Physicians are encouraged to collaborate with behavioral health care practitioners and share information to coordinate medical and behavioral health care. EmblemHealth evaluates the success of coordination of care by looking at the:
- Exchange of information between behavioral health care and medical practitioners including a complete history of the member’s current medications.
- Appropriate use of psychotropics and medication-assisted treatment (MAT).
- Appropriate diagnosis treatment.
- Referrals of behavioral health disorders.
- Treatment access according to regulatory standards.
- Follow-up care for members with coexisting medical and behavioral health disorders.
- Primary or secondary prevention and the special needs of members with severe and persistent mental illness.
Behavioral health screening tools
Physicians can be the members’ first contact when in need of behavioral health services and/or medications. Members tend to share symptoms, concerns, issues, and other needs with their PCPs rather than, or before, considering professional behavioral health services. Using behavioral health screening tools can help determine a diagnosis and related complications. The Behavioral Health and Substance Use section of Clinical Corner on our website includes screening tools that can quickly be used with a member via telephone, in person, email, or telemedicine. Members do not need a referral from their PCP to access behavioral health services; however, if you refer a member to one of our behavioral health services programs, please follow up to coordinate care.
EmblemHealth continually conducts activities to improve behavioral health and general medical care, including collaboration with behavioral health practitioners.
Practitioners’ opportunities for collaboration, continuity, and coordination of care include:
- Improve the process for members to authorize sharing of behavioral health information.
- Implement primary care guidelines for assessing, treating, and referring common behavioral problems.
- Increase non-behavioral health care practitioner satisfaction with feedback from behavioral health care practitioners.
- Improve procedures for treating hospitalized members with coexisting medical and behavioral health conditions.
- Improve management of elderly members with indications of depression and multiple behavioral health care medications.
- Educate primary care practitioners about appropriate indications for referring patients with hyperactivity disorder, substance use disorders, or depression to behavioral health care specialists.
- Facilitate communication between a medical practitioner and the behavioral health care practitioner who is treating the medical practitioner’s patient.
- Implement a prevention program for behavioral disorders commonly managed in the primary care setting.
- Exchange of information between behavioral health care and medical practitioners.
- Appropriate diagnosis, treatment, and referral of behavioral health disorders commonly seen in primary care.
- Appropriate use of psychotropic medications.
- Oversight of access to treatment and proactive follow-up for members with coexisting medical and behavioral disorders.
- Preventive behavioral health care program implementation in both primary and secondary settings.
- Accommodations to be made for the special needs of our members with severe and persistent mental illness.
Confidentiality for domestic violence or endangered victims
Please let your affected patients know they are entitled to these privacy protections:
- Group policy members may ask us to enforce an order of protection against the policyholder or other person. We will not disclose their address or telephone number for the duration of the order.
- We will accommodate any reasonable request for a covered individual to receive communications of claim-related information by an alternative means or at an alternative location. The member must give us a valid order of protection or let us know they are a victim of domestic violence and will be in danger by the disclosure of certain information.
If you think a patient is at risk, please let them know there are organizations ready to help. For a listing of domestic violence hotlines by county, go to the NYS Coalition Against Domestic Violence website: New York State Domestic Violence Programs County Listing. EmblemHealth’s Neighborhood Care sites are also available to assist. You can find additional information on our Domestic Violence Guidelines page.
Required training for behavioral health & substance use providers
The New York State Office of Mental Health (OMH), the Office of Alcoholism and Substance Abuse Services (OASAS), and the New York State Department of Health (NYSDOH) require EmblemHealth’s behavioral health providers to complete State-approved cultural competence training on an annual basis. To satisfy this requirement, providers must complete one of these two programs:
- OASAS-approved training. To access a list of OASAS-approved trainers, see the NYS OASAS Training Catalog.
- Two Uniform Network Provider Training modules. To access these training modules, visit the Center for Practice Innovations (CPI) Learning Community.
More educational materials
OMH also offers a host of educational materials on its website for behavioral health providers.
Children’s Medicaid health and behavioral health system transformation
The Community Technical Assistance Center of New York (CTAC) offers a collection of training resources around the Children's System Transformation. This includes the transition to Medicaid Managed Care, the new Children and Family Treatment and Support Services, and the aligned Home and Community Based Services. These materials are intended to help prepare new NYS Medicaid Children’s providers for the transition to Medicaid Managed Care. Materials can also be found on the CTAC website.