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New Performance Improvement Project (PIP) to Help Prevent Behavioral Health Readmissions
11/21/2019 • Posted by Provider Relations

Fidelis Care wants our members to lead healthy lives in their communities. A new performance improvement project (PIP) has been created for our HealthierLife (Health and Recovery Plan – HARP) members who experience frequent hospital admissions and emergency room visits for a behavioral health issue. The goal of this PIP is to prevent readmissions.

The key to preventing readmissions is closer collaboration among Fidelis Care, patients, inpatient and outpatient providers, and the patient’s support network. Fidelis Care has assigned Care Managers to each of the identified patients to help coordinate efforts.

Many hospitalizations and ER visits for behavioral health care are caused by a substance use disorder (SUD).  When treating a SUD, counseling and behavioral therapy become more successful when paired with medications.  This approach, known as “medication-assisted treatment (MAT)”, is designed to meet a patient’s mental and physical needs. 

MAT medications include:

      *Quantity limits apply

Fidelis Care is here to help you provide the best possible care to your patients.  By working together, we can help patients stay happier and healthier in their communities.  For help, please call 1-888-FIDELIS (1-888-343-3547), 8:30 AM – 5 PM, Monday – Friday.

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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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