Condition Care Management: Behavioral Health
Magellan has significantly enhanced our Intensive Care Management (ICM) model to focus on proactive identification of high severity and high cost members using predictive modeling, event-driven information and referrals from other resources. This enhanced model is called Magellan Condition Care Management: Behavioral Health.
Magellan Condition Care Management: Behavioral Health improves care for Magellan members who have chronic or severe behavioral health conditions and who are at risk for high utilization of services.
The new model is condition-driven. Early identification of members who are likely to be high risk and high cost will permit earlier intervention in the evolution of their condition. We believe that this early intervention will more effectively meet the needs of these members while supporting more appropriate utilization of services.
Members who are identified as potentially high risk and high cost will be eligible for the enhanced support offered by Magellan Condition Care Management: Behavioral Health, including health coaching, educational information about their condition, access to resources on our member Web site (for those customers which have made the Web site available to their members), and support for improved self-management of their condition.
By emphasizing member self-management of chronic conditions, Magellan Condition Care Management: Behavioral Health will target a reduction in inpatient and outpatient costs through avoided complications and exacerbations of the condition(s) that could otherwise result in an ER visit, hospitalization or increased utilization of outpatient services. The paramount goal is to improve the overall quality of life for the member.
Our data warehouse will be used in support of the predictive modeling that will make Magellan Condition Care Management: Behavioral Health unique in the marketplace. To take full advantage of the vast data we have now and to more effectively review and replicate organizational best practices, we have created a Center of Excellence for strategic management and overall program operations.
The Condition Care Management clinical team works closely with the regional Care Management Centers to arrange for and coordinate the appropriate local care for high severity/high cost members. Participants in the enhanced program will have an ongoing single point of contact with a Magellan clinical staff member.
Condition Care Management: Behavioral Health participants are identified in a number of ways:
- A sophisticated predictive model that incorporates previous behavioral health claims and authorization history (with the potential to utilize pharmacy and medical history, when available)
- Referrals from field Care Managers
- Hospitalizations (or authorizations for inpatient care)
- Behavioral health provider referrals
- Primary Care Physician referrals
- Health Plan referrals
- Member self-identification through self-assessment tools
- Referrals from other Magellan product/service areas
- Screening tools such as Health Risk Assessments
- Family Members
Health Coaches work closely with participants and focus on appropriate interventions, such as education about their condition, support of their self-management, support of treatment compliance, and information about community resources. Participants have full access to the wide variety of content, tools and resources offered through our member Web site.