Mental Health Services Evaluation
HealthInsight Oregon assists mental health programs and facilities with program and policy effectiveness evaluation, quality improvement, psychiatric facility review, service eligibility and utilization review, pre-audit compliance review and clinical record review. We have engaged in multiple clinical record and program review activities focusing on access to care, quality of care and care coordination, under contract with the Oregon Health Authority (OHA).
Child, adolescent, and geriatric treatment review
Since 1999, HealthInsight Oregon (formerly Acumentra Health) has conducted federally required quality and utilization review activities for several programs in Oregon that provide inpatient and residential treatment for Medicaid recipients under 21 years of age or 65 and older.
Our qualified mental health professionals ensure the provision of medically appropriate services by
- prior authorizing psychiatric treatment services for youth referred to specific residential treatment facilities, and authorizing continued stays
- authorizing Medicaid billing for recipients age 18-21 and over 65 who have been admitted to the Oregon State Hospital, and authorizing continued stays
- prior authorizing services for youth referred for intensive treatment services as an alternative to long-term hospitalization, and authorizing continued stays
- providing quality oversight for some residential treatment facilities in Oregon
- visiting specific residential treatment facilities for youth quarterly
- providing quarterly and annual reports to OHA on utilization review and quality-of-care outcomes
Mental health surveys and studiesAs the Medicaid External Quality Review Organization for Oregon, we survey more than 20,000 Oregonians each year to gauge consumer satisfaction with state-funded mental health services for children and adults. The survey results provide key input for OHA, managed care plans and lawmakers on the state’s efforts to improve mental health services and supports.
HealthInsight Oregon conducted the first comprehensive assessment of Oregon’s adult residential mental health system to identify system strengths and improvement needs. The state is using the results of the Adult Residential Mental Health Care Study to strengthen clients’ ability to make a successful transition to independent living.
For the Washington Medicaid agency, we conducted focus groups across the state with consumers and their advocates, health plan staff, law enforcement, community hospital staff, and mental health professionals to assess the degree to which mental health services met the state’s quality standards. Our report identified system-wide strengths and improvement needs.
More information about our survey and focus group experience and capabilities