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Introduction to BeaconHealth StrategiesApril 28, 2011.

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Presentation on theme: "Introduction to BeaconHealth StrategiesApril 28, 2011."— Presentation transcript:

1 Introduction to BeaconHealth StrategiesApril 28, 2011

2 2 Beacon serves 6 million members in 14 states, 10 Medicaid programs and 50+ health plans Medicaid Medicare Commercial Multi-Sector Health Plans

3 3 Beacon is one of the largest MBHO serving public populations in the state of NY New York Foot Print Working with Four Health Plan Partners and CCSI/NYCCP Working with members and providers since 1998 Case Management and quality improvement partnerships with 7 county systems −Chautauqua, Erie, Genesee, Monroe, Onondaga, Westchester, Wyoming NY clinical operations based locally in NY − UR, CM and Physician advisors 7,000 contracted providers in NY State New York Business Highlights Confidential

4 4 We provide a full range of clinical management services to our clients Administrative Services Fully integrated BH management system -Financial -Clinical -Network -Claims Network creation and management Provider credentialing Claims processing and payment Call center operations Utilization and Case Management Population Health Medical necessity review 3-tiered case management program -Case consultation -Care coordination -Intensive case management Follow-up after hospitalization “Aftercare” program Agency/Courts/School care coordination NCQA and URAC accreditation Predictive modeling and informatic case finding Total care management -Co-morbid mental illness and chronic disease Psychotropic drug intervention program Depression health management program

5 5 Beacon’s system of care was developed to serve deep-end patients in public programs BH Inpatient Utilization – Days per 1,000 members Beacon’s Core Business

6 Quantified correctly, behavioral health expenditures can be 20% of total spend 6 Inpatient, outpatient and diversionary MH services Substance use services Primary behavioral health diagnosis Obvious BH Expenditures 3x more likely to have 5 or more physical health IP stays 4x more likely to have 5 or more ER visits 2.5x more specialist utilization (excluding BH) 3x more pharmacy cost (excluding BH) Seriously Mentally Ill: Medical Utilization 71% of top 3% of spenders are BH co-morbid (exclude oncology, transplants, and geriatric end-of- life care) 69% of members with 3 or more chronics are BH co-morbid 76% of “outliers” for major chronic disease states are BH Chronic Physical Illness Chronic or unexplained pain Digestive disorders Unexplained pulmonary stress Medically Unexplained Symptoms 3-5% 10+% 3-5%

7 7 Behavioral health co-morbidity drives cost in the highest of the high cost cases All MassHealth Members ,000 enrollees $3.2 billion 51% BH co-morbidity Average PMPM Expenditure for High Cost Cases %

8 8 BH and Chronic Disease: A Volatile Cohort Cost Variation of Chronic Diseases

9 9 Responsive Inpatient acute care Enhanced Outpatient IOP w/out Walls Partial Hospitalization Intensive Outpatient Day Treatment Office Based Care LowHigh Price of Unit of Service LowHigh Service Intensity Crisis Stabilization Case Study: Value is driven by creating a care continuum and coordinating step-up / step-down Alternative levels of care CAITS

10 10 “Diversionary” service penetration increased dramatically across all lines of business NHPRI Percent of OP Utilizers Utilizing Diversionary Services (Before and After Service Expansions) Before new services ( )* After new services ( )*

11 11 Admission rates amongst OP utilizers dropped with the introduction of new services Before new services ( )* After new services ( )* NHPRI Acute MH Admission Rates for Members OP Utilizers (37%) (54%) (55%)

12 12 More community care resulted in better value Service Expenditures – Per Utilizer per Month CSNSubCare RIteCare/Children

13 13 Creating “Health Homes” that incorporate BH results in quality gains and better value Co-location of BH on site increases penetration of specialty BH services… …reduces psychiatric hospitalization …and generates measurable medical cost offset.

14 14 Getting value from the current system – using data to target services matters 59% decrease in ER utilization 62% decrease in IPMH ALOS 34% decrease in self-harm incidents 32% decrease in of physical harm to others 32% decrease in suicide attempts 50% decrease in arrests 44% increase in gainful employment SPMI Care Management Program ( Buffalo, Rochester, Syracuse) % of Highest Cost* SPMI Members Receiving County Services

15 “Integrated Partner Model” stressed local knowledge and management Beacon Integrated Partner Model Health Plans Community Services Government Partners Providers Families & Advocates Schools Mental Health Child Welfare Courts Medicaid DD/MR After School Prgrms. Rec. Prgrms. Housing Svcs. Mentoring Svcs. Faith-based agencies BH Specialists Primary Care BH in Medical Home Hospitals Diversionary Services Mobile Crisis Teams Parent Advisory Cmte. NAMI Consumer Strategies Education / Outreach Peer Specialists Parent Advocates On-site at managed care plan Beacon clinicians co-located with Medical Management team 15 Beacon provides connective tissue in a fragmented system of care

16 16 The top Medicaid health plans in America have chosen, and stayed with, Beacon #2, #3, #4, #5 and #7 Medicaid Health Plans in America are Beacon Clients # 2. Boston Medical Center HealthNet Plan (HMO) # 3. Fallon Community Health Plan (HMO) # 4. Neighborhood Health Plan of Massachusetts(HMO) # 5. Blue Cross Blue Shield of Rhode Island (POS) # 7. Neighborhood of Rhode Island (HMO) Beacon Client since ‘09 Beacon Client since ‘99 Beacon Client since ‘96 Beacon Client since ‘03 Beacon Client since ‘01 Top 10 Medicaid Health Plans


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