Behavioral Health Programs

Providing the right care at the right time.

As a member of the Envolve family of companies, Envolve PeopleCare is a leader in managing health benefits for vulnerable populations—including Foster Care, TANF, CHIP, SSI, Long-Term Care and SMI/SED.

Our success in managing care effectively is due to our focus on outcomes for members. Our Intensive Care Managers and Care Coordinators are the staff that make this happen. They provide support for members transitioning from one level of care to another, through coordination and advocacy. Our Care Coordinators work directly with members to help them overcome any barriers to achieving their goals. They help to arrange appointments and link members with transportation, utility assistance, clothing and food bank programs.

Intensive Care Managers and Care Coordinators use our Caring Voices program to help members stay connected. We provide members with cell phones pre-programmed with numbers of family, caregivers, providers, case managers and crisis lines.

Our Innovations:

Decision Support

You can’t manage what you don’t measure.

We leverage best-in-class business intelligence delivery to ensure a data-driven approach to all aspects of managing the care of our members. We continuously monitor all aspects of our business, including utilization and case management trends and projections, provider network composition and adequacy, quality and performance improvement and overall member population behavior and outcomes.

Our Decision Support Service team provides ongoing production and ad-hoc reporting, data mining, statistical analysis, predictive analytics and data visualization.

We offer a complete picture of the systems of care for our members, turning data into actionable information to support continuous improvement across our portfolio of services.

Behavioral Health

We develop provider networks, in both urban and rural markets, with broad cultural diversity that offer the most choice for our members. We support peer services, particularly in rural areas, where access to clinicians may be more limited—and creative solutions, such as telehealth. In every market, we identify providers with special expertise in meeting the unique needs of the populations we serve. We contract with hospitals, chemical dependency treatment facilities, community mental health centers and individual providers, such as psychiatrists, advanced nurse practitioners, psychologists and master-level clinicians. We collaborate with our providers to make sure the most effective treatment practices are offered.

Our knowledgeable, independently-licensed behavioral health professionals perform clinical reviews for pre-certification, concurrent and retrospective authorization requests, using InterQual, nationally recognized medical necessity guidance. Our utilization management techniques ensure that our members get the right care at the right time. We offer free continuing education for providers to help them stay up to date on the latest evidence for treatments. We also sponsor local trainings on topics relevant to our membership or to meet identified gaps in service knowledge.

In Indiana, we partnered with two agencies to bring a Respite program for our families, to help avoid unnecessary hospitalizations for teenagers, when a time out was needed.
In Georgia, we sponsored training in the Strengthening Families Program, an evidence-based practice that helps youth and their families build skills.

The Importance of Our Work

There’s no such thing as the status quo in our minds. We are innovators and we are proud of our accomplishments. We have introduced pilot programs and new products, in all of our markets, which are tailored to the needs of that specific population.

Our psychotropic medication utilization review (PMUR) process, created in 2008, has produced improvements in oversight and monitoring of psychotropic medication use in children in the Texas foster care system. The subsequent policy and health care delivery model changes have resulted in improved medication utilization for children and youth in foster care.  The data provided below highlights the impact of this review process on psychotropic medication use from implementation in 2008 through FY2011 in Texas.

We recognized a lack of coordination for children, so we introduced our Hope Bear program. This program provides members ages 4-18 with a package containing a Hope Bear, a gift card and a book about feelings, when a member attends their 7-day follow up appointment following discharge from the hospital.

We discovered that reaching members after discharge from the hospital is often challenging in some markets, so we introduced our Caring Voices program. This program provides members with cell phones that are pre-programmed with numbers for their providers and our clinical staff; this is particularly helpful for members that do not have a stable place to live.