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Member Services

Published February 08, 2019

Behavioral Health • Substance Use Disorder

In this section we share examples of health plans’ online resources for members and a toolkit for patients and family members.

How to Do It

Identify at-risk member needs, for example:
1. Member is experiencing pain
2. Member is concerned about mental health issues
3. Member is concerned about substance use disorder (SUD)
4. Member or family is concerned about overdose
Develop and make available resources for members.
Train member services to recognize and respond appropriately.

Health Plan Stories

Kaiser Permanente Southern California

At one point, a large number of member complaints were from opioid-seeking patients.

At one point, a large number of member complaints were from opioid-seeking patients. Kaiser Permanente Southern California (KPSC) recognized the need for member services and physicians to respond appropriately and consistently when members called or presented requesting a new opioid prescription or a renewal of an existing or expired prescription. KPSC developed a guide for member services representatives to help them address members’ concerns and direct them to the appropriate prescriber for follow-up. It also trained physicians to respond to requests with alternative solutions rather than simply denying members’ requests.

Partnership HealthPlan of California

Partnership HealthPlan of California trained member services staff to liaise with the Outreach and Understanding Can Help (OUCH) case management team. Member services representatives would listen for buzzwords (e.g., opioid, Vicodin, overdose, withdrawal) indicating a member was struggling with opioid use disorder. When member services encountered such members, they would refer the members to the OUCH team, and a case manager would handle the members’ requests and coordinate follow-up.