Fall 2009

Programs Target High-Risk Conditions

At a time when the term “prevention” has been thrust into the healthcare spotlight, Magellan would like to share information on three ongoing prevention programs in place at our California Care Management Center*. In collaboration with Western Health Advantage (WHA), we administer prevention programs for individuals who are known to be at high risk for depression because of specific comorbid conditions; cardiac patients suffering from depression; and women at risk for postpartum depression.

Co-Morbid Depression

Research shows that chronic medical conditions such as diabetes, COPD or asthma are highly correlated with depression. Developed in 2009 to support and perform outreach to WHA enrollees selected to receive services from WHA’s disease management vendor due to a chronic medical condition, the program involves screening, clinical review, referral, and follow-up. WHA’s disease management vendor’s nurse care managers screen for depression using the Whooley Depression Screening Tool. If a nurse care manager determines a screen is positive, the information is forwarded to Magellan and a Magellan care manager calls the enrollee to conduct a more thorough clinical review and assist with local resources, including a referral to a network provider. 

To date, six enrollees were contacted and one accepted a referral to a network provider. The other five enrollees reported their depressive symptoms had improved and did not feel the need to seek treatment at the time. Care managers will follow up with these enrollees and assist them in addressing any issues related to their depression as well as continue the effort to reach additional enrollees. 

Depression in Cardiac Patients

The targeted population for Depression in Cardiac Patients program is the WHA adult enrollee population—age 50 and over—who have had a cardiac event or procedure conforming to specified cardiac event diagnostic codes. Quarterly, the California Care Management Center receives a list of newly diagnosed WHA cardiac enrollees. Enrollees meeting the age criterion receive a mailing with the Whooley Depression Screen (to complete and return in an enclosed return-addressed envelope); educational material, such as a brochure on “Depression & Heart Disease”; and information about additional resources on the Magellan member website. When screening tools are returned, they are scored by Magellan care managers who contact enrollees with positive depression screens. Care managers conduct clinical reviews with enrollees and make appropriate recommendations, including referrals to network providers.

The program was implemented in 2007. Given the high risk for this population, we are continuing the program with intensified outreach by phone in addition to mailings. To increase low response rates (two percent in 2008 and four percent in 2007), WHA increased the frequency of contact from quarterly to monthly and reminded medical providers of the program through a WHA provider newsletter. Magellan’s Provider Advisory Group** also recommended outreach directly to the cardiologists to increase the likelihood of enrollees returning the screening tool. Additionally, Magellan encourages our behavioral health providers to refer appropriate WHA enrollees to the program. Going forward, care managers will contact enrollees within one week of scheduled appointment dates to monitor follow-up. As always, the California Care Management Center’s medical director continues to collaborate with WHA to develop additional interventions.

Postpartum Depression

The targeted population for Postpartum Depression program, implemented in 2008, is postpartum mothers enrolled with the WHA HMO. WHA sends mailings to postpartum mothers seven to 15 days following delivery of a live birth. The mailings describe the importance of monitoring for the presence of depression during pregnancy and after delivery and distinguish a passing phase of ‘baby blues’ from the onset of depression. The mailing also includes a two-item depression screening questionnaire for mothers to complete and return to the California Care Management Center. 

As in the cardiac program, when the screening tool is returned, it is scored by a specialized care manager who contacts enrollees with positive depression screens. The care manager conducts a clinical review with the enrollee and makes appropriate recommendations, including a referral to a network provider. The care manager contacts any enrollee for whom a referral was made within one week of the scheduled appointment date to monitor follow-up.

Only a small number of postpartum moms accepted referrals, but because of the high risk to the mother, the baby, and the family, each mom identified and referred to the appropriate resource is a victory for the program. To address the small percentage of enrollees who returned the screening tool, the Provider Advisory Group recommended Magellan reach out directly to WHA OB/GYN doctors to ensure they are aware of Magellan as a resource. We also are exploring other ways to improve the survey methodology and expand avenues of access for enrollees.

Magellan encourages provider input. If you have any questions or suggestions regarding our clinical programs, please e-mail Brenda Wood at bcwood@magellanhealth.com or call her at (310) 726-7109.