September 17, 2019
An addiction can happen to anyone at any time with any substance – alcohol, opioids or a broad range of illegal drugs. Likewise, mental illness – which impacts nearly 47 million Americans – can strike when least expected. Those suffering from a mental health condition, a substance use disorder or both can face challenges that seem insurmountable. Especially if a person is facing them alone.
The emergency room (ER) is often the first – and only – stop for those suffering from substance abuse disorder or mental health issues. Medicaid, the largest payer for mental health services in the U.S., found that nearly 12 million ER visits in 2007 were made by individuals with a substance use disorder, mental health issue or both – a rate that had increased another 15 percent by 2011. And a recent study by the National Institute of Medicine found that, between 2006 and 2014, the rate of alcohol-related ER visits increased by 47 percent.
Blue Cross and Blue Shield of New Mexico (BCBS of NM), knows the statistics well. In a region challenged by limited access to behavioral health services, it found that nearly a third of its ER visits were related to substance abuse and mental health disorders, particularly among members served through Medicaid. Many of these patients can be stuck in a cycle that has them returning to the ER time and again without the stable and coordinated care they need to address their addiction and related health challenges. The answer, the health plan found, was to engage patients from the moment they come to the ER and establish a trusted, peer-to-peer relationship that helps the patient find a path to their own recovery.
For those diagnosed with substance use disorder, the rate of relapse can be anywhere from 40 to 60 percent, and achieving improved mental health, for some, can be a life-long struggle. Suffering with such complex and debilitating conditions, some individuals may abandon hope for recovery. Some may not even know where to start. And others may find the recovery effort too complex or challenging, and refuse care that extends beyond the ER.
That’s where the Peer Support Specialist comes in.
Peer Support Specialists are themselves in active recovery from a mental health problem, substance use disorder or a combination of the two. On an emotional level, Peer Support Specialists use their own lived experience to walk alongside members on their journey, giving hope to people that struggle with social or emotional barriers, destigmatizing their condition and helping them stay motivated to reach their goals.
“When a Peer Support Specialist encounters a member that refuses care, they will make contact with the patient no matter how many times, how many admissions, until they can establish a rapport and connect them with the care they need,” explains Lisa Mortensen, senior director of behavioral health, clinical operations government programs at BCBS of NM.
Trained in how best to approach and engage patients as well as how to identify and connect patients to available resources – such as homeless shelters, health clinics and mental health services – a certified Peer Support Specialist is an integral part of the recovery process, helping to bridge the gap between members and needed care.
“Peer Support Specialists assist our members with everything from self-help education to medication adherence. They ensure patients attend recovery support groups and doctor appointments,” Mortensen explains. “And they help our patients address a variety of social factors that create obstacles to the member’s recovery, such as learning how to use public transportation or accessing housing.”
The two-year old program is already showing results. By deploying Peer Support Specialists to engage patients in their own recovery, BCBS of New Mexico has seen a 69 percent drop in ER visits and 30-day readmission rates have gone down by 52 percent for those that were in the pilot group. The impressive results prompted BCBS of New Mexico, which began the program with one Peer Support Specialist, to expand to 20 new personnel, covering seven emergency rooms in the state.
And other Blue Cross and Blue Shield companies are following suit. Florida Blue’s