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1 Beacon Health Strategies, LLC August 2005

2 Introduction l Greetings and Overview What is a Managed Behavioral Health Organization? l A Managed Behavioral Health Organization (MBHO) is a company that works in partnership with health plans, Medicaid agencies, and / or state and local governments to ensure that members of a health plan or publicly funded health program such as Medicaid receive easy access to cost effective, high quality mental health and substance abuse treatment. Beacon Overview Who is Beacon? l Founded in 1996, Beacon is a locally owned Managed Behavioral Health Organization committed to serving a small number of respected customers in the Northeast

3 MH/SA Disorders are Challenging to Identify and Treat l Not as straightforward as compared to medical / surgical Identification, Prevalence and Treatment of MH/SA Services l Small number of individuals with complex needs drive costs o 3-5% of commercial dollar premium l According to the World Health Organization, 5 of the top 10 causes of disability are related to a MH or SA disorder l Complexity of need calls for even greater need to coordinate care with other systems l Frequent co-occurring issues (diabetes and depression, post-partum etc.) makes appropriate treatment harder to achieve

4 MH/SA Services are Not Always Clinically Appropriate and Can be Costly l Providers differ widely in terms of their MH/SA training and their commitment to practicing evidence based medicine often resulting in: o Over treating (more care does not equal good care ) o Under or mis-diagnosing o Inconsistent outcomes l Tendency of some payers to purchase services based on price rather than on outcome l Over time, length of stay has gone down and member wellness and satisfaction has gone up l Today, there are many treatment options in between traditional inpatient and outpatient care to improve appropriateness of care and maintain members in their community Appropriateness of Services

5 Challenges Ever Present in Gaining Access to MH/SA Services l Service availability issues o Issues in geographic distribution o Issues in provider specialty availability l Stigma associated with MH/SA conditions l Identification (self and primary care) l Uneven insurance coverage l Linguistic and cultural barriers Access to Services

6 How? l Identification and implementation of best practices l Driving improvements in access l Integration with medical and primary care and other systems l Organization and improvements to service delivery system l Monitoring heterogeneity of needs l Prevention and early intervention l Ensuring quality l Close coordination with stakeholders (consumers, MH/SA providers, PCPs, state agencies, service delivery improvement working groups) Companies Like Beacon Help Address the Issues

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