Last week we had a great time in New Orleans at The 2017 OPEN MINDS Strategy & Innovation Institute, where among other things, we talked about the importance of innovation in the current health care market (see ‘Agile Innovation’ Needed For The Challenges Ahead). One of the big issues that surfaced again and again over the course of the institute was how provider organizations can work with payer organizations to implement innovative programs and treatment models.
In the session, Together Is The Way Forward: Creating Successful Patient-Centered Outcomes Through Creative Payer & Provider Partnerships, we heard from one payer/provider partnership about the keys to making collaboration work. The session featured Melissa Norris, BA, Executive Director, Psychamerica Behavioral Services, LLC / Big Bear Behavioral Health, Inc.; and Darryl Donlin, LCSW, MBA, Vice President of Network Operations, New Directions Behavioral Health. Big Bear Behavioral Health is a Florida-based non-profit provider organization, providing mental health outpatient services and targeted case management for children and adults. New Directions provides managed behavioral health services, employee assistance program (EAP) services, organizational consulting, and health coaching to private and public health plans.
From Mr. Donlin’s perspective, the key to building a relationship with health plans is to start by identifying the big “pain points” for the payers you work with (or ones you’re hoping to work with in the future), and then consider how your organization can deliver services or programs that will meet their needs. In our current market, health plans are struggling with rising costs, high readmission rates, and complex consumers with comorbid medical conditions and social support needs. When approaching a health plan, it is essential to keep those factors in mind and be prepared to discuss how your organization will help to address those challenges. To that point, Mr. Donlin recommends finding the answers to five key questions before building a health plan proposal:
- What are your “pain points” to managing care for complex members?
- Are you satisfied with the outcomes your provider network is delivering?
- What are the barriers to compliance with the aftercare plan?
- What solutions do you have to overcome those barriers?
- What “go-to” resources do you use in the community?
For many specialty provider organizations, getting answers to these question will spell the difference between investing in treatment solutions payers don’t want and need – or being the “leader of the pack” in an industry-wide race to fill gaps in systems of care, reduce costs, and deliver the kind of performance that can reward both yourself and your payer. The reality of the market is that each payer will give you a different answer (if they will give you an answer). However, it’s safe to expect certain topics – high-level acuity, rising costs, high readmission rates, social determinants undercutting treatment goals, and hard-to-treat medical conditions – that are all common challenges facing payers.
Mr. Donlin noted some mutual goals provider organizations can focus on, including: make access to care convenient; overcome social determinants of health; close gaps in care; emphasize holistic care; and increase member engagement.
Mr. Donlin and Ms. Norris shared how they tackled these five questions. New Directions wanted to improve access to care and increase member engagement through a more holistic model. Doing so would help close gaps in care. The solution turned out to be a commercial behavioral health home (BHH). Under this model, Big Bear received a bundled payment to manage care for commercial-insured consumers with behavioral health needs. The program focused on a consumer-centric approach, addressing all of the person’s needs (not just mental health). Under this model, Big Bear was able to demonstrate reductions in 10-day, 90-day, and 6-month readmissions.
From a strategy development perspective, here are a few key steps that Big Bear Behavioral Health followed that translate well for all specialist provider organizations looking to form new partnerships with payers: First, build the services lines that can “solve” the payers’ problem and develop a clear value proposition and performance metrics for your program/services. Second, work to build relationships with key payers and partners in your market. Once you have a strong relationship and a strong program model, you will be able to work with payer partners to “customize” your programs, your program management, and your reimbursement to meet their needs.
Looking for more, but couldn’t attend The 2017 OPEN MINDS Strategy & Innovation Institute this year? Catch up on our coverage on Twitter @openmindseditor – #OMInnovation.