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PLAN ADMINISTRATION

As a Mental Health Plan (MHP) and Drug Medi-Cal-Organized Delivery System (DMC-ODS), ACBH offers a wide variety of services and programs designed to meet the needs of its beneficiaries. Plan Administration includes Financial Services, Information Systems and Technology Support Services, Mental Health Services Act Services, and Quality Management Services.

The ACBH Quality Management (QM) mission is to ensure Alameda County Medi-Cal beneficiaries and Medi-Cal eligible residents receive timely access to appropriate, cost effective, and quality behavioral health care services within the Mental Health Plan (MHP) and Drug Medi-Cal-Organized Delivery System (DMC-ODS).  The three main types of quality measures are considered: structure, process, and outcomes.  The ACBH Quality Management (QM) Program is comprised of Quality Assurance (QA), Quality Improvement (QI), and Utilization Management (UM).  The following provides an overview of responsibility and functions for the three units.

 

Quality Assurance (QA)

QA has overall oversight and monitoring responsibility for the quality of services, inclusive of ensuring that applicable Federal, State, and local laws, regulations, and policies are met by all ACBH providers.  Below are examples of QA functions:

  • Establishes clinical record documentation standards and conducts clinical chart audits
  • Receives, resolves, and monitors beneficiary grievances and appeals with annual analysis and trends reporting to the ACBH Quality Improvement Committee (QIC)
  • Clinical review of Unusual Occurrences with annual analysis and trends reporting to the ACBH QIC
  • Develops and renders provider trainings
  • Develops and renders Brown Bag Q&A sessions and Technical Assistance (TA)
  • Serves as ACBH lead for the Department of Health Care Services (DHCS) Triennial System and Non-Hospital Service Chart Review Audit
  • Conducts and monitors Medi-Cal Site Certification for contracted and county-operated mental health programs

 

Quality Improvement (QI)

QI has overall responsibility for developing, implementing, and overseeing the department’s federally mandated Quality Assessment & Performance Improvement (QAPI) Program.  Through the lens of system structure and operations, QI collaborates with key stakeholders including ACBH leadership, contract providers, consumers, and family members to build a culture of Continuous Quality Improvement (CQI).  Below are examples of QI functions:

  • Directs Quality Improvement Committee (QIC) and subcommittees
  • Develops and evaluates Quality Improvement activities, including Performance Improvement Projects (PIP)
  • Develops and evaluates Quality Improvement Work Plan (QIWP)
  • Serves as ACBH lead for annual External Quality Review Organization (EQRO) reviews
  • Develops and implements performance assessment and monitoring strategies
  • Collects, analyzes, and reports performance measurement data
  • Coordinates ACBH’s Policies & Procedures

 

Utilization Management (UM)

UM has overall responsibility to strategically design and implement Federal and State regulations and laws as it pertains to coverage and authorization of services, assuring that beneficiaries have appropriate access to services.  UM evaluates medical necessity, appropriateness and efficiency of services, with an emphasis on high-level and high-cost services.  Prospective, concurrent, and retrospective review methodologies are utilized to determine service access, appropriateness and cost-effectiveness.  Service and payment authorization determinations are rendered in accordance with medical necessity and appropriate level-of-care criteria and tools.  Below are examples of UM functions:

  • Develops and implements utilization data reporting systems to identify utilization trends and provider patterns
  • Service authorization for a range of Specialty Mental Health Services, to include but not limited to acute psychiatric hospital, residential treatment, and day treatment
  • Service authorization for Substance Use Disorder residential treatment services
  • Serves as ACBH lead for the DHCS Triennial Short Doyle/Medi-Cal (SD/MC) Hospital (aka John George Psychiatric Hospital) Chart Audit

The MHSA, otherwise known as Proposition 63, was passed by California voters in 2004 and is funded by a one percent income tax on personal income in excess of $1 million per year. It’s designed to expand and transform California's behavioral health system to better serve individuals with, and at risk of, serious mental health issues, and their families. MHSA addresses a broad continuum of prevention, early intervention, and service needs and the necessary infrastructure, technology, and training elements that effectively support the public behavioral health system.

For more information, see our Mental Health Services Act webpage

The Alameda County Behavioral Health Care Services (ACBH) Finance Division is comprised of 5 units specialized in providing quality financial services by ensuring efficient and effective management of the public’s financial and physical resources.

For more information, see our Financial Services webpage

The mission of the Alameda County Behavioral Health (ACBH) Information Systems division is to support ACBH staff, providers and community with technological needs, in order to provide Behavioral Health services while meeting State mandates as a Mental Health Plan and Drug Medi-Cal Organized Delivery System.

ACBH Information Systems is the single point of contact for our users to gain assistance in troubleshooting, diagnosing, and resolving any Information Technology related concern. The ACBH IS division brings a strong focus on customer service and aims to meet and exceed user expectation by providing a positive user experience.  ACBH IS staff is responsible for a variety of complex systems. We manage, configure, troubleshoot and deploy all hardware and software for ACBH staff. We are responsible for storing and backing up all of ACBH Protected Health Information (PHI).  Our Team’s mission is to support and develop Information Systems applications for ACBH business initiatives. Our goal is to provide software and data tools that will empower our customers and end-users to make meaningful business and strategic decisions. 

As a leader in data engineering, data science, and business intelligence within Alameda County Behavioral Health, our vision is to create a vibrant data informed culture that accelerates collective action and accountability. With our support the County of Alameda will end structural inequality and ensure health for all Alameda County residents.

Data Services gets the right data to the right people at the right time.

Why do we exist?

  • To help ensure ACBH can provide the best care to clients.
  • To provide actionable information and data solutions to maximize ACBH’s ability to reach and serve more clients.
  • We are dedicated to helping ACBH leadership make data-informed decisions

 

What do we produce? 

Business Intelligence:  Identifying the business needs of key stakeholders and connecting them with quality and meaningful data.

  • Mastery of data
  • Compliant use and sharing
  • Recommendations and Decision Support
  • Data Story Telling

 

Data Engineering: The creation and maintenance of systems that handle data at scale.

  • Data Warehouse – a centralized hub of data entrusted to adhere to appropriate guidelines in use and distribution by all of its contributors.
  • Automated data discovery
  • Information delivery via automated dashboards, reports, and broadcasts.
  • Innovation and improvement of data tools
  • Data Accessibility

 

Data Science: Advanced statistics, modeling and machine learning.

  • Coordinates research and analytic activities

 

Data insights (generate actionable insights applying advanced statistical techniques like predictive statistical models, segmentation analysis, customer profiling, analysis, survey design, and data mining.)

Our leaders are here to support the critical infrastructure needed to support departmental operations and functions. Our team works together to ensure the highest quality and care is delivered to our clients, patients, and family members.

Plan Administration Leaders

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Imo Momoh, MPA

Deputy Director
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Cecilia Serrano

Finance Director
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Tracy Hazelton, MPH

Mental Health Services Act Division Director
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Karen Capece, LCSW

Quality Management (QM) Program Director
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Natalie Courson

Deputy Director Information Systems