Behavioral Health Best Practices

Transcription

1 Behavioral Health Best Practices Rhonda Roper, LCSW, CCM, Behavioral Health Clinical Director Tabitha Miller, LCSW, Behavioral Health Clinical Manager

2 Behavioral Health Overview

3 Behavioral Health (BH) Overview Behavioral Health (BH) is a core competency with a full team of BH professionals eager to work with providers, members and BlueCross BlueShield of Tennessee medical staff to ensure our members receive quality care. This includes around-the-clock coverage for emergency admissions and crisis calls. Internal phone lines are forwarded to our after-hours vendor when the office is closed. The PCP consultation line is available to community providers that need assistance with referrals to a BH provider or a consultation with a board-certified psychiatrist. (Call , listed on the BlueCross website via the BH Provider landing page.) 3

4 Behavioral Health (BH) Overview Case management referrals are accepted from a wide variety of sources including BH UM, Medical UM and CM, internal reports, self-referrals from members, and community providers. BH case managers work with members on goal setting, provide a variety of educational materials, and support members and families in their resiliency journey. BH and medical collaborative activities occur regularly, including integrated clinical rounds with both the medical director and psychiatrist on complex cases. 4

5 Workflow Process

6 Workflow PCMH initiates a request for BH support by ing a designated BH Health Navigator (HN) for support. The BH HN will call out to the member as requested and assess needs and attempt to engage in case management services. 6

7 Workflow If the member is contacted during the initial call out, the HN screening tool will be completed and consent for Case Management (CM) services is requested. If the member consents, the case will be built and assigned to BHCM for support. 7

8 Workflow If HN is unable to contact the member, the HN Template is completed and HN call loop will be initiated and task will be set for followup calls (three calls in 10 days). 8

9 Workflow Each member interaction is documented under progress notes in CareAdvance with HN Template (via manual entries). The case will not be present if HN is unable to contact the member or if the member declines CM services. 9

10 Best Practices

11 Depression Depression is a very common behavioral health condition that can happen to anyone. It is defined by changes in mood as well as physical symptoms. Depression is just like any other medical condition, and it requires the appropriate care and support. It is not a sign of weakness or failure. BlueCross Behavioral Health team s goal is to be the hope for our members. Our case managers are highly trained, knowledgeable and compassionate to every member that requests assistance. Our staff works with each member to find treatment options close to home and help them live a better life. Should an issue arise after hours, we have a system in place to keep assistance moving forward until our case managers can reach out. 11

12 Substance Use Disorder (SUD) Current terminology has changed to Substance Use Disorders (SUD) instead of Substance Abuse or Addiction. There is frequent overlap of SUD and other mental health conditions (also called cooccurring disorders). Patients often use multiple classes of drugs or multiple drugs within the same class. Addiction is defined by taking more of a substance than is intended, as well as focusing on obtaining, using and recovering from the substance. Signs of addiction can include disrupted work, school or home life, as well as a loss of interest in activities or hobbies a person once enjoyed. 12

13 Substance Use Disorder (SUD) We use the following screening assessment to identify members with possible Substance Use Disorder (SUD) symptoms CAGE-AID Have you felt you ought to cut down on your drinking or drug use? Have people annoyed you by criticizing your drinking or drug use? Have you felt bad or guilty about your drinking or drug use? Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? /best-practices-for-adults-/best-practices-for-adults-1.html 13

14 Substance Use Disorder (SUD) We connect members to multiple treatment options. These can include: Insurance-based options Outpatient medication management/therapy Ambulatory detox Intensive outpatient Partial hospitalization Residential treatment Medical detox Non-insurance-based options 12-step recovery groups Faith-based recovery groups Half-way houses 14

15 Medication Assisted Therapy (MAT) Multiple providers can provide Medication Assisted Therapy as part of a member s care. These may include: Some residential, detox, partial and IOP programs Anesthesiologists Urologists OB/GYNs General Practitioners Internists Surgeons Allergists ED Physicians and more 15

16 Medication Assisted Therapy (MAT) BH is currently building MAT access, capacity and quality by: Developing guidance, coding and pricing specific to MAT services Supporting network through hub and spoke tele-education project Enhancing provider directory to assist in identifying MAT prescribers Encouraging partnerships between prescribers and other providers to ensure members medical, behavioral and psychosocial needs are met 16

17 Resources

18 Resources We have numerous ways to connect members to the care they need. Commercial Provider line Commercial BH/CoverKids Case Management BlueCare/TennCareSelect Provider line BlueCare/TennCareSelect BH Case Management PCP Consult line

19 Resources Provider Resources include: Manager, Provider Relations Bob Deatherage (865) East Knox Region Brenda Simmons, Network Manager (865) Middle Region Lee Green, Network Manager (615) East Chattanooga Region Michael Burks, Network Manager (865) West Region Phillip Gomez, Network Manager (731) Middle/West Region Jennifer Ramsden, Network Manager (423) Upper East Region Catherine Overstreet, Network Manager (423)

20 Resources Additional BH-related resources include: National Domestic Violence Hotline Veteran's Crisis Line TALK (8255) TTY: Tennessee Prevention Network TALK (8255) National Suicide/ Mental Health Prevention Hotline: HELP (4357) 20

21 Questions and Comments