Leveraging the Value of Behavioral Heath Integration In Your PCMH. August 26, 2016
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1 Leveraging the Value of Behavioral Heath Integration In Your PCMH August 26, 2016
2 Introductions Brooke McCulley LCSW, CCM Behavioral Health Clinical Operations Manager BlueCare, TennCareSelect, DSNP, MA, CoverKids Office: (901) Cell: (901) BlueCare CM Referrals: Ext Rhonda V. Roper, LCSW Clinical Manager Commercial Behavioral Health Services Office: (423) Cell: (423) Commercial CM Referrals: Ext
3 Unaddressed Comorbid Behavioral Health Issues among Medical Populations: Scope of the problem 50% of Americans have one or more chronic health condition 1 in 4 adults in the United States experience a behavioral health issue in a given year Patients with a chronic disease and behavioral health comorbidity cost as much as 50% more than those without the behavioral health condition 3
4 The Impact of Behavioral Health Comorbidity in our PCMH BH Comorbidity No BH Comorbidity Average PMPM $ $62.90 *2015 PCMH PMPM 4
5 Addressing Comorbid Conditions Our BH experts manage health, not just illness Our programs are relevant for entire population diagnosed and undiagnosed alike Just as everyone has a fluid physical health status, everyone has a fluid behavioral health status 5
6 BlueCross Structural Changes to Enhance Integration Government behavioral health programs were in-sourced Jan. 1, 2015 Commercial behavioral health programs followed Jan. 1, 2016 Purpose is to enhance capabilities in integrated care and improve quality of care Integrated rounds occur across all lines of business with both the medical director and psychiatrist on complex cases We welcome PCMH Care Coordination participation in Integrated Care Team calls! 6
7 Population Health Our Population Health model is an integrated care management program All members of our population health team are trained to assess our member population for behavioral health needs Care managers are trained to manage both medical and behavioral health needs Members are screened by a mini health risk assessment that includes screening for substance use disorders and mental health issues Additionally, referrals for care manager interventions are identified through a variety of ways including: risk stratification, utilization management, and our complex, chronic care management programs and PCMH Care Coordinators 7
8 Behavioral Health Resources 8
9 Crisis Resources Mobile Crisis Services is a 24/7/365 response team for those who are experiencing a mental health emergency. Services include Mobile Crisis Services for children and youth. Telephone services provided by trained crisis specialists Face-to-face or Telehealth assessment Referral for additional services and treatment Call CRISIS-1 ( ) and you will be routed to a trained crisis specialist in your area. 9
10 Member/Provider Resources BlueCross website ( offers tools that help members access and utilize behavioral health programs and services such as: Behavioral Health Toolkit Screening and training resources Behavioral Health Referral and Consultation line Behavioral Health Toolkit Toolkit/index.page 10
11 Behavioral Health Toolkit 11
12 Behavioral Health Toolkit (cont.) 12
13 Behavioral Health Toolkit (cont.) 13
14 And Coming Soon to a Provider Near You 14
15 Tennessee Health Link Tennessee is working with providers to improve integrated and value-based behavioral and primary care services for TennCare members with significant behavioral health needs Tennessee Health Link (formerly Health Home ) will help providers to integrate care and build capacity to transition to value-based payment and delivery in the future Currently 19 providers in the THL network The program will launch Dec. 1, 2016 THL referrals can be made through the BlueCare CM referral line: Ext
16 How THL Can Support Your Members Comprehensive care management (e.g., creating care coordination and treatment plans) Care coordination (e.g., proactive outreach and follow up with primary care and behavioral health providers) Health promotion (e.g., educating the patient and his/her family on independent living skills) Transitional care (e.g., participating in the development of discharge plans) Patient and family support (e.g., supporting adherence to behavioral and physical health treatment) Referral to social supports (e.g., facilitating access to community supports including scheduling and follow through) 16
17 Pain Medication & Care Improvement Program Overview 17
18 The Pain Conundrum: Tennessee Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee as were written in Minnesota. - CDC Source: The Episodes of Pain Care Company Confidential and Proprietary 2016 axialhealthcare All rights reserved 18
19 Aberrant Prescribing Patterns (APP) BlueCare Tennessee PMCIP Program Components: APP + RIM Bottom 2% Based on Quality Scores - APP; On a quarterly basis axial to run proprietary analytics to identify those practitioners demonstrating risk factors against APP quality benchmarks Risk Identification & Mitigation (RIM) Top 20% Based on Prescribing Volume - RIM Practitioner: On a monthly basis axial generates practitioner-level reporting of opioid prescribing and practice patterns as benchmarked against 15 evidence-based quality standards, and in-network peer group RIM Practitioner Reports educate providers on their practice patterns, opportunities for improvement and standards of care ~4,000 RIM scorecards mailed to date RIM Patient; On a monthly basis axial identifies BCT pain patients on opioids demonstrating risk factors Reporting will be provided to BCT beginning October to support a care management pilot for ~300 patients The Episodes of Pain Care Company Confidential and Proprietary 2016 axialhealthcare All rights reserved 19
20 Aberrant Prescribing Patterns (APP) Methodology and Indications High Risk for: Death Illness Addiction Diversion APP SCORES Indicates likelihood of Aberrant Prescribing Patterns Derived from 8 Quality Metrics Addiction Dose Duration Early Refills Multi-Prescriber Opioid Panel Size Poly-drug Script Length The APP Score is determined based on an analysis of BlueCare Tennessee medical and Rx claims only. The APP Score translates, on a scale of 0 100, into the percentage of patients receiving opioids prescribed by the provider that are placed at high risk of patient harm by the provider due to inappropriate opioid use. Confidential and Proprietary 2016 axialhealthcare All rights reserved 9
21 Risk Identification & Mitigation (RIM) Reports Provider Education RIM scorecards are provided for the top 20% (~800 prescribers/month) of opioid prescribers based on prescription volume. RIM provides monthly prescribing patterns and highlight The health plan is monitoring me How do I compare to my peers? Am I improving? Where can I improve? Opioid Patient Risk Factors The Episodes of Pain Care Company Confidential and Proprietary 2016 axialhealthcare All rights reserved 21
22 Questions? Cheryl McClatchey Director of Behavioral Health Programs (423)
23 Appendix: State/National Resources National Institute of Mental Health: National Alliance on Mental Illness: Substance Abuse and Mental Health Services Administration: Crisis Stabilization (TN): 23
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