A 24/7 approach to treating serious mental illness

A global pandemic halted day-to-day activity. The country was gripped by social unrest. The economy slumped. A polarized political climate kept many on edge. The past year has brought mental health challenges for nearly everyone.

Sixty percent of adults say the issues America faces are overwhelming to them. And nearly 20 percent say their mental health is worse than in the previous year. For individuals who have experienced trauma or face other health challenges due to social factors, the risk of serious behavioral health problems is even greater. 

In Nevada—a state where more than 6 percent of the population lives with a serious mental illness,  such as bipolar disorder, major depression or schizophrenia, and nearly 60 percent of those with these serious conditions  do not receive any treatment—Anthem Blue Cross Blue Shield of Nevada (Anthem BCBS) developed a new program to aid their Medicaid members who are facing challenges related to trauma, suicide or other complex behavioral health issues.

Collaborating with Mindoula, an independent population health management company, Anthem BCBS offers 24/7 specialized care through a combination of in-person care teams, telehealth and advanced technology tools. Utilizing case managers, community health workers, behavioral health specialists and peer support, the program relies on data-driven interventions and predictive analytics to allow someone experiencing a mental health incident to quickly and effectively communicate with their care team as well as be virtually monitored if necessary. The program also allows individuals to manage their care and treatment as part of an ongoing plan.

“People of all ages are struggling with life challenges, especially amid the COVID-19 pandemic and social unrest,” said Lisa Bogard, president of Anthem Blue Cross and Blue Shield Nevada, Medicaid. “Violence, trauma, stress, isolation, financial instability and other adverse social experiences can severely impact health, by adding programs and interventions that address disparities we are helping empower our most vulnerable members.”

Initially started as a pilot for those dealing with trauma, including individuals impacted by interpersonal violence—including gang and domestic violence—specialized, strategically selected care was offered by connecting members with specialty support teams and recently designed/released technology tools to help identify and address needs. The program is expanding to include children and young adults at risk for suicide, as well as those with severe mental health needs who are also struggling with complex physical health challenges.

“We know many are facing multiple challenges at once,” added Bogard. “We cannot work on improving their mental health if their physical health is creating a roadblock; the same is true for many social factors impeding good health. We must address all of these together.”

Physical and behavioral health are supported through care teams and a series of artificial intelligence (AI) apps driven by predictive analytics developed, in part, from claims data that can identify and flag anything that may be related to violence. Many are struggling with housing, food or job insecurity as well as mental health issues that are preventing them from taking control of their life and health. To alleviate some of these stressors, participants are also given the tools needed to access social resources, including financial aid, housing, food, education, employment and transportation. 

The program is working to not only improve health but also lower costs. The pilot found participants, compared to matched groups, experienced a 48 percent decrease in hospitalizations, reduced emergency room visits by 13 percent, lowered pharmacy costs by 25 percent and decreased medical costs by 38 percent.

Anthem BCBS aims to close gaps in care and increase access to behavioral health and primary care as well as improve access to substance use disorder programs and community resources that address social determinants of health. The hope is to reduce violence-related injuries as well as decrease costs associated with care including hospitalization, emergency room visits and uncoordinated prescribing.

See what other Blue Cross and Blue Shield companies are doing to improve mental health.