Each year, Evernorth^® Behavioral Health is required to evaluate its Behavioral Complex Case Management Program for accreditation purposes. Following are key findings from the 2023 evaluation.

Program overview

The Behavioral Complex Case Management Program uses centralized management, common processes, and standardized tools and metrics across all clinical areas. The program aims to improve engagement in treatment, help your patients understand their diagnosis, and improve treatment adherence. Individual case management plans are developed in collaboration with the treating provider and the patients and/or their families, when appropriate. The Behavioral Complex Case Management Program receives referrals from multiple sources, including hospital discharge and pharmacy information, claims data, client referrals, customer referrals, behavioral professional referrals, and referrals received through the utilization management process.

In addition to coaching and case management services, the Patient Health Questionnaire-9 for depression and the CAGE Adapted to Include Drugs (CAGE-AID) questionnaire for substance use disorders are used as standardized condition-specific screening tools in the Behavioral Complex Case Management Program.

Updates

The Behavioral Complex Case Management Program implemented various updates in 2022 that continued through 2023 to improve outreach to Evernorth Behavioral Health customers and help them achieve their goals. This work continues to maximize efficiencies and thus improve customer impact. Through streamlining and duplication reduction efforts, behavioral health operations continued to increase productivity and give Evernorth case managers the time to focus more on connecting with customers. The case management program continues to evaluate the needs of our customers and develop and explore various proof of concepts and additional opportunities to further support your patients with Evernorth coverage.   

Key findings

The Behavioral Complex Case Management Program monitored several processes and outcome metrics to measure case management effectiveness.

The three highest number of referrals came from the following sources:

• Utilization management process.
• Hospital discharge information.
• Claim information.

Programs receiving the highest volume of eligible referrals:

• Coaching and Support for Substance Use Disorders.
• Coaching and Support for Parents and Families.
• Intensive Behavioral Case Management.

The overall Behavioral Complex Case Management Program met goals for:

• Customer satisfaction (93 percent achieved compared to 90 percent goal).
• Reach rate (38 percent compared to 35 percent goal).
• Engagement rate (31 percent compared to 30 percent goal).
• Completion rate (88 percent achieved compared to 88 percent goal).

Screening results:

• 17 percent of patients who screened positive for depression experienced moderate symptoms.
• 22 percent of patients scored in the severe range for depression.
• 21 percent of patients who completed the CAGE-AID questionnaire scored positive for substance use, while 79 percent scored negative.

Individuals who screen positive for mental health and substance use conditions are further assessed and offered additional services, as appropriate, through behavioral coaching and case management services.

Additional information

For additional information about behavioral coaching and case management services, or to determine a patient’s eligibility for this service, please call the number on back of your patient’s ID card.

If you have questions about the Behavioral Complex Case Management Program, please contact Evernorth Behavioral Health Provider Relations department at 800.926.2273 or visit Provider.Evernorth.com.