Blue Cross and Blue Shield of New Mexico (BCBSNM) announces behavioral health (BH) quality improvement results
BCBSNM continually monitors and evaluates our BH care management program through the Behavioral Health Quality Improvement Program (BHQIP). The BHQIP identifies program enhancement opportunities benefiting members, physicians, and other health care providers and shares information that can be used to achieve the best possible health outcomes.
BCBSNM evaluated coordination of care activities as part of its BHQIP because we believe physicians and other health care providers are more satisfied and member health outcomes are better when care is coordinated. As you are aware, coordination of a member’s care between physicians and other health care providers is important so that:
- Physicians and other health care providers share relevant information
- Care is not duplicated
- Unnecessary care is prevented
- Members are aware of all the benefits and treatment options available for their needs
BCBSNM measured coordination of care and is providing results in the following three areas:
- Coordination with Primary Care Physicians (PCPs): BCBSNM BH clinicians encouraged BH physicians and other health care providers during telephonic reviews to coordinate with the member’s PCP. This coordination was reported to have occurred during 94 percent of BH care management reviews in 2012, up from 79 percent in 2011.*
- Coordination of Medication: The rate of psychiatrists coordinating medications with PCPs and other specialists increased from 31 percent in 2011 to 61 percent in 2012. Most physicians agree that this coordination is helpful in treating their patients – satisfaction with this coordination was over 90 percent in 2012.*
- Coordination of Care for Members with Medical and BH Conditions: BCBSNM clinicians help members understand their condition and treatment options and assist them with transitions between levels of care and treatment settings. They also help coordinate communications and referrals between physicians and other health care providers when a member has both a medical and a BH (mental health and substance abuse) condition. This is accomplished through outreach to treating providers to discuss cases and additional benefits available to their patients, assistance with closing gaps in care, and/or assistance with locating additional resources to help the patients understand their care. During 2012, 94 percent of the eligible members referred from medical care management programs were successfully enrolled in the BH case management program. Likewise, 56 percent of the eligible members referred from the BH care management program were successfully enrolled in the medical case management program.*
To share feedback or learn more about the Behavioral Health Care Management and Quality Improvement Program, visit the Clinical Resources section of the Provider website at bcbsnm.com/provider.
Find out how the Behavioral Health Case Management program helps members with mental health and substance abuse issues get information and support in upcoming issues of the Blue Review.
*Results are blended across Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas.
Blue Review • December 2013 • bcbsnm.com