Quality is Our Top Priority

Our Quality Improvement Program focuses on a number of initiatives each year and, for each one, identifies specific improvement goals and tracks progress toward them. Summaries of several current quality improvement initiatives are below:

Improve Coordination of Care

When a patient is seeing multiple providers, it's critical that all of them know what the others are doing. To achieve better coordination of care between behavioral health and primary care providers, MHN:

• Promotes care coordination using the following channels:
  • A statement on MHN's online Provider Portal and in its Practitioner Manual
  • An orientation letter sent to all new MHN practitioners
  • Reminders in re-credentialing paperwork
• Developed and distributes a Behavioral Health Coordination Form that facilitates information-sharing about the patient's treatment plan/s
• Makes outreach phone calls to encourage MHN's behavioral health providers to talk with members about sharing information with healthcare providers regarding the member's care

• Encourages members:
  • To be informed about the importance of carrying a list of all their healthcare providers and medications
  • To give consent, if asked, so that information-sharing among healthcare providers can occur
  
  

  Increase Member Satisfaction

  MHN systematically monitors member satisfaction and has done so for many years. Satisfaction surveys seek to determine for example, how satisfied members are with MHN's responsiveness and with their outpatient providers. MHN's goal is that at least 85% of members rate their satisfaction as "good," "very good" or "excellent." In 2009, MHN exceeded the goal overall on each of the survey items: more than 90% of members reported high levels of satisfaction with various aspects of their behavioral healthcare. MHN's Quality Improvement Committee monitors member satisfaction quarterly. To this end, MHN encourages all members to complete a satisfaction survey upon receipt by mail.

  
  

  Improve Follow-Up After Psychiatric Hospitalization

  Ensuring timely outpatient follow-up is one important way to improve behavioral health services. This is because inpatient psychiatric treatment generally addresses only the most pressing emergency issues, such as resolving a crisis or making sure that someone is no longer at risk of hurting themselves or others.

  In other words, treatment only begins in the hospital. Most of the lasting and meaningful care patients receive happens as a result of a good partnership, built over time, in a behavioral health provider's or doctor's office. Being seen soon after discharge helps ensure that a recovery plan is in place and that prescribed medicines are at the right doses. Follow-up surveys show that only about half of patients are seen by a behavioral health practitioner within the first week of discharge.

  Improving follow up after inpatient services is an important focus for MHN. Our policy is that members who have been in a psychiatric hospital should have an appointment with a behavioral health practitioner within the first week (seven days) after leaving the hospital. A special work group has been meeting since 2001 and is dedicated to educating providers, members and hospitals about the importance of mental health follow up. Among Health Net of California members, follow up within seven days has risen from 28 percent in 2000 to 58 percent in 2009.

  
  

  Members are encouraged to keep scheduled aftercare appointments and to contact MHN if they need assistance arranging one.

  
  

  Improve Depression Treatment Outcomes

  In 2008, MHN found that more than 40 percent of Health Net of California outpatient adult claims were for services related to depression. In any given year, 10-20 percent of adults in the US have a depressive disorder. Although depression is a very common condition, many people do not receive optimal treatment. This is due to a variety of reasons, including incorrect diagnosis, improper medication (type or dose) or inadequate follow up care.

  Making sure individuals with depression are diagnosed and treated properly is an important public health concern, and MHN is addressing it by ensuring that members have easy access to our network of providers or doctors. Toward this end, we have:

  • Recruited more psychiatrists and eliminated their re-authorization requirements
  • Posted clinical screening tools, articles and clinical practice guidelines about depression on our provider website
  • Reduced practitioner paperwork
  • Included patient education information in the Depression Clinical Practice Guideline, a best practices resource for providers

  As a result of these improvements, in 2009, more than 90 percent of health plan members reported that routine appointments were scheduled to their satisfaction. In addition, MHN made appointments available to members with urgent clinical needs more than 90 percent of the time in 2009.

  
  

  Improve Treatment Initiation and Completion Rates for Hazardous Substance Abuse

  The misuse of alcohol or other drugs is a serious and prevalent problem. Unfortunately, many people who are identified with alcohol or other drug problems don't receive a full course of treatment. According to one large quality assurance organization (NCQA), in 2009 fewer than half of those identified as having an alcohol or drug problem actually initiated some kind of treatment, and more than 75 percent of those who started treatment discontinued prematurely.

  A key focus of our clinical care managers is promoting comprehensive treatment planning. Through care shaping questions, care managers attempt to ensure that substance use is assessed in every case and addressed when it needs to be. Research shows that the more one remains involved in some kind of substance abuse program, the better the odds of recovery. Through the use of attendance confirmation and post-discharge follow-up calls, MHN reaches out to providers and members to encourage those who begin treatment to stick with it. For example, if a behavioral health provider diagnoses a member with an alcohol or other drug problem, MHN would encourage the member to attend at least three more visits with the provider within the next month or so. (According to the National Institute of Alcoholism & Alcohol Abuse, problem drinking in men under 65 means drinking more than 14 drinks per week, or drinking more than 4 drinks on one occasion, or drinking during high risk situations, e.g., while driving.) For assistance with alcohol-related issues, please speak with a primary care physician or contact MHN for information about referrals.