Nonprofit health plan Point32Health has instituted a new care navigation program to meet unprecedented behavioral health demands.

As part of the program, Point32Health has created a new employee role specifically designed to connect members to behavioral health care. This allows the payer and its provider network to foster a “symbiotic relationship.”

“The missing piece that we’ve identified, that we’ve heard through feedback, is that because of the [clinician] shortage, it takes so much time for the average person, leaving voicemails and researching,” Bill Harlan, vice president of behavioral health at Point32Health, told Behavioral Health Business. “For some consumers, it might be their first time accessing behavioral health services, so there is a light education to help folks know what they’re getting into.”

This new program comes in the midst of an ongoing behavioral health crisis in the U.S., marked by elevated levels of mental illness and opioid use that have persisted unabated for the past three years.

Through Point32Health’s program, members call a phone number and are either connected directly or receive a callback to speak with a service navigator. Service navigators guide members through a brief questionnaire to determine patients’ goals and needs.

The conversation is not a diagnosis tool, Harlan said, but sometimes the conversations demonstrate a need for specific services, in which case service navigators can triage and connect patients with clinicians or care managers.

In most cases, service navigators will determine preferences, like in-person versus telehealth or clinical specialty.

Service navigators confer directly with providers, taking the legwork out of setting up appointments. A desire to avoid the process of calling, leaving voicemails and calling back was one the most common pieces of feedback Point32Health receives, Harlan said.

“It’s helped that we have a few relationships with some providers that are symbiotic relationships,” Harlan said. “They love to get referrals, and we love to give referrals,so we can make sure that happens in a more expeditious way.”

After the initial appointment, service navigators make a follow-up call to confirm that the clinician is a good fit and meets expectations. The follow-up call can also be an opportunity to determine if a different clinician would be a better fit.

“Educating consumers that they can audition a few different therapists is completely appropriate,” Harlan said. “They don’t give you a manual when you decide to get some support. We try to encourage members to consider that if there’s any ambivalence at all.”

Since the program’s inception, service navigators have helped approximately 1,000 members. The program started with a single service navigator in 2023, but Point32Health has ramped up and hired approximately eight full-time employees.

The program doesn’t solve the problem of ghost networks ” Harlan said, but it is a step towards correcting it.

Health plans’ provider directories often include inaccurate or outdated information or include providers who no longer accept patients, creating “ghost networks.” Point32Health recognizes this issue, Harlan said, and sees a “big opportunity” to ensure provider data is accurate.

Point32Health has ambitions to expand the service navigation program, including offering alternative routes besides phone calls.

“Now that we’ve operationalized this, we want to capitalize on the investment to really show value and better care for folks,” Harlan said.

Point32Health’s overall behavioral health strategy now focuses on whole-person health, as the company has addressed some “delineation” across its business lines.

“We had Optum Behavioral Health delegated to pay claims, pick up the phone and do all the utilization management review and case review,” Harlan said. “We felt strongly that behavioral health is so top of mind and so key to success that having our programs all live together, our medical programs, our pharmacy programs and all of our behavioral health programs, really live within our four walls, will help us get where we want to be and faster and have better accountability on the outcomes.”