pacificare brochure
TRANSCRIPT
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T H E B E S T C H O I C E F O R B E H A V I O R A L H E A L T HT H E B E S T C H O I C E F O R B E H A V I O R A L H E A L T H
PACIFICARE BEHAVIORAL HEALTHH E A LT H P L A N D I V I S I O N
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Accountability and measurable results are hallmarks that
distinguish our enduring partnerships with health plans
like yours. We’ve been doing it for nearly 20 years, and
we understand your business.
In fact, we’ve tailored our innovative clinical and
operational systems to meet and exceed your requirements.
And it’s all delivered through our dedicated Health Plan
Division. Predictive modeling, medical care integration,
clinical oversight, localized account and network
management — all exclusively focused on your business.
We also offer flexibility and choice through customized
plans and financing options that fit your distinct
environment. And like a good partner, we guarantee
our performance. There are no surprises with PacifiCare
Behavioral Health, just proven results and value.
We are the best choice for integrated-behavioral health
care services in the industry.
And we can prove it to you.
partnerships.
Every step of the way.
PROVEN
PROVENvalue.
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PacifiCare Behavioral Health adheres to a care management
approach we call “Best Care,” which drives innovations and
initiatives that identify patient needs, integrate therapies and
enhance outcomes. Best Care places resources where they make
the greatest impact, utilizing several powerful proprietary methods
and systems. This approach delivers high-quality behavioral health
care services that are affordable, readily accessible and proven to
work seamlessly in even the most complex benefit environment.
And we have the data to back it up, so you can see that you’re
getting a sound return on your investment.
BEST CARE.
PROVEN
Real-TimePredictive modeling.
When we pioneered our ALERT® system, we finally gave real
meaning to the term outcomes management. ALERT is an
innovative, predictive modeling system that uses individual
patient-reported data collected throughout a treatment episode.
These data are analyzed against practitioner assessments to
identify and trigger real-time interventions. This process not
only identifies high-risk members early, but also dramatically
improves clinical outcomes.
approachA
Value of ALERT®
Improves practitioner detection of suicide risk by 35%
Improves practitioner detection of substance abuse
risk by 17%
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EFFECTIVENESS.
Population-Based
Our Assertive Care Management approach is yet another
industry advancement that reaches beyond traditional targeted
care management. Individually assigned care managers function
as patient advocates to ensure effective and timely treatments.
They go the extra mile by collaborating with members and
practitioners to make sure high-risk members remain stable.They also work in tandem with families, social service agencies,
courts and schools to make sure your members have access to a
full range of support services, promoting faster recovery and
lower costs.
Performance-Tiered
We add additional value to our comprehensive, credentialednetwork, tiering by specialty and clinical outcomes to ensure
you get the very best practitioners and facilities. We use a
sophisticated nine-point profiling system to connect your
members to practitioners who consistently demonstrate
effective, efficient care. In addition, we give practitioners direct
feedback based on their performance — which contributes to
best practices and continuous quality improvement.
We have developed a proven approach to integrating medical
and behavioral treatment. This well-coordinated system fosters
care integration by medical and behavioral health care
practitioners, medical groups, pharmacy and benefit managers
and health plan utilization staff to ensure members receive the
most thorough treatment.
We coordinate care using a variety of tools and protocols, suchas participation on health plan committees, providing access for
physicians to 24/7 dedicated consultation services and supporting
members with disease management programs, which compliment
medical care.
Medical
THAT focusesON
Care management.
Provider network.
Care integration.
Assertive Care Management Lowers Costs
28% decrease in inpatient/residential care admits
18% decrease in inpatient/residential care days
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Every health plan is unique, which is why we offer a full spectrum
of carve-out solutions from high-touch managed care plans to
customized PPO services. Our solutions are offered through fully
insured, shared risk and ASO arrangements — the choice is yours.
In fact, our unique value-based pricing model ensures your choices
are never limited. It provides you the freedom to match the level
of clinical support your membership requires, with the degree of
financial risk you choose to control. Our unlimited product and
pricing flexibility gives you exactly what you need, while helping
you get the most for your behavioral health dollar.
Many ChoicesUnlimited flexibility.
We’ve taken great care to design managed mental health and
chemical dependency plans that offer comprehensive, responsible
care. They not only integrate seamlessly with medical plans, but
can also be tailored specifically to your membership.
Behavioral Health Plans
Our EAP helps differentiate your health plan by giving your
clients the best productivity tools on the market. These 24/7,
year-round services include per-incident counseling plans and
access to work-life referrals for child and elder care, legal
assistance, financial planning and budgeting, alternative health
care, grief counseling, child rearing, personal relationships, life
transitions and much more.
Employee Assistance Programs (EAP)
FLEXIBLE
PERFORMANCE.PROVEN
PRODUCTS.
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We can tailor our behavioral health support for your members’
medical treatment, ranging from congestive heart disease or
cancer to smoking cessation and diabetes management. Weempower and inspire participants to make healthy lifestyle
choices through education and ongoing support. But we go
beyond the scope of traditional disease management by
providing unique and effective programs:
Disease Management ProgramsPowerful, effective.
Depression Management
Taking Charge of Depression® is nationally recognized for
treating and managing the leading cause of work absenteeism.
The program is designed to support medical care providers insuccessfully treating their patients’ depression. This program also
provides patients with a self-help tool kit that supports them in
making important lifestyle changes.
Chemical Dependency Relapse Prevention
Navigating Change SM gives your members the tools and support
they need for successful recovery. This program starts when
intensive outpatient treatment comes to an end. Program
participants receive ongoing telephone support and a variety
of self-help tools to keep them sober and productive.
Licensed Care Management Tools
PacifiCare Behavioral Health offers the industry’s only set of
unique licensed care management tools designed specifically forhealth plans managing their own behavioral health programs.
These tools are designed to boost HEDIS scores and positively
impact clinical outcomes. Any or all of these tools will contribute
to greater administrative efficiency and improved member care:
ALERT
Taking Charge of Depression
Population-Based Care Management
24/7 After Hours Services
Enhance administrative efficiencies.
Taking Charge of Depression® Works
38% reduction in symptoms
64% decrease in impaired work productivity
63% of participants medication-compliant for 90
consecutive days at program-end
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Your health plan’s success depends on more than just
partnering with the right behavioral health plan. For this
reason, PacifiCare Behavioral Health goes beyond typical
account services and takes a proactive approach to your
overall business and financial health.
Our account managers are health plan advisors with
clinical backgrounds who provide a single point of service
and accountability. They use timely, accurate data to help
you make informed decisions. And they introduce
solutions to help control costs and alert you to business
trends and warning signs.
But the account managers are not alone. They’re backed
by a dedicated support team of operational, clinical and
technical experts, ensuring you will always receive the
right answer from the right person at the right time.
Superior Account Management
We operate from a single-platform, integrated system
that efficiently links our clinical and administrative
processes. Therefore, the real-time, account-specific
reports we produce provide you with meaningful data
integral to managing your business. Vital clinical data
support predictive modeling and management of high-
risk members. We meet your operational needs with our
timely, comprehensive authorization and claims data.
This data integration means greater efficiency and cost
savings for you.
Best InformationIn real time.
Quality measurements are critical to your success —
and we do everything we can to help you achieve it. We’ll
participate in your quality improvement process to ensure
your behavioral health program meets the highest
standards, from increasing your HEDIS scores to offering
behavioral health oversight. We’ll help your pharmacy and
therapeutics committee devise a smarter formulary. We’ll
also assist you with your behavioral health legislative and
regulatory compliance needs.
Improve QualityIn every area.
SERVICE
Our proven passions.accountability.AND
Your support team.
Behavioral health may be a small part of the total benefit
package, but it’s an important and differentiating element.
We assist your sales activities with tailored new business
plans and help your account teams in numerous ways.
Taking this extra step is what true partnership is all about.
Genuine PartnershipSupporting your success.
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When you put our knowledge to work, we become your best
partner for controlling the rising cost of behavioral health care.
Product flexibility. Value-based pricing options. A sound
approach to coordinated care. And expert account service.
Each of these allow us to deliver a measurable return on your
investment. In fact, we are so confident, we guarantee it.
PacifiCare Behavioral Health offers the best choice for
Behavioral Health.
Let us prove it to you.
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proven accountability
PROVIDESADDED VALUE.
PACIFICARE BEHAVIORAL HEALTH:Committed to quality.
Our commitment to the highstandards for managedbehavioral health careorganizations is pervasivein everything we do.
All PacifiCare BehavioralHealth regional servicecenters have earned three-year, Full Accreditation fromthe National Committee forQuality Assurance (NCQA).This rating is the highestlevel possible for a managedbehavioral health careorganization.
PacifiCare Behavioral Health
Western Region
February 2003–February 2006
Southwest Region
October 2002–October 2005
Northwest Region
May 2002–May 2005
Additionally, PacifiCare Behavioral Health is an “inprocess” organization on our way to receive URACaccreditation for the core standards, utilizationmanagement module and case management module.
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www.pbhi.comUNION BUG