As part of the Integrated Care DC program, Anchor Mental Health, a division of Catholic Charities, worked with HMA coaches to better understand and address their quality data to improve clinical outcomes. This work included a focus on the use of CRISP tools as well as a review of the MCO behavioral health quality scorecards.
For example, Anchor combines CRISP Alerts, Discharges, and Transfer (ADT) feeds for consumers who have recently had an emergency department (ED) or inpatient visit. They align this data with the AmeriHealth scorecard outcomes. The Anchor quality team provides this patient-level data to its Assertive Community Treatment (ACT) team to focus its resources on the highest utilizers of BH-related ED visits. By drilling down on specific cases, they identified ways to improve transitions of care, outcomes, and patient satisfaction that may be applicable to their larger population of consumers.
ACT uses a team approach to follow-up after hospitalizations and partners with consumers to improve physical and behavioral health outcomes and reduce unnecessary ED utilization. The Anchor team was excited to report a significant reduction of emergency department (ED) visits for one consumer who had 13 visits in the fall of 2021. He now has regular follow-up visits with his primary care and specialist providers instead of emergency room encounters. He rarely visits the ED, thanks to the team providing whole-person care.
Through Integrated Care DC, our “team developed and implemented plans for improving the overall health of our consumers,” said Karen Ostlie, senior director of behavioral health transition at Anchor Mental Health. “We’re excited to continue our population health approach in improving clinical health outcomes.”
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