1. How Can we Help? Health Plan Resources for Behavioral Health Needs 1 Rena Sheehan, LICSW Director of Behavioral Health, BCBSRI May 5, 2015

2. Overview Potential Behavioral Health Needs and Services Health Plan Case Management Programs What to expect from a referral Case Example Contact List 2

3. Behavioral Health Needs Members’ behavioral health needs can vary, health plans cover a range of treatment services consistent with a member’s specific benefits. Health plans also offer programs and services through behavioral health case and disease management programs that can assist you in both identifying and accessing the appropriate services and resources for members. 3

4. Potential Behavioral Health Needs* 4 Counseling/Therapy Medication Management Home and Community Based Services Inpatient, Residential or other Higher Levels of Care Case Management programs can assist you at every level of need. * Services available are specific to a member’s benefit design. Benefits should always be verified.

5. Appropriate Referrals Members with chronic medical conditions with a behavioral health need. Members with co morbid medical and behavioral health conditions who experience gaps in care such as medication adherence issues or missed appointments. Members with identified behavioral health conditions that are untreated or do not appear to be well managed. 5

6. Role of the Behavioral Health Case Manager The role of a Behavioral Health Case Manager includes: Assessing and addressing barriers to member self management of behavioral health conditions Assistance in accessing resources, services and supports Coordinating with the member’s treatment providers Providing condition education and self management tools The Behavioral Health Case Manager does not provide counseling or therapy services. The Behavioral Health Case Manager should not be used as a substitute for acute or emergent care in a crisis situation. 6

7. How to Refer and What to Expect To refer, use the contact information provided at the end of the presentation or in the binder. Turn around time for referrals: no longer than 5 days. Referral may be for assistance with resources or ongoing co management. The BH Case Manager will outreach the member and continue to coordinate with you around the member's goals, progress and any additional needs. 7

8. What Can a Member Expect? Outreach call within 5 days of referral Introduction to the program and how the Case Manager may help the member Psychosocial assessment if member agrees to participate Discussion and agreement on goals and steps to achieve goals Schedule of contacts going forward A member remains in the program until the member no longer wishes to participate or achieves the identified goals. 8

9. Case Example A member who was receiving case management services through a health plan medical case manager expressed feelings of anxiety and identified a significant loss of a loved one. The medical case manager referred the member to the behavioral health case manager. The behavioral health case manager educated the member on symptoms of grief, and sent educational materials on grief/bereavement, including what to expect at the one year anniversary and holidays. Member was referred to local bereavement counseling and called to schedule individual counseling in her home through a local bereavement support agency, which will be free of cost to her. Case management also worked with the member’s PCP to assess for medication appropriateness to treat anxiety and to facilitate a referral to a home health agency that provides services to members with primary behavioral health needs. 9

10. Case Management Access Information Health PlanContact Information NHPRI: Beacon Health Strategies 1-800-215-0058 ValueOptions Case Management 1-800-274-2958 United HealthSee binder 10