Case study: success stories from Elevance Health’s Suicide Prevention Program (SPP)

Suicide Prevention Program

Suicide is a public health crisis, and the second-leading cause of death among young people aged 10 to 14, and 20 to 34 in 2021.¹

However, there is hope, as evidenced by Elevance Health’s Suicide Prevention Program. The initiative is led by Dr. Jessica Chaudhary, Medical Director, Carelon Behavioral Health, a division of Elevance Health.

The program, driven by predictive analytics, identifies members at risk for a suicidal event in the following 12 months, typically five months prior to an attempt. To prioritize member outreach, the program organizes members into risk categories.

SPP also provides clinical case managers and peer support in the form of wellness and recovery specialists (WRS). The staff helps members focus on safety planning, risk reduction, family support, access to community resources, and after-hours support.

The goals are to prevent suicide attempts, reduce emergency room and inpatient utilization, and achieve positive health outcomes. “With our program’s early intervention, we aim to avert a crisis, not respond to one,” states Dr. Chaudhary.

 

Program outcomes and savings

A recent SPP study indicated a reduction of over 20% in adolescent and young adult suicidal events for commercial risk-based members engaged in control groups. The data was consistent with a 30% monthly reduction in behavioral health spending per engaged member, post-intervention.

“Since this study, we have expanded the program to cover more members. The data shows we can potentially change the trajectory for some of these individuals,” explains Dr. Chaudhary.

 

Using predictive analytics for prevention

Bryan Furches, Senior Analytics Consultant, Carelon Behavioral Health explains: “To predict an individual’s risk of engaging in self-harm, we consider over 900 potential factors. The factors include the individual experiencing homelessness, abuse, previous self-harm attempts, or treatment regimens over the previous 18 months. When developing the predictive tools, we examine which factors are present in those who engage in self-harm.” 

The program also looks at the entire membership within a certain date range, using claim and enrollment information within the range to calculate all the potential predictors. “We tag each member who went on to engage in self-harm over the following 12 months, using statistical testing to find the variables and relationships indicating the strongest predictive efficacy of subsequent self-harm,” says Mr. Furches. “The results of the statistical tests calculate a member’s risk of self-harm based on the known risk factors. To mitigate potential risks such as accuracy and fairness concerns, the program develops recommendations, for associates to confirm, on most of the membership (60%, for example), with the remaining membership data (40%, for example), kept blind from the development process. Once development is complete in the 60% population group, the program tests against the remaining 40% blind group.”  The program uses the performance of the predictive mechanism on the final testing group to determine the accuracy and fairness of the methodology.

Mr. Furches recognizes the need to mitigate potential bias. “Our self-harm risk models do not indicate issues in socioeconomic, gender, or race-ethnicity biases. In terms of age, however, models tend to overpredict risk in members over 50 while underpredicting risk in members in their 30s and 40s, especially in the absence of prior mental health diagnoses. We are aware of the potential for age bias and are actively addressing it.”

 

Aftercare

Eligible members who have completed the initial SPP can participate in the aftercare portion of the program centered around outreach. The outreach intervals are one month post-SPP completion, three months post-SPP completion, and six months post-SPP completion. The intention is to address care gaps.

 

SPP success stories

JW, 39 years old

 

Reason for referral

JW was referred to the program for suicidal ideation, anxiety, and psychosis. He had been diagnosed with bipolar disorder in December 2021, and was hospitalized in the spring of 2022 for a manic episode.  

At the time of his referral, JW was experiencing symptoms such as irrational thinking, racing thoughts, irritability, and paranoia. He expressed fear that he was going to have another manic episode, leading to increased anxiety, depression, and suicidal ideation.

At the time, he was participating in an intensive outpatient program (IOP) that he thought was helpful. He had not worked in several years, spending most of his time writing a book he wanted published.

JW’s initial goals were to learn more about his illness, how to manage his symptoms; and to eliminate further manic episodes. His long-term goal was to go back to work.

 

Outcome

JW met all his goals and has remained free from suicidal ideation/homicidal ideation (SI/HI) and self-harm for several months. He reports having more confidence in knowing what his symptoms and triggers are. He has been seeing a therapist and a psychiatrist on a regular basis.  

JW reports a better understanding as to how medicines help him avoid mania and help him sleep. He engages in healthy activities like yoga and strength training several times per week. He started a new job in May as the caretaker of his apartment building. He talks with the WRS on a regular basis. He will continue to talk with her post-discharge from intensive case management to less intensive case management, for aftercare planning.

 

How SPP made a difference

• JW experienced a decrease in his depression. His Patient Health Questionnaire-9 (PHQ9) score was 11 upon his enrollment, decreasing to a score of 6 in May 2023. 
• JW’s anxiety decreased. His Generalized Anxiety Disorder Assessment (GAD7) score was 5 upon his enrollment, decreasing to a score of a 3 in May 2023.
• JW obtained employment in May 2023.

 

RS, 17 years old

 

Reason for referral

RS had experienced suicidal ideation and needed coping skills.

 

Outcome

RS had been admitted to inpatient care, stating she felt overwhelmed. She reported that while in inpatient care, she learned coping skills that she went on to use successfully. She also shared her newly learned skills with the staff and other patients. 

RS indicated that everyone with whom she shared her new coping skills were very grateful. She said it made her feel empowered when she shared these tools. 

 

How SPP made a difference

• RS learned that she was able to foster hope within herself and gain confidence by utilizing the coping skills she had developed. She also realized that by using the tools and sharing them with others, she made a stronger, more positive impact on the people around her. She also felt a sense of accomplishment, understanding how these coping skills worked. 
• RS went back to school to study psychology, wanting to help people going through some of the same issues she had experienced. She stated that she was feeling much better, wanting to share the tools she had learned with everyone she encountered. Her mother also indicated she had seen major improvements in her daughter. 

 

How SPP makes a difference

“We see this as a team-based approach,” believes Dr. Chaudhary. “We help create a safety plan that individuals can use. By the end of the program, they learn who they can call, and which services are available to them.”

Empowerment is the driving force within the program. “Individuals, especially young people, feel more hopeful and empowered when they have a safety plan,” concludes Dr. Chaudhary. “When they learn that there is an alternative, that is a very powerful experience for them. It gives people hope.”