Depression management program encourages timely care
HEDIS scores rise in several areas
A comprehensive approach to depression management has paid off for Health Alliance Plan (HAP), a Detroit-based HMO. The Depression Disease Management program includes educational mailings for members, behavioral health case management, a partnership with physicians, and an adjunct program that helps identify people with congestive heart failure and diabetes who are at-risk for depression. A similar program helps identify new mothers who are at risk for postpartum depression.
Collaboration between departments at HAP is a key element of the program. The Quality Management Department handles oversight of the disease management program in partnership with behavior health case managers in the coordinated behavioral health management (CBHM) department and HAP’s traditional case management department.
"It’s open-ended. We are all part of the same health plan, and we have a software system that allows us to communicate with each other and perform case management [jointly]," says Mary Clare Solky, MA, director of CBHM.
For instance, members who are in HAP’s other disease management programs are screened for depression, referred to a behavioral health specialist in some cases, and enrolled in the Living Well with Depression program.
New mothers receive a depression screening questionnaire in their postpartum packet.
Here are some of the plan’s achievements:
- According to HEDIS 2000 figures, 92% of HAP’s commercial patients who were hospitalized for mental illness saw a counselor within 30 days of discharge, up from 86% the previous year.
- Two HEDIS measures that gauge adherence to prescription regimes for depression management have increased during the past two years since the Depression Management Program was implemented.
- HAP achieved the national best practice for HEDIS 2002 rates for Follow-Up after Hospitalization for Mental Illness within seven days of discharge with a score of 84.95%.
About 21,000 members who have been diagnosed with depression are enrolled in HAP’s Depression Disease Management.
Members who have been diagnosed with depression receive an introductory letter telling them about the depression disease management program, called the "Living Well with Depression" program and offering them an opportunity to opt out, says LaShawnda Cash, MPH, depression management coordinator in HAP’s quality management department.
"We have set up the program so members can opt out easily if they want. In the two years of the program, only about 250 of the 21,000 members identified with depression have chosen to opt out," she says.
If they don’t opt out, they receive educational material and a depression management toolkit that includes extensive information about the disease, information about antidepression medication, and a reminder log that members can use to write down the times and days they take their medications.
They are offered a variety of additional educational pieces on topics that include depression and obesity, depression in the elderly, depression and medication, and coping with a loved one’s depression. They can send in a card ordering the additional materials or access them on-line.
Members in the Living Well with Depression program also receive a quarterly newsletter addressing various subjects in which the members may be interested. For instance, the next issue features information on stigmas associated with depression and how the members can cope with them.
This year, members diagnosed with depression and on antidepressant medications will get medication reminder letters with information on prescribed medications, the recommended length of time they should take their medication, and the importance of following up with their physician.
When an HAP member is hospitalized for depression, the behavioral health case managers, masters-prepared behavioral medicine clinicians, step in.
There are 12 case managers in the CBHM department, each assigned to certain physician groups so patients always are seen by the same case manager.
Case managers provide care for members who need specific help with managing their depression, and sometimes follow them for years.
They contact patients to ensure that they get a post-discharge follow-up with a behavioral health professional within seven days of discharge.
"The case managers will work with a member until he or she has had a follow-up appointment," Solky says.
They call to remind the patient to go to the appointment and check with the physician to see that it was kept.
If someone is admitted to a hospital with depression, the behavioral health case managers give him or her intensive interventions.
"We all work hand in hand. The case managers ensure they are enrolled in the Living Well with Depression program if they have been diagnosed with depression," Cash says.
The plan sends its primary care physicians HAP’s depression clinical guidelines and other tools, such as office screening materials and panel reports on the patients they have diagnosed.
The reports include information such as the date the patient was diagnosed, prescriptions that have been filled, and visits to any other providers.
Working with and educating physicians is one of HAP’s major initiatives this year, Cash says.
"Some members who have a diagnosis of depression and are taking an antidepressant contact us to tell us they don’t have depression," Solky says. "Sometimes, it’s hard for them to hear that they have depression. Other times, their provider determines that it’s in their best interest not to know."
The health plan wants to encourage physicians to educate their patients about their diagnosis of depression. In the past, patients often were not informed of their diagnosis, she adds.
HAP representatives visit the offices of primary care physicians and behavioral medicine practitioners to make sure they are using the information they have received and to make sure patients’ care is being coordinated.
The insurer is working with other local insurance plans, physicians, and employer groups to develop clinical practice guidelines and other forms to assist physicians in identifying and managing patients with depression. This partnership allows one common message to be sent to all providers regarding appropriate, evidence-based treatment recommendations.
This year, HAP is focusing on developing and implementing a program to place some patients with higher levels of depression, who have not been hospitalized, in a more proactive case management program.
These case managers would telephone the members at intervals, possibly go to therapy appointments with them, and work with them and their families by telephone and in person.
"Once someone is diagnosed with depression, if it’s not treated properly and for enough time, the cases of remission and reoccurrence are very high. When someone has one episode, the chance of another episode is high," Solky says.
The case managers will help them recognize the warning signs so they can get help quickly rather than slipping into deeper depression.
"In most cases, the longer someone waits for treatment, the longer it will take to get the disease under control," Solky says.
The health plan also is working on ways to identify members who are undiagnosed or undertreated, Cash adds.
Dealing with behavioral problems
Managing care of patients with behavioral health issues is a major concern these days. Research has shown that patients who are depressed and those who don’t take their medication for psychological disorders are hospitalized frequently and have higher health care costs than the norm. In this issue, we’ll show you how a health plan screens patients with chronic disease for case management and why it also screens new mothers. You’ll learn how to maintain patient confidentiality in a depression management program and how to get help in setting up your program. We’ll give you tips from an expert on how to improve compliance for patients on antipsychotic drugs.
A comprehensive approach to depression management has paid off for Health Alliance Plan (HAP), a Detroit-based HMO. The Depression Disease Management program includes educational mailings for members, behavioral health case management, a partnership with physicians, and an adjunct program that helps identify people with congestive heart failure and diabetes who are at-risk for depression. A similar program helps identify new mothers who are at risk for postpartum depression.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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