To improve our members’ outcomes and reduce or avoid readmissions, it is important that patients see a behavioral health clinician within seven days of discharge.
Timely follow-up visits:
- Can occur any time between days one and seven
- May be held in person, via telehealth or through billable phone visits
Note: Discharge appointments or appointments occurring on the day of discharge do not count as follow-up appointments.
Care coordination and telehealth can help ensure members receive timely post-discharge care.
Your facility should:
- Begin follow-up planning at admission
- Schedule follow-up appointments, including one within seven days of discharge
- Consider choosing telehealth to help meet the Healthcare Effectiveness Data and Information Set (HEDIS®) standard for timely follow-up care and/or for ongoing care
- Discuss the importance of follow-up visits with patients and families
- Ensure accurate post-discharge contact information
- Call patients with appointment reminders
- Obtain necessary authorization forms when required
Information sharing
- Most behavioral health information can be shared among treating providers without a release of information (ROI).
- ROI is specifically required for coordinating with substance use disorder (SUD) providers or facilities. Download our Authorization to Disclose Protected Health Information form.
- Requesting unnecessary ROIs can delay appropriate care.
Care coordination is vital to good treatment planning and plays a critical role in improving outcomes. By working with us, the member and their family and/or support system, we collectively ensure members have successful discharge plans and can function at their highest ability when they leave the hospital setting.
Our care management team will:
- Determine a follow-up plan during the inpatient review process
- Help secure follow-up appointments, including finding new providers, if needed
- Contact members post-discharge to discuss follow-up
- Educate members on the importance of follow-up care with a licensed behavioral health provider
Connect with case management
Call 1 (866) 543-5765 or the Customer Service number on the back of the member’s card.
Telehealth enables members to receive timely follow-up care via computer, phone or tablet.
To learn more about our members’ telehealth options, access these toolkits from the homepage of our provider website:
- The Telehealth section of Behavioral Health Toolkit includes an up-to-date list of virtual providers.
- The Care Options Toolkit includes additional national behavioral health vendors available to some members.
The HEDIS measure Follow-Up After Hospitalization for Mental Illness (FUH) tracks post-discharge behavioral health care to ensure members transition safely from an acute hospital setting back to their home environments.
Qualifying clinician types
- Psychiatrist
- Licensed clinical social worker (LCSW)
- Licensed marriage and family therapist (LMFT)
- Licensed professional counselor (LPC)
- Psychiatric nurse
- Psychologist
- Providers rendering services via incident-to billing criteria—See our Incident to Services reimbursement policy
Qualifying services
- Intensive outpatient (IOP)
- Partial hospitalization program (PHP)
- Residential treatment center (RTC)
Regular appointments are essential for patient health, particularly for immunizations, screenings, preventive care and chronic disease management. Patients should also take all medications as prescribed.
We promote these health maintenance practices on our website and our social media channels, providing members with tips for scheduling and preparing for medical appointments. Members can also explore behavioral health options by logging into their accounts.
Preventive vs. diagnostic care
Please remind patients that diagnostic care addressing new symptoms or existing problems during a preventive visit will incur standard cost sharing (copays, coinsurance or deductibles), just as additional services during non-preventive visits would.
Preventive care resources are available for members in English and Spanish.
We use survey results, like the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to evaluate our members’ experiences with receiving their test results in a timely manner.
Studies show:
- Delayed test results can trigger unnecessary repeat testing, increasing health care waste
- Unscheduled or skipped follow-up appointments often lead to missed or delayed diagnoses
- Poor communication can result in medication errors and serious patient safety issues
- Patient trust and satisfaction often depend on timely results
Transform your test result process with these proven strategies:
- All results matter: Follow up on every test result, normal or abnormal
- Meet patients where they are: Let patients choose their preferred communication method (mail, phone, email or patient portal) to ensure they are notified of their results
- Maximize your electronic medical record (EMR): Use it to track test results automatically, flag abnormal results, enable team communication and communicate with patients through your patient portal
- Set clear expectations: Create a simple promise to your patients: “We’ll contact you within two or three business days with your results.” This small commitment can reduce anxiety, prevent unnecessary calls and improve staff efficiency.
Consider timely test result follow-up a quality improvement project for your 2025 program year. Here are some resources that can help:
- Review best practices in the Care Coordination section of our Quality Improvement Toolkit
- Download the Institute for Health Improvement’s Plan-Do-Study-Act (PDSA) Worksheet for structured improvement
- Implement the Agency for Healthcare Research and Quality’s Step-by-Step Guide for Rapid-Cycle Patient Safety and Quality Improvement to improve processes and workflows within your practice
Small changes in test result management can lead to big improvements in patient satisfaction, safety and practice efficiency.