Volunteer State Health Plan Webinar Event March 23 rd, 2012 Screening for Substance Abuse and Private Label Initiative Volunteer State Health Plan (VSHP) and BlueCross BlueShield of Tennessee (BCBST) are independent licensees of the BlueCross BlueShield Association. VSHP is a licensed HMO affiliate of BCBST.
Screening for Substance Abuse Services Leland Lusk Clinical Supervisor BlueCare and TennCare Select
Who should be screened for substance disorders? All individuals seeking services for mental health and/or substance abuse services.
Why screen for substance abuse disorders? High percentage of mentally ill patients are substance abusers Early detection allows for early intervention Allows for accurate diagnosis and treatment planning. Assists in developing relapse prevention and discharge plans Enables appropriate and effective prescribing of medication
Who should be conducting screenings? Psychiatric hospitals Mental Health Centers Emergency rooms and mobile crisis teams (MCT) Primary care offices Prenatal care settings Pain management offices
Screening Tools CAGE or CAGE-AID The CAGE-AID (Brown & Rounds, 1995) is a 4-item screen for substance use disorder. It is a reworded version of the widely-used CAGE (Ewing, 1984) adapted to include drugs. C. Have you ever felt you ought to cut down on your drinking or drug use? yes no A. Have people annoyed you by criticizing your drinking or drug use? yes no G. Have you ever felt bad or guilty about your drinking or drug use? yes no E. 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? yes no
Screening Tools, continued Michigan Alcohol Screening Test (MAST) or Drug Abuse Screening Test (DAST) Short, easy to administer screening tools that are somewhat longer than the CAGE and are used in Screening Brief Intervention Referral to Treatment (SBIRT) training.
How to conduct screenings 1) Develop rapport. 2) Explain why the questions are being asked and normalize them. 3) Score the screening tool, follow-up on responses, and decide on referral. 4) Screen for drugs 5) Collect collateral information. 6) Be observant
Helpful Links www.niaaa.nih.gov www.samhsa.gov www.drugabuse.gov
Private Label Initiative Cheryl McClatchey and Bo Turner
Enhancing our Approach to Integrated Care Volunteer State Health Plan continues to enhance the integrated model which was a key element in obtaining the BlueCare East and West contracts a few years ago. The new objective for 2012 includes a further refinement of the integrated model. Our behavioral health partner, Value Options, will continue in its current role but with a revised outward look for our providers. You will notice this change in a few subtle ways.
The New Approach for VSHP Behavioral Health Provider Relations Our provider relations approach has undergone some changes that will enhance the service level for the provider community. The support of our behavioral health and medical providers will become more seamless.
What Is It? In its simplest form, private labeling requires that all market facing references to VSHP services for its members and providers be labeled VSHP and VO will take more of a back shop role.
Member Interactions Members have always known VSHP is their insurance company Behavioral Health Care Managers interact with members and providers as BlueCare or TennCareSelect Most community outreach initiatives have been in conjunction with VSHP physical health and are labeled accordingly o There are still some residual references to VO o Members interacting directly with VO staff might receive VO business cards
Interaction with Providers and Outside Agencies Since behavioral health providers are contracted by VO, there may be confusion regarding the VSHP membership and claims payment Provider representatives are outreaching on behalf of VSHP but are clearly identified as VO Providers and outside agencies may think of VO as the BH entity rather than a contractor for VSHP
What are the effects of this? There may be the perception that there is an MCO and a BHO, and that integration is lacking It could potentially be perceived as the membership belonging to VO It could lead to confusion over which policies and procedures to follow
What are the changes? All staff associated with the VSHP contract will o Carry VSHP business cards o Refer to themselves as VSHP (not VO) o The VSHP name will be used in the market place regarding Behavioral Health Provider Relations Staff will become VSHP employees Overall, we think this process will have little or no operational impact on providers Our goal is to make the interaction with VSHP more seamless
Are there exceptions? Since the network will continue to be contracted by VO, the following functions will continue to be labeled VO: o Credentialing (although VSHP PR Staff will assist) o Contracting Certain senior level VO interactions with provider networks may still occur as it relates to contracting and national VO issues
What does this mean for you? Simplify your interactions around provider issues Allow you to continue to have a high level of support around provider issues Help clarify policy and procedure issues Give you more direct access to VSHP resources
Thank you Questions? Feedback? Volunteer State Health Plan (VSHP) and BlueCross BlueShield of Tennessee (BCBST) are independent licensees of the BlueCross BlueShield Association. VSHP is a licensed HMO affiliate of BCBST.