Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

region/plan-specific news : California

Treatment record review and clinical practice guideline adherence shows stable trend

When Magellan* conducted our annual review of providers’ treatment record and clinical practice guideline adherence, overall the results showed a stable trend.

If you were one of the providers who responded in Magellan’s* 2019 review, thank you!

For those who aren’t familiar with our quality improvement efforts in this area, the goal of the review** is to evaluate the quality of California providers’ record-keeping practices and documentation consistency with high-priority clinical process elements.

View aggregate highlights of record reviews for three years running below.

Quality of documentation

The TRR tool evaluates treatment records for the presence of adequate documentation in the following areas.

Areas of record review

2019

2018

2017

General information comprising the treatment record

92%

95%

97%

Consumer rights/confidentiality – evidence of signed forms

66%

59%

72%

Comprehensiveness of the initial evaluation

93%

95%

96%

Coordination of care (with PCP & other behavioral health providers)

47%

58%

46%

Treatment plan thoroughness

93%

93%

94%

Ongoing treatment plan

95%

96%

94%

Medication (MDs only; member education focus)

93%

97%

96%

Referral/outreach (community resource utilization)

72%

94%

82%

Total Score

89%

90%

91%

 Overall, coordination of care across the service continuum continues to be the lowest scoring area, falling well short of targets.

Communication with PCP

Improved evidence of care coordination among all participants concerned with a member’s care is needed to achieve safer and more effective care outcomes. Note: Scores for prescribing practitioners documenting attempts to discuss care coordination with the PCP at significant points in treatment is trending in a positive direction, at 72%.

Areas of record review

2019

2018

2017

Attempted PCP contact: Percent of providers who documented efforts to obtain member permission for PCP care coordination

44%

53%

48%

Member refusal: Percent of members who refused permission for PCP care coordination

84%

92%

74%

Percent of PCP communication after initial evaluation

33%

45%

34%

Percent of evidence of PCP communication at other significant points in treatment, e.g., medication initiated, discontinued, or significantly altered; significant changes in diagnosis or clinical status; at termination of treatment

72%

58%

43%

Quality of communication: Percent of communications that were timely, appropriate frequency, sufficiency and clarity

83%

95%

97%

Members appear to be reluctant to disclose the names and addresses of relevant healthcare providers involved in their care, including the PCP.

See our related article on why educating members about coordinating care with other providers is so important.

Adherence with clinical practice guidelines (CPGs)

Areas of record review

2019

2018

2017

Major Depression Therapeutic Interventions CPG average score

86%

96%

91%

Suicide Risk Assessment & Management CPG average score

92%

94%

93%

Substance Abuse CPG average score

92%

93%

92%

     Diagnostic Assessment average score

95%

95%

97%

Substance Use Disorder Therapeutic Interventions average score

91%

89%

85%

Attention Deficit Hyperactivity Disorder CPG average score

81%

95%

88%

     Diagnostic Assessment average score

74%

95%

83%

Magellan’s record reviews showed that providers scored highly in adhering to guidelines.

In the clinical areas summarized above, most key items reflect a stable trend of documentation quality by providers.

More information

You can find quality aids including clinical templates, audit tools, clinical guidelines and the provider handbook supplement (PDF) for California on www.MagellanProvider.com.

 

*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.

**We review records for a random sample of both high- and low-volume providers, although high-volume providers comprise the majority.

2019 MarCom Gold Award Winner 2018 MarCom Gold Award Winner
2017 MarCom Gold Award Winner 2016 MarCom Gold Award Winner

About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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