There was much discussion this week at The 2018 OPEN MINDS Executive Leadership Retreat about the meaning of the word “integration” and the impact of integration on the health and human service organizations in terms of both finances and culture. But integration has different meanings to different stakeholders in the field. The consumer perspective, the provider organization perspective, and the health plan perspective are all quite different.
For many provider organization executives, integration means integrated service delivery and the clinical practices necessary to deliver physical and behavioral health services at the same place, at the same time. But the health plan perspective on integration has a slightly different framework—one that is important to strategy for all stakeholders in the health and human services market. I was reminded of the key takeaways from the keynote address, Integration, The End Of The Carve-Out & The Importance Of Financing – The Health Plan Role In Facilitating “Whole Person” Care, by Devan J. Cross, President, MHN, a subsidiary of Centene at The 2018 OPEN MINDS Management Best Practices Institute. He shared that “integration” for MHN means the ability to coordinate consumer care across all service delivery systems – physical, behavioral, pharmacy, and social supports.
Mr. Cross described his work with the MHN to create a more consumer-centric integrated delivery system model. The model has three primary elements:
- Real-time data exchange between all stakeholders
- Streamlined care coordination using a primary case manager assigned based on a consumer’s specific needs
- Systems that assure that primary care professionals (PCP) can “easily” refer to behavioral health services
The MHN model uses an integrated data exchange to create a “complete picture” of the consumer. And, the consumer’s primary case manager is assigned based on their specific needs or conditions—which allows behavioral health professionals to serve as the primary case manager for consumers with mental illnesses and addictive disorders. MHN is also setting up systems that provide easy access to behavioral health services—including making sure that PCPs are educated about how to access behavioral health services for consumers; call centers to streamline access and appointments for behavioral health services; and improving the follow-up process after a PCP administers a PHQ9 assessment. He noted:
I don’t think there is single silver bullet for it. A lot of education efforts are needed, and we have to make it really easy for them to reach us. Do the PCPs know they can call us, and then we will help make an appointment with the member, rather than the member having to go on their own? How are we going out of our way to help that member? What I want to see is, if a PCP administers a PHQ9, are we then connecting back to help that member with that? If we can’t get that connection, we aren’t making that path any easier.
My other big takeaway from our discussion is that for health plans, an integrated model of consumer care doesn’t necessarily save money “out of the box.” It takes time, forcing health plan executives to make a commitment to “whole person” care as better for the consumer, even if the consumer moves to another health plan in a couple years. Mr. Cross noted:
Overall, the health care industry is recognizing you can’t separate the heads from the bodies. There is a recognition financially that it makes sense to have an integrated care model. When it’s coordinated, it can have a reduction of cost-but in the long run. That last one is hard, as it’s a long-term play. Who can say your consumers will be covered by your plan in the future? One has to take a holistic approach to buy into the long-term approach, and maybe even do it for the greater good. This is the risk you would take in an integrated model. Maybe the justification can’t be primarily financial, and if you get a return-on-investment, that should really be a secondary bonus.
What are Mr. Cross’ plans to move forward with integration based on superior real-time data sharing and interoperability? And what type of integration model are we most likely to see in the next five years? Mr. Cross noted:
You are going to have more single plans with behavioral health integrated. The carve-out as a separate entity, will become less and less of “a real thing.” Those that are carve-outs will need to have data exchange, transparent communication, and support for physical health providers—it needs to be as seamless as possible.
What we are doing right now is looking at the whole system — we are moving into a model where we have integration of our management team. That team is part of one health plan, not a subsidiary health plan. And, our physical and behavioral health case managers are in the same group, working in real time.
The reality is that, as a health plan, we aren’t at point of service. It’s the PCPs and therapists that actually deliver care. The level of trust is greatest with the clinical professional—its not the health plan. Our role really is to break down the barriers for those people who are delivering the care. That’s where the real key is. There is a lot of work around social determinants of health (SDH), and we are doing things with an eye on that. As we work to more integration, there is an understanding that preventative care across the whole body, even if we don’t realize the cost savings, is better for the consumers’ overall health in the long run.
I think that as we look ahead, it’s clear that the value proposition (and key elements) of the shared consumer, professional, provider organization, and health plan goal of integration is a work in progress. Mr. Cross left us with this advice for provider organizations who are trying to navigate these two worlds: ask yourself – is this program or innovation a financial benefit under the current billing structure and how can I pivot this program to be financially sustainable in the future?
For more on integration, join me at The 2018 OPEN MINDS Technology & Informatics Institute, in Philadelphia, Pennsylvania on October 23 for the session “The Systematic Approach To Integrated Health Care: The Data You Need To Make Primary/Behavioral Health Integration A Success” featuring Joseph P. Naughton-Travers, EdM, Senior Associate, OPEN MINDS; Christy Dye, Chief Executive Officer & President, Partners in Recovery; Bill Maroon, Organizational Development Specialist, Business Development Team, Resources for Human Development (RHD); and Emily Nichols, MPH, Director of Operations, Resources for Human Development (RHD)/Family Practice Counseling Network.