pacificare brochure

7/30/2019 Pacificare Brochure

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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.



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.



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



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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