The Blue Cross and Blue Shield of Illinois (BCBSIL) Behavioral Health Program encompasses a portfolio of resources that help BCBSIL members access benefits for behavioral health (mental health and substance use) conditions as part of an overall care management program. It also allows our clinical staff to assist in the early identification of members who could benefit from co-management of behavioral health and medical conditions.
Care/Utilization Management
- Inpatient Management for inpatient, residential treatment center services and partial hospitalization
- Outpatient Management for members who have outpatient management as part of their behavioral health benefit plan through BCBSIL
Case Management Programs
- Intensive Case Management provides more intensive levels of intervention for members experiencing a high severity of symptoms.
- Condition Case Management for chronic behavioral health conditions such as: Depression, Alcohol and Substance Use Disorders, Anxiety and Panic Disorders, Bipolar Disorders, Eating Disorders, Schizophrenia and Other Psychotic Disorders and Attention Deficit, and Hyperactivity Disorder (ADD/ADHD).
- Active Specialty Management program for members who do not meet the criteria for Intensive or Condition Case Management but who have behavioral health needs and could benefit from extra support or services.
- Care Coordination Early Intervention (CCEI®) Program provides outreach to higher risk members who often have complex psychosocial needs impacting their discharge plan.
Specialty Programs
- Eating Disorder Care Team is a multi-disciplinary team of BCBSIL behavioral health clinicians with expertise in the treatment of eating disorders. The team includes partnerships with eating disorder experts and treatment facilities as well as internal algorithms to identify and refer members to appropriate programs.
- Autism Response Team is a multi-disciplinary team of BCBSIL behavioral health clinicians whose focus is to provide expertise and support to families in planning the best course of Autism Spectrum Disorder (ASD) treatment for their family, including how to maximize their covered benefits.
- Risk Identification and Outreach (RIO) is an industry-leading model for leveraging robust data analytics to optimize solutions for complex healthcare priorities. This multi-disciplinary collaboration between Behavioral Health, Medical, Pharmacy and Clinical Data Technology groups is focused on mining, organizing and visualizing clinically actionable data for at-risk member populations and implementing clinically appropriate and effective interventions at both member and provider levels.
Referrals to Other BCBSIL Programs, Wellness and Prevention Campaigns
Behavioral health care management is integrated with our medical care management program, Wellbeing Management (WBM) to help members access their benefits and to help improve coordination of care between behavioral health and medical providers. Some members* may be referred to other WBM medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.
*Members experiencing inpatient hospitalization, complex or special health care needs or who are at risk for medical complications may be referred to WBM programs through a variety of mechanisms such as predictive modeling, claim utilization, inbound calls, self-referrals and physician referrals. If members do not have WBM as part of their group health plans, they will not be referred to other WBM programs.