For those most acutely affected by serious mental illness, inpatient behavioral health care can be an important aspect of treatment. But inpatient care often isn’t enough. Patients who get inadequate outpatient treatment — or no treatment at all — after they are discharged may end up in the emergency room or hospitalized again. Without appropriate follow-up care, they’re also at greater risk for financial difficulties, homelessness, unemployment and suicide.
The transition to outpatient treatment for behavioral health patients can be crucial to preserving the gains achieved in inpatient care. Many patients need a plan for continued care and the support to help them stick with it.
That’s the goal of Blue Cross and Blue Shield of New Mexico’s Behavioral Health Care Coordination & Early Intervention program (CCEI). By identifying and engaging at-risk patients, the program aims to help meet their medical and behavioral health needs, promote their safety and address any barriers to adhering to treatment plans.
It starts with encouraging members to make it to their first follow-up appointment within seven days of discharge and establish a relationship with a behavioral health professional.
“The idea is if they make their initial follow-up appointment, it reinforces the need to see the psychiatrist and adhere to medications and stay in treatment,” says Scott Holder, enterprise divisional vice president, Behavioral Health, Clinical Operations of our health insurance Plans in Illinois, Montana, New Mexico, Oklahoma and Texas.
The CCEI program has assisted about 15,000 members across our five Blues Plans since its inception in 2013. While still in inpatient care, members are included in the program if they meet certain criteria that can increase the likelihood of negative consequences. These “triggers” include having a diagnosis of an eating disorder, being age 12 or under, having been in inpatient care for 25 days or longer, having at least one behavioral health readmission in the past year or being identified as part of a vulnerable population. Members can also be included in CCEI at the discretion of our behavioral health clinical staff.
The program attempts to identify members for inclusion early so that post-discharge treatment planning can start before the member leaves the facility.
When members are identified, our discharge coordinators contact inpatient facility utilization review staff to provide information about CCEI, determine if there are potential gaps in establishing discharge plans and discuss how we can help coordinate the members’ care. The discharge coordinators also ask the facility staff to review information about CCEI with the members.
After members leave inpatient care, discharge coordinators try to contact them within 48 hours. The focus of the contact is to try to make sure members have a comprehensive plan to meet their medical and behavioral health treatment needs, including a behavioral health follow-up visit within seven days of discharge. Research has shown that patients who don’t keep their post-discharge follow-up appointment are twice as likely as those who keep their appointments to be rehospitalized in the same year.
If members don’t have an appointment, discharge coordinators help set one up. The coordinators also encourage members to see medical and behavioral health providers and make use of community support resources such as Alcoholics Anonymous or Narcotics Anonymous. Discharge coordinators also confirm that members attended their follow-up appointments and contact members again if they didn’t.
CCEI has improved outcomes. Members who engaged in the program showed 22 percent lower inpatient utilization in the six months following their initial post-discharge contact than members who didn’t engage in the program. The engaged members also showed 74 percent fewer behavioral health readmissions, 4 percent fewer avoidable emergency department visits and 46 percent lower total claims costs on a per-member-per-month basis.
Beyond the numbers, the program has made a difference in members’ lives. Paul* was a Blue Cross and Blue Shield member who was discharged from a behavioral health facility with a follow-up appointment scheduled in a month. But he started having side effects from his medication and needed to see a psychiatrist as soon as possible. After talking with him, Paul’s discharge coordinator contacted his primary care physician, and Paul got a referral to see a psychiatrist within seven days. He has not visited the ER or been readmitted to the hospital since.
“The big picture” for the program, says Holder, “is to keep members from needing to go back to the hospital.”
Blue Review • November 2015 • bcbsnm.com