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Collaborating on health improvement
Behavioral health concerns are on the rise. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working with providers to improve how and when behavioral health concerns are identified and treated. Together, we can help the whole person thrive by bringing physical and behavioral health together.
Take a look at some of our programs you can participate in, and learn about new tools and resources you can use in your practice. We look forward to working with you and supporting your continued efforts to improve health outcomes for your patients.
Close to 70% of behavioral health patients have a medical co-morbidity.1
Blue Premier Behavioral Health Program
Value-based behavioral health care
In January 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) notified providers that Blue Cross NC would not start Blue Premier Behavioral Health Foundational (BPBHF) for program year 2023. As of August 31, 2023, all payments have been made to providers who earned a bonus payment in the 2022 BPBHF program measurement year. Thank you to all who participated in the program.
Any questions hould be directed to the Blue Premier Behavioral Health Foundational mailbox: BPBH@bcbsnc.com.
Blue Premier Behavioral Health Advanced (BPBHA)
Blue Cross NC partners with Mindoula2 to offer Blue Premier Behavioral Health Advanced (BPBHA), which addresses the complex health needs of members with serious mental illness, substance use disorder or both conditions. This program is available to members with Commercial, Federal Employee Program (FEP), IPP Host and Home, and Medicare Advantage plans. This value-based care program relies on Mindoula’s expertise as a tech-enabled behavioral health management company to expand access to behavioral health services, including:
- Clinical care
- Crisis support
- Assistance upon discharge from the hospital or emergency department
- Coordination of services to address barriers to care
These BPBHA services are designed to reduce hospital admissions for members with serious mental illness and substance use disorder, as well as improve their overall health and quality of life. This program addresses the mental health crisis and health care shortage in North Carolina by providing tech-enabled support that expands outpatient behavioral health care to members in the greater Triangle area, as well as eligible members outside of North Carolina.
Primary care settings are a “gateway” for many individuals with behavioral health care needs.
Behavioral Health Care Navigation services
Blue Cross NC has Behavioral Health Care Navigation services to make it easier to identify and address behavioral health disorders earlier and more effectively. This allows for better integration of physical and behavioral health care. It's an important part of our long-term strategy to help deliver quality care, increase long-term savings and improve patient experience.
Our Care Navigators will aid primary care providers to connect their patients to the right behavioral health professionals. To complete a referral request for your patient, fill out our Behavioral Health Referral Form.
Based on the information provided, the Care Navigators will identify a behavioral health provider who can treat your patient. The Care Navigator will also reach out to the member to help schedule their appointment and follow up to see if the appointment was held.
Blue Distinction Centers
For substance use treatment and recovery
Blue Distinction is a national designation given by Blue Cross Blue Shield (BCBS) companies to recognize providers that demonstrate expertise in delivering quality specialty care – safely, effectively and cost-efficiently.
The goal of the program is to help consumers find both higher quality and more affordable health care for their specialty care needs, while providing a credible foundation on which employers may customize their employee benefits.
Providers who offer or help to support treatment for substance use disorders, including opioid use disorder, can qualify for the Blue Distinction Centers for Substance Use Treatment and Recovery specialty.
Go to the Blue Cross Blue Shield Association site to download:
- A list of Blue Distinction Centers
- Selection criteria
- Designation materials
Questions?
Disclosures:
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American Hospital Association (AHA). Trendwatch. Increasing Access to Behavioral Health Care Advances Value for Patients, Providers and Communities (PDF). May 2019.
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Mindoula is a next generation population health management company that scales the human connection through technology in addressing mind, body, and life challenges. It identifies, engages, and serves populations who might otherwise be left behind, and delivers tech-enabled, team-based, 24/7 support and care across the continuum of care. Mindoula’s adaptive data science approach, multi-platform technology stack, and virtual + in-person care extension teams enable its enterprise partners to achieve improved outcomes and significantly reduced costs by integrating behavioral, medical, and social determinants of health. Headquartered in Silver Spring, Maryland, Mindoula is currently operating in Maryland, Virginia, the District of Columbia, North Carolina, Nevada, Louisiana, West Virginia, California, Texas, Kentucky, Tennessee, Washington, Arkansas, Colorado, Missouri, New Jersey, Michigan, Pennsylvania, Delaware, South Carolina, Georgia, Mississippi, Minnesota, and Florida, with continued national expansion plans to meet the growing need for integrated whole person care.
Blue Distinction® Centers met overall quality measures for patient safety and outcomes, developed with input from the medical community. Blue Distinction® Centers+ also met cost measures that address consumers' need for affordable healthcare. Individual outcomes may vary. National criteria are displayed on www.bcbs.com. A Local Blue Plan may require additional criteria for facilities located in its own service area. To find out which services and providers (including hospital based physicians) are covered under your policy, or to learn about Local Blue Plan Criteria, contact your Local Blue Plan; and contact your provider before making an appointment to verify its current Network and Blue Distinction Centers status. Each hospital's Cost Index is calculated separately, based on data from its Local Blue Plan. Hospitals in portions of CA, ID, NY, PA, and WA may lie in areas served by two Local Blue Plans, resulting in two Cost Index figures; and their own Local Blue Plans decide whether all hospitals in these areas must meet Blue Distinction Centers+ national criteria for one or both Cost Index figures. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. To find out more, contact your Local Blue Plan.
Designation as Blue Distinction Centers means that these facilities' overall experience and aggregate data met objective criteria established in collaboration with expert clinicians' and leading professional organizations' recommendations. Individual outcomes may vary. To find out which services are covered under your policy at these or any other facilities, please call your local Blue Cross and/or Blue Shield Plan; and please call your provider before making an appointment, to verify the most current information on their Network participation status. Neither Blue Cross and Blue Shield Association nor any of its licensees are responsible for any damages, losses, or non-covered charges that may result from using this website or receiving care from a provider listed in this website.
All other trade names are the property of their respective owners.
Headway is an independent company providing behavioral health services on behalf of Blue Cross NC. Headway does not offer Blue Cross or Blue Shield products or services.
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Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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