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: California
Providers' adherence to treatment record and clinical practice guideline standards stays strong
The Human Affairs International of California (HAI-CA)* care management center recently completed collating the results of our annual member treatment record review, which included clinical practice guideline audits for select diagnostic categories. The results show a positive continuing trend of providers following best practices.
For the review, HAI-CA examined a representative sample of records from California network providers (some see a high volume of Magellan members and some a low volume).
Quality of providers' documentation
Using a formal treatment record review tool, our staff evaluated providers’ records for the presence of specific documentation comprising a comprehensive treatment record. Results for 2023 are presented below. The aggregate quality goal for 2023 was 80%.
|
Treatment Record Area |
2023 Result |
|
Use of a generally accepted standard of care |
93% |
|
Consumer rights and confidentiality |
78% |
|
Comprehensive initial evaluation |
93% |
|
Individualized treatment planning |
88% |
|
Quality of ongoing treatment, including special populations |
93% |
|
Community referral/outreach |
91% |
|
Coordination of care |
66% |
|
Use of an accepted standard of care for medication management |
100% |
|
Treatment record result total |
88% |
Items with highest satisfaction:
- Use of a generally accepted standard of care
- Comprehensive evaluation
- Individualized treatment planning
- Quality of ongoing treatment, including special populations
- Use of an accepted standard of care for medication management.
Key opportunities:
- Coordination of care between providers, including primary care
- Patient rights information provided at the beginning of treatment.
To address concerns in these key areas:
- Quality clinical reviewers provide individualized feedback and consultation to providers
- An audit tool is available online for providers to access.
Adherence with clinical practice guidelines
This review examined the extent to which clinical interventions that providers implement for members are consistent with our well-established guidelines, applicable to specific diagnostic groups.
Please see the 2023 results below. Providers continue to exceed the benchmark of 80% for adherence to all clinical practice guidelines.
|
Diagnostic Category |
2023 Result |
|
Attention deficit hyperactivity |
93% |
|
Major depression |
96% |
|
Suicide risk |
99% |
|
Substance use disorder |
91% |
Applied behavior analysis results
Magellan also conducts an annual applied behavior analysis (ABA) treatment record review process. For 2023, providers met or exceeded documentation requirements across all quality domains. The audit scores averaged 99% and were well above the passing threshold of 80%.
Resources to assist you in treatment planning
Magellan quality clinical reviewers offer individualized feedback and consult with providers regarding treatment record reviews. Providers who receive review data regarding the records reviewed can speak with licensed clinicians about their results.
For additional information about treatment records and quality reviews, visit our Clinical Forms page. Navigate to our Clinical Guidelines page for the tools we use to assist providers in screening, assessing and treating many common disorders.
Thank you for your ongoing commitment to providing quality behavioral healthcare services.
*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.