Effective continuity and coordination of care between primary care physicians (PCP) and behavioral health providers (BHP) is critical to the comprehensive treatment and well-being of your patients, our AmeriHealth members. During a one-year period, up to 30 percent of the general population meets the criteria for at least one behavioral health disorder. Behavioral health disorders influence many factors in medical care, such as a patient's adherence to medication or a treatment plan or keeping office visit appointments, and they can lead to a decrease in successful patient outcomes.¹ AmeriHealth and its delegated behavioral health provider, Magellan Healthcare, Inc. (Magellan), work to facilitate continuity and coordination of care between PCPs and BHPs to promote optimal patient outcomes.

AmeriHealth clinical staff annually conducts onsite reviews of PCP records to assess the office systems and documentation in place for coordination of care between medical and behavioral health providers. Based on Healthcare Effectiveness Data Information Set (HEDIS^®) criteria, AmeriHealth selected two behavioral health disorders commonly seen in primary care — attention-deficit/hyperactivity disorder (ADHD) and depression — as the targeted diagnoses for review. Medical records are reviewed for care provided during the previous calendar year (January through December).

Medical records are reviewed for the following:

• documentation that the PCP discussed behavioral health services with the member/ caregiver;
• for newly diagnosed members, documentation of a PCP referral to behavioral health services, and follow-up to the referral;
• for members with a known history/diagnosis, documentation of coordination of care from the PCP to the BHP;
• for members with a known history/diagnosis, documentation of coordination of care from the BHP to the PCP.

Assessment results

The following are the results of the 2017 onsite medical record reviews for care delivered January through December 2016:

• ADHD: Medical record review reported five members with documentation of newly diagnosed ADHD. Two members were prescribed medication and one member was referred to a BHP; however, this member?s record showed no documentation of follow-up to the BHP referral. Two members were provided a new diagnosis of ADHD with no documented intervention. In addition, the review for coordination of care for members with ADHD showed 42 records with documentation of history/diagnosis of ADHD. Of those 42, only 18 (42.86 percent) provided documentation that the PCP discussed behavioral health services with the member/caregiver. Further review shows that coordination of care from a PCP to a BHP only occurred in three cases, and coordination of care from a BHP to PCP only occurred in four cases.
• Depression: Medical record review reported 58 members with documentation of newly diagnosed depression. Of those newly diagnosed, there were no referrals to a BHP. In comparison, 40 members (68.97 percent) with a new diagnosis of depression were prescribed medication by the PCP. In addition, the review for coordination of care for members with depression showed 447 records with documentation of history/diagnosis of depression. Of those 447, only 99 (22.15 percent) provided documentation that the PCP discussed behavioral health services with the member/caregiver. Further review shows that coordination of care from a PCP to BHP only occurred in 15 cases, and coordination of care from a BHP to PCP only occurred in 23 cases.

Collaboration efforts

Behavioral health encompasses behavioral factors in chronic illness care, care of physical symptoms associated with stress rather than diseases, and health behaviors, as well as mental health and substance abuse conditions and diagnoses.² We encourage our network providers to discuss behavioral health with AmeriHealth members/caregivers and to educate them on the impact of behavioral health on their medical care outcomes. If your patient, an AmeriHealth member, is already involved with or requests a referral to a BHP, explain what information will be shared with the identified BHP. When possible, provide your AmeriHealth members with a consent form to sign at the time of this discussion so the member/caregiver can ask questions and avoid misunderstanding regarding the collaboration of care with the BHP. In addition, AmeriHealth strongly encourages network providers to coordinate medication management for a behavioral health diagnosis with a BHP for optimal member outcomes.

To facilitate member care between PCPs and BHPs, AmeriHealth and Magellan created a Clinician Collaboration Form, which can be completed and sent electronically or printed and mailed to the collaborating BHP provider. The form can be downloaded from our websites for AmeriHealth New Jersey and AmeriHealth Pennsylvania or from the NaviNet^® web portal under Health and Wellness in the Administrative Tools & Resources section of AmeriHealth Plan Central.

Note: Member consent is required to exchange a member's personal information and discuss behavioral health issues with other providers.

¹Croghan TW, Brown JD. Integrating Mental Health Treatment Into the Patient Centered Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019ITO2.) AHRQ Publication No. 10-0084-EF. Rockville, MD:Agency for Healthcare Research and Quality. June 2010.

²Integrationacademy ? AHRQ-What Is Integrated Behavioral Health Care. Available from: https://integrationacademy.ahrq.gov.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.

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