Blue Cross NC behavioral health program expands to 100 North Carolina counties effective August 1

Beginning August 1, 2024, the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Behavioral Health Total Care (BH Total Care) program for members with serious mental illness (SMI) and/or substance use disorder (SUD) will expand to the entire state of North Carolina.

The program provides comprehensive care that addresses both the physical and mental health needs of members with SMI and/or SUD, ensuring that they receive the holistic care they deserve. It is available to Commercial, Federal Employee Program, and Medicare Advantage lines of business.

Additional BH Total Care highlights for providers to know include:

• Mission:
  • Through our behavioral health home model, Blue Cross NC aims to provide a nurturing and empowering environment where individuals can access a range of services, navigate the healthcare system effectively, and ultimately achieve improved outcomes and enhanced overall well-being.

• Program Philosophy:
  • The BH Total Care program operates on the principles of a behavioral health home, akin to a medical home but tailored specifically for behavioral health needs.
    • Centralized coordination:
      • Serving as a central point of coordination for members.
    • Continuity of care:
      • Prioritizing continuous, personalized treatment plans.
    • Integrated services:
      • Offering integrated services that address both physical and mental health concerns.

• Location:
  • Your patient, our members, will be contacted via phone, email, and/or an application called Wellframe (they will work with our Case Managers to set-up this application on their Android or iPhone device). 

• Referral process:
  • Members cannot be referred into the BH Total Care program directly by providers. Instead, eligibility is determined based on specific qualifying events within a 12-month period.
  • At least two qualifying events within a 12-month period such as:
    • ED (Emergency Department)
    • Inpatient
    • RTC (Residential Treatment Center)
      
      
• Care Team:
  • Members enrolled in the BH Total Care program will work with a dedicated team of professionals, which may include:
    
    • Behavioral Health Case Managers (BHCM)
      • BHCMs specialize in addressing the behavioral health needs of members in the BH Total Care program.
    • Physical Health Case Managers (PHCM)
      • PHCMs are responsible for addressing any physical health needs of members within the BH Total Care program. 
    • Peer Support Specialists
      • They provide one-on-one support, drawing from their own experiences with substance use challenges. 
      • Currently, our peer support specialist works only with substance use disorder (SUD) in North Carolina.
    • Care Navigators
      • Care Navigators assist members in accessing services, scheduling appointments, and overcoming barriers to care. 
    • Engagement Specialists
      • They conduct outreach activities to connect with members, assess their needs, and promote awareness of available resources.

For more information or questions about the BH Total Care program, please contact: BPBH@bcbsnc.com.