•Medicaid beneficiaries and families
•Mental health practitioners
•Hospitals
•Department of Mental Health
•Department of Children and Families
•Department of Aging and Independent Living
•Vermont Department of Health
This measure looks at continuity of care for mental illness. It measures the percentage of Medicaid beneficiaries 6 years of age and older who were hospitalized for selected mental disorders and who were seen on an outpatient basis by a mental health provider within 7 days, or within 30 days after their discharge from the hospital. The specifications for this measure are consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services.
It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness. An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient’s transition to the home or work environment is supported and that gains made during hospitalization are not lost. It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care.
The trend lines above show that Vermont Medicaid's actual performance was on a bit of decline that leveled off in 2019. The national average, remained lower than Vermont's performance.
Last updated: September 2021
•Schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan.
•Educate patients and practitioners about the importance of timely follow-up visits.
•Consider reminder systems or “re-schedule” notices that are delivered to patients.
•Develop outreach systems or assign case managers to encourage recently discharged patients to keep follow-up appointments or reschedule missed appointments.
DVHA led a formal Performance Improvement Project (PIP) on this topic from 2013-2015. When that PIP cycle ended, Vermont Medicaid continued to focus on improving follow-up after hospitalization for mental illness by participating in a joint payer project, lead by the Vermont Program for Quality in Healthcare (VPQHC), also with the goal of increasing the number of mental health follow-up appointments after an individual has been hospitalized for mental illness. This project wrapped up in June 2018.