidents and serves as a formal review body for any Level III incident. The Gommittee reviews several reports, including "Incidents by Type", "Incidents by Provider" and "Incidents by Consumer" to identify trends in the provider community. Any noted trends are pursued by the Client Rights Coordinator and/or relayed to the monitoring team for immediate investigation or incorporation into ongoing monitoring activities. Quality Improvement Projects / j In accordance with indicator 1.6.1 of the Performance Contract, OPC has developed and implemented annual Quality Improvement projects that,, upport the following objectives of reform: ~ ~~ ` ~~'~~~ • Safeguarding the health, safety, and rights of consumers • Supporting the achievement of desired outcomes and satisfaction. for,,co~nsumers • Ensuring fair access to services, especially for those most in need `'~.~` ,; • Ensuring the integrity, effectiveness, and continuous improvement df services • Ensuring compliance with basic state and federal requirements and standards • Evaluating the system reform`fmplementation process While the Quality Improvement/Prov~tler;,Re~lations Department is responsible for compiling and overseeing the submission of the,report to DMH, the projects themselves are a product of interdepartmental and community collaboration. Consumer Outcomes The Quality Improvement/Provider Relations. Department is responsible for the collection and..analysis of consumer outcomes data gathered from sources such as the NC-TOPPS;.fDD-CQ1,, NC-SNAP, National Core Indicators and both internal and external'consumersotisfaction surveys. ,~, f Consumer Rights OPC meets ~ all applicable State guidelines regarding the development and implementatiori'~,of` a Client Rights Committee (CRC). Consumers, family members, providers/professionals;~advocates, and Area Board members are all represented in the membership of this Committee. The CRC for OPC Area Program meets monthly, which exceeds the requirement set forth in State rules. Members of this Committee regularly review data from all incidents received from providers that report the use of restrictive interventions; allegations of abuse, neglect, or exploitation; client rights violations; and suspension or expulsion from services. As a part of this review process, the CRC identifies emerging trends or patterns that might require further investigation by the LME and makes recommendations for follow-up. Such trends may be specific to a particular provider, or relate to a pattern of incidents within the OPC catchment area. The CRC also reviews individual complaints that involve Client Rights issues and monitors the 44 45 LME's investigation and response to such complaints. The CRC and OPC's Monitoring Team enjoy a collaborative relationship in safeguarding clients' rights within Orange, Person, and Chatham Counties. Throughout its history, the Client Rights Committee has monitored and approved the planned use of restrictive interventions for consumers who receive services within this catchment area. As OPC has divested its services, fewer behavior intervention plans are being submitted to the CRC for approval. During the past year, members of this Committee have been focused on developing a structure that ensures appropriate oversight of client rights within this catchment area. The CRC is currently in the midst of surveying all OPC providers to learn about their processes for monitoring the protection of client rights. Plans are being developed for the members of OPC's Client Rights Committee to provide technical assistance and training to provider staff, as well as to members of providers' Client Rights Committees. ~~` ~~~ Consumer and Family Advisory Committee ~ ~~ ~. ~ ~,. The Client Rights Coordinator provides staff assistance to~CFAC and serves as the liaison between the committee and OPC LME. Routine ;CFAC support activities include mailing of meeting announcements and agenda, proVidirg, information to the CFAC on reform and other information disseminated from DMH, educating members on internal system issues and problems, and coordinating with other departments within OPC to ensure that CFAC is educated and involved in issues relayed to LME operations. The CFAC liaison also manages conference registrations and reimbursements, and performs other administrative and supportive functions as needed. OPC is diligent in actively involving CFAC m'~planning and policy development. CFAC sets its own priorities and objectiues,_develops its own annual budget, and is involved in numerous projects. These projects `have included sponsoring local Wellness Recovery and Action Plan (WRAP) and Pee~~~~Specialist,~_t~aining ;opportunities, as. well as developing and presenting a Peer Support V1(arkshop for the past three consecutive years. ,, Strategic Objectives: • Develop and implement a standardized and equitable process that can objectively evaluate the provider community and allow for informed consumer choice. Target Date: January 2008 Responsible Parties and Stakeholders: all LME Departments, Area Quality Management Committee, CFAC, Provider Community Although OPC has implemented an Annual Provider Self-Report that requests information on several quality indicators, there is still a need to produce a report containing objective measures of quality services. CFAC and other community groups have expressed an interest in obtaining such a report to offer consumers enough information to allow for informed choice. Over the next several months, 45 46 OPC will be reviewing all sources of provider data such as monitoring results, progress towards national accreditation, number/types of complaints and incidents, fidelity to EBP models and collaborating with its stakeholders to determine the most effective and consumer-friendly way to present this information. • Improve collection, tracking and analysis of provider outcome data. Target Date: July 1, 2007 and on-going Responsible Parties and Stakeholders: All LME Departments, CFAC, Provider Community Currently OPC maintains separate databases to track provider demographic information, incidents, complaints, billing and reimbursement. In order to effectively evaluate the provider communi~ and perform other necessary functions of the LME, OPC will be improvirig'and``expanding its current system to facilitate the integration of all this information. With ;full implementation of the Pro- FilerT"' system, OPC will be able~to ,reduce the separate databases and consolidate all pertinent information in order~to effectively evaluate the provider community and perform other necessary functions of the LME. ~~. ~, • Improve collection, fracking~`and~analysis of consumeroutcome data. Target Date: July 1, 2007 and on=going ~~,_,__ ~ '~~ Responsible Parties and Stakehi7lders:~; , all ~: LME Departments, Area Quality Management Committee, CFAC, Provider'CommurCify ~, OPC's current collection, tracking and analysis of consumer outcome data is in its early stages. We would like to°' increase collection and hope that the integration of .our internal systems will`s facilitate that process. It is our goal to examine _data obtained from consumer satisfaction surveys,. a review of PCPs, including.those:_of high risk/high cost consumers, NC-TOPPS, DD-COI, National Core Indicators, `and NC-SNAP to determine if services are meeting the needs of ~' consumers and whether additional services are needed. With full implementation of;the Pro-FilerT"' system, OPC will be able to reduce the separate databases and~~consolidate all pertinent information in order to effectively evaluate the provider community and perform other necessary functions of the LME. ~~~ • Provide technical assistance and education to assist providers in conducting annual quality improvement studies. Target Date:~.lune 1, 2007 and on-going Responsible Parties and Stakeholders: QI/PR Department, Area Quality Management Committee, OPC Provider Community One area in which we commonly receive requests for technical assistance is the development and implementation of provider quality improvement plans. Our goal is to continue to provide requested technical assistance and add quality improvement training to our training schedule. We hope that by focusing 46 47 technical assistance in this area, we will increase provider compliance with the IPRS contract requirement for three annual QI projects. • Review and make improvements as needed in any of the above objecfives as a part of a continuous quality improvement plan. Target Date: June 30, 2010 Responsible Parties and Stakeholders: CFAC, Senior Management Resource Allocation ~~~, /- The entire Quality Improvement/Provider Relations Department:., consists of 7.9 FTEs, 1.25 of which are devoted to the Quality Management`function~as described in the cost model. These positions are broken down as follows: ~~`~~ ~~~~ Director 5 FTE Client Rights Coordinator .5 FTE Administrative Assistant .25 FTE According to the cost model, OPC~would be allowed 2.5 FTEs to fulfill this function. OPC's variation from the cost model `is primarily due to the location of the Data Analyst position in the Finance Department arad '#he'sharing of administrative assistant duties with the Care Management Department'`and the Provider Relations function of the LME. Another variation from the cost model is he inclusion of staffing for the Consumer Rights Committee and the Consumer and Family Advisory Committee within the Quality Improvement/Provider Relations Department: ,'An additional .5 FTE for the Client Rights Coordinator is dedicated to fulfilling these functions. Business Rules -~ ;. ;, Rules that enhance the efficient function> - . ~~~- - • A strong Quality Manage ,~= and effective operations of the Quality Management nt Committee with a membership that includes LME staff; consumers and providers. • A quarterly~'reporting system that addresses all Quality Management Activities including trends in Incident Reporting and Complaints. OPC has produced this quarterly report for many years and provides it to multiple stakeholder groups, including the Area ,Board, CFAC and the Client Rights Committee. • A willingness and commitment from LME staff and departments to explore new and creative ways of improving services and outcomes for consumers. 47 48 Two creative options OPC has developed or will be developing include: • Rapid response homes to keep children. in the community and prevent hospitalization. • Funding transportation of consumers discharged from State hospitals to decrease our hospital utilization rates Rules that inhibit the efficient and effective operations of the Quality Management function: • Disparate internal systems to track provider and consumer outcome information. Currently OPC maintains separate databases to track provider. demographic information, incidents, complaints, billing` and reimbursement. In order to effectively evaluate the provider community and perform .other necessary functions of the LME, OPC will be improving and expanding its current system to facilitate the integration of all this informatioh._ With'full~mplementation of the Pro- FilerT"" system, OPC will be able to reduce ':the separate databases and consolidate all pertinent information in order to effectively evaluate the provider community and perform other necessary functions of,the_LME. • Lack of data and timeliness in receiving data from~State sources. A goal of OPC -i's lto improve and expand our collection, tracking and analysis of consumer and provide~~,,outcomes (see Strategic Objectives above). We believe that this p~i^ocess~~would;,k3e further enhanced if LMEs could receive data from sources such as~Medicaid ~Paid._Claims,, DMH Annual Consumer Satisfaction data and the DD-COI. ~~Wefeel that the addition of this data will only improve our ability to monitor outcomes for our community. ,\ ~ • Completion of service divestiture within the last .year has led to a delay in enforcing the collection ofi"outcomes data. Like other LMEs, OPC has struggled with provider compliance with the NC- TOPPS. Many providers have experienced difficulty adding this requirement to their workload. We are diligently working with programs to increase compliance and demonstrate NC-TOPPS usefulness as a clinical assessment tool and applicability to Person Centered Planning. 48 49 PROCESS REVIEW REPORT Local Business Plan Development OPC conducted a survey of consumers, family members, providers and community partners to provide information regarding the development of the Local Business Plan and to solicit input for our planning. The survey was provided electronically for those who had access to a computer and 1,000 hard copies of the survey were mailed to providers as well as distributed at Provider Meetings. To date, 112 responses have been received and the responses compiled for review and action by all stakeholders. The survey will remain posted on the website as part of our continuous quality improvement activities. In addition to the surveys, OPC Management and staff took part in various meetings and forums where the development of the Local Business Plan was discussed. These meetings took place over several months and involved various levels of staff from within our organization. t,- ~. /` ~ 49