Behavioral CMs help manage bipolar members
Behavioral CMs help manage bipolar members
Program aims to reduce hospitalizations
Members with bipolar disorder are getting the help they need to keep their condition under control through a new telephone coaching program from Health Alliance Plan (HAP) of Michigan.
In the program, behavioral case managers, who are psychologists or social workers, work with members on issues such as mood management; signs and symptoms of bipolar disorder; medication compliance; and relationships with family, friends, and employers.
The behavioral case managers work closely with the health plan's nurse managers to provide a seamless continuum of care for members with behavioral disorders and chronic diseases.
It's too soon to have outcomes data, but members have received the program well, says Mary Clare Solkey, MA, LLP, LPC, HAP's director of behavioral health.
"There has been a very low rate of people who weren't interested in participating. Based on anecdotal information, I think we'll show positive outcomes with few re-hospitalizations and an improvement in overall health status," she says.
Bipolar disorder, also known as manic depressive disorder, is characterized by symptoms of depression and manic behavior with normal behavior in between.
"About 3%-6% of the population has bipolar disorder. It's a chronic condition, and people who have it generally need to receive care for the rest of their lives," Solkey says.
People who have bipolar disorder often keep it under control for a while, then have a crisis, Solkey points out.
"When people are having manic symptoms, they feel good and this leads them to go off their medication or stop seeing their doctor. As time progresses, they may become more and more out of touch with reality and can develop psychotic symptoms," she says.
Depression associated with bipolar disorder can be extremely debilitating and lead to psychosis.
When people feel normal, they truly believe that they no longer need medication, she adds.
"However, they follow the cycle throughout their entire lives. Some may experience only depression with minor mania. Some have complete mood swings from serious depression to complete mania and some fall in between," she says.
HAP began the program in 2007 to help their members with bipolar disorder who were often hospitalized for a crisis, then re-hospitalized six months or a year later when they got into a crisis situation again.
"There is clear evidence that medication is the key to improvement for people with bipolar condition. The more education they have about the side effects, the greater likelihood they will stay on the medications," Solkey says.
Members are identified through claims when they have been hospitalized with a diagnosis of bipolar disorder. Some are referred by their providers and others are self-referred.
Since up to 60% of people with bipolar disorder also have chemical dependency, the health plan has recently begun evaluating everyone who is discharged from a chemical dependency program.
Behavioral health case managers contact all patients who have been discharged from the hospital after treatment for bipolar disorder and those who were referred through another means and offer them the opportunity to participate in the program.
They contact members with chemical dependency issues and use three questionnaires to screen them for bipolar disorder. They are the PHQ-9 (Patient Health Questionnaire) for depression, the GAD-7 (a generalized anxiety disorder questionnaire) and the MDQ (Mood Disorder Questionnaire).
The behavioral health case managers can help members make appointments for therapy and support them in following their behavioral health treatment plans.
Members who agree to participate in the program receive information about the disorder as well as a chart for tracking their moods on a continuum from depressed to manic. The case managers encourage members to call their therapists if their moods are close to one end of the continuum or other.
The behavioral case managers also help members access HAP's HealthTrack disease management program web site, which includes information for members with bipolar disorder and depression, along with mood-tracking tools and links to on-line and local support groups.
"The case managers talk to the members about going online or go on-line with them to demonstrate how to fill out the mood-tracking chart. They can sign up to receive e-mail or text messages to remind them to fill their prescriptions," she says.
The program is individualized according to the preferences of the members. If members prefer to receive all resources by mail, HAP mails them materials at two-week intervals. Some move directly into a once-a-month check in. Most agree to receive a phone call from the behavioral case manager every two weeks.
The behavioral case managers call members in the program about every two weeks, depending on the member's schedule and preferences, and work with them on barriers to compliance and other issues.
They help the members understand their moods and the triggers that can cause or signal a relapse. For instance, the anniversary of a traumatic event may bring on a crisis, or someone with bipolar disorder may never feel the urge to drink alcohol except just before an episode of depression or mania.
The case managers coach members on how to talk with their employer or family members about their condition and to enlist their aid in recognizing when the member is about to experience a manic or depressive episode.
"People with bipolar disorder may not recognize symptoms within themselves and need help from family members or friends about what behavior they have observed just before an episode of depression or mania started and come up with a plan to avoid the crisis," she says.
For instance, a family member may notice that the patient typically sleeps less just before an episode of mania. As a back-up plan, they agree to call the doctor if the behavior persists and the member doesn't take action, she says.
"The case managers do a lot of individualized coaching in regard to whatever will help the member avoid the same pattern of illness," she says.
When the members complete the initial phase of the program, which lasts about three months, they have the opportunity to participate in a case management level two program for up to a year.
In that program, the case managers make monthly telephone calls to members to make sure they are seeing their doctor, staying on their medication, and setting personal goals that will help them stay healthy.
At HAP, the behavioral case managers work closely with the nurse case managers who provide disease management for patients with chronic medical conditions, adds Richard Precord, MSW, director, clinical care management.
"We are working to provide a seamless and integrated approach to care for our members," he adds.
"We know that there is a high prevalence of depression in individuals with chronic health conditions. It's not unusual for a member with diabetes and co-morbid depression to have trouble managing the diabetes until the depression is identified and treated," he says.
When the nurse case managers make an outreach call to a member with a chronic disease, they refer the member to a behavioral case manager for additional screening for depression, anxiety, mood disorders, and chemical dependency.
The behavioral case managers literally work side by side with the disease case managers, Precord says.
"We integrate our disease management with behavioral case management and pharmacy management. The nurse case managers and behavioral health case managers work as a team and all have access to the same records. Our members don't feel like they're being passed back and forth. It's a coordinated effort," Precord says.
Members with bipolar disorder are getting the help they need to keep their condition under control through a new telephone coaching program from Health Alliance Plan (HAP) of Michigan.Subscribe Now for Access
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