MBHN statistical analysis of behavioral health utilization data indicates that major depression is the leading behavioral health condition for health plan populations for which New Avenues administer benefits. This accounts for a fourth of outpatient visits and is the most common diagnosis for inpatient treatment and ECT. In order to improve outcomes for persons suffering from major depressive disorders, New Avenues adopted a disease management outreach program to intervene and support the recovery process for those persons who are at moderate to high levels of risk.

The Depression Disease Management Program goals are to provide tools and support to help individuals reach recovery, encourage self-empowerment in managing one’s illness, increase adherence to treatment, reduce the incidence of relapse, treatment failure, ER visits,  andre-hospitalizations, and avert the tragic losses related to lost work time, family breakdowns, and suicide.   New Avenues delivers a Depression Disease Management program designed and based on the Lilly USA Depression Disease Management model.

The program delivers targeted outreach to enrolled members with moderate to high levels of risk as demonstrated by prior hospitalizations, extended treatment, suicide attempts or risk, multiple episodes of care, the presence of serious co-morbid conditions, referrals by primary care provders or utilization review.

The Depression Disease Management Program Features:

• Telephonic outreach by licensed clinical social workers
• Personalized service at no cost to the member
• 4 mailings to the member
  • Tools to adhere to treatment
  • Understanding one’s condition
  • Dealing with stress
  • Health lifestyle choices
• Coordination of care with the member’s treating providers and primary care physician.
• Communication with medical utilization review for addressing co-morbid cardiac, pulmonary, diabetes, obesity, or chronic pain conditions if applicable.
• Consents for Case management and involvement of providers and family members.

Results:

• 73% of members discharged from a hospital setting for a mental health condition had an appointment within 7 days of their discharge; 90% of members had an appointment within 30 days. This results from our persistent follow-up efforts to assist members with post hospital care.

What have members told us?

Feedback from a member discharged from the hospital and grateful for the help and guidance that she received from her Care Manager…