COMPILED BY THORA MADDEN
California Broker reached out to several industry experts toweigh in on mental health benefits. There’s never been a timewhere mental health services were more important. Find out what these industry pros had to say …
DESCRIBE YOUR COMPANY’S ROLE OR PRODUCTS IN THE BEHAVIORAL HEALTH SPACE.
Mental and emotional health has long been an important topic, but employers got a closer look at how employees are doing and the challenges they face in light of the pandemic. As a result, they want to enhance their benefits offerings to support wellness in this area. In fact, the 2020-2021 Aflac WorkForces Report showed that 26% of employers said employee mental health issues had an effect on their company in the past year, and 26% of employees said they expect their employer to offer mental health assistance benefits to make them feel more comfortable going to a physical worksite.
Aflac examined the journey an employee experiences when seeking treatment for mental health symptoms. As a result, we have enhanced our products to make sure we not only react to an event like hospitalization or disability by providing cash to help with expenses health insurance doesn’t cover, but also to focus on well-being. Our group short-term disability product provides mental illness coverage, and as a means to help support early diagnosis and treatment.
Aflac considers a mental health screening a covered condition for group supplemental wellness or health screening benefits. In addition, we provide employers with access to value-added services such as an employee assistance program and telehealth, including meeting with a counselor or psychiatrist virtually. This can help provide support for treatment and round out their strategy to support mental health, stress management and overall wellness.
We have enhanced our products to make sure we not only react to an event like hospitalization or disability by providing cash to help with expenses health insurance doesn’t cover, but also to focus on well-being.
— Stephanie Shields, Aflac
Jennifer Christian- Herman, Ph.D., executive director, Mind Body Medicine – Behavioral Health, Blue Shield of California
We are living in unprecedented times, the likes of which our society has not experienced in more than 100 years. For more than a year now, COVID-19 has caused worldwide disruptions in our work lives, family relations, job security and economic activity. In addition, social distancing has led to feelings of separation, loss of community, stress and anxiety.
Now, more than ever, Blue Shield recognizes the need to address the behavioral health needs of our members, including the biological, psychological and social factors that impact their behavioral health. Our whole-person approach to health and well-being, collaborative-care philosophy, and relentless innovation are what set us apart. These are the drivers that enable us to deliver a high- quality, personalized experience to our members.
Together with our behavioral health partners, Blue Shield is scaling an integrated medical and behavioral health program that seeks to ensure coordination between primary care physicians, specialty medical practice clinicians, and behavioral health professionals with the goal of providing a more holistic care experience. We aspire to ensure members have timely access to behavioral health care and that their cultural, ethnic, gender and language preferences are taken into consideration when finding the right provider.
As part of our commitment to transforming health care, we offer a comprehensive program of industry- leading behavioral health services. Blue Shield health plans provide a sophisticated approach to managing both inpatient and outpatient behavioral health services, employing specially trained behavioral health clinicians to assess members’ situations and direct them to the most appropriate care setting. We ensure a seamless coordination process for the care of members with significant behavioral health needs through co-located care managers and a collaborative approach that promotes integrated care coordination. This simplifies the member experience and enables personalized, relevant andresponsive care, while still leveraging cutting-edge technology to expand access to these services. We provide additional flexibility through a variety of member access points (e.g., telebehavioral health and tech- enabled hybrid applications).
In addition to our legacy partnership with our behavioral health partner, Magellan Health® (Magellan), we have expanded our network with innovative provider partners and solutions.
Telebehavioral health services: Blue Shield offers 24/7/365 telemedicine and telebehavioral health services to members through Teladoc. This includes a nationalnetwork of physicians and experienced psychiatrists, psychologists, therapists and social workers to address a broad range of common illnesses and provide relief for issues like addiction, depression, stress or anxiety, domestic abuse, grief counseling and more.
Telebehavioral health sessions conducted during the COVID-19 period are covered in the same way in-person visits are covered. All credentialed and contracted behavioral healthcare providers are now permitted to conduct telehealth video sessions for all routine services and certain advanced behavioral analysis, intensive outpatient treatment programs, and partial hospitalization program services. If a member is unable to participate in a face-to-face telehealth video session, outpatientproviders may also conduct sessions via telephone.
So, if members need care, they can call their provider to see how to receive services via their phone or video conference.
Blue Shield has extensive experience supporting transgender benefits and providing patient advocacy services for members diagnosed with gender dysphoria through our integrated care management model.
— Jennifer Christian-Herman, Blue Shield of CA
Wellvolution: Blue Shield’s award- winning lifestyle medicine program, Wellvolution®, combines best- in-class digital therapeutics, evidence-based therapies, and member-centric design to ensure members have access to personalized, flexible tools that work within their existing routines and address their unique problems.
To help members with social distancing during the current COVID-19 outbreak, we adapted our Wellvolution diet and lifestyle programs to support members during this uncertain time. These 100% virtual programs are customized to meet current challenges, supporting members to take better care of their physical and emotional health while they remain at home. We also expanded the platform to include on-demand exercise videos and a recipe library of healthy recipes for all dietary needs to increase well-being support for our members during the pandemic.
Bright Heart Health: We are also employing technology to address behavioral health concerns through our partnership with BrightHeart Health. They provide expert care and support to adults through two-way video conferencing via phone, tablet, or computer. Bright Heart works with over 150 hospitals, specializing in opioid disorders, substance abuse treatment, chronic pain/opioid dependency and eating disorders. Bright Heart Health is equipped to complete intakes within 24 hours of receiving a patient self-referral or provider referral, offering members on-demand care and minimal wait times.
Value-added services: Blue Shield’s value-added services provide our clients with game-changing opportunities that offer a broader clinical value story through seamless integration and improved competitive positioning through innovation and improved costs. Our newest cutting- edge solutions focus on technology, medical/behavioral integration, early intervention. We work to break down the stigma of mental health needs while promoting awareness, through these behavioral health programs andservices:
Behavioral health condition management services: Our integrated care management model leverages a behavioral health condition management component designed to help members overcome depression so they can effectively manage their chronic conditions. Behavioral health coaches, who are master’s-level clinicians, engage members using motivational coaching techniques and cognitive skill-building exercises, and they support members in developing their own self-management plans.
Pain management services: We also offer, as part of our integrated care management model, a comprehensive and collaborative approach to pain management, including pain interventions that provide support for members who may be at risk for opioid overuse or substance abuse. Various outreach strategies are leveraged to prevent unnecessary surgery, inappropriate medication use, and expensive emergency-room visits. Strategies include telephonic coaching by medical and behavioral health clinicians, medication reconciliation by a licensed pharmacist, 24/7 access to tailored, evidence-based digital programming, and self-guided modules.
Complex case management services: Magellan’s complex case management services expedite and support access totreatment facilities and care for more acute behavioral health conditions. We partner with Magellan to offer an integrated medicaland behavioral health model that helps ensure coordination between primary care physicians (PCPs), specialty medical practice clinicians, and behavioral health professionals, with the goal of providing a more holistic care experience.
Autism and applied behavior analysis services: The Magellan Autism Connections® program helps families navigate the complex healthcare system, obtain access to quality providers, and receive support within their communities. The program combines the expertise of fully credentialed providers who meet applied behavior analysis requirements with targeted efforts to engage and serve children diagnosed with autism and their caregivers to ensure everyone impacted receives the care, guidance, and support they need.
Maternal mental health services: Members experiencing maternal behavioral health conditions such as depression (including postpartum) and anxiety either before, during, or after pregnancy receive an additional layer of support via our Prenatal Program. Members are provided access to behavioral health specialists who can offer help and guidance with stress management, coping mechanisms, managing depression or anxiety, and more.
LifeReferrals 24/7: Members can get in-person and telephonic support for all areas of their lives — from relationships and child and elder care, to financial and legal issues — with LifeReferrals 24/7™. This employee- assistance-program-like offering includes three face-to-face counseling sessions with licensed therapists in each six-month period at no extra charge.
Transgender patient advocacy services: Blue Shield has extensive experience supporting transgender benefits and providing patient advocacy services for members diagnosed with gender dysphoria through our integrated care management model. We offer personalized advocacy and health education services bydedicated nurse case managers to address the complex medical and psychosocial implications of gender transition, and our comprehensive medical policy follows internationally recognized standards of care from the World Professional Association of TransgenderHealth.
Community health advocates: As part of our Health Reimagined program, we are piloting the use of community health advocates in select regions to work directly with, or on behalf of, patients to navigate the health system and connect them with community resources that address their behavioral health and social needs while aiming to reduce health inequities. Community health advocates act as navigators and liaisons with local stakeholders and provide the empathetic support and real-time problem solving necessary to enable whole-person health and wellness.
Workplace support services: Managers and supervisors receive telephonic support to assist with employee issues, such assubstance abuse or personal and family problems, that could be impacting job performance. Workplace Support consultants are master’s level, trained clinicians who assist with the development of corrective action plans and a proper return to work, as appropriate, for the employee. Workplace Support consultants partner with managers and supervisors to ensure services are done in accordance with a client’s human resources and legal policies.
Unum Spokesperson Pam Jenkins, Assistant Vice President, Product & Market Development, Colonial Life
Various programs proved their value last year during the pandemic. Colonial Life provides an Employee Assistance Program (EAP) within our Group Term Life product. Workers have free access to confidential counseling and resources such as securing local childcare options and finding alternative elder care solutions. In most states, employers may choose to offer our disability plans with psychiatric or psychological condition benefits.
Brian T. Sullivan, RHU, REBC, FLMI, MHP, CHRS, Market Vice President, Humana
Humana’s wellness programs, Humana Employee Assistance Program (EAP) and Go365, offer a variety of resources to provide mental health support. With Humana EAP, employers have the option to offer the traditional EAP offerings, including professionals who can connect employees to a network of licensedcounselors. But it also offers other components, such as life coaching, a legal/financial benefit, and a website. Go365 offers digital mental health resources, Unwinding Anxiety and MyLife, as well as a SelfHelpWork’s stress course called Living Easy: Stress & Resiliency.
Yener Balan, M.D., DFAPA, Kaiser Permanente
Along with our expansive mental health offerings, collaborative approach, and responsive care, our integrated system—which offers care and coverage together—is uniquely built to meet our members’ needs during this difficult moment in time.
We draw from a full spectrum of proven care. From primary care to specialty mental health care to emergency care and everything in between, our providers coordinate and manage care delivery across an expansive mental health care ecosystem. That gives our members many options—including options for getting care remotely—and they can work with their provider to select the care that’s right for them. At the center of all of this is our electronic health record system, which allows members to manage their care online and gives us the ability to coordinate their care. Our doctors know what they need to do, and the ecosystem enables us to provide care based on what works and helps us make sure the patient experience is as seamless as possible. The ability to maintain clear communication across our care teams is particularly critical during a crisis, which can affect how and where care is delivered.
We also always try to spot concerns early, which is why providers across our network have the knowledge, training, and resourcesto address mental health concerns. Patients and their providers develop care plans tailored to their challenges and goals, includingfrequency and duration of visits.
Adjustments are made as needed. Ongoing feedback from members helps us understand what tools, therapies, and self-care techniques are helping, identify additional things to work on, and decide on a path forward after achieving treatment goals.
The result is a fluid care experience that evolves with our members’ needs.
Mary Langowski, CEO, Solera Health
We have several programs that serve behavioral health through our all-encompassing Solera Connect platform. This matches consumers to their best-fit, health community-based and digital solutions while creating a single touchpoint for condition management and streamlined engagement.
Moreover, people are matched to their level of acuity by condition with the ability to move up or down as needed based upon ongoing data monitoring of how consumers are progressing. This ensures that peopleare getting the right level of support that they need. With the platform and a single agreement, we simplify the difficult tasks in getting programs launched, including claims processing, consumer engagement, eligibility screening and vendor management, thereby speeding up rollout of solutions and saving costs. Specifically, we offer both a Diabetes Prevention and Weight Management Program and have recently launched a bundled suite of programs called Solera True Strength which combines Stress, Sleep & Resilience with Tobacco Cessation and Social Isolation.
All credentialed and contracted behavioral healthcare providers are now permitted to conducttelehealth video sessions for all routine services and certain advanced behavioral analysis, intensive outpatient treatment programs, and partial hospitalization program services.
— Jennifer Christian-Herman, Blue Shield of CA
HOW HAS COVID CHANGED WHAT YOU DO? FOR EXAMPLE, ARE PEOPLE ACCESSING YOUR SERVICE IN A DIFFERENTWAY? HAVE YOU SEEN AN UPTICK IN USE?
Stephanie Shields, AFLAC: Many changes have taken place in the insurance industry because of COVID-19, especially the acceleration of digital initiatives for American businesses. Aflac is constantly evolving to enhance the customer experience, from benefits enrollment and education to policy management and filing a claim. Our efforts to expand and reach more people were in place before the pandemic. We continually work on ways we can better respond to customer needs by being easier to use, to obtain and to be more accessible to a greater number of consumers.
Aflac has digital tools in place to provide solutions for businesses that have had to shift to operating remotely. We partner with many third- party platforms that offer benefits administration solutions to employers and a seamless digital experience for their employees. Inaddition, we have updated customer- facing technology capabilities, changing the way we engage and service our customers and support brokers.
Jennifer Christian-Herman, Ph.D., Blue Shield of CA: A silver lining to the COVID-19 pandemic crisis has been the capacity to rapidly expand telebehavioral health services. Blue Shield, in partnership with Magellan andTeladoc Health, Inc. has dramatically expanded these services, and as a result, provider/member utilization has risen significantly.
During the COVID-19 public health emergency, telehealth services have expanded to ensure patients continue receiving care in a timely fashion in a safe manner that mitigates risks to both members and providers. We have made several adaptations to our telehealth approach to support this expansion, including temporary changes to our levels of care.
Members have exhibited a greater willingness to access treatment through telehealth modalities. For the periods of April to September, 2020, Blue Shield and Magellan experienced a reduced need to look outside the network to accommodate geographic needs and specialty requests to meet appointment standards due to increased telehealth utilization.
This decrease was partially offset by the need to accommodate social- distancing restrictions and heightened safety measures for members and employees, increasing wait times for some patients and facilities. Some specialized in-person services have also been limited due to the pandemic, resulting in the need to utilize out-of- network services.
The following list outlines various program adaptations Blue Shield and Magellan have implemented or supported providers in implementing over the course of the pandemic: We adopted the best practice to allow providers the freedom to select the Health Insurance Portability and Accountability Act (HIPAA) compliant telehealth platform of their choice for delivering care.
We expanded support for providers, making it easy for them to onboard for telehealth. Through Blue Shield andMagellanProvider.com, we offer a free webinar, “Telehealth 101: What You Need to Know and How to Get Started”; lists of telehealth payable services and billing instructions; “10 Steps to Getting Started as a Telehealth Provider”; and answers to frequently asked questions about telehealth.
Some partial hospital programs (PHP) moved to a telehealth format, offering group and individual therapy, psycho-pharmacological management, and assessment via two-way video.
Patients have participated in these programs from home or other suitable locations outside the traditional structured PHP setting.
For intensive outpatient program (IOP) services, we have seen two models emerge that incorporate telehealth modalities:
- video visits or telehealth-based IOP, during which the member attends only from an offsite/home setting via a telehealthconnection
- a hybrid model that combines in- person and video visit–based care and requires evaluation of the treatment plan and therapeutic program components to ensure clinical validity.
Prior to COVID-19, Applied Behavior Analysis (ABA) historically allowed very limited telehealth opportunities. As ofMarch 2020, in response to requests by state regulatory bodies, Blue Shield and Magellan began allowing telehealthaccessibility for all ABA codes. This was warmly received by the ABA provider community, as it enabled them to seetheir members and remain compliant with shelter-in-place directives. Early feedback from providers has indicated patient satisfaction scores have remained the same for both types of visits.
Blue Shield and Magellan have continued to receive and review requests for psychological and neuropsychological testing throughout the pandemic. Some providers have been using telehealth in their testing, and our internal psychological testing team has compiled a list of testing measures that are conducive to telehealth services. We use this list, as well as the American Psychological Association’s principles, as guidelines for telehealth testing during the COVID-19crisis.
While Blue Shield specifically and the nation in general have made great strides in combating the COVID-19 pandemic, the crisis is far from over. Together with our partner Magellan, we have quickly responded to the public health emergency, making needed changes tosupport timely access to care and patient safety. We recognize, however, that the changes we’ve made during this critical time require further evaluation before we commit to making them permanent. We are currently documenting specific plans for this evaluation and recommended actions based on observations during the pandemic period.
We expect to assess whether some of our expanded telehealth services deliver an optimal level and quality of care outside of these extenuating circumstances. For some levels of care, we do not believe telehealth to be a best practice and will likely revert to pre-pandemic policies. Inother cases, through adapting our policies, we have determined that defining a new level of care to account for telehealth access may be appropriate.
Pam Jenkins, Colonial Life: The pandemic increased the risk of mental and behavioral health issues and made people more financially fragile. In this environment, benefits to help protect people from the financial costs of illness, injury or loss of life are more important than ever. Unfortunately, the pandemic has made benefits enrollment — and learning whichbenefits are best for you — harder, too.
We’ve always focused on meeting our customers where they are — making sure they understand and choose the right benefits — regardless of whether it’s in-person or virtual. When offices began to close in the U.S. last year, we already had a virtual meeting platform forbenefit counselors, but we expanded our number of virtual counselors. Our Employee Assistance Program (EAP) also provides phone and online chat solutions for a variety of personal and work issues.
The ability for customers to connect with benefits counselors during off- hours is also paramount. If 10 p.m. on a Wednesday is the best time, Colonial Life can make it happen. Virtual makes it possible.
Brian Sullivan, Humana: Go365 rewards points to members for working out, but we verify their activities before doing so. Since gyms and other fitness facilities had shut down or otherwise experienced a drop in attendance, we added functions to our program where members could earn points for exercising along with virtual fitness programs like Classpass or Echelon. They also have the ability to submit a selfie to our Go365 app as proof for working out. We also expanded our eligible activities for earning points to make it easier for members to be rewarded for being healthy. In addition, weoffered webinars, new content and communications to help members with stress, exercise and prevention. With EAP, we added text-based and video counseling options to our network, to make it easier to get help virtually, as well as adding new website content and promotional flyers addressing mentalhealth issues related to the pandemic.
Dr. Balan, Kaiser Permanente: The toll the pandemic is taking on us all is undeniable, and there’s no question that COVID-19 will continue to affect people’s mental health around the world. Early on, the Journal of the American Medical Association projected a nationwide increase indepression, anxiety and post-traumatic stress due to COVID-19. (This is according to Sandro Galea, M.D., et al., “The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention,” Journal of the American Medical Association Internal Medicine, April 10, 2020.)
People who already struggled with addiction are suffering in isolation, creating dangerous andpotentially life-threatening situations.
— Dr. Balan, Kaiser Permanente
Sadly, that is proving true with more recent data suggesting that signs and symptoms of mental health conditions continue to rise, particularly among young people and caregivers. As people search for ways to cope with increasing stress and anxiety, we’re seeingstartling increases in substance use and addiction. Unfortunately, the national opioid crisis has only worsened during the coronavirus pandemic.
In June, four out of 10 adults said they’ve dealt with mental health or substance use issues, while more than one out of 10 said they’ve either started using substances or increased their use. (Mark E. Czeisler et al., “Mental Health, Substance Use, and SuicidalIdeation During the COVID-19 Pandemic—United States, June 24–30, 2020,” Morbidity and Mortality Weekly Report, August 14, 2020.)
People who already struggled with addiction are suffering in isolation, creating dangerous and potentially life-threateningsituations. A recent study (“June Brings Some Mental Health Relief for U.S. Workers, but Risk for Mental Health Conditions Remains High,” Total Brain, accessed Sept. 23, 2020) found that:
- 54% of employees are at increased risk of a depressive disorder, 49% have a higher risk of post-traumatic stress disorder
- 41% have a higher risk of a general anxiety disorder
- 11% have a higher risk for addiction.
This confluence of problems contributes heavily to deaths due to drugs, alcohol, or suicide, also known as “deaths of despair.” These deaths have been on the rise the last decade and projections for the coming months are grim. However, we know they’re preventable.
COVID-19 has brought increased stress upon Americans, with a Gallup poll showing that 55% of people are experiencing stress “a lot of the day”, which is why we launched the True StrengthBundle to help address this combination of conditions.
— Mary Langowski, Solera Health
Mary Langowski, Solera Health: With COVID-19 we have seen more demand for all of our programs. A recent American Psychological Association survey showed 42% of respondents reporting undesired weight gain, due to the pandemic, which is a high contributing factor for the onset of diabetes, so both payers and employers are moving to help consumers stem the tide. Moreover, COVID-19 has brought increased stress upon Americans, with a Gallup poll showing that 55% of people are experiencing stress “a lot of the day”, which is why we launched the True Strength Bundle to help address this combination of conditions.
Our programs are traditionally accessed both in-person and digitally. To adapt for COVID-19, our community- based organizationssuccessfully and quickly moved to offer virtual classes, but digital options continue to remain extremely popular.
WHAT SHOULD BROKERS AND BENEFITS PEOPLE KNOW AND DO TO HELP CLIENTS BETTER UNDERSTAND AND UTILIZETHEIR BEHAVIORAL HEALTH BENEFITS?
Stephanie Shields, AFLAC: Maintaining ongoing, authentic relationships with clients is vital. Check in with them regularly to listen and provide counsel, both generally and about emotional health benefits.
This could include helping employers construct a benefits education strategy to help workers learn about and take advantage of all the offerings available to them. With employees continuing to operate remotely, it’s important for employers to see how their workers are dealing with the extraordinary challenges of pandemic conditions.
Aside from a mental health issue, many people are struggling with extended periods of isolation, facing stress and anxiety abouthealth concerns, or juggling a variety of responsibilities personally and professionally while working from home. In particular, women are ademographic bearing many burdens.
Research shows that, compared with men, they complete more household chores and provide more child care and caregiving for older adults. Yet, they have less leisure time, which can affect their ability to get much-needed rest and self-care. And that data predates COVID-19, which put many women in a position to have to choose between work and child care. Brokers have an opportunity to lend a listening ear and offer solutions to help workers set their employees up for success.
On the topic of emotional health, a non-benefits consideration is informing businesses about national programs they can promote to employees such as Crisis Text Line, which Aflac supported during COVID-19 with a $1 million donation to assist frontline workers. The not-for-profit organizationresponds to thousands of texts each day from individuals experiencing mental or emotional distress. They reported an increase in communication with frontline workers and their family members impacted by the pandemic. Individuals seeking crisis counseling who text FRONTLINE to 741741 are connected to trained counselors who provide support in dealing with issues such as anxiety, stress, fear, and isolation and help them identify coping strategies and other resources.
Jennifer Christian-Herman, Ph.D., Blue Shield of CA: To help ensure employers, employees and individuals have comprehensive knowledge of Blue Shield’s behavioral health benefits and know how to access them, we encourage brokers and benefits professionals to partner with their Blue Shield sales representatives, who can provide them with the current layout of Blue Shield’s offerings.
At Blue Shield, we know that behavioral health is more than just a provider network, covered benefits, and tech-enabled care. Our members need to:
- Recognize early signs and symptoms
- Understand what programs are available and appropriate for them
- Quickly access care across all acuity levels
By realizing our vision of an improved healthcare delivery system, we believe that future members will actually have less need for behavioral healthcare services, because problems that lie in social and behavioral circumstances—which can progress into medical issues—will be lessened.
This is key to emphasizing not only Blue Shield’s behavioral health and wellness benefits, but to communicating the importance of addressing mental health and helping members find clinicians they can trust.
Pam Jenkins, Colonial Life: Brokers should:
- Continue to talk about the importance of dealing with any mental concern as a health
- Contribute to the process of destigmatizing mental
- Recognize the impact to an employer’s bottom line if employees are struggling to find help with personal issues. This can result in higher absenteeism, poor job performance, and impac
Brian Sullivan, Humana: We believe that intervening early can help reduce the rate at which employees present with more advanced complications, such as depression and chronic stress. Behavioral health solutions should address a wide range of severity and diversity of mental health issues. Humana EAP, for example, could be seen as an offering only for “serious” situations like fitness for duty evaluations, but they can also offer more preventive, everyday resources to help people cope. Those under-utilized aspects of EAPs should be explored and promoted more. And wellness programs should be more holistic in nature, not just addressing nutrition and exercise, but also stress and anxiety—two major drivers of poor health in general.
Dr. Balan, Kaiser Permanente: Our goal is to always be available for our members, especially when they need us most. We moved fast to shift delivery of nearly 100% of our scheduled mental health services to telehealth options, including group visits. This helped ensure our members could receive high-quality mental health care without delay and without risking exposure to COVID-19. We were able to quickly ramp up our telehealth offerings because we already had a robust, highly efficient telehealth system. We also accelerated investments that have enabled us to collect reported patient outcomes remotely, without patients having to come into the office.
These things make it easy for members to get care remotely through video visits, phone appointments, e-visits, email consultations, mail- order pharmacy, and a host of other virtual support options on kp.org and the Kaiser Permanente app found at kp.org/getcare. In addition, our emotional wellness support resources have been essential during the pandemic. Whether it’s to help with sleep, stress, or relationships, we offer many digital resources for our members’ mental health and wellness, including popular wellness apps like myStrength and Calm. The myStrength app (a wholly owned subsidiary of Livongo Health, Inc.) offers a personalized program with interactive activities, in-the- moment coping tools, inspirational resources, and community support. Calm is a meditation and sleep app designed to help lower stress and reduce anxiety.
Our goal is to always be available for our members, especially when they need us most. We movedfast to shift delivery of nearly 100% of our scheduled mental health services to telehealth options,including group visits.
— Dr. Balan, Kaiser Permanente
Mary Langowski, Solera Health: Both brokers and benefits professionals should know that the two keys to maximizing behavioral health benefits for consumers are awareness and choice. Many people do not even know that there are behavioral health benefits available to them, so clients should be encouraged to outreach to their member population. More importantly, clients need to understand that different people learn differently, so offering just a single point solution provider for a behavioral health condition will not work for everyone.
This is not a case where one size fits all, which is why Solera curates networksof providers offering a range of learning methodologies and algorithmically matches members to the best fitting solution for them.
WHAT IS YOUR COMPANY’S MAJOR FOCUS OR CONCERN IN THE NEXT YEAR OR TWO?
Stephanie Shields, AFLAC: Aflac, along with the world, will continue to navigate the global pandemic’s effects in 2021. This year we continue to secure our financial position, align our workforce, and reinforce and accelerate our digital roadmap. Looking ahead to 2022, Aflac will hone in on our growth initiatives, including building a coordinated value proposition and experience for our newly acquired businesses and expanding our distribution through new channels. In addition, we are also continuing to look at how we can leverage automation and digital solutions to create efficiencies for our customers.
Jennifer Christian-Herman, Ph.D., Blue Shield of CA: We are focused on further integration of medical and behavioral health care. Together with our behavioral health partners, Blue Shield offers an integrated medical and behavioral health program that seeks to ensure coordination between PCPs, specialty medical practice clinicians, and behavioral health professionals, with the goal of providing a more holistic care experience.
Our behavioral health vision for 2021–2024 is focused on further integrating medical and behavioral health care by leveraging the collaborative care model and existing accountable care organization (ACO) partnerships to:
- Implement a value-based care model
- Integrate primary care behavioral health
- Base decisions on data-driven stratified medical behavioral integration
Members and providers will also have improved access to digital self- help tools that provide evidence-based treatment options and care navigation. In-flight initiatives to improve medical/ behavioral health integration include:
- Integrated efforts to streamline primary care/behavioral health referral
- Telebehavioral health and in-home services to improve access to care
- Initiatives focusing on post-inpatient admission follow- up requirements and attention deficit hyperactivity disorder medication follow-up
- Licensed liaison clinicians coordinating care between medical case management and providers
- Overall management of healthcare costs, including behavioral health, through the proper application of medical necessity criteria and minimizing unnecessary emergency-room visits, potential medication interactions, and hospitalizations
- Monthly joint clinical rounds to ensure a smooth transition process for members with significant and complicated comorbid health issues
- Dedicated nurse case managers who provide services for chronic behavioral health and medical issues
- A PCP hotline available to doctors and medical staff for consultationsAn online PCP Toolkit with resources and tools to support the coordination of care between primary care and behavioral health professionals
- An ACO liaison coordinating care between the medical group, Blue Shield, Magellan, and behavioral health providers
- Community transition coordinators to assist members transitioning from high-volume facilities
- Use of technology to transform the healthcare industry through innovation. We believe technology is a strategic differentiator. Our goal is to bring health care tothe digital age through the right technology capabilities to build a meaningful digital experience for our users.
Over the course of the next few years, our focus will be on accelerating the development of digital tools for members. In addition, we will be expanding upon our health and wellness and treatment cost tools to provide integrated care guidance and give members more control and options to engage in their care in a self-service manner.
We will also focus on expanded personalization, more targeted content and messaging, and leveraging artificial intelligence to make the member experience highly relevant and drive better engagement. In addition, we are evaluating other ways to get members to the right care at the right time, such as channeling and incentive strategies.
Our vision is to build a relationship with our members in which we become their trusted advisor for their healthcare needs at an exceptional service level.
We want them to know that we are not just a health plan provider—we are an integrated solutions platform actively supporting their health through a multi- faceted, 360° approach. We are taking bold steps to reimagine health care by using technology to put members at the center, help providers focus on delivering the best clinical care, and improve the health and wellbeing of individuals and their communities.
Our ongoing digital strategy roadmap is built upon one of our key strategic pillars — high-tech, high-touch support. This roadmap also aligns with our customer-focused goals of becoming trusted advisors to all our members by providing an experience that is simple, human and intelligent, and by meeting their healthcare needs at an exceptional service level. Our efforts are not only focused on digital solutions; we are taking an omni- channel view to ensure integration of alltouchpoints, with interactions tailored to member preferences and needs.
We are already making inroads through the following technological initiatives:
Connect and EngagementPoint: In 2020, we launched the omni- channel member engagement systems Connect and EngagementPoint exclusively for our self-funded clients. The Connect and EngagementPoint ecosystem includes all digital programs and services in one place —includingpreferred vendor partners — to drive member engagement. This digital ecosystem leverages claims data, individual preferences, anduser activity data to deliver personalized recommendations and empower members to improve their health.
We are so confident in their efficacy that these programs come with a performance guarantee as a standard.
We believe that intervening early can help reduce the rate at which employees present with more advanced complications, such as depression and chronic stress.
— Brian Sullivan, Humana
Virtual care: We believe that a variety of member access points (e.g., telehealth and tech-enabled hybrid applications) that complement traditional in-person care are necessary to ensure timely, affordable access to medical and behavioral health care.
We continue to expand virtual care through collaborations with Teladoc, myStrength by Livongo Health, and innovative provider partners like Bright Heart Health to help members obtain the highest quality care at the lowest cost for conditions that are eligible fortreatment via virtual care.
Holistic health platform: We are helping to improve the health and well- being of the population by addressing social determinants of health such as food insecurity, homelessness, and social connectedness. Current initiatives include a new holistic-health platform that leverages our Wellvolution platform, community health advocates to engage members in their local communities, and data intelligence from mySidewalk and Unite Us to enhance community understanding.
COMMITMENT TO INNOVATION
Blue Shield is all in on innovation. We are rebuilding health care from the ground up by leveraging innovative clinical research, analytics and collaborations with our network providers and other healthcare partners to transform the way health care is delivered. Followingare just a few examples of how we are achieving this.
Colonial Workers have free access to confidential counseling and resources such as securing local childcare options and finding alternative elder care solutions.
—- Pam Jenkins, Colonial Life
Health Reimagined: Our Health Reimagined program is an innovative plan to transform the healthcare system by combining industry- leading care models with a simplified, personalized member experience to deliver high-quality, sustainably affordable care. We are piloting programs for Health Reimagined in four distinctly different regions throughout the state: Butte, Los Angeles, Monterey, and Sacramento counties. Each county has unique qualities that help us understand which approaches are most effective.
Altais: Blue Shield recognizes that the healthcare system is contributing to physician burnout and fatigue due to mountingadministrative burdens. To address these challenges, Blue Shield has invested in a new company, Altais, that empowers doctors to focus on what they do best: connect with and treat patients. Altais helps medical and clinical professionals seamlessly leverage technology so they can focus more time on the health and well-being of their patients, reduce cumbersome administrative burdens, strengthen thevibrancy of their practice, and enjoy a sense of professional satisfaction.
BlueSky mental health initiative for youths: Blue Shield recognizes the essential role mental and emotional health play in a person’s overall well-being, starting in childhood. No one is immune to adversity, yet each person’s future depends on their ability to cope through life’s challenges. Enter BlueSky, a multi-year initiative that brings together leading community organizations to provide mental health resources for middle- and high-school students. BlueSky initially launched in 19 middle and high schools in Alameda and San Diego counties, supporting a total student body of more than 20,000. As more elements of the program roll out and it expands in geography, tens of thousands more students will be able to access these additionalmental health support services.
Pam Jenkins, Colonial Life: With so many people absent from their normal workplaces, the normal enrollment methods — like benefit fairs, in-person group meetings and live one-to-one benefits counseling— might not be the “norm” for the foreseeable future. We will continue to expand our various enrollment methods, with a strong focus on virtual enrollment and how we can leverage technology to help our customers make critical benefits decisions. We also plan to continue to grow and expand our benefit offerings — making sure they’re modern, current, and reflective of a multi-generational workforce.
Brian Sullivan, Humana: In the next year or two, we have two major focuses:
- Help companies establish a culture of well-being amidst the long- term effects of the pandemic, which will be far-reaching andunprecedented, and
- Expand the definition and expectations of “well-being” so that employees are not just incurring lower healthcare costs, but also feelsupported, resilient and
Dr. Balan, Kaiser Permanente: Kaiser Permanente is at the forefront of mental health and wellness, fueling the global conversation and engaging with diverse partners to make mental health and wellness a reality for all. We’re fostering open and honest conversations with people of all ages, including with our “Find Your Words” campaign, which is designed to make it easier for people to support themselves and others, and ourinnovative Presence of Mind initiative, which focuses on helping youth and young adults prioritize their well-being in collaborationwith the esports and gaming community.
These are just a few examples of how we’re cultivating health for our members and making a positive difference in homes, workplaces, and communities.
In addition to the acceleration of telehealth and digital self-care, we can also report investments in key areas, including hiring more than 500 mental health clinicians in California in the last 5 years, committing $11 million toward technology, and $700 millionin expanding and enhancing mental health care facilities. This is reported by Kaiser Permanente’s internal data. We’re continuing to expand our rapid intake and assessment center to expedite care for our members. And we’re working in our communities to reduce stigma, address homelessness, and reduce the barriers that prevent people from seeking the mental health support they need.
Mary Langowski, Solera Health:
Solera’s main focus is continuing to partner with forward-thinking payers and employers to roll out the best behavioral health programs in the industry and help as many people as possible. Working with us, payers and employers can be comforted knowing that they will always have the latest and greatest programs available for their audience.