For accountable care organizations (ACO) to be successful in our market, they need to build sustainable partnerships with health plans. And for a specialty provider organization to be successful in the world of ACOs, they need to position their organization to develop strategic relationships with ACOs. Building these relationships was the focus of the session, ACOs & Chronic Care Management: Opportunities For Behavioral Health Organizations In Population Health Management, featuring Rebecca Plonsky, LICSW, Vice President of Development for Integrated Behavioral Health-East and Southwest Region, Prospect CharterCARE, at The 2017 OPEN MINDS Strategy and Innovation Institute.
Prospect CharterCare operates an integrated care system in Rhode Island and is affiliated nationally with Prospect Medical Holdings. Prospect Medical Holdings covers 435,000 lives across six states. The Prospect CharterCARE system in Rhode Island consists of an addiction treatment center, outpatient centers for behavioral health and primary care, and two hospitals. Currently, Prospect CharterCARE operates a Next Generation Medicare ACO, a Medicaid ACO, a Medicare ACO-like structure, and a commercial ACO-like structure. In 2018, the organization is looking to develop another commercial ACO-like structure.
Prospect CharterCARE works with 10 ACOs, with an expected 65,000 lives by the first quarter of 2018 – and Ms. Plonsky talked about the four steps that have enabled her organization to successfully implement multiple ACO contracts with health plans – what she called the “four levers” of success:
Lever 1: Robust Continuum of Care – As an integrated care system, Prospect CharterCARE already had a number of systems in place that allowed them to connect with the full continuum of care, but the organization also focused on building new models of care that would allow for greater care coordination. They also developed deep partnerships and contracts with provider organizations outside of their network, including two community mental health centers. And across their ACO continuum, Prospect CharterCARE has adopted a coordinated regional care model (CRC), based on the evidence-based Collaborative Care Model (CCM), which is endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Psychological Association. This model can include a care manager, a medical assistant, a psychiatric consultant and an LICSW, psychologist, or registered nurse – all led by a primary care physician.
Lever 2: Commitment to Quality – Prospect CharterCARE committed to improving outcomes for both consumers and their clinical professionals. This meant that the organization not only adopted practices that have standardized and validated outcomes (such as the PHQ 2 and 9), but also focused on providing clinical professionals with additional care coordination training and tracking consumer and clinical professional satisfaction.
Lever 3: Willingness to Accept Financial Downside Risk – In order to successfully implement integrated partnerships with payers, Ms. Plonsky said that organizations must be willing to accept 5-10% downside risk or quality withholds. Organizations must commit to winning or losing with their partners. To help guard against potential losses, Ms. Plonsky suggests first implementing a one-year pilot program and asking for full delegation from the insurer.
Lever 4: Develop Strong Partnerships with Insurers and State Leaders – Finally, developing strong partnerships with stakeholders who also have a vested interest in caring for your population is crucial. Sitting at the table and providing insights on how to best serve populations is important as is building trust. When there is trust between organizations, there is a better chance to adapt and change models to best suit the needs of the consumer and the provider organization.
What does this is mean for specialty provider organizations serving complex consumers? We know that among many ACOs, there is a great need for behavioral health services and funding (see ACO & Consumers With Complex Needs). We also know that ACOs are taking many different approaches to meeting this need, with some systems partnering with independent systems and others developing the capacity to provide services internally. Under the Prospect CharterCARE model, they are developing most of the programming for behavioral health within the health systems that own/operate the ACOs – and have deepened partnerships with behavioral health organizations who provide specialized services. For specialty provider organizations, this an emerging opportunity with many potential new roles. To determine where your organization fits in this evolving marketplace, you need to understand not only the ACO’s approach to care management, but also how they are partnering with health plans to manage cost and quality of care.
For more on care coordination for complex consumer populations, join Heidi Waters, Ph.D., the Director of Outcomes Management at Otsuka Pharmaceutical Development & Commercialization, Inc. on July 27 at 2:00 pm (EST) for the webinar, Providing Effective Collaborative Care In Major Depressive Disorder: Strategies & Resources From Otsuka’s Frameworks In Health & Quality Program, discussing the Frameworks In Health & Quality disease management program that is focused on collaborative care for MDD.