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

2. Beacon is transitioning to a collaborative approach to strategic provider management

3. 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

4. Value-based payments

5. 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

6. Development of Preferred Networks

7. 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, Impact of the Wait for an Appointment on the Rate of Kept Appointments at a Mental Health Center.

8. 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

9. 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

10. 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

11. 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

12. Provider partnership program

13. 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

14. Thank you!
Questions?