Building The ‘Next Generation’ Behavioral & Social Service ACO

Executive Briefing | by | February 20, 2017


Monica E. Oss
Monica E. Oss

“Chance favors the prepared mind.” – Louis Pasteur

This quote came to mind last week at The 2017 OPEN MINDS Performance Management Institute as I listened to James McCreath, Ph.D., vice president of Behavioral Health & Psychiatry at Trinitas Regional Medical Center, during his keynote presentation, Using Innovative Provider Partnerships For Strategic Success – How Two Provider Organizations Built A Statewide Integrated Behavioral Health Network.

Dr. McCreath opened the second day of the institute with his perspectives from the recent creation of a multi-health system integrated behavioral health network — the Trinitas-St. Joseph’s Behavioral Health Network in July 2016 (see Trinitas & St. Joseph Hospitals Form Behavioral Health Network). The network is the result of a collaboration between Elizabeth, New Jersey-based Trinitas Regional Medical Center and Paterson, New Jersey-based St. Joseph’s Regional Medical Center.

Dr. McCreath presenting at The 2017 OPEN MINDS Performance Management Institute

My big takeaway from Dr. McCreath’s presentation was the importance of strategy. Not the strategic plan that sits on the corner of your desk. Rather, the constant focus on the long-term vision for the organization that helped Dr. McCreath and his team expeditiously develop a strategic partnership that has created the largest behavioral health integrated delivery system in the state. When the right partner came along, Dr. McCreath was able to not only recognize the opportunity – but to act.

The right partner, in this case, was St. Joseph’s Regional Medical Center. With strategy in hand, Dr. McCreath was able to work with the St. Joseph team and create the new organization in less than six months. The path that he chose was to start with a Management Services Organization (MSO), a relatively uncomplicated relationship that was not too disruptive to the two very large health systems. This enabled the working relationship to launch quickly and provided a focus for the initial collaboration. This is the “crawl, then walk, then run” approach to making strategy work – the need to “get started” on the possible rather than wait for the perfect (see The Value Train Has Left The Station).

The long-term goals of the new organization are three-fold. First, prepare for value-based care and move beyond fee-for-service (FFS) while getting beyond the current geographic footprint of the two health systems. Second, increase the systems role in providing integrated service delivery with behavioral health and primary care. Finally, create a framework for the long-term financial sustainability of the behavioral health services within its two parent hospital systems.

One competitive advantage of the newly-created organization is their immediate “statewide” footprint. The new organization has four statewide tech-enabled programs: the CARES program (Crisis Assessment Response and Enhanced Services) provides behavioral health crisis services to consumers with developmental disabilities; the S-COPE (Statewide Clinical Outreach Program for the Elderly) program provides crisis response and behavioral health services to seniors living in nursing homes; the ACCESS program, which provides mental health services to consumers with hearing impairments; and a ten-bed acute inpatient unit for adults with a dual diagnosis of developmental disabilities and a mental illness from across the state. As Dr. McCreath described it, their plan is to “hang more programs” off of this existing statewide infrastructure.

This year will see a few key developments for the Trinitas-St. Joseph’s Behavioral Health Network. First, there will be a big focus on collaborative care — working with the many private practices owned by the two health systems on the development of collaborative care models. And, secondly, a plan to leverage the network’s 40-plus psychiatrists, encouraging them to provide services to other provider organizations. And, lastly, the network is creating private practices for commercial insurance and self-pay consumers. To do this, Dr. McCreath’s focus is not on capital for beds, but on capital for operating expenses to expand community-based programs. His reasons are straightforward — the payer demand for more intensive community-based services and the need for fewer inpatient beds.

The Trinitas-St. Joseph’s Behavioral Health Network is a great example of the “next generation” behavioral health and social service delivery model described in Mr. Wheelan’s keynote, Emerging Medicaid Performance Expectations – How They Are Shaping Future Payer/Provider Relationships — a behavioral health and social service ACO focused on the needs of complex consumers. I think this is an emerging model that we are likely to see more of as the use of value-based reimbursement in the health system matures.

For more, don’t miss these exciting presentations on these innovative value-based reimbursement models: “ACOs & Chronic Care Management: The Importance Of Behavioral Health In The Move To Population Management,” “Finding New Opportunities With Health Plans: How To Market To Managed Care,” “Key Competencies For Population Health Management: Preparing For Value-Based Reimbursement,” and “There Is No Plan B: How To Demonstrate Your Value & Create The Collaborations That Matter In A Changing Market,” on June 6 and 7 at The 2017 OPEN MINDS Strategy & Innovation Institute in New Orleans.

 


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