Provider Newsletter April 2011 - Community Care Behavioral Health

THE
A Newsletter for Community Care HealthChoices Providers
PROVIDER
LINE
Vol 2-2011
Interested in Learning
More About SMIs and
PBIs
Through ongoing collaboration with network providers,
Community Care monitors the quality of member
services. Two processes utilized include Significant
Member Incident (SMI) and Provider Benchmarking
Issue (PBI) activities.
The SMI process includes timely reporting to
Community Care by providers of identified adverse
events and subsequent review of actions taken to
ensure member safety. PBIs are monitored through
an internal process and consider multiple aspects of
service and access to care.
Community Care’s Quality Management department
will be offering a webinar to all providers who would
like to learn more about both of these processes.
The webinar will include SMI categories, definitions,
and reporting requirements, along with the specific
performance standards that are monitored through the
PBI process.
The webinar will be conducted on Wednesday, June
29, 2011, from 11:00 a.m.- 12:00 p.m. Registration is
required. Providers may register using the following
link: https://ccbh.webex.com/ccbh/onstage/g.
phpt=a&d=710004145. We look forward to your
participation in the training and discussion.
SAVE THE DATE...
Community Care’s 2011 summer
institute, “RECOVERY for the
mind and body,” is being held:
August 11, 2011
at the Danville Elks Club
in Danville. PA
August 17, 2011
at the Royal Palace Inn
in Ridgway, PA
August 30, 2011
at the Yorktowne Hotel
in York, PA
Intended for service providers,
consumers, families, and other
behavioral health stakeholders,
the institute will focus on the
relationship between physical
health and serious mental
illness, how recovery strategies
can be used to help with physical
health challenges, and the role
of physical health in behavioral
health recovery plans. Mark your
calendar and watch for more
details!
1
Community Care Provider Line: 1-888-251-CCBH (2224)
© 2011 Community Care Behavioral Health Organization

2
Substance Use
Disorders Among Older
Adults-A Growing Issue
In 2009, it was estimated that 2.8 million people in
the United States age 50 and older had a substance
use disorder. By 2020, this number is expected to
double.
Older adults who abuse drugs or alcohol are
at greater risk for physical and mental health
complications, including drug-medication
interactions, delirium, memory loss, falls, and
fractures. This group also is at greater risk for
hospitalization, nursing home placement, and
serious health problems, including death.
Older adults often experience addiction to drugs
and alcohol differently than younger age groups.
Some adults enter late age with a lifetime history of
drug and alcohol abuse. Others develop problems
in combination with the physical, cognitive and
behavioral issues more likely to be present in
older adults. For example, as their bodies change,
older adults are less able to metabolize alcohol.
Also, they are commonly prescribed drugs with
abuse potential, such as sleeping medications
and narcotic pain killers. Depression, anxiety and
cognitive effects of aging such as confusion and
forgetfulness may also play a role. Other social
factors common to older adults, including isolation,
loss, changing roles, and economic hardship can
also contribute to the development of substance
use problems. The good news is that certain
factors, such as supportive family and social bonds,
access to resources, involvement in the community
and ability to live independently, can protect against
the development of a substance use disorder in
older adults.
In addition, an estimated 50% of older adults with
substance use disorders also have a co-occurring
mental illness, such as depression and anxiety.
Substance use disorders are also considered
chronic conditions, requiring intensive and
sometimes long-term support. Although there is
no cure, addiction can be managed with proper
treatment and persons can recover.
Identification and treatment of substance use
disorders in this population can be a challenge.
Older persons may be reluctant to ask for help
with issues of substance use disorders because
of feelings of shame or denial. Families may
also be unaware of the problem or find the use
socially acceptable. Clinicians may have difficulty
diagnosing substance use disorders in older
adults because the symptoms often look like other
disorders, such as dementia or depression. Some
clinicians find it difficult to address the problem
with their older clients or may also ignore the
problem believing it’s not worth treating substance
abuse in older adults.
It is important for older adults to talk to with their
health care providers about these issues. Treatment
approaches for substance use disorders that take
into account the physical, social, and cognitive
effects of aging are best. The PA Client Placement
Criteria for Adults (PCPC) are guidelines designed
to provide clinicians with a basis for determining the
most appropriate level of care for persons with drug
and alcohol problems. Levels of care available range
from medically managed inpatient programs and
residential programs, to outpatient programs.
To learn more, contact Community Care or visit:
• SAMSHA (Substance Abuse and Mental Health
Service Administration): www.samhsa.gov
• IRETA (Institute for Research, Education and
Training in Addictions): www.ireta.org
• National Institute on Aging: www.nia.nih.gov
Community Care Provider Line: 1-888-251-CCBH (2224)

Always Online
We would like to remind you about our website,
www.ccbh.com. We include information about
many topics of interest here. You can view and/or
download information about the following topics
on our website by clicking on Provider Resources,
HealthChoices Resources, and then Informational
Articles.
• Information about our Quality Improvement
Program including goals, processes, and
outcomes related to care and service.
• Our efforts to measure the accessibility of care
and service for members, such as how long it
takes to get an appointment, and actions taken
to improve accessibility.
• The clinical practice guidelines and processes
utilized to measure adherence to the guidelines.
• Our expectations for exchange of information
with PCPs and within the behavioral health
continuum to facilitate continuity and
coordination of care.
• Our Medical Necessity Criteria, including how to
obtain or view a copy.
• The toll-free number to contact staff regarding
utilization management issues, or if you have a
utilization management question.
• The availability of, and process for, contacting
an appropriate professional advisor to discuss
utilization management decisions.
• A description of the availability of an
independent external appeals process for
utilization management decisions made by
Community Care.
• Our policy prohibiting financial incentives for
utilization management decision-makers.
• Members’ rights and responsibilities.
• Our confidentiality policies including: what a
“routine consent” is and how it allows us to
use information about enrollees; a member’s
right to approve release of personal health
Community Care Provider Line: 1-888-251-CCBH (2224)
w w w.ccbh.com
information not
covered by “routine
consent;” how members
may request restriction
on the use or disclosure of
personal health information,
amendments to personal
health information, access to personal health
information or an accounting of disclosures of
personal health information; our commitment
to protect the member’s privacy in all settings;
and our policy on sharing personal health
information with employers.
• Information about our preventive behavioral
health programs including how successful these
programs have been.
• For our treatment record policies regarding
confidentiality of treatment records,
documentation standards, systems for
organization of treatment records, standards for
availability of treatment records at the practice
site and performance goals, please see your
Provider Manual, which can also be found at
www.ccbh.com.
• For a description of the process to review
information submitted to support your
credentialing application, correct erroneous
information and upon request to be informed
of the status of your credentialing and
recredentialing application, please see your
Provider Manual, which can also be found at
www.ccbh.com.
If you have questions about accessing our website
or would like more information or paper copies of
any of the above items, call 1-888-251-2224.
Please call Community Care’s
Provider Line toll-free
at 1-888-251-2224
to report all adverse events.
3

4
Pharmacy News
Antipsychotic utilization trend
for children in HealthChoices
Allegheny County
There are significant concerns regarding the use
of antipsychotics in children and adolescents.
Antipsychotics are often prescribed in this
population to treat nonpsychotic disorders
and for off-label indications. Studies have
indicated that children and adolescents when
compared to adults, have higher rates of some
antipsychotic-induced adverse effects. These
include sedation, extrapyramidal side effects,
withdrawal dyskinesia, prolactin elevation,
weight gain, and some metabolic abnormalities.
The article, Cardiometabolic Risk of Second-
Generation Antipsychotic Medications During
First-Time Use in Children and Adolescents,
reported substantive weight gain during a 12 week
trial of Abilify, Zyprexa, Seroquel or Risperdal
in children who had not previously received an
atypical antipsychotic. Weight gain, ranging from
an average of 10 pounds with Abilify to an average
of 19 pounds with Zyprexa was noted for all 4
antipsychotic medications. Considerable increases
in glucose, cholesterol and triglyceride levels were
also observed during the 12 week trial. 1 There are
concerns that these adverse effects may cause
long-term health consequences.
Prior authorization policies regarding
antipsychotic use in children have been put into
place by DPW and physical health plans to help
address the above concerns. UPMC for You is
the only health plan in Allegheny County to have
an antipsychotic prior authorization policy that
includes children between the ages of 6 and
11. Antipsychotic prior authorization policies
regarding use in children currently in place by
other Medicaid physical health plans in Allegheny
County are for children less than 5 years of age or
for children less than 6 years of age.
Community Care conducted trend analyses to
determine if UPMC’s prior authorization policy
on antipsychotic use in children has decreased
antipsychotic utilization in this population.
Antipsychotic utilization of all HealthChoices
members aged 0-11 in Allegheny County was
compared to the antipsychotic utilization of UPMC
for You members in Allegheny County aged 0-11
each month from January 2009-October 2010. The
results show a significant decrease in utilization for
UPMC for You child members in Allegheny County
compared to the Allegheny County HealthChoices
aggregate. These results will be reviewed with
all Allegheny County Medicaid health plans and
other stakeholders since this off-label use of
antipsychotics in children has been identified as a
potential quality of care concern.
1. Correll CU, Manu P, Olshanskiy V, et al. Cardiometabolic risk of
second-generation antipsychotic medications during first-time use
in children and adolescents. JAMA. 2009;302(16):1765-1773.
Study finds off-label prescribing
of antipsychotics increasing
A recent study published online in
Pharmacoepidemiology and Drug Safety identified
that many prescriptions written for atypical
antipsychotics are given for off-label use in the
absence of strong evidence.
Researchers at the Stanford University School
of Medicine and University of Chicago analyzed
the results of a physicians’ survey, the IMS
Health National Disease and Therapeutic Index
survey. The survey looks at conditions treated by
the participating physicians and the drugs they
prescribe. Researchers identified antipsychotic
(continued on page 5)
Community Care Provider Line: 1-888-251-CCBH (2224)

(continued from page 4)
drugs prescribed by these physicians and the
reasons for their use. Efficacy ratings from the drug
compendium Drugdex were then used to assess
the strength of the evidence supporting those
antipsychotics prescribed for non-FDA approved
indications.
The researchers found that antipsychotic treatment
prescribed during the surveyed doctors’ visits
almost tripled from 6.2 million in 1995 to 16.7
million 2008. Antipsychotic use for indications that
lacked FDA approval increased from 4.4 million
prescriptions during surveyed doctors’ visits in
1995 to 9 million in 2008. Fifty-four percent of the
surveyed prescriptions for atypical antipsychotics
in 2008 had uncertain evidence. It is estimated
that $6 billion was spent in 2008 on off-label use
of antipsychotic medications nationwide, of which
$5.4 billion was for uses with uncertain evidence. 2
In 2006, prescriptions for antipsychotics started
to decrease slightly after the FDA issued warnings
about their safety.
The results of this study add to the concerns facing
this particular class of drugs, which have been
the focus of thousands of lawsuits. Every major
pharmaceutical company marketing an atypical
antipsychotic medication has either settled a lawsuit
or is currently under investigation for skewing study
results or for practices relating to the promotion of
the drugs for off-label uses. Atypical antipsychotics
as a class make up the single largest target of
litigation filed under the federal False Claims Act.
To learn more about the study or about lawsuits
involving atypical antipsychotics visit http://
onlinelibrary.wiley.com/doi/10.1002/pds.2082/
pdf and http://www.nytimes.com/2010/10/03/
business/03psych.html.
2. Alexander GC, Gallagher SA, Mascola A et al. Increasing
off-label use of antipsychotic medications in the United States,
1995-2008. Pharmacoepidemiol. Drug Saf. 2011;20:177-184.
Assessment of metabolic
monitoring for consumers on
antipsychotic medications
Community Care collaborated with several of
the Pennsylvania HealthChoices physical health
managed care plans to determine the rate of
metabolic monitoring for members taking
antipsychotic medications. Community Care
identified members who were prescribed an
antipsychotic medication from December 1, 2008
through March 31, 2009. The physical health
plans then provided laboratory claims data for
the identified members. The data consisted of
glucose and lipid claims with service dates between
September 1, 2008 and March 31, 2010. The
overall rate of annual lab monitoring increased from
51% in 2008 to 69% in 2010.
Community Care assessed when laboratory
evaluations were being conducted in relation to the
antipsychotic fill date to determine if the American
Psychiatric Association’s recommended guidelines
were being followed. These guidelines recommend
baseline evaluations of serum lipid and glucose,
evaluation of serum glucose after 90 days, and
then annual reassessment of serum glucose. Of the
members who were prescribed an antipsychotic
medication during the above time period, 1896
were identified as newly starting an antipsychotic
medication. Community Care determined that
only 229 of these members had baseline glucose
and lipid levels done within three to six months of
their first antipsychotic prescription fill. Of the 229
members, only 49 had their glucose and lipid levels
repeated within the next four months.
Informational letters discussing the importance
of metabolic monitoring for those prescribed
antipsychotic medications will be sent to providers
and to the parents/guardians of members.
5
Community Care Provider Line: 1-888-251-CCBH (2224)

6
Safety Update: Use of
Antipsychotics During
Pregnancy
The US Food and Drug Administration
has updated the Pregnancy section
of drug labels for the entire class
of antipsychotic drugs. The drug
labels will describe in more detail
and consistency the potential risk
for abnormal muscle movements
(extrapyramidal signs or EPS) and
withdrawal symptoms in newborns
whose mothers have been treated with
antipsychotic medications during the
third trimester of pregnancy.
A search of the FDA’s Adverse Event
Reporting system data base through
October 29, 2008 identified 69 cases
of neonatal EPS or withdrawal with
all antipsychotic drugs. A majority
of the cases were confounded by
other factors but there were some
cases which suggest that neonatal
EPS and withdrawal may occur with
antipsychotics alone.
The FDA is advising clinicians to
monitor neonates displaying EPS or
withdrawal symptoms, noting that
while some recover within hours or
days, other may require prolonged
hospitalization.
Quality Improvement
High-quality care is a priority for Community Care. Our quality
improvement program is designed with input from network
practitioners and follows the guidelines of the National
Committee for Quality Assurance (NCQA).
Areas of focus include:
• Delivering high value, culturally competent care that
incorporates the special needs and preferences of members.
• Continuously improving the clinical care and service provided
to members.
• Enhancing the community’s health status through wellness
and preventive behavioral health programs for members.
• Pursuing opportunities to improve the health status of
members and targeting efforts to the needs of the population.
• Ensuring that care and services are available and provided to
members in a timely manner that is appropriate to the needs
and preferences of members.
• Ensuring that care and services are coordinated between
providers and across all delivery settings through the care
management process.
• Establishing collegial relationships with providers to achieve
superior clinical and customer service outcomes.
• Providing exceptional customer service.
• Continuously improving quality improvement processes by
maintaining comprehensive, current, and effective quality
management policies and procedures.
• Analyzing performance data and identifying opportunities to
improve performance and outcomes.
For more information regarding our quality improvement
program call 1-888-251-2224. We will provide you with a
program description and an update on progress toward meeting
our goals.
For the complete MedWatch Safety
Summary along with information for
health care professionals, please refer
to the FDA website at http://www.fda.
gov/Drugs/DrugSafety/ucm243903.
htm.
Send suggestions for improving our quality improvement
program to:
Community Care Behavioral Health Organization
Quality Management
One Chatham Center, Suite 700
112 Washington Place
Pittsburgh, PA 15219
Community Care Provider Line: 1-888-251-CCBH (2224)

Care Coordination
Individuals with behavioral health disorders are often at
greater risk of developing physical illnesses. Therefore,
behavioral health specialists and medical practitioners should
coordinate care to promote overall better health for patients.
Some facts to consider regarding the physical/behavioral
health connection:
• Treating depression can help improve the prognosis
of a co-occurring medical illness.
• People who have untreated mental health issues use
more general medical services.
• People who have depression are more likely than others
to develop diabetes.
• Anxiety disorders are linked with many physical health
illnesses, including epilepsy, cardiac disease, asthma,
and diabetes.
Some medications used to treat behavioral health disorders
also have an effect on physical health and require more
intensive monitoring. For instance, some antipsychotics can
affect blood glucose and lipids, and some antidepressants
can cause weight gain. Patients taking these medications may
need to see their physical health practitioners more often.
Community Care strongly encourages you to coordinate care
with all other practitioners who are seeing the same patient.
Coordination decreases duplicating assessments, procedures,
and tests, while promoting patient safety and improving
treatment outcomes.
Web-based Provider Trainings
Access Standards
Community Care providers are
contractually obligated to provide
access to appointments for members
that meet HealthChoices program
requirements.
Community Care members are
entitled to:
• Services for routine behavioral
health needs within seven calendar
days.
• Services for urgent needs within
24 hours.
• Non-life-threatening emergency
services within one hour.
• Immediate emergency services in
life-threatening situations.
If you are unable to meet these
standards, notify your Provider
Representative as soon as possible.
7
Community Care has developed a series of
informative, web-based trainings on several levels
of care to familiarize providers with those services
and the expectations of Community Care’s Quality,
Care Management, Network, Fraud and Abuse, and
Complaint and Grievance departments regarding
those services. The trainings are posted on our
website, www.ccbh.com, under Provider Resources.
Community Care Provider Line: 1-888-251-CCBH (2224)

8
Dating Abuse: How
to Talk to Your Teen
~ From the PA Department of Public Welfare
It’s never too soon to talk to your teen about dating
abuse. Know the facts and risks about teen dating
abuse. Abuse can be physical, sexual, or emotional.
It includes deliberately hurting feelings, namecalling,
or controlling money.
Life presents many chances to discuss abuse with
your teen. You can:
• Talk about events from TV, movies, or real life.
• Ask your teen what a positive relationship looks
like.
• Ask your teen what an abusive relationship looks
like.
• Ask your teen if she knows anyone who is being
abused and, if she does, talk about ways to help.
• Remind your teen that dating should be fun!
If you find your teen is being abused, you can:
• Map out ways to stay safe.
• Discuss options with your teen. Your local
domestic abuse program can help.
• Remind your teen of the right to say NO, even
after she or he has said yes.
• Let your teen know she can always come to you
for help.
Don’t judge your teen or push her to talk, as she
may stop talking about the abuse. Don’t blame your
teen for being abused. Remain calm and supportive
of your teen’s response. Your teen may just be
trying to understand dating and respect. If your
teen is in immediate danger, call the police and
your local domestic violence program for support.
Remember, dating abuse also happens online and
through texting.
Teens who need help can call the
National Teen Dating Abuse Helpline
at 1-866-331-9474 or
1-866-331-8453 (TTY for the Deaf).
To learn the facts and risks
about teen dating abuse, go to
http://www.loveisrespect.org,
http://www.breakthecycle.org, or
http://www.loveisnotabuse.com/web/guest/home.
To speak with someone about abuse or locate
a local domestic violence program, call the
National Domestic Violence Hotline
at 1-800-799-7233 (SAFE) or
1-800-787-3224 (TTY for the Deaf).
Visit http://www.thehotline.org
for more information.
Community Care Provider Line: 1-888-251-CCBH (2224)
04152011MA