Want good results? Coordinate medical, behavioral case management
Want good results? Coordinate medical, behavioral case management
Mental, physical issues often occur together
Recognizing that medical problems and behavioral health issues are often intertwined, payers and providers are coordinating behavioral health and medical health case management.
"It's imperative to take an integrated approach to meeting the medical and behavioral health needs of patients. This approach treats the whole patient," says Dena Miller, RN, MSN, vice president of clinical innovation and implementation at Fallon Community Health Plan in Worchester, MA. "Commercial payers, as well as state and federal government payers, see the value in an integrated model of care coordination that deals with mental health and substance abuse issues as well as medical issues."
People with significant medical illnesses often develop depression, anxiety, or substance abuse problems that can interfere with their treatment, Miller says. At the same time, people with serious mental illnesses tend to also have severe medical needs. They are more likely to smoke and get less exercise than people without mental illness, which often leads to cardiovascular issues. People who are taking the second generation of antipsychotics have fewer side effects but tend to gain weight and have an increased risk of diabetes.
"More attention to good behavioral health will increase the quality of life for people with medical illness. It's wonderful that providers no longer identify people in silos but instead look across the spectrum," she says.
Fallon Community Health Plan's medical and behavioral case managers sit in close proximity and often co-manage cases for members in its Medicaid HMO and dually eligible members over 65.
Bob Holtz, MA, MBA, LMHC, vice president of behavioral health services for Capital District Physicians Health Plan, with headquarters in Albany, NY, adds that behavioral health issues often affect medical issues, Holtz says. "When our predictive modeling software mines claims data and identifies patients who are at risk for hospitalization, those with high risk factors for medical issues often have a comorbidity with a mental illness," he says.
For instance, there is a high rate of comorbidity between diabetes and depression, and each condition affects the self-management and self-care of the other, he adds.
Diabetics typically have a complicated care plan. They have to measure their blood sugar levels and take medication on a daily basis, and have their eyes checked and their feet examined regularly. "They often have medical complications as well," he says.
When patients are depressed, they often don't feel like doing anything and managing their health doesn't seem important to them, so they don't follow their treatment plan, he says. "They may be inconsistent in care and may feel suicidal. They may think 'diabetes is going to kill me anyway so why should I do these things?' and their motivation level is very low."
If behavioral health problems such as bipolar disorders, depression, anxiety, or substance abuse aren't treated, patients may miss self-care, resulting in an exacerbation of their symptoms and putting them at a risk for complications that could lead to emergency department visits, and hospitalization, he says.
"If we can manage the physical and mental health symptoms together and get patients on medication or psychotherapy, their mood improves, they can manage their self-care, they experience fewer complications, and become a healthier individual all around," he says.
Depression is often the underlying cause in why patients with chronic diseases can't improve or self-manage their conditions, adds Angela Gandolfo, MBA, advisor for performance improvement in clinical operations at UC Davis Health System in Sacramento, CA. Gandolfo helped develop a depression management program in which nurse case managers and primary care physicians at UC Davis Family Medicine collaborate to help patients manage their depression along with their medical illnesses. (For details on this program, see related article on page 90.)
"Depression is often one of the root causes of why people can't move forward with taking care of themselves. Patients who have chronic illness often have underlying depression as well," she says. Chronic diseases often enhance depression if people already have it or cause depression among newly diagnosed patients who didn't previously have depression, she adds. "When patients have depression, ongoing management of their chronic conditions is impacted. That's why we need to address depression along with their chronic diseases."
Capital District Physicians Health Plan (CDPHP) had carved out services to a managed behavioral healthcare company for 13 years when the health plan decided to move behavioral health services in house. At the time, patients with behavioral health problems were referred to the vendor but there was no coordination with the staff providing medical management at CDPHP. "There was no effective continuity of treatment and care between behavioral health and the medical world," Holtz says. "The clinical staff felt that behavioral health issues are part of the whole medical picture and that operating in silos isn't an effective way to reach out to members. We designed the behavioral case management model so that it is connected and integrated with the existing medical case management."
Under a new program, rolled out in 2010, the medical case managers and behavioral health case managers collaborate on management of patients with medical and behavioral health diagnoses. "Clearly patients receive better medical care and have better outcomes if we manage both the behavioral issues and the medical issues together," Holtz says.
Recognizing that medical problems and behavioral health issues are often intertwined, payers and providers are coordinating behavioral health and medical health case management.Subscribe Now for Access
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