V Nonstandard Clinical Practices That Are Outside of the Community Standard of Care

MANAGING MENTAL HEALTH, INTELLECTUAL/DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES 910.673.9111 ■ (F A X ) 910.673.6202 ■ W W W . SA ND H IL L S C EN TE R . O R G ■ VI C TO R IA W HI TT , CEO

Integration of Care

Sandhills Center believes an integrated care model of behavioral and medical health is in the best interest of those we serve. To promote this integrated model, Sandhills Center:

 Convenes collaborative meetings with all three Community Care of North Carolina entities serving Sandhills Center members. These collaborative meetings allow an opportunity to identify ways to ameliorate physical and behavioral health issues leading to a high risk/high cost designation of a specific member.

 Reviews data of behavioral and medical information from multiple sources to identify correctible clinical areas of concern that present a financial risk, including:  Polypharmacy  Nonstandard clinical practices that are outside of the community standard of care  Substandard clinical care that leads to overuse of ED’s and hospital bed days  Lack of compliance with medications and follow-up  Failure to follow clinical best practices  Failure to appropriately monitor psychotropic induced metabolic syndromes (hyperlipidemia, Diabetes Mellitus, obesity) through laboratory studies  Failure of psychiatric/behavioral health providers to coordinate with physical health providers around drug/drug interactions and medical/psychiatric comorbidity, etc.

 Identifies Quality of Care concerns around behavioral and physical health issues through any clinical department - Utilization Management, Care Coordination, Customer Service, Provider Network or Quality Management. Additionally, Quality of Care concerns may be identified and filed by family members, providers or community stakeholders. No matter the source, Quality of Care concerns are reviewed carefully by the Quality Management Director and Medical Director.

Additionally, Sandhills Center uses recognized tools and independent expertise to assist in our integration efforts, including:

 Utilization Management staff evaluating authorization requests against clinical best practices and against a polypharmacy work tool and drug/drug interaction work tool.

 Clinical expertise through PREST, Inc peer review to address physical health quality of care concerns through a network of board certified physicians performing independent peer review. Prest Peer Review also incorporates recommendations for care including community standards of care and clinical best practices.

 Clinical Screening and Triage work processes which include assessments for active, comorbid medical problems as well as complicating substance use withdrawal signs and symptoms.

P.O. Box 9, West End, NC 27376 Serving Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, & Richmond Counties Available 24 hours a day at 1-800-256-2452