Depression program maintains confidentiality
Depression program maintains confidentiality
Reminder calls increase patient compliance
When Buffalo, NY-based Univera Healthcare decided to include depression management in its array of population-based disease management programs, the quality management staff were concerned about preserving patient confidentiality.
"Because depression is such a sensitive area, we didn’t want to use the same approach we do in diabetes or immunization management. We didn’t automatically identify everyone in the population because we didn’t want lists of patients with depression floating around," says Kathleen Curtin, NP, MBA, vice president of quality management administration for Univera Healthcare. Univera has recently merged with Excellus Inc., now its parent company.
With the help of researchers from Dartmouth College, the health plan hit on a simple idea: instead of coming up with lists of their members diagnosed with depression, the plan began notifying prescribing physicians when patients failed to refill their antidepression medication.
"The patient is already being cared for by the physician, so there is no breach of confidentiality when we send them a computer-generated letter," Curtin adds.
One goal of the program was to ensure that patients refill their antidepression medications. Health plan officials know that it usually takes several weeks for antidepression medication to have the intended effect.
If patients fail to take their antidepression medicine and their disease is not controlled, it can significantly reduce their quality of life and may lead to high and often unnecessary health care utilization.
Often a simple reminder can work wonders. For instance, in a pilot project, patients who received three or four brief telephone calls from nurses over a six-month period showed a 30% improvement in refilling their prescriptions. Here’s how the depression management program works:
The quality management department and the pharmacy benefit department at Univera identify patients who have picked up their first prescription for antidepressants but have failed to get it refilled.
The physician who wrote the prescription, usually either a psychiatrist or a primary care physician, receives a letter explaining the program and the list of patients who failed to get their prescription refilled. The letter includes information about recognized standards of care and medical literature that suggest that newly diagnosed patients be on antidepression medicine for at least six months.
"We notify them first that literature recommends maintaining the patients on therapy for six months, and then we let them know when the patient is not being maintained on therapy," she adds.
The health plan suggests that the physicians follow up with their patients by telephone or letter and let them know the importance of consistency in taking antidepression medicine. If the physicians have a question about patients on the list, they can call a toll-free hotline for clarification.
Physicians are encouraged to refer patients to the Care Calls Program, which includes scheduled telephone calls to make sure overall depression therapy is going well. Physicians have responded positively to the program, Curtin says.
"In an entire community, physicians get a letter listing only one or two patients each month. They remember the patients and want to follow up," she says.
When a Care Calls nurse receives a referral from a physician, she calls the patient to make sure that patient is taking the medication as prescribed and is keeping scheduled appointments.
The nurses typically call patients three or four times over a six-to-12-month period. They have been trained to understand that they are making a simple reminder call and that they shouldn’t try to do therapy over the telephone, Curtin says.
"We don’t have the resources for intensive management in our Care Calls program. We have a case management program to provide that service for complex patients. The nurses understand that we are organized into different levels of care, each with its own interventions," she says.
Univera’s case management program for complex behavioral health patients is an adjunct to its population-based program. The complex case management program is for member with complex needs or comorbidities and is run by the behavioral health department.
The intensive program is traditional case management for complex behavioral health patients. This includes telephonic interventions that are tailored to each individual based on their treatment plan.
Many of these participants are diagnosed when a Univera member is hospitalized with a mental health-related diagnosis. The case manager monitors the patient’s progress in the hospital, participates in the discharge plans, and encourages follow-up appointments with a behavioral health counselor.
The health plan has always had a case management program for complex mental health patients. The other two levels of care have been developed within the past 18 months.
The intensive behavioral health case management program has been in effect for some time. Univera developed the two other levels of care programs in the past 18 months when their HEDIS performance measures showed a need to improve in the areas of short-term and long-term medication therapy.
The HEDIS results from the first year of the programs are not yet available, but based on outcomes from a pilot program, Curtin expects to see overall improvement, particular for participants in the Care Calls program.
Before rolling out the program to the entire population, Univera conducted short-term pilot projects of three to six months’ duration for all three components of the depression management program.
The design team that initiated the program looked at the pilot and decided how to roll out the full program and will make any necessary modifications to the program.
"We are interested in seeing the impact on our HEDIS scores. If there has been no impact, we’ll have to make significant changes," Curtin says.
One of her goals for the coming year is to increase the number of referrals that physicians make to the Care Calls program.
"We found that this could be a powerful intervention that worked very well in the pilot project. We are going to start selling this concept to physicians so we can generate more referrals," she says.
When Buffalo, NY-based Univera Healthcare decided to include depression management in its array of population-based disease management programs, the quality management staff were concerned about preserving patient confidentiality.Subscribe Now for Access
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