mental health · mental health . note! contents are subject to change and are not a guarantee of...
TRANSCRIPT
Mental Health
Note! Contents are subject to change and are not a guarantee of payment.
Companion Benefits Alternatives (CBA) is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross BlueShield of South Carolina.
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Agenda
• General Information • Program Overview • Case Management • Health Coaching • Contacts
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Overview • Behavioral health benefits management for more than 20 years. • Licensed clinical staff specializing in behavioral health. • Fully integrated with our health plan partners.
• Toll-free number included on insurance identification card • Services included in benefits books • Consolidated customer service • Centralized claims processing • Integrated clinical system utilized by medical and behavioral
staff
Program Overview
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
• Who is eligible? – Employees – Covered dependents on the policy
• Behavioral health benefits provide: – Utilization management – Case management – Health coaching programs
Program Overview
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Referral Source for Case Management and Health Coaching
Screening and Case Assignment
Health Surveys
Employee Assistance Programs
Medical, Lab, Pharmacy
Claims
Direct Referrals
Customer Service
Pre-Certification
Nurse Line Referrals
Behavioral Health UM
Identification for Screening
Referral Sources
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
What is Case Management? • Extra support for people with high-risk behavioral health conditions that
require high levels of benefit usage. • A collaborative process that involves a member, his or her providers and the
health plan case manager.
The case manager serves as a member’s advocate and his or her primary goal is to assist and guide the member through treatment and the recovery process. He or she can:
• Coordinate services • Provide authorizations • Help members set and reach goals • Provide accountability and adherence to prescribed treatment plan
Case Management
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Case Management Programs We offer specialized care for a variety of specific conditions through case management: • Alcohol and/or drug use • Bipolar disorder • Depression • Eating disorders • Schizophrenia
Case Management
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Benefits of Case Management Case managers can help providers by:
• Proactively evaluating different interventions based on established guidelines and clinical criteria.
• Providing care coordination and arranging secondary services specific to each member.
• Maximizing use of available benefits and community resources. • Offering member education about mental health and substance abuse
disorders. • Coordinating with medical case management to identify potential drug
interactions with psychotropic medications to impact medical conditions that may be directly related to the behavioral health disorder.
Case Management
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
What is Health Coaching? • Providing assistance for members with chronic conditions, or members who
are at risk for chronic conditions. • Providing members with a better understanding of their conditions and an
awareness of available treatments through their health benefit or community resources.
• Reinforcing positive health behavior between physician visits. With member permission, our health coaches will communicate with providers on progress, issues, etc. This facilitates necessary feedback for behavioral modification, which may prevent or delay disease progression.
Health Coaching
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Health Coaching Programs Using clinically proven methods, our health coaches can help members understand and manage a number of conditions:
• Adult attention deficit hyperactivity disorder (ADHD) • Bipolar disorder • Depression • Postpartum depression (for new mothers) • Recovery support (substance abuse) • Stress management
Health Coaching
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Personal Support for Long-Term Success • Our case managers and health coaches are experienced specialists—
licensed social workers, nurses and LPC’s that operate under the understanding that “one size does not fit all.” Each person faces different challenges and has different requirements, so we work with members to create personalized care plans.
• A strong support system is essential to long-term success. That’s why we supply both members and their loved ones with educational resources and community referrals.
• All our programs are available to members at no cost as part of their behavioral health coverage.
Health Coaching
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Working with Providers • We provide one point of contact within CBA who is a trained
behavioral health clinician. We grant access to specialized resources in and out of the community.
• We encourage opportunities for improved communication with members.
• We work with prescribers through our Partnering with Providers program to reduce overutilization of controlled substances.
• We collaborate with providers through requests information for purpose of care coordination.
Provider Communication
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Working with Members • We provide support through telephone, online, email and mail. • We provide customized educational information about
member’s specific medications and health issues. • We offer assistance with discharge planning, referrals to
specialized resources in and out of the community. • We encourage healthy lifestyle choices by partnering with
members to reach their goals. • We act as advocates to coordinate member-centric care and
empower members to take an active role in their healthcare management.
Member Communications
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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
Contact Us • Website: www.companionbenefitalternatives.com (This link leads to a third
party site. That company is solely responsible for the contents and privacy policies on its site.)
• Network Inquiries: [email protected]
• Information on CBA programs: [email protected]
• Telephone: 800-868-1032 – Christi Bost: Supervisor of Disease Management/Health Coaching
Ext. 25779, [email protected] – Jody Rock: Supervisor of Case Management
Ext. 25802, [email protected]
Contacts
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