Organizational Support

Similar to your organization, ValueOptions recognizes that enhanced outcomes can be achieved by treating both the physical and behavioral health needs of your membership.

We can seamlessly integrate behavioral health services into your health care delivery system to help individuals change their behavior—so that they are more likely to follow their treatment plan, quit smoking, lose weight, and so forth. We can work together to improve your system’s ability to identify individuals with behavioral health conditions that may impact their heart health—and treat those conditions.

To do this, we can consult with your organization to build a cardiovascular-behavioral health program that suits the needs of your constituencies: plan executives, clients, members and providers. Ultimately, we can work hand-in-hand to deliver individualized care and superior clinical outcomes, helping your members gain mastery over one of the leading causes of death, disability and diminished productivity.

Plan executives

Your ValueOptions account executive can help you present to your internal teams—senior leadership and your peers in other functional areas critical to program success. This discussion would include:

• A presentation on the financial and human costs of co-morbid heart disease and behavioral disorders, emphasizing the opportunity to improve overall health and member satisfaction in a cost-effective manner. Your plan executives will recognize that this approach offers a win-win equation that will be well received by accreditation organizations.

• Information on ValueOptions’ capabilities, as described in the “Helping Individuals” section. In addition to identifying and treating behavioral health conditions, this includes ValueOptions’ health coaching services to promote lasting behavior change that can reduce lifestyle risk factors for heart disease.

After key stakeholders agree that this approach warrants further review, ValueOptions can assist you with organizing a cross-functional team to assess current programs, practices and available resources and explore opportunities to improve the integration of physical and behavioral health care services.

Based on this review, ValueOptions can recommend practices, methodologies, work flows and tools for service delivery and communication that:

• Strengthen the connection between medical, behavioral and pharmaceutical benefits. Examples include establishing linkages and transfer scripts as well as reporting mechanisms to update PCPs on behavioral health treatment progress.
• Facilitate early case identification of individuals with behavioral health conditions that impact heart health. Examples include offering screening tools for depression to primary care physicians and reaching out to at-risk individuals identified through claims data.
• Respond to educational and training needs of PCPs regarding behavioral health issues and offer consultation and referral information.
• Improve treatment compliance by providing essential psychosocial support to heart patients.
• Reach out to prevent heart disease by supporting individuals in making lasting healthy lifestyle changes.

Clients

We understand the challenges that your employer clients face in today’s competitive climate as labor costs continue to rise. Improving the health and productivity of the workforce while keeping health care costs down is a primary focus.

Please refer to the “Support—For Employers” section for suggestions you can share with your employer clients as you partner to help them build support for a workplace-sponsored cardiovascular/behavioral health program. Your ValueOptions account executive also can offer assistance in strategizing with a client.

Members

In the “Helping Individuals” section we discuss how we can help your members through:

• Assessment and treatment for behavioral concerns—such as depression and anxiety—that impact heart health
• Stress management counseling
• Support in complying with a treatment plan for heart disease, including addressing psychosocial needs and strengthening patients’ support systems
• Support for making lasting lifestyle behavior change
• Educational information (articles, tip sheets, quizzes, etc.), workshops, health fairs

The “Strategy—For Health Plans” section provides guidance and tools for building a communication campaign with objectives to:

• increase members’ awareness of the behavioral health conditions that impact their heart health
• promote more active involvement in the prevention and management of heart disease

Your ValueOptions account executive can provide important project management support for this campaign.

Providers

We can support your providers in screening, treating and educating their patients through screening tools, a depression practice guideline, consultation with behavioral health specialists and communication materials.

Members often turn to their PCP for behavioral care, and depression may be present in up to 30 percent of a PCPs patient caseloads.¹ However, research studies have indicated that PCPs miss the diagnosis of depression as much as two-thirds of the time, while often under treating the remaining one-third of their members who are correctly diagnosed with depression.²

For PCPs to become more effective at identifying, treating and/or referring medical patients with co-morbid depression, they need the support and guidance of behavioral health specialists.

Screening tools

We recommend that all PCPs screen for depression using the “Patient Health Questionnaire—PHQ-9” screening instrument. This tool was developed by Pfizer Inc. and permission is granted for use in clinical settings: www.pfizer.com/pfizer/do/mn_health.jsp. When indicated, patients should be referred to a ValueOptions network provider. We offer a sample letter that may be used to communicate this recommendation.

If time does not permit use of the PHQ-9, we recommend that physicians ask the following two questions, which together have been proven extremely reliable:

• “During the past month, have you often been bothered by feeling down, depressed or hopeless?
• “During the past month, have you often been bothered by little interest or pleasure in doing things?”³

According to the literature, negative responses to these two items rule out depression for most patients. A positive score on either would indicate the need for more intensive screening; at that point we recommend a referral to a ValueOptions network provider.

Depression practice guideline

We also recommend notifying all PCPs of the American Psychiatric Association’s “Practice Guideline for the Treatment of Patients With Major Depressive Disorder.” This treatment guideline can be found on the APA’s Web site: http://www.psych.org.
 
Consultation with behavioral health specialists

We can offer your PCPs access to phone consultations with behavioral health specialists for guidance on behavioral health treatment challenges, as well as a 24/7 line for crisis assistance.

Communications

To support your PCPs in communicating with their patients about behavioral issues that impact their heart health, please refer to the “Tools” section. You can make these patient education materials—articles, tip sheets, quizzes and more—available to your providers for use with their patients. These materials can help:

• support individuals who are changing their behavior for improved health
• encourage compliance with a heart disease treatment plan and support individuals in dealing with the stress and emotions surrounding their condition
• help individuals identify the signs of depression, anxiety and chronic stress, and know when to seek help for them

1 Lemelin, J., Hotz, S., Swensen, R., et al. (1994). Depression in primary care: Why do we miss the diagnosis? Can Family Physician, 40:104-108.
2 Salazar, W. H. (1996). Management of depression in the outpatient office. Medical Clinics of North America, 80(2):431-55.
3 Whooley, et al. (1997) Case finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 12:439-445.