Here's How Elevance Health Helps Members Find A Healthier Path Forward

As the COVID-19 pandemic dominated public attention, people sought ways to cope with their stress. Factors such as loneliness, mental health conditions such as anxiety and depression, financial stressors, and access to treatment have strained and disrupted lives across the country as people dealt with the ripple effects of the pandemic. Members like Earl¹ for example, have experienced substance use disorder, including opioid use disorder, and challenges related to social drivers of health.

A recent Elevance Health review of member claims from its affiliated commercial and Medicaid plans data² showed the rate of individuals receiving care for behavioral health diagnoses increased from 2020 to 2021, in line with national trends. The number of people getting care for alcohol use disorder increased by 9%, other substance use disorders increased by 8.9%, and opioid use disorders increased by 4.6%. While these increases in diagnoses are concerning, these findings also acknowledge that members are seeking care that may have been delayed due to the pandemic and they are addressing the factors that have contributed to their diagnosis. 
 

Case Managers Support Members in Their Recovery

Supporting health plan members who are experiencing substance use disorders and other behavioral health conditions is integral to our commitment to treat behavioral health as what it is: health. At Elevance Health, we treat mental health and substance use disorders as equitably as broken bones and heart disease. We recognize that addressing the behavioral drivers of health means taking a multi-faceted approach that reduces stigma, ensures access to quality care, creates equitable access to evidence-based treatment options, and helps communities build resilience.

With the help of a case manager, Earl has enrolled in a withdrawal management program and obtained support services that helped him secure housing and start working again. Taking a holistic approach to health includes helping health plan members address physical, behavioral and social drivers of health such as housing and employment needs, and this leads to improved outcomes.  
 

Developing Innovative Treatment Programs 

With substance use disorder diagnoses on the rise throughout the country, we identify ways to support health plan members and their communities for behavioral health needs. A major challenge of treating opioid use disorders is the reliance on traditional treatments, which have been marginally effective. The traditional, long-used “detox then abstinence” approach puts up to 91% of people treated at high risk for another overdose. A promising alternative to this approach is the Changing Pathways program by Elevance Health’s Carelon Behavioral Health, which leverages medications for opioid use disorder and peer recovery support to address the social and behavioral drivers of health. 

The program has seen positive results:

• Carelon Behavioral Health members engaged in the Changing Pathways program in Connecticut were 2.5 times more likely to adhere to their treatment for 90 days following discharge than people who went through traditional withdrawal management and later started medications for opioid use disorder.  
• Members who continued their medications for an opioid use disorder regimen had a 75% reduction in overdose rate on average in the 90 days after discharge compared with those who did not.  

The High Outreach to Promote Engagement (HOPE) program serves members with complex conditions. These individuals have the highest rates of multiple chronic conditions and higher than average emergency room visits and inpatient admissions for both mental health/substance use disorder and physical health. Case managers in this program take a broad view of a patient’s health and assist in a variety of ways, including providing transportation or coordinating doctor appointments. Anticipating and supporting a member’s needs before and after they seek medical care significantly improves outcomes and lowers healthcare costs. The program’s efforts have decreased major incidents such as ER visits and inpatient hospitalizations by 50%.

Resilience Through Information, Support and Education (RISE) uses a predictive model that identifies members at risk of developing a negative health outcome from alcohol or opioid  related issues and connects them with a case manager before these issues get worse. This approach has led to increases in member engagement in proactive changes.  

As high rates of substance use disorder continue, we will continue to support the members of our affiliated health plans in this and all aspects of their health. From stories of dedicated case managers empowering members in their recovery, to innovative programs like Changing Pathways, HOPE, and RISE, our approach to supporting health plan members who experience substance use disorders and other mental health conditions is holistic and continues to evolve based on evidence-based treatment options. 

¹Member’s name has been changed to protect their identity.

²The Elevance Health analysis of member claims from its affiliated commercial and Medicaid plans data was conducted in May 2022 to review mental health reporting prevalence and trends in the United States from 2019- 2021. The claims data was collected by age group and compared among the Gen Z, Millennials, Gen X, Boomers and Older Seniors age ranges.