Intensive services program for children, adults now available for Blue Cross commercial providers

A program that’s been successfully developed for Blue Care Network commercial and BCN Advantage℠ members over the past few years is now payable for Blue Cross Blue Shield of Michigan as well — for both our commercial and Medicare Plus Blue℠ members. Our Adult Intensive Services and Child Intensive Services program provides intensive case management services for members with chronic mental illness.

The program works especially well for members with a recently identified acute illness who aren’t yet responding to treatment after discharge from a hospital or other care facility, as well as those who haven’t achieved remission. It’s designed to offer face-to-face services, with telemedicine used when necessary, such as in rural areas or with homebound members.

It seeks to meet the needs of the following types of individuals:

• People recently discharged from a higher level of care who are still in the early stages of healing and need support
• People with a history of nonadherence to treatment and frequent hospitalizations
• People with severe chronic mental illness who need support and coordinated care to stay stable and out of the hospital
• People who have been seen by one of our crisis teams, as part of our crisis services program, and haven’t returned to their functional baseline.

Program services include the following:

• Identifies barriers to care
• Teaches problem-solving skills
• Arranges community services to address social determinants of health, food insecurity, adherence to medication and treatment program
• Continues alternative treatment protocols if determined to be clinically necessary 
• Allows services to be applied to families and individuals with autism, especially those with neurobehavioral symptoms that, if left untreated, can result in admission to a higher level of care 

Individual professional services, such as psychotherapy, psychiatric evaluation and management services, psychological testing and autism treatment services, if necessary, can also be provided.

Provider requirements

Health care providers who have the resources to provide all necessary care for these individuals, under the supervision of a psychiatrist, can participate in this program. Participants must be contracted with both Blue Cross and BCN to provide these services as outlined in the BCN contracting documents.

There is no special credentialling needed, and services can be provided by an M.D., D.O. or outpatient psychiatric clinic. Also, it’s not necessary to obtain prior authorization before performing these services.

Key to the program — and key and the successful treatment of our members — is coordination of care among all providers who are involved in treating the member, as well as the member’s support systems. If the member is receiving care management through Blue Cross, providers need to coordinate their efforts with the care manager provided by the member’s plan.

If you have any questions, email Dr. William Beecroft at WBeecroft@bcbsm.com or Bill Pompos at WPompos@bcbsm.com.