Target Criteria was set for both RTF and Mental Health Inpatient providers as follows.

RTF Providers target criteria included:

1. Average Length of Stay (ALOS) less than or equal to the Network Average.
2. Ratio of Inpatient admissions to Members during the RTF stay less than the Network Average.
3. Greater than 30 Members served.
4. No founded Complaints indicative of Member Safety or other risk problems.
5. No founded Quality of Care issues indicative of Member Safety or other risk problems.
6. At least 1 RTF external quality measures better than the HealthChoices average.
7. Verified reporting of restraint episodes to CBHNP.

MH Inpatient Providers target criteria included:

1. Average Length of Stay (ALOS) less than or equal to the Network Average.
2. 30-day Readmission Rate less than or equal to the Network Average of 11.47% for children or 14.45% for adults since no provider met the desired gold standard of equal to 10%.
3. No Complaints indicative of Member Safety or other Risk problems.

1. Programs having an average monthly census of greater than 75 children.
2. Data gathered for BHRS providers is for the purposes of comparison and ranking.

Specialized Evalutors high volume definition included:

1. Evaluators submitting an average of 20 or more initial evaluations per year.
2. Data gathered for Specialized Evaluators is for the purposes of comparison and ranking.

Non-Specialized Evaluators high volume definition included:

1. Evaluators submitting an average of 15 or more initial evaluations per year.
2. Data gathered for Non-Specialized Evaluators is for the purposes of comparison and ranking.

The high-volume definitions used for purposes of provider profiling are:

• RTF – Facilities with greater than 20 admissions during the Contract Year
• 14 RTF providers qualified as high-volume
• No RTF provider met all of the provider profiling target criteria

• MH Inpatient – Facilities with greater than 100 discharges in the Contract Year
• 13 providers qualified as high-volume
• The IP facilities that served Members from the North Central Regions were profiled using only three months worth of available data.
• 5 MH Inpatient providers met all of the provider profiling target criteria:
  Chambersburg Hospital
  Holy Spirit Hospital – Behavioral Health Services
  Lancaster General Hospital
  Lancaster Regional Medical Center - IP
  PinnacleHealth Hospitals, Inc

• BHRS – Agencies with Average Monthly Census of at least 75 Members
  • 7 providers qualified as high-volume for the Capital Region
    

    Each high-volume BHRS provider is listed in rank order against peers (with 1 being the best performing provider on these identified criteria):
    
    1. CSG
    2. Philhaven
    3. Northwestern Human Services - Edgewater
    4. Pennsylvania Counseling Services, Inc.
    5. Milestones
    6. T.W. Ponessa
    7. Youth Advocate Programs

    While ranked for performance, the differences between providers were generally small and all are in good standing.

  • 8 providers qualified as high-volume for the North Central Regions
    
    Each high-volume BHRS provider is listed in rank order against peers (with 1 being the best performing provider on these identified criteria):
    
    1. Alternative Community Resource Programs (Bedford/Somerset)
    2. Robert Lambert (Blair)
    3. Northwestern Human Services (Franklin/Fulton)
    4. Community Services Group (Lycoming/Clinton)
    5. Northwestern Human Services (Lycoming/Clinton)
    6. Children’s Behavioral Health (Bedford/Somerset)
    7. Northwestern Human Services (Blair)
    8. Manito (Franklin/Fulton)

    The BHRS providers in the North Central Regions were profiled using only three months worth of available data.  While ranked for performance, the differences between providers were generally small and all in good standing

Provider profiling is an important provider-level quality improvement activity and is reviewed by Credentialing Committee, Quality Improvement Committee, and is subsequently made available to the Members of CBHNP.