Provider Communications MHN Behavioral Health Care PCP tools for coordinating care Tina Machi, Health Net We offer tools and resources for improving member health.
Managed Health Network (MHN), Health Net s behavioral health division, provides members with services through its specialty network. Members in need of ongoing treatment have access to a full continuum of preventive, supportive services through a comprehensive network of behavioral health providers. Ric Magallon, Health Net We help to create optimum health outcomes. Referring members to MHN Primary care physicians (PCPs) can refer a member to a participating MHN behavioral health provider using the Provider Search function on the MHN Web site at https://members.mhn.com/mbh/homepage. Also available on the Web site is information on disease management programs offered for most common behavioral health conditions. Help with referrals is available by calling (800) 977-0281. MHN strives to meet member needs in a timely manner. MHN consistently meets the following access standards for members: Routine appointments within 10 business days Urgent appointments within 48 hours Emergency (non-life-threatening) appointments in six hours Communicating with behavioral health providers Health Net encourages regular, open communication between PCPs and members behavioral health providers. To help facilitate this, we encourage you to remove and make copies of the enclosed Behavioral Health Coordination Form to give to members request that they have their behavioral health provider complete the form and return it to you (with the member s consent). You may also contact the behavioral health provider directly for an update on the member s care, with the member s permission. Behavioral health conditions and resources The following information and resources are for some of the most common behavioral health conditions that indicate behavioral health intervention from PCPs, specialists and MHN. If you need assistance for a member who demonstrates symptoms or has been diagnosed with any of these conditions, please refer the member to an MHN provider or contact MHN directly. Depression Studies show that approximately one in five Americans suffer from behavioral health conditions, such as depression and anxiety, both of which are associated with reduced quality of life, social functioning and excess disability (disability that is present beyond what is expected from a disease or condition). Most of these people are not diagnosed nor do they receive treatment. When a member is diagnosed with depression, it is important for him or her to engage in the treatment plan. Emphasize that depression is a medical illness, recovery is expected and that successful treatment is best if started as soon as possible.
Medication tips and tools When treating depression with medication, it is important to communicate the following to the patient: It is essential that medication be taken every day, or as prescribed by the physician It may take two to four weeks to achieve noticeable effect Continue taking the medication even if feeling better Refill prescriptions early so they do not run out Keep all follow-up appointments Call the physician if experiencing unexpected side effects Consider referral to MHN s Depression Management Program for members who call frequently about their prescribed antidepressant medication, schedule numerous appointments for insignificant physical complaints (but refuse referral to behavioral health specialists), or are non-adherent to your recommendations. This is a free telephonic depression program that may benefit members with clinically significant depression. For the best outcome to successfully treat members with depression on antidepressant medications, members must be seen for follow-up visits and evaluated for medication effectiveness and side effects. Measures to track medication efficacy include: Acute phase newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days (12 weeks) Continuation phase newly diagnosed and treated members who remained on an antidepressant medication for at least 180 days (six months) Depression Management Program The MHN Depression Management Program is available for members who may be at risk for depression. Providers or members may call (800) 327-8344 from 7:30 a.m. to 4:30 p.m. (Pacific Time) to learn more about or register for the program. Depression handouts Providers have access to informative member handouts about depression that can be printed from the Health Net provider Web site at www.healthnet.com/provider and distributed to patients. Health Net outreach Health Net conducts automated outreach calls to members when gaps are identified in antidepressant medication refills. These automated telephone calls remind members to continue taking their medication and to refill prescriptions, while emphasizing the importance of reporting any medication problems or concerns to their providers. The calls also offer a warm transfer to a Health Coach if the member has questions about medications or treatment. Attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood behavioral health disorders, according to the National Institute of Mental Health (NIMH). When children are treated with ADHD medications, follow-up treatment for medication effectiveness and side effects is key to successful treatment outcomes. Measures to track medication efficacy for children ages six to 12 on ADHD medication include: Initiation phase members ages six to 12 who had a follow-up visit with the prescribing provider within 30 days of beginning ADHD medication MHN providers are available to help assess if a member requires behavioral health intervention and provide necessary support services.
Continuation and maintenance phase members ages six to 12 who were prescribed ADHD medication remained on the medication for at least 210 days (seven months) and who, in addition to the visit in the initiation phase, had at least two more follow-up visits with a practitioner within 270 days (nine months) Currently, Health Net Healthcare Effectiveness Data and Information Set (HEDIS ) 1 scores show that only 24 to 38 percent of these children have follow-up visits. To improve follow-up treatment efforts, Health Net encourages you to refer to Health Net s Attention-Deficit Hyperactivity Disorder in Children medical policy, available on the Health Net provider Web site at www.healthnet.com/provider under View our Medical Policies. Alcohol and other drug use Routine screening for alcohol and other drug (AOD) use, for both new and existing patients, is critical for early identification and treatment. Members who are diagnosed may not consider behavioral health treatment for their condition. However, with proper evaluation and treatment, including outpatient treatment from MHN, members can receive assistance to overcome problematic use and realize a healthier lifestyle. To assess whether a patient is using any substance that is problematic, ask the following six questions: 1. Do you drink alcohol? 2. Have you ever experimented with drugs (legal or illegal)? 3. Have you ever felt you should cut down on your drinking and/or drug use? 4. Have people annoyed you by criticizing your drinking and/or drug use? 5. Have you ever felt bad or guilty because of your drinking and/or drug use? 6. Have you had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? Three or more yes responses indicate a high likelihood that the member s substance use is problematic. Health Net, using HEDIS measures, tracks the initiation and engagement in treatment, as follows: Initiation of treatment members who initiate treatment through an inpatient alcohol dependence admission, outpatient visit, intensive outpatient encounter, or partial hospitalization within 14 days of the diagnosis Engagement of alcohol dependence treatment members who initiate treatment and had two or more additional services, such as attending a recovery program, counseling or visiting a health provider s office, within 30 days of the initial visit If appropriate, advise members to cut down their usage of alcohol and other drugs. Let them know that they can arrange a specialty evaluation or treatment through MHN. Members can call the telephone number on the back of their Health Net identification (ID) cards at (800) 977-0281 to request information about referrals. Members who demonstrate symptoms of behavioral health conditions can be referred to an MHN provider using the Behavioral Health Coordination Form. 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
BEHAVIORAL HEALTH CARE COORDINATION FORM Instructions: Primary Care Physicians (PCPs): Copy and give this form to members and request that they have their behavioral health provider complete the form to communicate the member s treatment updates to you. Include your contact information in the appropriate area below to ensure receipt of the form. Members/Patients: Give this form to your behavioral health provider to complete and return to your PCP. Behavioral Health Provider: Complete the appropriate areas of this form to ensure care coordination with the member s PCP. Responsible practice requires coordination of care with other treating professionals and health care delivery systems as clinically appropriate. Consider using this form (or one with comparable information) to send to the member s PCP. Name of Patient Patient ID Number Information exchanged for purposes of treatment, payment and health care operations is permitted under the Health Insurance Portability and Accountability Act (HIPAA) even without a member s authorization to do so. A member s authorization is required only before behavioral health practitioners share psychotherapy notes (session notes kept separate from the medical record consisting of the contents of conversation during a private, group, joint, or family counseling session), which are not included in this form. PCP or Other Health Care Professional Name/Fax # Address/Telephone # ******************************************************************************************* Dear Doctor: Today s Today s Date Date The above named patient is receiving behavioral health services. Date of first Session Current Diagnosis: Current Psychotropic Medications MEDICATION DOSAGE START DATE PRESCRIBED BY Coordination of Care Issues Behavioral Health Practitioner Name/Fax # Address/Telephone # This information has been disclosed to you from records whose confidentiality is protected by confidentiality provisions of most states law and applicable federal law. Under such law, you are prohibited from making any further disclosure of these records without the specific written consent of the person to whom they pertain or as otherwise specifically required or permitted by law. A general authorization for the release of medical or other information is not sufficient for this purpose. Federal regulations under 42 CFR Part 2 restrict any use of the confidential information to criminally investigate or prosecute any alcohol or drug abuse patients. MHN is a subsidiary of Health Net. Health Net. A Medicare Advantage organization with a Medicare contract. Material ID # Y0035_2012_0644 (H0351, H0562, H5439, H5520, H6815) Compliance Approved 01312012
Health Net National Provider Communications 11971 Foundation Place Rancho Cordova, CA 95670 MHN Questions or referrals: (800) 977-0281 www.mhn.com 12-032 6026293 Health Net is a registered service mark of Health Net, Inc. All rights reserved.