When given the PHQ-9 screening before and nine months after participating in LifeSolutions, 46% of members showed a decrease of 50% or greater in depression symptoms, or reported no depression.

"If a member has hypertension, you can measure blood pressure to see if there is any improvement, but it's difficult to measure depression," says Hyong Un, MD, national medical director for Aetna Behavioral Health in Hartford. Conn. Aetna relies on a three-pronged approach to addressing depression: screening members for behavioral health problems using the PHQ-9 tool; helping members find and adhere to a treatment plan; and treating patients with chronic depression through disease management.

Dr. Un believes that medications should be used in conjunction with outreach, education, psychotherapy and counseling and care management in a coordinated effort between medical and behavioral health providers. He says that when those components are combined, patients show a 10% improvement in drug compliance rates, they feel better, and there are fewer absences from work.

Ft. Worth, Texas-based CorpHealth, a subsidiary of Humana, is focusing on low-income, prescription drug plan members who qualify for drug assistance from manufacturers and may enter the donut hole under Part D. RxMentor screens members—currently an estimated 182,000—to see if they qualify for drug assistance from manufacturers and to ensure that there is no gap in accessing medications because of cost.

A new program, which began this quarter, addresses outliers in Humana's Medicare Advantage Prescription Drug Plan by identifying practices that fall outside of evidence-based standards, such as multiple prescriptions from different physicians, for example. CorpHealth sends quarterly letters to physicians whose patients may not be receiving best-practice medicine. The letter outlines the problem and recommends an evidence-based solution. If providers receive multiple letters regarding the same member, their patient is offered enrollment in an integrated case management program.

The organization will initiate a program during second quarter to screen members for bipolar disorder and refer them to a behavioral case manager to help reduce the gap between identifying patients and arranging effective treatment, which can be as long as seven years, according to Melanie Hunziker, director of pharmacy.

USING INTERACTIVE CALLS

WellPoint also is addressing bipolar disorder by assigning clinical staff from WellPoint Behavioral Health to call and intervene if a member has stopped treatment. These live calls emphasize key messages about bipolar disorder and general information about its treatment. The clinician also helps to solve issues that may be affecting treatment adherence.

For members who start on antidepressant medication, WellPoint sends a letter, which provides information about depression in general and some key messages about medications, and an interactive, automated phone call in a Q&A format.

When these members are late on a refill, they receive a reminder call, which emphasizes the importance of continuing their medication and not stopping without consulting a physician. The late refill call also addresses side effects.

Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, Calif.