L.A. Care Health Plan Behavioral Health Support Services E.E. Lazarou, MD, MS, RD Health Integrated

What's going on tonight? Health Integrated Confidential2  Why is behavioral health important in the primary care world?  How do we at Health Integrated fit in?  How can we help you?  Practical Application: Case Scenario  Questions?

1.NIMH American College of Physicians The Reality of Behavioral Health (BH) Care Delivery  74% of Americans seeking help for BH issues seek treatment from their PCP 1.  PCPs prescribe approximately 65%+ of all prescriptions for antidepressants 2.  BH issues exacerbate and complicate physical health condition treatment and adherence.  Cost of psychotropics now exceed cost of specialist provided behavioral health services in many health plans.  Lack of BH/Medical coordination results in fragmented care, care gaps, and reduced clinical and financial outcomes. Health Integrated Confidential3

So, what are we going to do about this? Health Integrated Confidential4

L.A. Care has partnered with Health Integrated  L.A. Care has recognized a need for greater support to primary care physicians who are managing members with comorbid behavioral health conditions.  Health Integrated has extensive experience in helping manage patients with comorbid medical and behavioral problems. Health Integrated Confidential5

Higher Risk Lower Risk Helping High Risk Members who Comprise the most Difficult to Reach, Engage and Costly Population Health Integrated Confidential6  The high risk group typically represents the members who are difficult to reach and motivate. It’s these members who drive up health care costs and utilization.  Health Integrated’s Behavioral Health Support Program is an expansion of L.A. Care’s current capabilities and processes meant to support primary care physicians.  This teamwork positively impacts patient health while reducing costs and educating providers on the front line.

Behavioral Health Support Services How does it work and what are the processes? Health Integrated Confidential7

Step 1: Support providers in managing members with mental health conditions  Toll free physician hotline and to request psychiatric consult and recommendations.    Provide Primary Care Physician support with appropriate medication regimens  Inform prescribing PCPs of findings via mail.  Proactive outreach by Board Certified Psychiatrists to offer support and consult.

Step 2: Support providers by identifying members that need help with mental health issues  Proactive identification via analysis of claims data (medical, behavioral and pharmacy.)  Provide Behavioral health care management services for high risk members  Assist PCP in referring cases to appropriate behavioral health network clinicians  Notify primary care physicians of identified member for referral support via mailings.  Send reports to appropriate behavioral health network of identified members. Health Integrated Confidential9

Step 3: Provide behavioral health care management services  Treating physician will receive a consent form for patient signature.  The Care Managers are RNs or BH clinicians.  Care Management is an integrated process with medical management initiatives.  Care Managers encourage members to access behavioral health specialists for ongoing treatment.  Updates are provided to the treating physician on the status of their patient enrollment.

Case example: Provider Support  There is a call from a PCP with the following question: “I have this patient with depression and now they are starting to say they are hearing things…I have them on Zoloft 25mg…what do I do now?”  The patient does have a comorbid COPD and was just on prednisone for that.  I asked how long the depressive episode has lasted and what are the symptoms? Health Integrated Confidential11

Case example: Provider Support  Differential is that it is a worsening of her depressive illness with suboptimal medication dose of Zoloft, or SE from Prednisone in the context of a mood disorder.  In either case – the Zoloft needs to be increased as the dose is a starting dose.  Have to decide whether or not to start an antipsychotic. Health Integrated Confidential12

Case example: Provider Support  If this is a SE of the Prednisone you can choose to stop that R/B wise.  This also depends if you can see the patient back for follow up and if they have a good social support that will get back with you.  If neither of those is the case, it’s safer to start a low dose antipsychotic.  In either case, you need to either refer to a Psychiatrist, or follow up closely. Health Integrated Confidential13

To summarize  We’re Here to Help you!!  Contact US  Toll free number:  Health Integrated Confidential14

Questions?