L.A. Care Health Plan Behavioral Health Support Services E.E. Lazarou, MD, MS, RD Health Integrated.

L.A. Care Health Plan

Behavioral Health Support ServicesE.E. Lazarou, MD, MS, RD

Health Integrated

http://www.lacare.org/

What's going on tonight?

Health Integrated Confidential2

Why is behavioral health important in the primary care world?

How do we at Health Integrated fit in? How can we help you? Practical Application: Case Scenario Questions?

1. NIMH 1999

2. 2005 American College of Physicians

The Reality of Behavioral Health (BH) Care Delivery

74% of Americans seeking help for BH issues seek treatment from their PCP1.

PCPs prescribe approximately 65%+ of all prescriptions for antidepressants2.

BH issues exacerbate and complicate physical health condition treatment and adherence.

Cost of psychotropics now exceed cost of specialist provided behavioral health services in many health plans.

Lack of BH/Medical coordination results in fragmented care, care gaps, and reduced clinical and financial outcomes.


So, what are we going to do about this?


L.A. Care has partnered with Health Integrated

L.A. Care has recognized a need for greater support to primary care physicians who are managing members with comorbid behavioral health conditions.

Health Integrated has extensive experience in helping manage patients with comorbid medical and behavioral problems.


64%

15% 15%

20%

13%

18%

7%

37%

1%

10%

0%

10%

20%

30%

40%

50%

60%

70%

Well At Risk Chronically Ill Chronically Ill &

Psychosocial

Issues

Terminally Ill

Population % Population Costs

HigherRisk

LowerRisk

Helping High Risk Members who Comprise the most Difficult to Reach, Engage and Costly Population


The high risk group typically represents the members who are difficult to reach and motivate. It’s these members who drive up health care costs and utilization.

Health Integrated’s Behavioral Health Support Program is an expansion of L.A. Care’s current capabilities and processes meant to support primary care physicians.

This teamwork positively impacts patient health while reducing costs and educating providers on the front line.

Behavioral Health Support ServicesHow does it work and what are the processes?


Step 1: Support providers in managing members with mental health conditions

Toll free physician hotline and email to request psychiatric consult and recommendations. 866-390-0943 [email protected]

Provide Primary Care Physician support with appropriate medication regimens Inform prescribing PCPs of findings via mail. Proactive outreach by Board Certified Psychiatrists to offer support and consult.

mailto:[email protected]

Step 2: Support providers by identifying members that need help with mental health issues Proactive identification via analysis of claims data (medical, behavioral and

pharmacy.)

Provide Behavioral health care management services for high risk members

Assist PCP in referring cases to appropriate behavioral health network clinicians

Notify primary care physicians of identified member for referral support via mailings.

Send reports to appropriate behavioral health network of identified members.


Step 3: Provide behavioral health care management services Treating physician will receive a consent form for

patient signature. The Care Managers are RNs or BH clinicians. Care Management is an integrated process with

medical management initiatives. Care Managers encourage members to access

behavioral health specialists for ongoing treatment. Updates are provided to the treating physician on the

status of their patient enrollment.

Case example: Provider Support

There is a call from a PCP with the following question: “I have this patient with depression and now they are starting to say they are hearing things…I have them on Zoloft 25mg…what do I do now?”

The patient does have a comorbid COPD and was just on prednisone for that.

I asked how long the depressive episode has lasted and what are the symptoms?



Differential is that it is a worsening of her depressive illness with suboptimal medication dose of Zoloft, or SE from Prednisone in the context of a mood disorder.

In either case – the Zoloft needs to be increased as the dose is a starting dose.

Have to decide whether or not to start an antipsychotic.



If this is a SE of the Prednisone you can choose to stop that R/B wise.

This also depends if you can see the patient back for follow up and if they have a good social support that will get back with you.

If neither of those is the case, it’s safer to start a low dose antipsychotic.

In either case, you need to either refer to a Psychiatrist, or follow up closely.


To summarize


Questions?

http://www.lacare.org/

L.A. Care Health Plan Behavioral Health Support Services E.E. Lazarou, MD, MS, RD Health Integrated.

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