Carisk is committed to providing compassionate care for all Pathways 2 Recovery, with access to patient-centered personalized services, careful assessment of their physical and emotional needs, customized treatment plans and coordinated care.
AVAILABILITY AND ACCESSIBILITY
Carisk maintains strict standards for the number of psychiatrists, psychologists, masters-level therapists, and facilities per 1,000 Members. All Members are within 30 minutes’ drive to a Carisk network Provider; on average a Member is within 5 minutes to a Carisk Provider and 10 minutes to a hospital. Carisk regularly assesses the ability of the Practitioner Network to meet the linguistic, cultural and special needs and preferences of the Membership. We add new practitioners on a regular basis to continue to meet our standards and the needs of the Membership.
Carisk standards for accessibility to outpatient appointments are:
- Routine care within 10 business days for Commercial health plan Members and within 7 business days for Medicare and Medicaid Members.
- Urgent care within 48 hours for Commercial health plan Members and within 24 hours for Medicare and Medicaid Members.
- Non-life threatening emergency care within 6 hours.
- Medication evaluations by psychiatrists within 10 business days for Commercial Members and within 7 business days for Medicare/Medicaid Members.
- Psychiatric consults within 6 hours for stat consults and within 24 hours for routine consults.
- Psychological testing within 30 days for Commercial/Medicare/Medicaid Members.
Members with urgent care needs and non-life-threatening emergency care needs are tracked. The Members who did not keep their appointments within the specified time frames frequently arranged times that were more convenient to them and were not at risk. Personal scheduling issues of the Member (vacation, work schedules, etc.) were found most often to be the reason why Members did not keep their appointments within time standards.
Carisk’s standard for the average time to answer the telephone is within 30 seconds. The Carisk standard for telephone call abandonment rate (the number of calls where the caller hangs up before reaching a live operator), is less that 5 percent. We also have staff and practitioners available to assist Members in languages other than English, including Spanish, Creole, and French.
Carisk also has a TTY line available for the hearing impaired. The telephone number to access this service is 305.514.5399 or 855.276.7285.
CONTINUITY AND COORDINATION OF CARE
Carisk has many activities that focus on improving the coordination of care between behavioral health and medical care and also among all behavioral practitioners treating the same Member. This is important for Member safety. We encourage Members to sign consent to release information to facilitate communications with primary care physicians (PCPs) and behavioral health practitioners.
The rate of communication between practitioners is tracked using practitioner surveys every quarter. Information regarding treatment coordination is also included in treatment record review.
Carisk has noted that one of the major barriers to improved coordination is refusal of the Member to sign the required release of authorize coordination with the PCPs. Carisk will continue to educate practitioners, CMHCs and Members about the importance of coordination of care through communication on the Carisk website and in the Member and practitioner newsletters.
Carisk began compiling an annual Practitioner Profile Report (Provider Report Card) in an effort to inform Providers on their average episodes, average length of stay, and coordination rates compared to the network averages as an effort to increase coordination rates to standard level. The Provider Report Card is mailed annually to all practitioners.
Member satisfaction is very important to Carisk. A Member satisfaction survey is conducted annually. More detailed information on the Member satisfaction survey results can be accessed upon request.
Carisk considers complaints carefully. Complaints from Members are reviewed individually as soon as they are received, and a thorough investigation of the issues surrounding the complaint is conducted. Although the time standard for resolving complaints is 30 days from receipt, Carisk strives to resolve all complaints within 24 hours. The Member is notified of the resolution of the complaint and of the right to appeal the decision, if appropriate. Appeals of the proposed resolution of complaints are also carefully considered.
On a regular basis, Carisk conducts a Practitioner Satisfaction Survey for practitioners who have seen at least five (5) Members in the past year.
In the most recent survey, overall satisfaction with Carisk Behavioral Health was excellent at 92.4%. Average satisfaction with the member services department was 88.3%, average satisfaction with the claims department was 81.2%, and average satisfaction with the utilization management department was 79.3%. Representatives from Operations and Clinical Services analyze the results and comments to determine appropriate interventions to improve provider satisfaction in the identified areas. On an ongoing basis, Carisk reviews, tracks and trends practitioner satisfaction input through this formal evaluation process. This process provides a means for how well Carisk is meeting the needs of practitioners and identifies additional opportunities for improvement to increase practitioner satisfaction levels going forward.
CLINICAL PRACTICE GUIDELINES
Carisk has adopted eight clinical practice guidelines. These guidelines have all been developed by medical specialty societies. The following six guidelines have been adopted from the American Psychiatric Association:
- Major Depression Disorder in Adults
- Treatment of Patients with Panic Disorder
- Treatment of Patients with Bipolar Disorder
- Treatment of Patients with Substance Abuse Disorders: Alcohol, Cocaine, Opioids
- Assessment and Treatment of Patients with Suicidal Behaviors
- Treating Schizophrenia
Two guidelines related to the treatment of children and adolescents have been adopted from the American Academy of Pediatrics:
QUALITY IMPROVEMENT PROGRAM
Carisk’s Quality Improvement Program is designed to improve the quality of clinical care and service that is provided to Members. We continually monitor and assess our performance in areas we consider key to providing quality care, excellent customer service and improving Member safety. The Quality Improvement Program includes activities designed to measure and assess performance in areas such as:
- Availability – the distance Members need to drive to reach practitioners and facilities, and the number of practitioners and facilities needed per 1000 Members
- Accessibility – the time for Members to be offered appointments for routine care, urgent care and non-life-threatening care
- Accessibility statistics for how quickly Members receive assistance when calling Carisk by telephone
- Member satisfaction activities that include annual surveys and analysis of complaints and appeals
- Adherence to clinical practice guidelines
- Continuity and coordination of care within the behavioral health continuum and between behavioral health and medical delivery systems and practitioners
- Specific clinical quality improvement activities
- Increasing the number of Members who complete an initial outpatient appointment within 30 days of discharge from inpatient care for a behavioral health condition
- Increasing the number of Members under age 18 who complete four or more outpatient visits within 90 days of an ADHD diagnosis
- Increasing community tenure for individuals with severe mental illness
The Quality Improvement Committee (QIC) oversees implementation of the Quality Improvement Program. The QIC is chaired by the Medical Director and includes a range of practitioners who treat Members in all settings. The QIC sets standards and goals for measurement activities, collects data to measure performance against the standards and goals, analyzes data, determines interventions to improve performance, oversees implementation of the interventions, and schedules re-measurement to evaluate the effectiveness of interventions. The Quality Improvement Director oversees and implements the activities of the Quality Improvement Program and, in collaboration with the Medical Director, prepares an annual evaluation of the Quality Improvement Program.
If you would like more information about the Quality Improvement Program, or paper copies of materials, please contact the Carisk QI Department at 305.514.5300. We welcome your comments and ideas about how we can improve our care and services.
Clinical Quality Improvement Activities
Carisk has identified specific clinical quality improvement activities that affect a significant portion or high risk segments of the Membership. Interventions have been implemented over time to successfully improve performance in these areas.
The rate of Members who complete an initial outpatient appointment within 7 or 30 days of discharge from inpatient care for a behavioral health condition is monitored on a quarterly basis.
BEHAVIORAL HEALTH SCREENING PROGRAMS
Carisk has established two behavioral health screening programs that are designed for Members with specific diagnoses. These programs are for Major Depressive Disorders (MDD), and Alcohol Use. Members who have used the programs tell us that the programs are very helpful.
Carisk is interested in helping our Members and their families stay healthy. The purpose of the Behavioral Health Screening Program is to determine whether a Member warrants attention for a mental health and/or substance use condition. Screening determines the likelihood that the Member has one or more mental health and/or substance use disorders.
We have developed two Behavioral Health Screening Programs for common behavioral health conditions. These programs provide your Members with the opportunity to complete a self-assessment with information that will help you assess and treat their behavioral health conditions. The Behavioral Health Screening programs cover depression and alcohol abuse.
Major Depressive Disorder
MDD is one of the most frequently seen mental health diagnosis in adults. About 6% of the general population may be depressed at any given time. Some people who are depressed have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still others can function reasonably well at work and put on a “happy face” in front of others, while deep down they feel quite depressed and disinterested in life. There is no one way that people look and behave when they have major depression. Whenever Carisk becomes aware that an enrollee has been diagnosed with MDD, we automatically send the American Psychiatric Association’s MDD Patient and Family Guide to the enrollee. This Guide contains valuable information on MDD and its treatment, and provides resources to get more information on MDD. For more information on the program, or to receive a copy of the Guide, please call Member Services at 855.541.5300. We strongly encourage you to take advantage of this program if you or a family member has symptoms of MDD.
In life, everyone has moments of feeling sad or down at times. But these feelings are usually temporary and pass within a few days. When someone has depression, it interferes with their everyday life. If you feel sad often and think you may have depression, take the assessment quiz.
Screening for at-risk drinking is recommended for all adults. The AUDIT for Adults is a validated, reliable, public domain at-risk-drinking screening instruments that are suitable for self-administration and recommended for this population. The CDC recommends that health plans screen Members for at-risk drinking.
Excessive alcohol consumption can have serious short-term and long-term effects on one’s body and health. The CDC lists some of the short-term risks include, injuries, alcohol poisoning, and violence. Long-term risks include high blood pressure, heart disease, stroke, and liver disease. To get an idea if you may have an issue with alcohol, take the assessment quiz.
PSYCHIATRIC ADVANCE DIRECTIVE
A Psychiatric Advance Directive is a legal document written by a currently competent person who lives with a mental illness. It describes the person’s mental health treatment preferences, or names an agent to make treatment decisions for the individual, should he or she become unable to make such decisions due to psychiatric illness (NAMI, 2015).
Carisk encourages Members to discuss Psychiatric Advance Directives with their Behavioral Health Practitioner and inquire on how to create one. There may come a time when you are unable to make your own treatment decisions. Be prepared.
Please click here for additional information related to Advance Directives in the state of Florida.
AVOID MEDICATION ERRORS
A medication error is “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer,” according to the National Coordinating Council for Medication Error Reporting and Prevention. The council, a group of more than 25 national and international organizations, including the U.S. Food & Drug Administration (FDA), examines and evaluates medication errors and recommends strategies for error prevention
Click here to read important information from the FDA designed to educate consumers on how they can help reduce medication errors by remaining actively involved in their care.