Painful struggles with homelessness, incarceration and substances often include frequent hospital visits for a small number of Blue Cross and Blue Shield of Illinois (BCBSIL) Medicaid members.
Some go back to the hospital soon after they’re discharged. Their destructive addictions and other behavioral health battles put them at risk for physical harm, including overdoses and assaults.
People trapped in these cycles often don’t trust the people who can help, says Dave Pock, a veteran behavioral health specialist and life coach. He’s part of a highly specialized BCBSIL team helping these members get the care and resources needed to change their lives.
“We’re in this for the long haul,” Pock says. “It’s about long-term investment in our members.”
The Intensive Engagement Support Systems (IESS) program is among the ways BCBSIL helps members address complex needs affecting their health and well-being. The IESS team offers coaching, education and advocacy to help stabilize chaotic lives, while connecting members to community resources and health care providers.
The work demands patience and perseverance. Years may pass before a member accepts the outreach. Then, the path forward is filled with setbacks and relapses.
"We try everything under the sun to help them succeed. "
The IESS program focuses on members hospitalized at least six times in three months, including some with nearly two dozen admissions in a single year.
“We stick with the people everyone else abandons,” says team manager Suzanne Letang, who launched the program with a two-person team. “Our specialists have very personal relationships with these members. We try everything under the sun to help them succeed. To see them take small baby steps and progress is really awesome.”
By concentrating on the health and social needs of 60 members, the program helped save nearly $700,000 in hospitalization costs just six months after its launch.
In one case, Pock worked for more than a year to help one member get physical and behavioral health care and enroll in recovery programs. The member — whose mother helped Pock throughout — had been homeless and involved with the criminal justice system while struggling with addiction and depression. He eventually developed coping skills and the support network he needed to gain visitation of his toddler daughter.
Success stories like that one show that intensive outreach and connection to community resources can make a difference. The key is gaining member trust by including them in the process, rather than telling them what to do, Pock says. The first step toward building rapport may be as simple as helping someone buy a pair of shoes.
“It feels really good when I’ve earned someone’s trust,” Pock says. “If I can help someone stay out of the hospital for three months, that’s a significant gain.”
Emergency rooms have long been the primary health care source for many patients with substance abuse disorders and mental illness. About 1 in 8 ER visits involves a mental illness or substance use disorder, according to research by the Agency for Healthcare Research and Quality.
However, after treating patients, hospitals sometimes discharge them without providing services or referrals for follow-up outpatient care or treatment. As a result, another mental health or substance use crisis often leads to another trip to the emergency room.
At least once a week Pock checks in with members and links them to agencies and community organizations that can assist with drug and behavioral health treatment, health care and other resources. When possible, he also partners with family members who remain devoted despite their loved one’s challenges.
“Most families really want to help, but they don’t have the skills to do so,” Pock says. “They’re very willing allies, which just multiplies my impact with members.”
Yet, substance use disorders and other behavioral health conditions can be too powerful to overcome, no matter the level of support, dedication and engagement offered.
Last year, a member who fought more than a decade to find relief died after a drug overdose.
His mother, who tirelessly worked with Pock to save her son, wrote a note expressing appreciation for the persistence, support and strength Pock and his colleagues provided throughout her son’s battle.
“She wants to create a legacy for increased compassion and understanding for those struggling with addiction and behavioral health issues,” Pock says. “It’s heartbreaking how some of our members are suffering from profound addiction. We engage with them any way we can.”