SummaCare participates in behavioral healthcare clinical studies annually as part of NCQA requirements. The requirements' intent is to look at the coordination of care between medical and behavioral healthcare practitioners in order to improve health outcomes. SummaCare assesses the following areas of collaboration between medical and behavioral healthcare:
The details of each area of focus are as follows:
The discharge summary from an inpatient behavioral health hospital stay is an important tool to facilitate communication between the behavioral healthcare facility and the patient's primary care provider (PCP) and outpatient providers. It is important for all patients to be reminded of the importance of sharing information between all the care providers that they see. With patient consent, a discharge summary should be provided to the PCP and primary therapist. This sharing of information is for the patient’s benefit to ensure their safety and improve outcomes. PCP engagement, by providing appropriate follow-up care after hospital discharge, is an important element in preventing readmission and continuing the member’s care.
Many members receiving new prescriptions for antidepressants do not receive concomitant therapeutic counseling. Primary care plays a key role in treating depression and referring patients for therapeutic counseling is a key component of an effective treatment plan. Behavioral health providers can also support patient compliance with keeping PCP follow-up appointments and taking medication.
SummaCare’s Major Depression Clinical Practice Guideline details recommendations for the management and treatment of depression.
Timely medical consults for members with coexisting medical and behavioral health disorders is important for improving patient outcomes. For patients having an acute behavioral health admission, it is important to identify any significant medical conditions that may need to be addressed during the inpatient stay. Medical consults should be ordered, completed and documented within one day of request for consultation, including those ordered from the emergency department.
Diabetes screening is important for any patient with schizophrenia or bipolar disorder who has been prescribed anti-psychotic medications.* Screening for diabetes may lead to earlier identification and treatment of diabetes. Screening for diabetes for patients with schizophrenia or bipolar disorder using atypical anti-psychotic medications is also a HEDIS quality measure used by NCQA to rate health plans. Lack of appropriate care for diabetes for people with schizophrenia or bipolar disease who use anti-psychotic medications can lead to worsening health and premature death. Proper monitoring and service coordination for both behavioral and physical health conditions is an important way to improve the health and outcomes for patients.
*Cohn T, Prud'homme D, Strainer D, Kameh H, Remington G. Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Can J Psychiatry. 2004 Nov;49(11):753-60.
If you have not met with your assigned Provider Engagement Specialist or would like to schedule an in-office training or meeting to address any questions regarding the authorization process, claims issues, appeals, SummaCare products/benefits or Plan Central training, please contact the assigned Provider Engagement Specialist for your office.