ETHOS AND PROGRAM DESIGN
The central premise of the Carenodes Behavioral Health Case Management (BHCM) Program is to promote collaboration between all treating providers, ensuring coordination between medical care and behavioral health care. Once members are identified, Behavioral Health Care Managers outreach / consult with our community partners in medical and behavioral health practice settings. Our program supports the treatment planning needs of providers with respect to behavioral health services and often provides consultation/ suggestions for modifications in current care. This coordination is performed through various avenues including
- Notification letters to physicians informing them that their patients are engaged with the program,
- Telephonic outreach calls,
- Opportunity/option for physician peer-to-peer consultation when needed.
The essence of behavioral health management is ensuring that we direct our members to the right services at the right time.
Our triage and tracking processes include specialized support during service level transitions, such as a discharge from inpatient to outpatient follow-up treatment to ensure that members are attending follow up appointments with community providers within 7 days of hospital discharge. In addition, we utilize a readmission risk algorithm, which identifies members most at risk for readmission to inpatient hospital care. Specialty services are also offered to members diagnosed with eating disorders, maternal mental health issues, families of children and adolescents with a recent inpatient psychiatric stay, and members referred from community providers affiliated with Enhanced Personal Health Care. Also, consenting members engaged in medical care management programs with a positive PHQ2 depression screen or any other BH condition impeding the member’s ability to manage their medical condition are routed to BH for intervention.
Clinical Team/Patient/Family Engagement
Our clinicians work with the member and their family to:
- Understand the options available for behavioral health treatment, utilize insurance benefits for the lowest possible out of pocket cost, and decrease unnecessary health care expenditures
- Advocate for the coordination of all care, both medical and behavioral health
- Educate on symptoms and condition management to prevent future inpatient hospitalization stays
- Discuss and identify barriers to treatment compliance and offer resources and support to overcome them
- Improve overall health outcomes for improved quality of life
