CommCARE President and CEO Terry Trafton attended the OPEN MINDS Health Plan Partnership Summit in February. He participated in a dialogue between health plan executives and leaders of Behavioral Health organizations who came together at the Summit to learn about ongoing trends.
Attendees at the conference heard from several health plans and included a town hall panel discussion. Talks were facilitated by OPEN MINDS Senior Associate Deborah Adler, and featured the perspectives of executives of four health plans—Charles Gross, Ph.D., Vice President, Behavioral Health, Anthem, Inc.; Beth Rath, PMP, Vice President Network Operations, New Directions; Kelly J. Champ, Vice President, Network Strategy & Innovation, Optum; and Matt Miller, Senior Vice President, Public Sector, Magellan Healthcare.
According to Sarah C. Threnhauser, Open Minds Associate, there are some emerging similarities across all plans:
First, most of the health plans are now working within the same reimbursement continuum—currently operating some pay-for-performance programs, with upside risk-based arrangements. Health plans are also starting pilot programs and value-based reimbursement (VBR) arrangements that include downside risk, with the goal of shifting a greater percentage of reimbursement to that model over time. Many of the health plans were focused on a shift to bundled payments and case rates encompassing multiple conditions, including addiction treatment, major depression, schizophrenia, and applied behavioral analysis for autism.
Second, many of the health plans are starting to use similar performance metrics, with a greater attention to medical measures, total cost of care, and funding integrated care (including social determinants of health). Physical health and behavioral health are funded separately, making it difficult for specialty provider organizations to get a clear picture of the total cost of care. The question posed—how do specialty provider organizations get data to show that a behavioral health services result in total cost of care savings? There are two paths. One path is: specialty provider organizations can form their own partnerships with health systems and primary care practices. This could include accountable care organizations (ACOs), collaborative care models with health systems, or specialty medical homes. Through these collaborations, organizations will have access to a more comprehensive data set and be better positioned to get the data needed to show the value of a whole person care model. The second path is: focus on diversion, prevention, and re-admissions. If specialty provider organizations can show that programs are preventing hospitalizations, emergency room visits, or even incarcerations, they can demonstrate global savings to health plans.
Finally, health plans have been operating a wide array of VBR arrangements—and they are seeing more results. During the session, the faculty shared results from integrated bundled payment pilot programs, which have resulted in reductions in average length-of-stay (LOS), inpatient admissions, hospital readmission rates, and emergency room visits; improvements in follow-up after hospitalizations; and reductions in overall cost of care.
Terry Trafton says, "It is clearly evident that CommCARE’s Independent Practitioners Association must continue working to build network contracts that consider the evolving movement towards value-based care and continue to make the appropriate movements with our partnerships for collaborative care and enhancements in whole person health, improve outcomes data, and reduce costs across the continuum. Having our own cost and performance data is the key for the total population we are serving."
