Section One - Executive Summary
Anthem Blue Cross and Blue Shield is pleased to offer this toolkit to assist you in
providing health services to our members. The materials in this toolkit include:
 Clinical Practice Guidelines, which include information on the diagnosis and
treatment of various behavioral health conditions and referrals to a behavioral
health specialist
 Nationally Recognized Screening Tools
 Coordinating care with other practitioners involved with our member’s care
 Member education and links to useful web sites
The following behavioral health disorders, listed with their associated Heath Plan
Employer and Data Information Set (HEDIS) measures, are included in this toolkit:
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is a condition that is screened, diagnosed and treated by both primary care and
behavioral health professionals. It is advisable for the prescribing clinician to see
children, aged 18 and under, at least once per month until optimal treatment results are
achieved. Follow-up visits should occur once every three months.
Depression
For newly diagnosed members taking an antidepressant medication, it is recommended
that follow-up visits with either a primary care physician/clinician or a mental health
physician/clinician occur three times in a three-month period. At least one of these visits
must be with the prescribing clinician.
Depression in the Cardiac Member
Approximately 15% to 20% of Coronary Heart Disease (CHD) individuals meet the
criteria for major depression. Many more suffer from milder forms of depression. A
number of studies demonstrate a relationship between depression and increased cardiac
morbidity and mortality in individuals with CHD. There is also evidence that depression
increases the risk of cardiac readmissions. It is recommended that individuals with CHD
be screened for depression as soon as possible following a cardiac event. (Please use a
depression screen as a guide for our members with other chronic and potentially disabling
conditions such as diabetes and asthma.)
Postpartum Depression (PPD)
The “baby blues” are very common in women who have just given birth. Research has
determined that 50% or more of women experience the baby blues and that
approximately 10% of these women could potentially have postpartum depression.
Without proper diagnosis and treatment, symptoms may continue for a year or longer. It
is recommended that all postpartum women be screened for depression at their first postnatal follow-up visit and, if positive, referred to behavioral health specialists.
Alcohol and Substance Abuse (AOD)
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People with alcohol and/or other drug disorders often have multiple and complex health
and social problems. It is recommended that follow up visits take place within 14 days of
discharge from a medical or behavioral health inpatient hospital admission. Any
subsequent outpatient treatments should occur within 30 days of initial therapy.
We hope that you find this toolkit helpful. You can access this toolkit from the Anthem
provider section of Anthem.com.
The contents of this toolkit are based on the guidelines of national organizations
including:
 The National Institute of Mental Health
 The American Psychiatric Association
 U.S. Department of Health and Human Services
 Agency for Health Care Research and Quality
 American Academy of Pediatrics
 National Institute on Alcohol Abuse and Alcoholism
 U.S. Preventive Services Task Force
 American Society of Addition Medicine
 Substance Abuse and Mental Health Services Administration
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