Missouri Behavioral Health Independent Practice Association (IPA) September 12, 2016

Healthcare is Changing! Government and private payers are looking to integrated delivery systems that apply population management, eliminate duplication through integration, and encourage partnerships among providers – pay for value. The Triple Aim of healthcare reform intends (1) to assure reasonable access and a positive patient experience, (2) to improve community health and well‐being, and (3) to contain or at least manage costs. In Missouri, the managed care companies will eventually win – want to prove value of network and services NOW!

Managed Care Growth Medicaid management has also undergone profound change, with states increasingly outsourcing the care to private insurers such as Aetna, Centene, Wellcare, and UnitedHealthcare. By 2016, 76-79% percent of beneficiaries in Medicaid and Children’s Health Insurance Program (CHIP) will be covered by private managed care. Over the past four years, Medicaid managed-care enrollment has increased by 48% to 46 million beneficiaries.

What is an IPA? An Independent Practice Association (IPA) is a separate company whose membership is comprised of independent healthcare providers. The goals of an IPA are to eliminate some of the isolation, risks, and expenses of independent providers while preserving each provider’s independence. Through the establishment of this network by means of an independent practice association, the IPA will improve the quality and efficiency of care provided to our communities and offer meaningful value to payers.

Why is there a need to create an IPA? Public and private payers requirements are changing (example: Local Care Coordination Programs) Someone else will come in and seize the opportunity (FQHC IPA being engaged on behavioral health) Demonstrate value to legislators Affords the opportunity to participate in ACOs (dual eligible pilot project) Technical Assistance and General Discussions regarding contracting with Managed Care Companies Saving private and public payers with integrated care and not able to communicate those efforts

Membership Who can join? Initial membership of the IPA will be comprised from the Coalition. IPA board members would determine whether or not to expand membership to further develop the network. This would be determined by the Board and/or governing documents. Providers wishing to join the IPA will complete and sign an application and the participation agreement, then return them to the IPA for processing. Membership of the IPA would be subject to Board Approval. Are Coalition members required to joining the IPA? IPA membership is voluntary and no agency is required to join the IPA. Ideally, as we move towards greater clinical integration, it will be beneficial to have all providers participate, recognizing the value of an integrated model and leveraging tools to reduce practice variation.

Benefits of Membership Technical Assistance regarding contracting Parity Technical Assistance Clinical initiatives that will lead to demonstrable quality and cost efficiency in the delivery of care. Demonstrate value to payers Credentialing Serve as a central point of communication, information and resource to participating providers and payers. Measure with electronic tools the quality and efficiency of the participating providers.

Benefits of Membership Explore with payers alternative reimbursement programs, including pay for performance, shared savings, program development funding, and methods to recognize care coordination activities. Management of CEU and CME Legal and Regulatory Guidance Marketing and Communicating Value Staff Training and Education Recruitment The ability to sell services to a new market: self-insured employers

IPA and Clinical Integration Clinical Integration may be broadly defined as the coordination of care across people, functions, activities, processes, and operating units to maximize the value of services delivered. A clinically integrated group of otherwise independent providers may contract together with payers if they meet certain conditions, including having a common set of clinical guidelines, a common information technology platform for sharing of clinical information, performance monitoring, and performance incentives.

IPA Contracting and Clinical Integration To meet the FTC’s guidelines for clinical integration, organizations must demonstrate that they are designed to monitor and improve the quality of clinical care while also reducing overall costs. Even if all the tests for Clinical Integration are met, networks are still not allowed to increase prices through aggregating market power. They can, however, seek higher prices from the market for a better, more attractive, differentiated product.

Collaboration, demonstrating value, and integration is essential to achieve the clinical quality and efficiencies necessary to be successful in the future delivery of healthcare.

Missouri IPA Results Have full statewide network of 25 behavioral health providers. Hospital system behavioral health providers most difficult to sign. Believe it will take $400,000 to operate the IPA, due to it being included in a current company (so no full-time CEO costs). Some Administration. Full time credentialing FTE Full time network & provider relations. Designed to benefit the providers, not the company -- don’t want “profits” to the company, want payments to the providers.

Missouri IPA Results Have one signed MCO contract with base compensation of $100,000 to support CommCare operations. Have a 20 MCO member DM pilot - $1,500 per month for outreach. Close to contracts with other two current MCOs. Close in contract negotiations with Exchange Plan commercial. Very optimistic initial discussions with VA/Tri-Care vendors. Have contracted with Cactus credentialing software to do the IPA credentialing for entire network. Warning on FQHC IPA experience.