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Behavioral health: Promoting provider communication and collaboration

October 3, 2016

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.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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