Since 1977, SCAN Health Plan has been serving California seniors with health plan coverage. And as mental health conditions have worsened among adults 65 and older, Long Beach-based SCAN has been trying to address its members’ whole-person care needs with an emphasis on behavioral health solutions.
“The most basic whole-person approach is to understand that a human being is not divided by who covers their various health services,” Eve Gelb, the senior vice president of member and community health for SCAN, told Behavioral Health Business. “They are a human being, and we need to support that human being to live a healthy and independent life, regardless of whether it’s medical services or social support.”
One of the nation’s largest not-for-profit Medicare Advantage (MA) plans, SCAN serves 270,000 members across California, in addition to Nevada and Arizona – states where it recently expanded. SCAN’s MA plan – which pays provider groups a capitated rate for services – assigns members to different tiers of coverage based on a number of care needs that are determined from health risk assessments (HRAs), which are mandated by the Centers for Medicare and Medicaid Services (CMS).
The HRAs occasionally uncover behavioral health needs, helping SCAN figure out the best care plans for its members. When performing HRAs, SCAN is mindful of the language it uses with beneficiaries regarding possible adverse behavioral health conditions.
“We’re not using the terms ‘depression’ or ‘anxiety.’ We’re asking them about their emotional well-being.” Gelb said. “They are responding to us and telling us about their emotional well-being. Based on that, we have the conversation about mental health because they’ve opened the door.”
Among the resources SCAN connects members with are other beneficiaries, which is part of its “Member2Member” peer support model. Beneficiaries, as needed, are also given care navigators who can direct them to community resources that address various social needs.
Social isolation is an issue that has been affecting a number of SCAN beneficiaries, which the peer model seeks to address. According to SCAN, 41% of female plan members report feeling “sometimes lonely,” while over a quarter of its male members say the same.
Peer beneficiaries connect with other plan members over multiple interactions, currently being done telephonically due to the pandemic. After an initial call to develop a rapport, a subsequent call is tailored around goal-setting and emotional well-being objectives.
After a few more calls, beneficiaries might become eligible for more intensive services. Those services are provided both telephonically and in-person by social workers, community health workers and others.
Currently, SCAN’s peer program reaches around 10,000 beneficiaries.
“They set some goals, whether it be a goal around physical activity, engaging socially with a new person, rebuilding a relationship with their loved one or connecting with their doctor,” Gelb said. “A lot of times what we’re wanting people to do is not be afraid to have conversations with their doctor about their mental health.”
As far as addressing a beneficiary’s complex social needs, SCAN claims that its use of peers has resulted in more beneficiaries seeking treatment for a variety of mental health issues. Beneficiaries have also reported feeling more comfortable talking to peers about physical health issues like urinary incontinence, which has been linked to social isolation and mental health concerns.
SCAN has previously estimated that the number of its members seeking treatment for urinary incontinence has increased as a result of its peer interventions. Overall, Gelb noted that peers have had a positive impact on keeping other beneficiaries engaged socially during the pandemic.
“When the pandemic hit, we did just tons of social isolation outreach calls,” she said. “And we’ve seen that that had a positive impact on member retention and customer experience.”
SCAN had previously planned to roll out an in-person version of the peer program before Covid, and still has plans to do so once the pandemic subsides.
Gelb feels that the peer program, over time, can be especially helpful in engaging underserved communities that have long dealt with issues of stigma regarding mental health.
“We are particularly failing with respect to people who speak different languages other than English, and people of color when it comes to really understanding how to support those populations,” she said. “The outcomes are worse for people of color and people who don’t have English as their first language. Peers are a fantastic way to close those gaps.”
Companies featured in this article:
