1. “Better Practices” in Behavioral Health Benefits Management Stewart Beltz The Board of Pensions of the Presbyterian Church (U.S.A.) September 28, 2010

2. Topics Presbyterian Church Board of Pensions Who we are “Better Practices” in Behavioral Health 1.Vendor Service Integration 2.Integrated Benefit Administration 3.Coalition Purchasing 4.Custom Solutions –Autism & developmental disabilities –Faith based provider recruitment –EAP management consultations

3. The Board of Pensions of the Presbyterian Church (U.S.A.) An agency of the Presbyterian Church –Serve all U.S. Presbyterian ministers, church workers and retirees Church Pastors must participate Other church workers may participate –Provide DB pension, healthcare, LTD, death benefits, optional benefits and financial assistance

4. Demographics 17,000 Active “members” (employees) 40,000 covered lives Ministers (65%) & Lay staff (35%) Older (av. 52) Male (59%) In 50 states, PR and overseas missions Pastor salaries are modest (~$52,200) Benefits are important protection 11,000 Retirees on Medicare Supplement

5. Benefits Embody Presbyterian Values Stewardship –Proper use of the gifts of God's creation –Well-managed benefit plans Self-insured and fully funded “Keeping our Promises” –Strong sense of fiduciary responsibilities –Community caring –Work ethic and personal accountability “Stewardship of Self” –Health –Financial –Vocational –Spiritual

7. Behavioral Health Benefits CIGNA Behavioral Health (CBH) EAP: 1-6 session model Work Life Services: legal, financial, childcare, etc. Outpatient visits: $25 copay Coinsurance for higher level care 80/20 (INN), 60/40 (OON) after deductible 2009 Utilization EAP: 6.2% O/P:100 clients/1,000, 10.2 visits/client 48% in-network I/P: 5 admits/1,000, 9.3 day ALOS 86% in-network

8. “Better Practices” in Behavioral Health 1. Vendor Service Integration 2. Integrated Benefit Administration 3. Coalition Purchasing 4. Custom Solutions

9. 1. Vendor Service Integration Creating a member centric service model Presbyterian “cultural sensitivity” Annual training with all front line service teams Vendor integration summit Annual face to face working meeting Identify collaborative improvement opportunities Vendor partner integration manual Documents workflows, roles & handoffs Vendor hosted webinars Ongoing cross training for all vendor partners –EAP training, Prescription drug program, Case mgmt, etc.

10. Member Centric Service Model Plan Members

11. 1. Vendor Service Integration Creating a member centric service model Presbyterian “cultural sensitivity” Annual training with all front line service teams Vendor integration summit Annual face to face working meeting Identify collaborative improvement opportunities Vendor partner integration manual Documents workflows, roles & handoffs Vendor hosted webinars Ongoing cross training for all vendor partners –EAP training, Prescription drug program, Case mgmt, etc.

12. 2. Integrated Benefit Administration Integrated Medical & MH Benefits Unified deductibles & OOP maximums –In network and Out of network Claims Cross Accumulate Coordinated between CBH  Highmark Satisfies Mental Health Parity Simplifies Benefit Design

13. 3. Coalition Purchasing Church Benefits Association (CBA) –Jointly negotiated contract terms Presbyterians, Episcopalians, American Baptists, and 2 Lutheran Denominations –Stronger voice for our members –Explore common challenges & solutions –Shared account management & service teams Comparative reporting and norms –CBH developed expertise in serving needs of: Clergy Faith-based organizations

14. 4. Custom Solutions Autism & Developmental Disabilities Autism spectrum disorders, Down syndrome, Spina bifida, Cerebral palsy, Intellectual disability Enriched benefits coverage Applied Behavioral Analysis (ABA) therapy Additional speech, occupational and physical therapies Requires specialty case management & vendor coordination Required a special definition of medical necessity

15. 4. Custom Solutions Faith Based Provider Recruitment 4,866 faith based counselors CBH Customized network better serves churches EAP Management Consultations CBH Modified Management Referral Process –Better serves church organization’s structure Functions like the “HR consultants” to the church Staffed by an “ordained” LSW at CBH