Behavioral Health Program Components

The BCBSTX Behavioral Health Program encompasses a portfolio of resources that help BCBSTX members access benefits for behavioral health (mental health and substance use disorder) conditions as part of an overall care management program. It also allows our clinical staff to assist in the early identification of members who could benefit from co-management of behavioral health and medical conditions.

Behavioral Health Program Components:

• Care/Utilization Management:
  • Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services.
  • Outpatient Management for members who have this component as part of their behavioral health benefit plan through BCBSTX. It includes management of intensive and some routine outpatient services.
  • Refer to Behavioral Health Utilization Management Program Overview for more detailed information.
• Case Management Programs:
  • Intensive Case Management for members experiencing a high severity of symptoms by providing more intensive levels of intervention.
  • Condition Case Management for chronic BH conditions such as:
    • Depression
    • Alcohol and Substance Abuse Disorders
    • Anxiety and Panic Disorders
    • Bipolar Disorders
    • Eating Disorders
    • Schizophrenia and other Psychotic Disorders
    • Attention Deficit and Hyperactivity Disorder (ADD/ADHD)
  • Active Specialty Management for members who do not meet the criteria for Intensive or Condition Case Management but who have behavioral health needs and could benefit from extra support or services.
  • Care Coordination Early Intervention^® (CCEI) Program provides outreach to higher risk members who often have complex psychosocial needs impacting their discharge plan.
• Specialty Programs:
  • Eating Disorder Specialty Team is a clinical team with expertise in the treatment of eating disorders who partners with eating disorder experts, treatment facilities as well as internal algorithms to identify and refer members to appropriate programs.
  • Autism Response Team whose focus is to provide expertise and support to families in planning the best course of Autism Spectrum Disorder (ASD) treatment for their family, including how to maximize their covered benefits.
  • Risk Identification and Outreach (RIO) is an industry-leading model for leveraging robust data analytics to optimize solutions for complex healthcare priorities. This multi-disciplinary collaboration between Behavioral Health, Medical, Pharmacy and Clinical Data Technology groups is focused on mining, organizing and visualizing clinically actionable data for at-risk member populations and implementing clinically appropriate and effective interventions at both member and provider levels.
• Referrals to other medical management programs, and wellness and prevention campaigns