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Offering Essential Solutions to people with depression

June 1, 2009
by Loren Nix
| Reprints
A managed care company creates a multiservice program

CBA's essential solutions team with the urac award. back row (l to r): deborah wilson-brown, christi bost, shermel brown, rosa wilson. seated: lynn watts, clinical director

CBA's Essential Solutions team with the URAC award. Back row (l to r): Deborah Wilson-Brown, Christi Bost, Shermel Brown, Rosa Wilson. Seated: Lynn Watts, Clinical Director. Photographer: Rick Gallion

Untreated or undertreated depression leads to significant personal morbidity, increased medical service utilization, increased mortality, and increased burdens on employers because of absenteeism and decreased productivity. To combat these effects of depression, Companion Benefit Alternatives, Inc. (CBA) implemented Essential Solutions for depression management. CBA introduced this specialized disease management program, which recently was awarded silver honors in URAC's prestigious 2009 Best Practices in Health Care Consumer Empowerment and Protection Awards competition, in September 2006.

Columbia, South Carolina-based CBA is a managed behavioral health organization administering mental health and substance abuse benefits for more than one million people served by BlueCross and BlueShield of South Carolina and other Blue Cross and Blue Shield health plans, BlueChoice HealthPlan of South Carolina, the Federal Employee Health Benefits Program, and Planned Administrators, Inc., plans (CBA is a separate company that administers mental health benefits). In conjunction with David Oslin, MD, and the Behavioral Health Laboratory based at the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, CBA developed Essential Solutions as a flexible service to help manage the behavioral health needs of patients seen by primary care providers (PCPs). Essential Solutions addresses all stakeholders' needs by supporting PCPs; providing education and resources for best care practices to members and physicians; supporting referrals to behavioral health specialty care, as needed; and monitoring results for cost-benefit and quality analysis.

Several principles define the program.

  • Crosscutting. The program provides support for depression, alcohol, and anxiety problems. For each disorder the program addresses a broad spectrum of severity, offering Watchful Waiting for subsyndromal symptoms to Referral Management for the most complex or severely affected individuals.

  • Targeted interventions. The program provides assessment, monitoring, early intervention, disease management, and referral management. Thus, the program can be tailored to individual needs.

  • Flexibility. The program allows for multiple methods of case referral/identification.

How It Works

Members and their dependents over age 18 are eligible for the program based on:

  • Claims for a new antidepressant prescription or depression diagnosis

  • Referrals from other medical health and disease management programs for conditions such as diabetes, asthma, coronary artery disease, and maternity management

  • Referrals from existing medical and behavioral health case management programs

  • Member self-referrals

  • Member responses to Web-based health risk assessment screenings

  • Direct physician referrals

Essential Solutions is an opt-out program, with all eligible members included until they request disenrollment or if contact is unsuccessful after concerted effort. Licensed master's prepared social workers (LMSWs) or RNs who have received additional training in Motivational Interviewing (MI) techniques serve as CBA disease managers and perform all program interventions by telephone.

Essential Solutions provides educational materials and one-on-one communication with members that can be individualized. The program follows members through the treatment process and into remission, with follow-up and reassessment for possible relapses after program completion. Essential Solutions is divided into the following evidence-based modules.

Core Assessment. Program enrollment begins by completing the Core Assessment, a brief, structured, 20- to 30-minute interview that provides PCPs with a comprehensive overview of patients' mental health and substance abuse symptoms. CBA's disease managers conduct the assessment by telephone and enter the results into a computer program. The assessment includes the following screening tools:

  • PHQ-9 for assessing depression

  • Screeners for generalized anxiety disorder, mania, psychosis, and PTSD

  • A self-harm assessment for suicidality

  • Work Limitations Questionnaire (gathering information on absenteeism and work performance)

  • CAGE-AID to assess drug and alcohol use

  • Blessed Cognitive scale to assess possible hearing and/or cognition difficulties

CBA also gathers information regarding medications, adherence history to medication regimens, and possible side effects.

Following the assessment's completion, the disease manager generates an individualized lab report of the interview's outcome and, with the member's consent, mails it to the prescribing physician. Patients are mailed educational materials that provide brief suggestions for dealing with specific reported mental health/substance abuse symptoms.