The Practitioner Conection
Volume XXIX, 1st Quarter

AMBULATORY FOLLOW-UP AFTER INPATIENT DISCHARGE

Facility treatment may stabilize individuals with acute behavioral conditions, but timely and appropriate continued care is needed to maintain and extend improvement outside of the hospital. CIGNA takes a focused approach to managing the transition from inpatient to outpatient behavioral care. Performance is measured against industry benchmarks to determine if ambulatory follow-up appointments are being reasonably achieved for individuals discharged from a hospitalization.

Industry Benchmarks
The Healthcare Effectiveness Data and Information Set (HEDIS®) refers to effectiveness of care measures established by the National Committee for Quality Assurance that allow consistent monitoring of outpatient engagement rates for care following inpatient admissions. In order to facilitate successful individual treatment outcomes, CIGNA uses these standards to measure the percentage of discharges for people 6 years of age and older who were hospitalized for treatment of selected mental health disorders, where an outpatient visit, intensive outpatient encounter, or partial hospital visit with a mental health treatment professional occurs within 7 days of discharge and within 30 days of discharge. Goals are set from NCQA national averages and are 70% and 86% percent, respectively.

Improving Our Performance
To improve results CIGNA focuses on achieving an aftercare appointment within the first seven days after inpatient discharge. In 2008, CIGNA did not achieve established goals, but continued monitoring provides meaningful information for improvement regarding CIGNA's behavioral care management process and the adequacy of discharge planning.

To address our failure to meet the goals, CIGNA has attempted many strategies over time to improve these rates, including:
• Outpatient therapist or psychiatrist contact with the hospitalized individual before discharge,
• Expediting communications by quickly obtaining required Release of Information permissions,
• Finding appropriate therapists or psychiatrists who are geographically available and can schedule timely and convenient appointments,
• Handling authorizations effectively and efficiently and assisting in discharge planning, and
• Assuring that individuals have an outpatient appointment in place at the time of discharge, and a plan of treatment that they helped develop and agree upon.

Additional Efforts
One of the supports offered in 2008 is a ‘Meet & Greet' contact between the hospitalized individual and the program, psychiatrist or therapist who will provide therapy after inpatient discharge. A ‘Meet & Greet’ is a pre-discharge visit conducted for the purpose of coordinating and scheduling the ambulatory follow-up appointment within two to seven days after discharge. The ‘Meet & Greet’ does not include any counseling but offers a means for the treatment professional to meet the individual face to face and to schedule a post-discharge appointment. A CIGNA care manager will authorize the service at no cost to the hospitalized individual. Additionally, the Provider Relations Department is actively working to identify outpatient professionals located within the area surrounding high volume facilities who are able to offer appointments within seven days.

Another resource that CIGNA offers to individuals is the Intensive Care Management (ICM) Program. The purpose of this program is to improve the quality of life of people at high-risk for readmission by assisting them with the management of their behavioral health services after discharge from an acute level of care. The scope of services provided under this program include, but are not limited to, assistance with appointment reminders, coordination of treatment services between treatment professionals, and assistance managing the benefits available under the person's benefit plan. The ICM Program encourages compliance with aftercare but does not substitute for outpatient therapy.

In 2009, CIGNA will continue to partner with behavioral facilities, treatment professionals, and hospitalized individuals in an effort to improve rates for timely follow up appointments after inpatient discharge. The Provider Relations and Network Operations teams maintain practice and specialty profiles for every network professional. When a care manager is looking for outpatient resources, the specialty information is used to identify an appropriate program, psychiatrist, or therapist. You can view the specialties on your profile in the Online Directory at www.cignabehavioral.com. Because some of the specialties are periodically audited, please let your Provider Relations Representative know if changes should be made to your profile.

Other Featured Articles:

THE RELATIONSHIP BETWEEN CLAIM SUBMISSION AND ENGAGEMENT OF PEOPLE IN CHEMICAL DEPENDENCY TREATMENT

CIGNA EARNS FULL NCQA ACCREDITATION

COORDINATION OF CARE BETWEEN HEALTHCARE PROVIDERS

RECEIVING PAYMENT AT THE CORRECT ADDRESS AND CORRECT PAYEE INFORMATION

EVIDENCE BASED TREATMENT PLANNING

TELEPHONE AND APPOINTMENT ACCESS

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