region/plan-specific news
: California
Adherence to treatment record and clinical practice guideline standards stays strong
The Human Affairs International of California (HAI-CA)* care management center recently completed collating the results of its annual member treatment record review, which included clinical practice guideline audits for select diagnostic categories. The results show a positive continuing trend of providers following best practices.
For the review, HAI-CA examined a representative sample of records from California network providers (some see a high volume of Magellan members and some a low volume).
Quality of providers' documentation
Using a formal treatment record review tool, our staff evaluated providers’ records for the presence of specific documentation comprising a comprehensive record. Results for 2024 are presented below. The aggregate quality goal for 2024 was 89%.
|
Treatment Record Area |
2024 Result |
|
Clinical criteria that reflect a generally accepted standard of care |
93% |
|
Consumer rights and confidentiality |
77% |
|
Comprehensive initial evaluation |
92% |
|
Individualized treatment planning |
89% |
|
Quality of ongoing treatment, including special populations |
92% |
|
Community referral/outreach |
90% |
|
Coordination of care |
69% |
|
Criteria that reflect accepted standard of care for medication management |
91% |
|
TOTALS |
89% |
Items with highest satisfaction:
- Clinical criteria that reflect a generally accepted standard of care
- Comprehensive evaluation
- Quality of ongoing treatment, including special populations
- Criteria that reflects accepted standard of care for medication management.
Key opportunities:
- Coordination of care between providers, including primary care
- Patient rights information provided at beginning of treatment
To address concerns in these key areas:
- Quality clinical reviewers provide individualized feedback and consultation to providers
- An audit tool is available online for providers to access.
Adherence with clinical practice guidelines (CPGs)
This review examined the extent to which clinical interventions that providers implement for members are consistent with our well-established CPGs, applicable to specific diagnostic groups.
Please see results below. Our Providers continue to exceed the benchmark of 80% for all Clinical Practice Guidelines.
|
Treatment Record Area |
2024 |
|
Attention Deficit Hpyeractivity |
85% |
|
Major Depression |
94% |
|
Suicide Risk |
96% |
|
Substance Use Disorder |
96% |
Applied behavior analysis results
Magellan also conducts an annual applied behavior analysis (ABA) TRR process. For 2024, providers met or exceeded documentation requirements across all quality domains. The audit scores averaged 97% and all but one area was above the passing threshold of 80%. An opportunity for improvement in coordinating discharge planning for client was identified.
Resources to assist you in treatment planning
Magellan quality clinical reviewers offer individualized feedback and consult with providers regarding treatment record reviews. Providers who receive review data regarding the records reviewed can speak with licensed clinicians about their results.
For additional information about treatment records and quality reviews, visit our Clinical Forms page. Navigate to our Clinical Guidelines page for the tools we use to assist providers in screening, assessing and treating many common disorders.
Thank you for your ongoing commitment to providing quality behavioral healthcare services.
*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.