region/plan-specific news
: Commercial Health Plans - excluding California
Scores increase in multiple areas of providers' treatment records
Magellan compiles annual results of its provider treatment record review process applicable to the Magellan center serving commercial health plans in the states other than California. As reflected in 2024 results, providers complied well with most requirements.
Contracted Magellan practitioners provide us with the requested treatment records consisting of the entire medical record including intake forms and disclosures. The following summary compares CY 2023 and 2024 quality results by treatment record section.
|
Treatment record section |
2023 |
2024 |
|
1. General |
90.9% |
94.8% |
|
2. Client Rights and Confidentiality |
49.9% |
58.6% |
|
3. Initial Evaluation |
94.6% |
93.8% |
|
4. Coordination of Care (PCP Communication) |
36.1% |
55.9% |
|
5. Individualized Treatment Plan |
93.9% |
95.9% |
|
6. Ongoing Treatment |
99.7% |
99.4% |
|
7. Medication Management |
100% |
99.6% |
Results indicate increased performance in four of the seven measures and minimal change in two of the measures. Despite increased scores, there are opportunities for improvement in the Coordination of Care (PCP Communication)and Client Rights and Confidentialitymeasures as they remain below the target goal of ≥80%.
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!
The table below further breaks down results for coordination of care. Results show that only one provider measure exceeded the established target, and there are opportunities for improvement in 1) communication between behavioral health and PCPs, as well as 2) provider requests for member authorization of communication with PCPs.
|
Treatment record review results for coordination of care |
Goal |
2023 |
2024 |
|
Coordination of care between the treating clinician and other behavioral health providers |
≥ 80% |
68.2% |
96% |
|
Evidence of provider request of member for authorization to communicate with the PCP |
≥ 80% |
33.7% |
51.8% |
|
Evidence of communication with PCP after initial evaluation |
≥ 80% |
30.4% |
59.1% |
|
Evidence of at least one PCP communication at other significant points in treatment |
≥ 85% |
100% |
91.7% |
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.
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
- At treatment termination
We appreciate your efforts to increase the provision of well-integrated, whole-health member care.