How one big insurer integrates behavioral health

In order to better integrate behavioral health, Blue Cross Blue Shield of Massachusetts (BCBSMA) is expanding its behavioral health and substance abuse programming.

“Behavioral healthcare is an area that causes a lot of additional expenditures on the medical side,” says Ken Duckworth, MD, medical director for behavioral health at BCBSMA. “People with behavioral health vulnerabilities use a lot more medical services, and some of them may be unnecessary.”

Duckworth says that the program expansion is part of an overall consciousness in the healthcare industry that unnecessary testing and the overutilization of emergency rooms often go hand in hand with behavioral healthcare.

Additionally, Duckworth says, in comparison to improvements in other public health measures over the past 30 years, like cardiovascular illness and cancer, there has been little progress with suicide—another challenge the increased programming intends to address.

As a result of the Massachusetts health insurance mandate, more formerly uninsured individuals were introduced into the BCBSMA network, which was a population with more mental health vulnerabilities than the general population, Duckworth says. Of the plan’s 2.7 million members, he says about 300,000 (11 percent) receive behavioral healthcare services.

“Behavioral health is important from a public health outcome, financial expenditure and political perspective. The governors of several New England states have identified [addiction] as a problem, so we’ve been trying to think about it from a health plan point of view,” he says. "The plan’s Alternative Quality Contract, for example, is one way that we’re trying to connect the behavioral health with the medical need.”  

The Alternative Quality Contract is an incentive-based provider payment program implemented by the health plan. Although it can be challenging to determine population needs, Duckworth says BCBSMA has made an effort to figure out how to provide access through integrated behavioral health.

“These Alternative Quality Contracts [make providers] responsible for the whole health of the population,” he says. “As they take responsibility for the whole person’s health, they’re getting more interested in finding access for behavioral health. This is a problem we’re trying to solve by meeting with them, looking at their networks and looking at how they relate to their emergency room services.”

Mobile tool

Duckworth describes BCBSMA’s mobile and online platform, OneHealth, as “Facebook meets Alcoholics Anonymous.” It’s a social media construct where individuals with addiction vulnerabilities can communicate with peers and also have access to coaches and support teams. Members can only participate in the online and mobile platform when referred to by a provider or the plan itself.

The voluntary, private program offers members and their families 24/7 support, education and tools to assist with recovery, as well as real-time programming to monitor emotional states. Additionally, member can select up to three peers to communicate with via text message to request assistance during times of potential relapse.

Duckworth says the program is meant to provide adjunct support and is not intended to replace other treatments or therapies necessary for recovery.

“Some people might find this more convenient than going to 90 meetings in 90 days,” he says. “This is an example of how one could incorporate online social-media sobriety support into their daily routine.”

Another new BCBSMA behavioral healthcare program, REACH—Recovery Education and Access to Community Health—was designed to improve care for members with serious mental illness or substance abuse issues who have difficulty engaging in traditional care plans.

Developed in partnership with Beacon Health Strategies, a non-profit community mental health provider, REACH provides focused care plan development and management, active coordination of behavioral health and medical services, and community-based support to promote independent living.

Duckworth says that the program also offers financial assistance for medications to help low-income patients maintain adherence. 

“The idea behind the program is that the traditional gears of inpatient/outpatient therapy aren’t always sufficient for people who have more vulnerabilities, so this is the non-medical, non-traditional support,” he says. “We have a few years to show that it improves people’s qualities of life and results in less use of emergency rooms and readmissions.”

Mental health coaching

Life Balance, the plan’s new one-on-one coaching program, developed with Brigham and Women’s Hospital is designed to improve health outcomes for members with mental health problems that are also battling significant health conditions.

According to Duckworth, preliminary data has shown that the program improves patient’s coping capacities and reduces their medical expenditures, while also increasing the amount of time spent with primary care doctors.

“The program is designed to get people to talk about their distress instead of simply going to the emergency room and asking for an additional CAT scan when they had one three weeks ago,” he says.

BCBSMA also offers risk assessment tools on AhealthyMe.com that can help members identify common mental health conditions like stress, depression, prescription drug abuse, drug abuse and alcohol abuse.