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Behavioral Health Outliers Management Program
3/24/2020 • Posted by Provider Relations

Fidelis Care has expanded its behavioral health care management program.  This expansion included additional outreach and care coordination with behavioral health providers serving Fidelis Care members with higher needs for services and care coordination.  Members were identified based on high utilization and/or a combination of low utilization of outpatient behavioral health services following an acute behavioral health inpatient or emergency department episode. 

Fidelis Care clinical staff will reach out to providers for the purpose of discussing the member’s clinical needs, gathering information regarding the member’s progress in treatment, and identifying opportunities to collaborate with providers to enhance the member’s clinical and quality outcomes. The information shared during these discussions will not be used to render utilization management decisions, but rather to coordinate care and assess what additional supports, if any, the member may need to improve their clinical quality outcomes.

Providers servicing a Fidelis Care member meeting the criteria for the Outlier Management program can expect to receive a telephonic request from Fidelis Care clinical staff to discuss the member’s treatment plan and progress, level of engagement in care, and known barriers to treatment goals. Providers can also expect to receive additional information of value from Fidelis Care regarding any member gaps in care, recent emergency room / hospitalization services, and compliance with filling prescriptions.

We expect this clinical conversation to require approximately 15 minutes per case with a frequency that varies from monthly to semi-annually, depending on the needs and risk stratification of the member. Providers unable to meet the request for telephonic coordination within 14 days of the request will receive a follow up written request for the clinical record.

If you have any additional questions about the Outliers Management Program, please contact Fidelis Care at 718-896-6500: HARP members - please dial extension 16077 and for BH members - please dial extension 16072.



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