Behavioral Health

When our members are referred to our program, a care coordinator or case manager will reach out to them to determine their medical, behavioral or social needs. Although the program is not mandatory and the member has the ability to opt-out, we encourage them to take advantage of this special program to manage their health and help reduce health care costs.

Controlled Substance Monitoring Program

Working to reduce substance use disorder risk among members and improve quality of care, and life.

As part of Health New England’s overall Care Management program that helps members with complex medical or behavioral health needs, our Controlled Substance Monitoring Program addresses issues like chronic pain or frequently uncontrolled pain that requires the use of opiates for pain relief.

Program Goal

The goal of the Controlled Substance Monitoring Program is to ensure the safe and appropriate use of potential drugs of abuse with selective Care Management intervention. Through this program, our social workers can help members in coordinating or streamlining their pain management and assist if they have any concerns about addiction. By addressing a potential issue ahead of time, our ultimate goal is to help prevent at-risk members from developing a substance use disorder.

How it Works

Health New England’s Pharmacy and Care Management departments work with our pharmacy benefits manager OptumRx to identify members who are at risk for abuse. They look for members who have more than five providers writing prescriptions for opiates, are filling opiate prescriptions at more than two pharmacies, or have a “high” morphine-equivalent dosage. Once a member is identified as at-risk, Health New England reevaluates the member’s claim history and a social worker reaches out to each at-risk member.



Help is Only a Call Away

Members can self-refer or refer a family member for any of our Care Management programs by calling the Care Management team at the number below. Health care providers can also refer patients to our programs at (413) 787-4000 ext. 3940, Monday - Friday, 8 a.m. - 5 p.m.

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