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.
AmeriHealth and its delegated behavioral health
provider, Magellan Healthcare, Inc. (Magellan), 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
AmeriHealth 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
AmeriHealth utilized Healthcare Effectiveness Data and
Information Set (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
AmeriHealth 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 24 percent for members
with a diagnosis of ADHD, 11 percent for members
with substance use/abuse, and 6 percent for members
with depression. The average rate of documentation of
coordination of care from behavioral health provider to
PCP was 37 percent (ADHD), 26 percent (substance
use/abuse), and 28 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, AmeriHealth 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 for
AmeriHealth New Jersey or for AmeriHealth Pennsylvania
or from the NaviNet® web portal under Health and Wellness in the
Administrative Tools & Resources section of
AmeriHealth Plan Central.
Note: PCPs and behavioral health providers must obtain patient
consent to exchange patients? personal information
and discuss their behavioral health issues. AmeriHealth encourages you to
discuss with your patients the importance
of having this information for their health and safety. 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.
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
Magellan Healthcare, Inc. manages behavioral health and
substance abuse benefits for most AmeriHealth members.
NaviNet is a registered trademark of NaviNet, Inc.