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By Monica E. Oss

What is top of mind with thought leaders who are focused on the behavioral health/physical health integration? Four words—engagement, access, availability, and partnership. That was my takeaway from the recent discussion with Charles Gross, Ph.D. the Vice President Behavioral Health/Physical Health Integration at Anthem Blue Cross Blue Shield. Dr. Gross is responsible for helping promote access to integrated services for more than 8.2 million combined Medicaid and Medicare covered lives, as well as 19.4 million commercially covered lives. A big task in a changing market landscape.

In April of last year, Anthem released an update on its network contracting—nearly 60% of its health plan spending during the first quarter of 2017 had been through value-based care arrangements, including over 64,000 provider organizations participating in accountable care organizations (ACO) and patient-centered medical homes (see Anthem Blue Cross Nears 60% Value-Based Care Spending). Anthem has also been in the news with some groundbreaking developments. Earlier this month, Anthem acquired Medicare Advantage plans, HealthSun and America’s 1st Choice (see Anthem Acquires HealthSun and Anthem To Acquire America’s 1st Choice). They also were selected as one of the new Medicaid health plans in Virginia (see Virginia Medicaid Selects Six MCOs For Medallion 4.0 Integrated Physical & Behavioral Health Contracts). In October, Anthem announced a partnership with CVS Health to launch a new pharmacy benefit manager (PBM) company to be called IngenioRx— (see Anthem Partners With CVS To Start Its Own Pharmacy Business, IngenioRX).

Charles Gross, Ph.D

We had the opportunity to spend some time with Dr. Gross and get his perspective on where behavioral health in general, and managing the care for consumers with complex needs, fits in Anthem’s evolving and growing health system.

From Anthem’s perspective, what are the most pressing population health/care coordination issues you face?

Let me give you the Anthem behavioral perspective on this issue—although I have to say, I think the issue I am highlighting is one shared across the population health universe. So, from the behavioral health perspective, the most pressing issue is “engagement.” And by that I mean, how can Anthem, or for that matter all health care organizations (I would include in this category, providers or provider-owned organizations), authentically engage consumers in their health journey. We, like many organizations in the health care space, have very sophisticated predictive models, that can, with ever increasing accuracy, identify people at risk of developing significant health issues and also identifying consumers with a high likelihood of having their current health condition get worse. The question, the pressing problem as you describe it, is then how to engage that identified person? Engage them in a way that leads to significant changes in behavior that, in turn, leads to improved health outcomes.

What is Anthem’s vision for their provider network management in the years ahead?

Speaking from a behavioral health perspective, provider network management has at least two dimensions to it. First, there is the issue of access and availability. From a behavioral health perspective, this is a work force issue. There are simply not enough behavioral health providers—and this issue is particularly impacted when both geography and specialty are considered. So, one dimension is working as hard as we can to identify and contract with the number and types of behavioral health providers we need. And, in addition, where in those areas where there are simply not enough providers, that we develop and bring to bear other channels via which access to various forms of behavioral health services can be obtained. Anthem is working hard on all aspects—including digital solutions that increase access and availability of behavioral health services.

The second aspect of provider network management has to do with many of the other issues we are talking about. It involves redefining the term “provider network management” which is what you asked about. I would say the second dimension is a shift from “provider network management” to “provider network collaboration.” In the latter, we are moving from the top down relationship implied in the term “management’ to a collegial, conversational relationship. Think of Anthem moving from behind the desk talking to a provider on the other side, to an image of Anthem sitting alongside the provider, working collaboratively on improving health outcomes. Are we there yet? No. Are we committed to that change? I would say absolutely, yes.

What types of value-based reimbursement models for providers does Anthem have in place today?

I like to think of a spectrum of relationships. At one end, traditional fee-for-service models—at the other end, full-risk relationships. Populating the broad middle, a variety of fee-for-service plus quality bonus relationships. And, the bell curve image may be helpful here as an organizing image. Historically, the payer provider contracting relationships were a strongly right-skewed distribution. Currently, we are for discussion purposes in a period where the symmetric bell curve approximates where payer provider contracting stands—with the normal portion of the curve accounting for all sorts of different pay-for-performance or fee-for-service + quality bonus contractual relationships. I think the future of payer provider contracting will continue the curves move to the right—leading to a distribution that is skewed to the left—and I always had to slow down in stat class to get this right. An increasing number of provider contracts will move toward the value-based end of the spectrum, leaving the “long tail”, the skewedness, trailing off to the left. I also think it is very important to think beyond “value”- by that I mean that simply paying for “value” tied to specific outcomes is good, but not the end point.  I think the behavioral health-payer relationship needs to quickly get away from just paying for “value” and toward paying for the health care of the consumer, within of course the benefit design, from a more whole person perspective. 

What are health plans looking for from behavioral health provider organization partners?

This is an interesting question that I think we should rephrase, as that will get to one of the core issues here. Rather than thinking of what “health plans” are looking for from behavioral health provider organizations, I would like to think of this question as “What should health plans and behavioral health provider organizations look for in each other as potential collaborators?” By changing the question in that way, I am trying to get to the notion that both organizations need to get what they need from one another if the relationship is going to flourish. And by flourish, I want to emphasize that I am including a time dimension as well.

From Anthem’s perspective, we are looking for behavioral health provider collaborators who are looking for the same thing—a relationship that can be constructed to flourish over time, with the mutual shared goals of improving health outcomes—and doing so in a way that also meets both party’s goals. Not an easy task, and I hope my behavioral health provider potential collaborators hear in this my intentional effort to resonate a bit with all the deep and solid work that comes out of more traditional psychotherapy research; that is, the relationship, as experienced by both parties, is the key to all successful joint undertakings, whether they be payer-provider relationships, psychotherapeutic relationships, or marital relationships. We want a collaborator we work with over the long haul—and we want a provider who is looking for similar things from us.

For more on Dr. Gross’ perspectives on the future of behavioral health collaborations with health plans, join me on June 6 at The 2018 OPEN MINDS Strategy & Innovation Institute for his plenary session, “Going Beyond Innovation-Developing Collaborations with Health Plans”—and for a thought leader session with Dr. Gross immediately following his presentation.

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