The Care Advocacy Model promotes early identification and intervention for individuals who may have behavioral health problems co-occurring with other medical conditions. It also promotes care coordination across carriers, proactive outreach to prevent illness and wellness, and integration of medical, behavioral, and pharmacy data.
The program uses claims information, medication interventions, scientifically advanced surveys, etc., to proactively identify members who may be having behavioral health issues or may be at risk. These members receive personalized outreach and (with their permission) a Wellness Survey that identifies at-risk individuals, potential comorbidity, and psychosocial stressors.
Comprehensive care advocacy then helps guide members to the appropriate level and duration of care. All individuals at high risk and individuals accepting services are carefully monitored to encourage a successful outcome.
“By addressing the behavioral health issues that affect recovery from medical illness and long-term health and by getting people who are at risk into appropriate services earlier, the program helps manage both medical care costs and related productivity loss,” Mr. Prieto said. “At the same time,” he added, “IBM provides enhanced, integrated care for its employees.”
