The Value of Access: Partnering with Commercial Payors Alyssa Rose, JD, MSW, Director of Network Strategy, Beacon Health Options

Beacon is transitioning to a collaborative approach to strategic provider management

A collaborative partnership model is the target destination Providers Offer: Efficacious clinical care Robust transition/ discharge planning Primary care linkages Beacon Offers: Clinical best practices Longitudinal clinical/ care management Developed “system of care” services Shared data analytics Provider benchmarking Value-based purchasing Providers Receive: Reimbursement based on quality/outcomes More volume Less administrative burden More clinical self- management Beacon Receives: High-performing network Superior member outcomes Fewer resources dedicated to clinical reviews

Value-based payments

VALUE-BASED PURCHASING OPTIONS INCENTIVE-BASED TREATMENT RISK Value-based purchasing comes in many different forms besides capitation VALUE-BASED PURCHASING OPTIONS Total Health Outcomes Shared risk on total member experience Behavioral Health Capitation Risk for providers Full behavioral health payment Defined coverage set Episode Bundle Group of services Combined payment Quality goals Defined time period COMPLEXITY Case Rate Group of services Combined payment Monthly/weekly payment Pay for Performance (P4P) “Upside only” Key process measures Fee-for-service One service One payment INCENTIVE-BASED TREATMENT RISK Overtreatment Under-treatment Proprietary and Confidential

Development of Preferred Networks

We know that access is a critical issue in behavioral health There are Access issues to behavioral health providers Wait times have a huge impact on no-show and e.r. admission rates 1 in 5 adults with mental health needs report that they are not receiving the services they need Nationally, only 41% of adults with mental illness received any care in the past year Only four states were able to provide care to >50% of their mentally ill populations 59% of primary care physicians report being unable to obtain outpatient mental health services for patients due to local provider shortages/wait lists ~25% no-show rate if patient has to wait a single day Every subsequent wait day increases no-show rate by ~1% If patients do not receive timely BH care, they: Have a higher likelihood of using Emergency Rooms Lower treatment retention rate Higher hospitalization and re-hospitalization rate Sources: 2014 Beacon site visits, Massachusetts Gallucci et al, 2005. Impact of the Wait for an Appointment on the Rate of Kept Appointments at a Mental Health Center.

We envision a future where access means something more Traditionally, access has been defined by geographic proximity and provider size Proximity Size A member has a provider within a certain geographic distance from their home A provider is large enough to meet member demand for its services (clinician-to-member ratios) We envision a future where access means something more

Appointment Completions We hope to redefine access by its key outcome: the ability to secure an actual appointment Appointment Completions Members are not just referred, but secure actual appointments. Same-day and next-day appointments are available, and members have the appropriate transportation and resources to complete those appointments Care Flexibility Redefine access as: Members have the flexibility to choose the modality of their appointment (in person or online), and providers have the technology tools at their disposal to accommodate that choice JH Provider Quality Providers are not measured by their scale, but by the value they create. Members play a critical role in determining and reporting on provider quality

Appointment Completions To support this vision, we will leverage innovative tools and strategies Appointment Completions Care Flexibility Provider Quality Goal Giving out phone numbers and addresses is not enough – we aim to create a system where same-day and next-day appointments are achievable and completed In today’s world, access is about more than face-to-face time. Technology solutions enable members to choose from a wider set of providers, appointments, and treatment modalities Access to care should always imply access to quality care. We envision a world where members have a critical role in determining provider quality, not just claims and clinical data Solutions Interconnected scheduling platforms Open access provider scheduling & same-day next/day availability Telehealth Value-based payments (e.g., P4P incentives for decreasing wait times) Online CBT and counseling SMS & mobile messaging Telehealth Preferred provider network, tiered by quality Value-based payments (based on outcomes) Member-reported outcomes JH Beacon focus Mobile platforms (self-tracking and support) iPad member survey

There are steps we can take today in an attempt to enhance access while innovation grows We propose using value-based payments to increase access Start with 1 msa, build out as we demonstrate success Block-purchase time: pre-purchase time from psychiatrists or group practices to ensure they always make time for members Enhanced rate for same-day/next-day access: negotiate an enhanced rate for providers in exchange for guaranteed appointment within 24 hours Develop urgent access telehealth provider: negotiate with a willing telehealth partner to guarantee access Choose specific MSA Identify providers, likely those with low current utilization, high desired utilization, and in high-member-density locations Approach providers to request differential service levels with different payment mechanisms, either direct outreach or via RFP process Focus on outpatient psychiatry to start, but be open to other access points Track progress in year 1 and roll-out to other MSAs as success is demonstrated (proof of concept and cost containment) TP

Provider partnership program

Provider Profiler Enhances Collaboration and Supports Practice Transformation We share 20+ metrics with providers, including both standard and novel measures We craft a narrative to draw attention to what we believe is important Benchmark against like providers in the state We are not rigid in our application of the data – context matters We work to set goals from each meeting that we collectively agree on We partner to deliver the training and administrative support providers need to improve

Thank you! Questions?