Primary Care Services — A Must for Patients Taking Antipsychotic Medication

Primary Care ServicesPatients with schizophrenia or bipolar disorder are disproportionately more likely to suffer chronic diseases and have a significantly shorter life span than the general population. Due to this alarming reality, preventive care for patients taking antipsychotic medication has moved into the spotlight in the past few years.

Here are some guidelines for screening and monitoring patients taking antipsychotic medication:

  • They should be screened annually for diabetes through either a fasting glucose test or an HbA1c test.
  • Patients with schizophrenia and diabetes should have both an LDL-C test annually and an HbA1c test quarterly.
  • Patients with schizophrenia and cardiovascular disease should have an LDL-C test annually.

EmblemHealth Must Report New Episodes of Alcohol or Other Drug Dependence

Often primary care providers or other non-behavioral health providers are the first to identify a patient as having an alcohol or other drug (AOD) dependence. EmblemHealth is required to report new episodes of AOD and encourage prompt initiation of treatment.

For providers submitting a claim that includes an AOD diagnosis for a patient who has not received AOD services during the previous 60 days, EmblemHealth will:

  • Report this as a new episode of AOD.
  • Follow up by analyzing claims for the patient to determine whether he/she initiated AOD treatment within 14 days of your diagnosis.
  • Analyze additional claims for the patient to determine whether he/she had two or more additional services with a diagnosis of AOD within 30 days of the initial visit.

AOD treatment can be initiated through an outpatient visit, inpatient admission or partial hospitalization.

Some patients may be actively using or have a history of substance abuse, but do not fit the criteria for an AOD diagnosis. Therefore, it is critical that providers apply the AOD diagnosis only after using standardized screening tools. The following tools are brief, easy to score and don’t require special training to use:

  • AUDIT-C (Alcohol Use Disorders Identification Test)
  • MISSI-SA (Modified Simple Screening Instrument for Substance Abuse)
  • CAGE-AID (Acronym from the four questions it asks when screening for alcohol and drug conjointly)

After identifying a new episode of AOD, strongly encourage your patient to start treatment immediately. For assistance in locating a mental health expert, they may call Customer Service at the phone number listed on the back of their ID card.

Help Your Patient Improve Their Mental Health

Since both mental and emotional well-being are essential to overall health, assessing your patient’s mental health is an important part of providing adequate care. For patients who demonstrate the need for mental health services, consider the following as you determine appropriate treatment options:

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