Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. G. Information Systems and Data Infrastructure

01/01/2014

Magellan uses data systems to handle prior-authorizations, claims processing, and tracking of patient care. Because Magellan is responsible for managing the majority of public behavioral health services for the state, these data systems give it the unique ability to track the utilization of services and monitor the quality of care for a large population of Medicaid and non-Medicaid-eligible adults. The state did not develop any data systems specifically for LBHP.

Magellan and OBH encourage providers (though they do not require them) to use the Clinical Advisor EHR. The Clinical Advisor system captures information about clinical interactions with patients (patient progress notes, treatment plans, etc.) and generates claims so that Magellan can reimburse providers. Thus, this system is able to capture information that can be used for quality monitoring. The system can also be used to schedule visits. The eligibility systems from several state agencies (Medicaid, OBH, DCFS) feed into Clinical Advisor to populate the system with unique beneficiary identification numbers that are used to track patients and monitor their care. Although the Clinical Advisor system interfaces with other eligibility, authorization, and claims systems, it was not specifically designed as a care management tool. Because it does not require the installation of desktop software, it is more easily accessed via the web. While some providers and hospitals have their own EHRs, some behavioral health providers are beginning to use Clinical Advisor.

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