Personal Note Initiation And Engagement In AOD Treatment
Fall/Winter 2005The Valued ProviderNew Authorization ProcessPage 3In This IssuePersonal NoteSabrina HouserArticlesBetter Service Through“Connections”Success Depends on SmoothTransitionsRuss Thompson, Ph.D.ValueOptions Implements NewAuthorization ProcessRepayment of Claims FundsEvidence-based Best Practices inCritical Incident Response ServicesBob VandePol, President, CCNValueOptions’ Top 10Top 10 Reasons to Visit AchieveSolutions Web SiteWhat’s New?Network-Specific InformationCONTACT USFor more information aboutarticles, visit our Web site atwww.valueoptions.com. Youmay also e-mail the Editor atthevaluedprovider@valueoptions.com.ValueOptions is headquartered inNorfolk, VA.Better Service Through “Connections”We proudly announce theimplementation of ValueOptionsConnections. An integrated platformof Information Technology (IT)applications, this new system enablesstreamlined efficiency in our servicecenters, as well as greatly enhancedWeb-based and telephonic self-servicecapabilities for our members andproviders.Internal operational enhancementsValueOptions ServiceConnect offerscustomer service staff a state-ofthe-art, interactive desktop interface.Representatives have immediate accessto a member’s complete ValueOptions’behavioral health service history. Thenew application enhances call centerproductivity and reduces overall callresolution time.ValueOptions BenefitConnect servesas a comprehensive warehouse for allgeneral client account information,benefits and eligibility requirementsand appeals information, as wellas claims and referral guidelines.This application reduces customerservice call processing times, allowingmore efficient service to our callers.ValueOptions CareConnect allowsclinical care staff to quickly focus onthe most pertinent clinical data and todevise, monitor, follow-up, and reporton individualized treatment plans forthe members they serve.ValueOptions NetworkConnectsupports all credentialing and networkmaintenance activities. Users leverageThe Valued Providerthe application to effectively manageand maintain all information relatedto a provider’s network participation.External self-service initiativesValueOptions TeleConnect (coming soon!),our new Interactive Voice Responsesystem, will enable rapid, 24 hoursa day, seven days a week (24/7) selfservice resolution of many memberand provider requests. Callers can checkmember eligibility, benefits or claimsstatus and request a form to be faxed.Callers will always have the option ofconnecting to a live agent at any time.ValueOptions MemberConnect, a Webbased self-service alternative, servesas a 24/7 one-stop shop for memberswho wish to complete everyday servicerequests online, such as checkingbenefits and reviewing claims status.ValueOptions ProviderConnect, a Webbased self-service alternative, servesas a 24/7 one-stop shop for providerswho wish to complete everydayservice requests online. You can checkeligibility, benefits, authorization andclaims status, view correspondenceonline, submit claims and update yourprofile.Read future newsletters and visit www.valueoptions.com/providers for updateson these exciting initiatives!Great-West Life ImplementationValueOptions is pleased to announcethe implementation of a new account,Great-West Life, effective 4/1/06.Visit www.valueoptions.com for moreinformation.
Personal NoteSuccess Depends on Smooth TransitionsInitiation and Engagement in AOD TreatmentRuss Thompson, Ph.D. ValueOptions’ Peer Advisor, Long Beach, CASabrina Houser, LPC, LMFT, PAVice President, Corporate Provider RelationsDear Provider Community,Over the past 12 months, we haveinvested heavily in an array ofInformation Technology initiatives(see page 1). These initiatives are bothinternal for our employees and externalfor our members and providers. Eachinitiative, however, was designed toenhance our services for our providersand members.A new initiative is our Outpatient andInpatient Treatment Authorizationprocess for our commercial accounts(Health Plans and Employer Plans). Weconsolidated the multiple forms acrossValueOptions’ service centers andimplemented a process to help us gatherquality data such as treatment history,relapse factors, and readmissions tohigher levels of care (see page 3).Our 2005 Provider Forums were asuccess. Many of you attended ourforums in person or telephonicallyand learned about our processesand initiatives as well as informationon major topics such as depression.Next year, we hope to offer the samequality presentations to our providercommunity.Finally, the hurricanes along the Gulfcaused great devastation. Many ofyou reached out independently, otherspartnered with us, and Crisis CareNetwork (CCN) offered assistance tothose in need. We appreciate everyone’sefforts to support our members andproviders in their affected areas.Thank you for the opportunity to serveyou. I look forward to 2006!How many of us in our outpatientpractices have been confronted withthe challenge of engaging a patient,recently discharged from inpatienttreatment for alcohol or other drugdependence (AOD)? It’s difficult,and imperative! Outpatient care is theopportunity to carry lessons learned ata higher-level setting into the patient’sreal world.An effective support system (includingself-help options) identified whilethe patient is still inpatient as well asthe identification of any co-morbiddisorders are integral to success.However, so is the awareness on thepart of the outpatient provider thatintense focus and attention are going tobe required to get the patient “hooked”on the recovery process itself. Ahighly structured and individualizedtreatment plan can be very helpful tothe transition process. The plan shouldbe devleoped prior to discharging thepatient from higher-level treatment andshould include a treatment contractagreed to by the patient.So, what’s so good about recoveryanyway?Our patients are in many casesconfronted with having to find newfriends and pastimes. Many experienceemotions never before felt orpossibly felt but not desired. Guidingpatients so that the experience is anintroduction into new possibilitiesand potential as opposed to an exercisein self-denial and deprivation is criticalto winning patient buy-in; a key factorin treatment success. Familiarity withwhat the patient previously gained byusing substances is essential if we areto assist them in filling those needsin other ways. More relapse occursduring transition between treatmentphases than at any other time duringAOD dependence treatment. Whilemany consider relapse a normal part ofthe recovery process, stepping downfrom inpatient treatment presents acritical turning point for patients asthey make the day-to-day, minute-tominute decisions necessary to maintaina clean-and-sober lifestyle.Effectively transitioning a patient tolower-level treatment and seeing himor her follow through with outpatienttreatment and support regime is onlythe first step in completing a fullcourse of treatment. It is a critical stepand a big opportunity for patient andprovider success.Several ValueOptions Service Centers are currentlyadopting the NCQA HEDIS standards on measuringInitiation and Engagement of AOD treatment.Engagement is an intermediate step between initiallyaccessing care and completing a full course of treatment.This indicator assesses the degree of engagement bymeasuring if two additional AOD services occurredwithin 30 days after initiation.What’s New?Our Web site (www.valueoptions.com/providers) offers an online, self-scoring versionof the CAGE (Cut, Annoyed, Guilty, Eye-Opener) self-screening questionnaire.The CAGE alcohol screening tool is brief (four questions), easy to use, and helpsdetermine if an individual has a potential issue related to alcohol use. The CAGE is avalidated instrument and an established standard of assessment. It is anonymous andcan be administered in an interview with a patient. (Click on Education Center)The Valued Provider
ValueOptions Implements New Authorization Forms ProcessIn November 2005, ValueOptionsimplemented its new clinical systemapplication: CareConnect. Basedon feedback from our providers,CareConnect is designed to streamlinethe authorization process, consolidatemultiple forms used across servicecenters and books of business, andstandardize our authorization processso as to enhance data collection andoutcomes measurement. In the future,ValueOptions will share comparativeaggregate outcomes data with ourprovider network.What Does This Mean For You?In order to capture neededinformation, we created new Inpatientand Outpatient registration formsto mirror the new system. We areasking our providers to begin usingthese forms immediately as thecurrent Outpatient Treatment Report(OTR) and Inpatient Treatment Report(ITR) are no longer compatible withValueOptions’ information system. Thenew forms will be the primary formsused for requesting authorizations. Theforms are listed to the right and can beaccessed at www.valueoptions.com.for Inpatient/Higher Levels ofCare for any employer group orhealth plan member(s), you willcontinue to request this authorizationtelephonically. However, theinformation required via thetelephonic review process will followthe new ITR format (use this form asyour guide for the telephonic reviewprocess).For more information about what processesare not changing, visit ValueOptions’ homepage or the “for Provider” Web page at www.valueoptions.com and select “ImportantChanges in Authorization Process.”Note: These new forms ONLY applyto ValueOptions’ commercial/healthplan members. The new formsDO NOT apply to ValueOptions’TRICARE Beneficiaries and Medicaidmembers in Arizona, Florida,Colorado, New Mexico, NorthCarolina, Pennsylvania, New Jersey,Massachusetts, Connecticut, and TexasNorthSTAR, so please use the sameprocesses you use today for thesemembers.What Does the Future Hold?In early 2006, ValueOptions plansWhat’s Not Changing?to simplify the authorization processThe basic processes you are using today even more by using TeleConnectfor obtaining outpatient authorizationand ProviderConnect as a meansfor ValueOptions’ patients remainsfor submission and approvalthe same. Only the forms indicated to of authorization requests. Whenthe right are changing. For example,implemented, both of theseif you currently request outpatientenhancements will be available 24authorization by faxing an OTR tohours a day, seven days a week.a specific fax number, please continueTo further assist you in understandingto send in faxes but instead use thethese changes, Frequently Askednew ORF1 form. If you currentlyQuestions (FAQ) are located atobtain authorization telephonicallyThe Valued ProviderNew Authorization FormsInpatient Treatment Report (ITR)form – used for authorization requestsfor inpatient and all alternative/higherlevels of careOutpatient Registration Form(ORF1) - used for routine outpatientcare (excludes psychological testingrequests). NOTE: The accompanying Psychological Evaluation Request(PER) form is also online.Medication Management Registration form – this form replaces the current Medication Management Registration form and will be used for requestsfor Medication Management servicesonly. ValueOptions’ providers credentialed to offer medication managementservices can begin using this new formas of November 16, 2005.Outpatient Review Form (ORF2)- In a small number of instances, additional information may be requiredfor outpatient requests for services.ValueOptions will bring these instancesto your attention and may ask you toprovide this additional information onthe ORF2, a companion form to theORF1.Download forms by going ers inthe News and Forms sections. TheFAQ will be updated as additionalquestions are posed by our providercommunity. You may also call the 800number on the back of the member’sID card.
ValueOptions’ Top 10Reasons to Visit AchieveSolutions Web SiteAchieve Solutions (AS) is designedwith the member in mind, offeringproviders thousands of articles,assessment tools, quizzes, etc. AccessAS at www.valueoptions.com/provider/education.10. Privacy—technology ensuresvisitor confidentiality9. Convenience—it’s available 24/78. Content credibility—a stricteditorial policy governs the creationand annual review of clinicalcontent7. Interactive quizzes—selfevaluations help the user assesspotential risk for conditions such asdepression or alcoholism and referto additional online information6. Skill-building trainings— conflictresolution and communication arejust a few of the topics available5. Monthly promotion—highlightedtopics focus on key healthobservances and foster protectivefactors for mental health4. Breadth of subject matter—morethan 5,000 articles, across morethan 200 topics such as depression,stress, parenting, elder care, childcare and legal and financial issues3. Spanish-language version—alltext and navigational elements arein Spanish; about 600 articles andquizzes on most popular topics2. Manager’s tools—articles andinteractive trainings to supportmanagers1. Conversation starter/enhancer—the site information and tools cancomplement your work with clientsRepayment of Claims FundsThe ValueOptions Special Investigations Unit (SIU) is responsible forreviewing and monitoring claims andbillings by providers to ensure paymenthas been properly requested and made.The SIU also monitors and investigatespotential cases of improper billing andfraud. In the event that improper orfraudulent billings are identified, theSIU sends a detailed written report detailing the findings including a requiredAction Plan with specific recommendations. The following reflects changesmade to our current policy in the eventa provider is required to repay claimfunds identified as part of aSIU investigation.What’s Changing?The SIU will specify a repaymentrequirement, if any, with the ActionPlan. The repayment amount will becalculated by applying the deficiencyratio determined in the sampling process against the total payments madeto the provider by ValueOptions. Forexample, if the audit sampling processdiscloses a 5% deficiency ratio, andEducationValueOptions would like to thank allwho participated in our 2005 ProviderForums. We certainly enjoyed yourcompany and hope that you make plansto join us next year. If you were not ableto attend a Provider Forum you may viewa Forum presentation by visiting www.valueoptions.com/provider/education.htm. NOTE: Where CME/CEU’s areoffered, only attendees may receive educationalcredits.We want you to help us plan our 2006Provider Forums. If you have an ideaThe Valued ProviderEffective January 1, 2006, changesregarding the Repayment of Claimsfunds will be incorporated in the ClaimsBilling Audit section of the ProviderHandbook.Our Web site is a vehicle for communicating any recent changes to our Handbook. We encourage you to go onlinefor the most-up-to-date Handbookinformation. If you have questionsabout the Handbook, please contactour National Provider Line at 1-800397-1630, Monday through Friday, 8a.m. to 5 p.m. EST. for assistance.the provider has received 100,000.00in payments from ValueOptions, therequired repayment amount will be 5,000.00. Once any Action Plan hasbeen delivered, additional documentation will not be considered for the purpose of adjusting the deficiency ratio.Required repayments must be madewithin ten (10) business days unless aninstallment payment plan is approved.What are providers saying about ourProvider Forums?“Very well organized. Excellent handouts!”“Very helpful!”“Love you provider folks”“Presenters were knowledgeable & pleasant”for a Provider Forum, online workshop,etc., send an e-mail to thevaluedprovider@valueoptions.com. Tell us your name,complete address, and the topic youwould like presented. We encourageyour feedback as we take your commentsseriously, incorporating suggested changesthat will help us meet your needs.
NETWORK-SPECIFIC INFORMATIONGreat Lakes Service Center (GLSC)Northeast Service Center (NESC)Great Lakes Service Center Prevention ProgramsThe Great Lakes Service Center in Southfield, Michigan manages a preventive healthprogram for postpartum depression. Its relevance lies in statistical findings thatwomen of child-bearing age suffer more often with depression than with any otherbehavioral health problem. Download these materials from www.valueoptions.com/provider/education or call (866) 228-8703 for copies.Coordination of care between Behavioral Health Care and the PrimaryCare PhysicianSafe and positive outcomes are more likely to occur when treatment planning iscommunicated and coordinated across the spectrum of the health care deliverysystem. Treatment records of behavioral health care providers are regularly auditedby ValueOptions for evidence that coordination of care is in effect for all patients.The GLSC looks for (1) evidence that a process is in place for obtaining writtenconsent from the patient to release medication information and other treatmentrelated information to the member’s Primary Care Physician (PCP) and (2) evidencein the patient record that the coordination took place. This documentation canconsist of a copy of a dated letter to the PCP, a fax transmission confirmation sheetor an initialed note at the bottom of the patient release form that identifies thedate and the method of the communication. We appreciate your compliance withValueOptions’ standards.GLSC Health Plan Division clients offer consumer-directed health care planMany of ValueOptions’ clients are offering new benefit plans. These are highdeductible health plans (HDHP) that meet the requirements for members to qualifyfor tax-favored contributions to a Health Savings Account (HSA) under the MedicarePrescription Drug Improvement and Modernization Act of 2003.Members’ ID cards will indicate that they participate in an HSA/HDHP plan.These plans have a combined annual deductible that is shared with medical,behavioral health and pharmacy benefits. It is very important that Providersbill ValueOptions before a member is charged to ensure they are collecting theappropriate amount from the member. Due to this coordination of deductibles,members should not be asked for payment at the time of service.These deductible plans will follow the same authorization policies for the plansthat are currently in place. Claims follow the same billing guidelines as the standardplans. If you have any questions, please call the number on the back of themember’s ID card.CaliforniaAttention All EAP/MHSA Providers!This is a reminder to check the member benefits regarding self-referral from EAP toMHSA. Many companies, such as Boeing, do not allow for this.The Valued ProviderAttention HealthAmericaProviders Timely Filing of ClaimsThe NESC urgently requestsadherence to the timely filing of cleanclaims! Providers are required to file“clean claims” within 90 days from thedate of service. Providers submittingclaims more than 90 days after thedate of service may be denied due tountimely filing and are prohibited frompenalizing beneficiaries by billing forsuch services. The claim must matchthe authorization for a claim to bepaid correctly. Call (866) 834-1717 formore information.Attention HealthGuard Providers!HealthGuard of Lancaster, Inc. willstop operating by the end of February2006. Subsequently the MHSAmanagement for their members underValueOptions will terminate at thattime. Until that termination date,employer groups will be transitioningcoverage to Highmark and otherinsurers. We strongly encourage youto submit claims for any servicesprovided to HealthGuard patients toValueOptions immediately followingthe delivery.NCQA UpdateValueOptions NESC is committedto maintaining excellence in careand service and fulfilling NationalCommittee for Quality Assurance(NCQA) accreditation standards forbehavioral health. To view our NESCKeyUpdates Newsletter, log /northeast schp.htmor call Carrie Turner at 1-800-3224824, ext. 2827
adopting the NCQA HEDIS standards on measuring Initiation and Engagement of AOD treatment. Engagement is an intermediate step between initially accessing care and completing a full course of treatment. This indicator assesses the degree of engagement by measuring if two additional AOD services occurred within 30 days after initiation.
2. Implementing customer engagement 12 Effective customer engagement is a dialogue 12 Effective customer engagement aims to build mutual trust 13 Effective customer engagement is strategic and planned 13 Effective customer engagement recognises a scale of participation 16 Effective customer engagement is conducted responsibly 17 Case Study 2 18 3.
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of engagement, as opposed to focusing on “engagement for engagement’s sake.” Source: Corporate Leadership Council research. Engagement Drivers * Rational commitment to the job was not measured due to its similarity to rational commitment to the team, direct manager, and organization. CLC’s Employee Engagement Survey
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course 1: foundations of the rosicrucian and holy grail tradition what is rosicrucianism? 3 the true, original rosicrucian and holy grail spiritual impulses 4 some hallmarks of rosicrucianism 5 glossary 7 first steps in initiation: "know thyself" 8 essential threefold practice of spiritual discernment 11 three great trials of initiation 12 the seven stages of classical initiation and grail .
Volume 21 - Number 112 March 1988 Celebrating Initiation Our freshly revised Rite of Christian Initiation of Adults is now in use. This challenging and practical Bulletin presents a clear picture of the process of initiation and its rites, and helps us to see the ways our community can grow in sharing and celebrating the Christian faith. 1
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