G5 : Building a Community System of Care for Adults with MH/AD Disorders DATA UPDATE

1. G5: Building a Community System of Care for Adults with MH/AD DisordersDATA UPDATE March 5, 2009

2. Focus • Review of data to see where we are relative to hospital and community services • Original intent was to compare with August 2007 presentation • Limted FY07 data presented (Q1-Q3) and inconsistent standardization of units made this difficult w/o re-running the FY07 results. • Answer questions about the Game Plan • Identification of indicators to be tracked to see how we’re doing w/ the transition

3. Desired Regional-Based System of Care Service Array Single Point of Entry • Basic Clinical Services • Physician Assessment • Diagnostic Assessment • Nursing Services • Counseling • Medication • Daily Living Skills Training • Inpatient Treatment • Extended care, facility-based • Crisis and Acute Care • Mobile Crisis CSP • Acute care beds • 23 hour obs • Evidence-Based Recovery Support Services • ACT • Intensive case management • Supported Housing/ITR • Supported Employment

5. Crisis services

6. Consumers Discharged from State Hospitals with LOS <= 3 Days, FY2007-08 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to regions based upon county of residence • Why change or no change? Where is acute/crisis capacity needed or where should it be better utilized?

7. Consumers Discharged from State Hospitals with LOS <= 3 Days, FY2008 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to areas based upon county of residence • Where is acute/crisis capacity needed or where should it be better utilized?

8. Consumers Discharged from State Hospitals with LOS <= 14 Days, FY2008 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to regions based upon county of residence • Where is acute/crisis capacity needed?

9. Consumers Discharged from State Hospitals with LOS <= 14 Days, FY2008 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to areas based upon county of residence • Where is acute/crisis capacity needed?

10. Consumers Discharged from State Hospitals with SA primary DX, FY2007-08 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to regions based upon county of residence • Why change or no change? Where is SA crisis capacity needed?

11. Consumers Discharged from State Hospitals with SA primary DX, FY2007-08 • Non-court controlled consumers discharged from AMH and secure cost centers • Discharged consumers assigned to areas based upon county of residence • Where is SA crisis capacity needed?

13. CSP Adult Consumers Served (Encounters), FY2008 • Most beds in Region 4 (117), followed by Region 1 (80) and Region 3 (74) • Region 3 – on a per capita basis, low CSP utilization and very low numbers of short hospital stays and SA discharges • Region 1 – on per capita basis, high CSP utilization and low numbers of short hospital stays and SA discharges • Region 4 - on per capita basis, high CSP utilization and high numbers of short hospital stays and SA discharges

14. CSP Adult Consumers Served (Encounters), FY2008 • Compare with carts of state hospital LOS and SA discharges in state hospitals. Again, less than perfect relationship.

15. CSP Adult Consumers Served (Authorizations), FY2008 • In terms of consumers served, authorizations almost identical to encounters. Focusing on encounters rather than authorizations should not skew results.

16. Crisis Services Adult Consumers Served (Claims & Encounters), FY2008 • Charts above allow the examination of array of crisis services (instead of just CSPs) by region • Services include CSP, ambulatory detox, residential detox, and crisis intervention • For example, Region 1 depends almost exclusively on CSP beds

17. Core Services

18. Core Svcs Adult Consumers Served (Encounters), FY2008 • On per capita basis, high utilization in South Georgia, less utilization in Metro Atlanta

19. Core Svcs Adult Consumers Served (Encounters), FY2008 • Within regional boundaries, utilization can vary. See Region 2 (Gainesville) and Region 5 (Savannah).

20. Day services

21. Day Services Adult Consumers Served (Claims & Encounters), FY2008 • Day services include SA Day, Intensive Day (Partial Hosp), Peer Supports, and Psychosocial Rehab • On a per capita basis, day services more heavily utilized in South Georgia. • Regions 1-3 have similar distributions across services (except Region 3 relies more on PSR and SA Day and less on peer supports) • Regions 4-5 have a similar distribution of day services.

22. Day Services Adult Consumers Served (Claims & Encounters), FY2008 • Day services include SA Day, Intensive Day (Partial Hosp), Peer Supports, and Psychosocial Rehab

23. Supported Employment

24. Supported Employment Adult Consumers Served (Encounters), FY2008 • 1,577 consumers statewide

25. Summary Billing Data

26. Adult Units X Rates (Medicaid & State), FY2008

27. Adult Units X Rates (Medicaid & State), FY2008 • Per claims and encounters, Region 4 bills almost 2X the community services as Region 1. • Similar distribution across regions. Crisis=10%, core= 67%, day= 8%, community support = 15%. What is the proper distribution?

28. Adult Units X Rates (Medicaid & State) – Per MH/AD Prevalence, FY2008

29. Adult Units X Rates (Medicaid & State) per MH/AD Prevalence, FY2008 • Based upon claims and encounters submitted, Region 3 and 4 outliers in terms of per capita utilization.