Summer 2009

Providers Encouraged to Improve Care Coordination

Magellan conducts treatment record reviews to meet the accreditation standards established by the National Committee for Quality Assurance (NCQA). The results of our reviews indicate opportunities for improvement nationwide for providers to strengthen communication with other medical and behavioral health practitioners working with the same member. Coordination of care with a member’s primary care physician (PCP) and collaboration among behavioral health providers are well-established standards of practice, but they present challenging aspects of providing quality care.

“Our reviews show that even when providers obtain the appropriate signed release of information from the member, their records do not always indicate contact with PCPs or other behavioral health providers,” said Gary Henschen, M.D., Magellan’s chief medical officer – behavioral health. “We recognize that providers must overcome numerous barriers, including time constraints and member resistance, yet we strongly encourage them to increase efforts to include coordination and collaboration as a routine aspect of quality care, especially when medications are prescribed,” said Henschen.

Please consider the following recommendations that may help address this most critical element in the care of your patients:

When initiating care at intake or initial assessment…

  1. Identify the member’s PCP or behavioral health practitioner.
  2. Secure a signed form to release information to and receive information from the member’s providers or PCP, or document the member’s refusal to sign a release form. (Magellan has posted a sample “authorization to disclose information” on this website that you can use to develop a similar form for your practice, modifying to comply with your state statutes.)
  3. If the member refuses to sign a release form, educate the member on the importance of open communication with their PCP or other behavioral health practitioner, especially if medications are involved.
  4. After obtaining the member’s permission, communicate with the PCP or behavioral health provider in writing as soon as possible.

When discharging from a program …

  1. Include a referral for aftercare in the discharge plan.
  2. Discuss the referral with the member and, if appropriate, with the family.
  3. Schedule an appointment and obtain the member’s consent to the appointment prior to discharge.
  4. Notify the provider in writing with a signed release of information form and a discharge summary to facilitate a smooth transition of care.
  5. Contact the provider to ensure the member was successful in keeping the initial appointment.

When making a referral…

  1. Contact the provider in advance to confirm the appropriateness of the referral and availability of an appointment.
  2. Inform the member and, if appropriate, the family of the referral, answering any questions about the reason for the referral. 
  3. Secure a signed release of information form.
  4. Assist the member in scheduling an appointment.
  5. Notify the provider in writing with a signed release of information form and a clinical summary to facilitate a smooth transition of care.
  6. Contact the provider to ensure the member was successful in keeping the initial appointment.

“These efforts by practitioners will facilitate more frequent communication and collaboration between health care professionals working with the same patients,” said Henschen.

For additional information, refer to the “Continuity, Coordination and Collaboration” page of our National Provider Handbook. Please e-mail your comments or questions to Marvin Guynes, national quality improvement director, at MCGuynes@MagellanHealth.com.