Pennsylvania Early Warning Monitoring Program
Mary Jeanne Serafin, MA

Pennsylvania Goals
* Statewide Mandatory MA Managed Care
* To Improve Access to Care
* To Improve Quality of Care
* To Stabilize MA Spending
* Created HealthChoices Program

HealthChoices Components Behavioral Health Component
* Carved out from Physical Health
* County Right of First Opportunity to Bid
* Managed by Co. Gov. or Private BH-MCO
* Only one BH-MCO in each County
* Enrollees assigned to BH-MCO in County
* Enrollees offered choice of providers

HealthChoices Implementation
* Start date 2/1/97
* All categories of Medicaid
* Counties or State contracts with MCO
* 895,907 lives
* Three Zones 
* Southeast, Southwest, Lehigh/Capital
* 25 Counties includes both urban and rural

Early Warning Program
* Joint SAMHSA, State, CMS Pilot
* Monitoring Program
* Limited Set Indicators
* Real Time
* Performance Based Measures
* Access
* Quality & Appropriateness
* Outcomes
* MCO Functions
* Stakeholder Feedback

Early Warning Program Purpose
* Enhance public accountability
* Improve healthcare safety net
* Direct oversight to problems
* Identify systemic stress
* Minimize burden

Early Warning Process
* County and BH-MCO involvement from the onset
* Included QM & IS staff
* Consensus on indicators

Public Accountability	
* Stakeholders
* Current Information
* Participate:
*  Indicator development
*  Evaluation of findings
*  Corrective activities
* New forums for communication and problem solving
* Enhanced stakeholder input  & confidence 

Special Needs Populations
*  Children
*  Serious and Persistently Mentally Ill
* Involuntarily committed
* Homeless
*  Minorities
*  Substance Abusers

Measurement
* Rapid
* Practical, reliable, valid 
* Lead indicators
* Multiple & redundant
* Measures       
* Sources 
* Specific indicators - event driven 
* Outcomes
* Benchmarks
* Broad indicators - open ended 

EWP Indicators 
Access
* Authorizations
* Denials
* Consumer complaints
* Provider grievances
* Provider surveys
* Change in MCO policy 
* Stakeholder feedback
EWP Indicators Quality
* Rehospitalization
* Involuntary commitment
* Provider survey
* Consumer complaints
* Grievances
* Stakeholder feedback

EWP Indicators MCO Operations
* Claims paid 
* Consumer complaints
* Provider survey
* Grievances
* Change in MCO policy
* Telephone 
* Stakeholder feedback

EWP Benefits
* Medicaid recipients
* Assure access
* General services
* Special services
* MCO
* Monitor quality
* Complaints addressed
* State,federal, local governments
* Real-time, reliable data
* Problems identified
* Improved efficiency
* Stakeholder collaboration & support 
* Advocates
* Real-time performance information
* Participation in problem identification and resolution
* Providers
* Direct feedback to state
* Assured prompt payment
* Improved treatment network 

EWP Report Access
* Mary Jeanne Serafin, MA
	Director, Quality Management Program
	Office of Mental Health and Substance Abuse Services
	300 Liberty Avenue, Room 413
	Pittsburgh, Pennsylvania 15222
	Phone (412) 880-0455  E-mail mserafin.state.pa.us
* Reports available on Department of Public Welfare website 
* www.dpw.state.pa.us/general/guides.asp