Earlier this year the Feds doubled down on pay-for-value – and their commitment to linking payments to alternative payment models, such as accountable care organizations (ACO) (see Medicare Bets Big On Pay-For-Value). And while most ACOs are responsible for behavioral health services, how those services get delivered is far from uniform – from managing care entirely within the ACO, to contracting with a network of independent provider organizations.
Recently I had a chance to listen in on how the ACO market is changing service delivery, and managing and delivering behavioral health care services for their members, in the session Where Do Behavioral Health Organizations Fit In The ACO Landscape? A Review Of Emerging Accountable Care Models – led by OPEN MINDS Senior Associate Joseph P. Naughton-Travers, Ed.M., and featuring Suzanne Kieltyka, Health Education Manager, Summit Strategic Solutions; Aaron McHone, Executive Director, Unity Point Health – Berryhill Center; and Sharon Sidell, Ph.D., Executive Director, Be Well Partners in Health, LLC.
What did I learn during the presentation? First, although a majority of ACOs are responsible for providing behavioral health services to their enrollees, about one third have no formal relationships with a behavioral health provider (see The Current State Of Behavioral Health In ACOs). Second, many ACOs attempt to provide as much case management and specialist services within their own system as they can. Finally, getting the ACO/behavioral health provider partnership right takes a lot of trial and error.
Suzanne Kieltyka presented her work at Summit Strategic Solutions, a management services organization (MSO) that operates as part of Summit Medical Group, a physician-owned multispecialty practice consisting of 218 physicians, 141 advance practitioners, 54 locations, and 275,000 primary care patients. Summit Medical Group operates as a Medicare ACO and utilizes a primary care behavioral health (PCBH) model. Under this model, up to 90% of behavioral health issues are managed in primary care, but individuals with complex, long standing mental disorders are referred to specialists. Summit’s biggest problem has been finding the right behavioral health provider organizations to fit in their model – organizations whose services are “scalable” and can keep up with the their growth in population.
Aaron McHone, Executive Director of Unity Point Health – Berryhill Center, a mental health program within the Unity Point health system. Unity Point operates a Medicare ACO and participates in the state of Iowa’s Medicaid ACO program. As part of this ACO system, Berryhill has been part of delivering integrated behavioral health and physical health services for ACO beneficiaries. The keys to that integration? A lot of trial and error. Berryhill Center tried co-location with one of their ACO partners, an FQHC, but it didn’t work because they utilized a “strip mall model,” rather than an integrated care, approach to co-location. Mr. McHone also noted that behavioral health provider organizations have to be willing to negotiate with ACOs and take a risk. Behavioral health provider organizations cannot expect to share in an ACO’s savings if they are also not willing to take a certain percentage of the downside risk.
Sharon Sidell, Ph.D. presented her work at Be Well Partners in Health, an Illinois-based, ACO-like coordinated care network that is managing services for adult Medicaid beneficiaries with serious mental illness who may also have concurrent medical issues, substance use issues, or a developmental disability. In Illinois, care coordination entities (CCEs) are a group of provider organizations that coordinate care for Medicaid complex consumers and are paid a per member per month (PMPM) care coordination fee. However, Illinois Medicaid is in a state of transition and the services provided by these CCEs are being folded into the state’s Medicaid managed care program. This means that Be Well is currently looking to contract with managed care organizations to provide intensive care coordination for special populations. Dr. Sidell noted that an important part of managing care for the SMI population also includes social supports, such as assistance with applying for and maintaining public benefits; assistance in locating and acquiring housing, food and clothing; and assistance with budgeting of monthly income, paying the bills and money management.
Given all of this experience, what was the best advice from our panel for integrating with an ACO? Develop organizational corporate relationships by reaching out to executives managing ACOs with a proposed model for addressing behavioral health for their members. Our panelists suggested these tips when talking with a potential ACO partners:
- Provide both “head” and “heart” reasons for your partnership. Data is critical to an ACO, but they also want to know what is in it for their consumers.
- Be clear about the geography that your organization can cover. A partnership won’t work if consumers aren’t willing or able to travel to your practice.
- Be willing to take on some risk. This is a business model, and you’re going to have to be willing to help front load some of the cost. Acknowledge that the ACO may not be able to pay very well, but that you understand the benefits of the increased number of referrals to your practice.
ACOs are of increasing importance for specialist strategy in the field. Their numbers and coverage are increasing (see In “Accountable Care”, Who Is Accountable For What Consumer?)and CMS Data Show Medicare ACO Programs Generated $237 Million In Savings During First Year). One thing we can be sure of is that the ACO model is here to stay – meaning behavioral health provider organizations must find a way to work with the ACOs in their area.