We are pleased to continue our short series of articles in Partners in
Health UpdateSM that is designed
to explore potential barriers and opportunities to facilitate communication and
collaboration between
primary care physicians and behavioral health providers and to achieve optimal
outcomes for your
patients.
Part 3 ? Facilitating collaboration between
medical and behavioral health providers
Effective continuity and coordination of care between primary care
physicians (PCP) and behavioral health providers
is critical to the comprehensive treatment and well-being of members.
Independence and its delegated behavioral
health provider, Magellan Healthcare, Inc. (Magellan), an independent company,
work to facilitate continuity and
coordination of care in the following ways:
- communicate to network providers the expectation that they coordinate care
with other medical and behavioral
health providers;
- conduct treatment record reviews annually to evaluate for practitioner
performance;
- identify barriers, opportunities for improvement, interventions, or
resources to promote communication.
Treatment record reviews
Magellan conducts treatment record reviews of randomly selected high-volume
behavioral health providers for the purpose of evaluating the quality of
patient care and the coordination of clinical care. Appropriate treatment
record documentation is based on established treatment record standards to
facilitate communication, coordination, and continuity, and to promote
efficient, confidential, and effective care.
Review results
High-volume providers for this review included providers who saw at least 50
unique members during the previous two-year period from the measurement year
(2013 through 2015).
Coordination of care decreased 9 percentage points to a rate of 56 percent
in 2015 from 65 percent in 2014. Evidence
of providers requesting authorization from members for PCP communication
decreased significantly from 76 percent
(2014) to 52 percent (2015) with a three year downward pattern. Alternatively,
evidence of members refusing
authorization for PCP communication increased from 66 percent in 2014 to 82
percent in 2015. Three-year trend
analysis for this indicator shows an upward trend. The rate for PCP
communication after an initial evaluation increased
from 47 percent (2014) to 51 percent (2015), with no discernable pattern for
the last three years. Evidence of at
least one PCP communication at significant points in treatment and continuity
and coordination between the primary
clinician and multiple other providers both declined in 2015 with PCP
communication showing a higher rate of decline
of 22 percentage points (68 percent in 2014 to 46 percent in 2015). Trend
analysis for the three measurement years
shows this to be an ongoing trend for both indicators.
Provider site assessments
Independence clinical staff 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 for three behavioral health disorders
commonly seen in primary care:
- attention-deficit/hyperactivity disorder
- depression
- substance use/abuse
Independence utilized Healthcare Effectiveness Data and
Information (HEDIS®) data and enrollment files to identify
members and their PCPs. Because PPO members are
not required to identify a PCP, the Plan assigns members
to ?PCP? specialty based providers that those members
visited in the last 18 months. The eligible PCP population
consisted of all PCPs or specialty based providers
with members in their panel who meet eligibility criteria
according to HEDIS.
Assessment results
Independence is reporting first-year rates that will serve
as baselines moving forward. For documentation of
coordination of care from PCP to behavioral health
provider, the average rate was 18 percent for members
with a diagnosis of ADHD, 11 percent for members
with substance use/abuse, and 8 percent for members
with depression. The average rate of documentation of
coordination of care from behavioral health provider to
PCP was 42 percent (ADHD), 26 percent (substance
use/abuse), and 22 percent (depression). Record review
reported that the diagnosis with the highest population
of members treated was depression, and the diagnosis
with the highest percentage of coordination of care was
ADHD.
Collaboration efforts
To facilitate care between PCPs and behavioral health
providers, Independence and Magellan created a
Clinician Collaboration Form, which can be completed
and sent electronically or printed and mailed to the
provider. The form can be downloaded from our website
or from the NaviNet® web portal under Health and Wellness in the
Administrative Tools & Resources section of Independence Plan Central.
Note: PCPs and behavioral health providers must obtain patient
consent to exchange patients? personal information
and discuss behavioral health issues. Independence encourages you to discuss
with your patients the importance
of having all related medical and behavioral health information to promote
continuity of care and achieve optimal
outcomes. When possible, provide your patients with a consent form they can
sign at the time of this discussion so
they understand the information that will be shared and provide their written
consent.
Magellan Healthcare, Inc. manages behavioral health and
substance abuse benefits for most Independence members.
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.