For people with a serious mental illness or substance use disorder, understanding how and where to access healthcare can be particularly overwhelming. It’s not just that behavioral health conditions are often linked to physical conditions requiring medical help. It’s also that several other factors – like food, housing and social and financial circumstances – play a role in determining whether these members can find the right support to address all of their needs.
At Anthem, we understand that caring for a behavioral health condition goes beyond treating both the mind and body. It also means identifying the ways the environment may affect a member’s condition and connecting them to community resources that can sustain their well-being over time.
To meet the needs of the most complex members of our affiliated health plans, we created the High Outreach to Promote Engagement (HOPE) program. These vulnerable populations have the highest rates of multiple chronic conditions and higher than average emergency room visits and inpatient admissions for both behavioral health and physical health.
Through the HOPE program, members were better able to improve their physical and emotional health while avoiding major incidents, as ER visits and in-patient hospitalizations decreased on average by 50 percent. Anticipating and supporting member’s needs before and after they need medical care significantly improve member outcomes and lower healthcare costs.
Advocating for a member’s whole health
At the center of HOPE – and the central point of contact for participating members – stand the program’s case managers. These licensed clinicians are responsible for supporting members in receiving all the services they need to live healthier lives. This includes helping members understand their healthcare, preparing them for discharge from inpatient hospital stays, setting up medication schedules and making follow-up appointments.
Case managers also take a broad view of a patient’s whole health. They understand members may lack the resources to attend a follow-up appointment, so they may assist with providing transportation and even accompany them to their doctor visits, prior to the pandemic. For some members, they may need to check in on them at a homeless shelter or arrange for power of attorney for a loved one. They also make sure members work closely with other program staff, who are certified peer support specialists and have personally experienced a mental illness or a substance use disorder.
It’s all about making sure members know they have an ally to advocate for them and provide resources they need. “Often, members don’t know what’s available to them—either from insurance benefits or community resources. They need a supporter, and we can be that for them,” said Linsey Langmo, one of the managers of the HOPE program.
Being at the center of care allows the case manager to form a stronger relationship with the member and gain their trust. Unfortunately, many members with complex behavioral health conditions don’t trust medical personnel. But when members realize that case managers can successfully coordinate their care, then they’re more likely to reach out and accept the support they need – whether that’s admission to an addiction inpatient treatment facility or a ride to a therapist.
Together, trust and HOPE will be there for our members with complex behavioral health conditions as we continue to support their health in all its forms.