region/plan-specific news
: Commercial Health Plans in AL, AZ, CO, CT, DE, FL, HI, IL, LA, MD, NC, NJ, OH, OR, PA, SC, TN, TX
Scores increase in multiple areas of providers' treatment records
Magellan compiles annual results of its provider treatment record review (TRR) process applicable to the Magellan center serving commercial health plans in the states listed above. In 2022, providers complied well with most TRR requirements.
Contracted Magellan providers provide us with the requested treatment records, consisting of the entire medical record including intake forms and disclosures. The following summary compares 2021 and 2022 quality results by treatment record section.
|
Treatment record section |
2021 |
2022 |
|
1. General |
92.8% |
92.0% |
|
2. Client Rights and Confidentiality |
62.7% |
55.7% |
|
3. Initial Evaluation |
92.9% |
93.2% |
|
4. Coordination of Care (PCP Communication) |
50.3% |
46.0% |
|
5. Individualized Treatment Plan |
91.9% |
91.5% |
|
6. Ongoing Treatment |
99.4% |
99.6% |
|
7. Medication Management |
98.2% |
98.3% |
Year-to-year comparison results indicate steady performance in five of the seven measures, and opportunities for improvement in the Coordination of Care (PCP Communication) and Client Rights and Confidentiality measures. As you know, a member’s mental health can impact their medical treatments (and vice versa), so it is important to share information with the member’s PCP. Thank you for your commitment and attention to this area!
In the table below, coordination of care is further analyzed. Results show that all measures except one exceeded the established targets, and there is an opportunity for improvement in provider request of member authorization for PCP communication.
|
Treatment record review results for coordination of care |
Goal |
2021 |
2022 |
|
Coordination of care between the treating clinician and other behavioral health providers |
≥ 80% |
97.1% |
95.6% |
|
Evidence of provider request of member authorization for PCP communication |
≥ 50% |
50.9% |
41.5% |
|
Evidence of communication with PCP after initial evaluation |
≥ 55% |
64.1% |
56.6% |
|
Evidence of at least one PCP communication at other significant points in treatment |
≥ 85% |
100% |
93.8% |
Once the behavioral health provider receives member authorization, it’s vital to document—in the record—evidence of coordinating care with other providers, including medical providers, after the member's initial evaluation and on an ongoing basis. This coordination keeps all participating clinicians up to date on the member’s treatment experience.
Providers should communicate with PCPs at significant points in treatment, including when there are safety issues; at the time of significant changes in clinical status such as hospitalization; after medications are initiated or significantly altered; after significant changes in diagnosis or treatment plan; and at treatment termination. This communication solidifies the treatment team’s efficacy and makes positive member outcomes more likely.