Many executive teams of provider organizations are scrambling to make integrated care models work – both from a consumer experience perspective and from a financial sustainability perspective. This challenge includes both integrated care delivery providing primary and specialty care at a single location, and integrated care coordination models like medical homes. But the same challenges apply to payer organizations – particularly those that are managing behavioral health “carve out” programs.
How are these payers addressing the integrated care models? I learned a lot about this issue from our three faculty members – Dan Berger, Director of Business Architecture, Optum Specialty Networks; William Lopez, M.D., CPE, Lead Medical Director, Cigna Corporation; and Lyndra J. Bills, M.D., Regional Medical Director For Physical Health/Behavioral Health Initiatives, Community Care Behavioral Health – during their presentation How To Create Successful Partnerships With Managed Care Organizations: The Payer Perspective On Integration & Medical Homes at the 2014 OPEN MINDS Planning & Innovation Institute session.
What is the advice from the payer perspective? I came away with four take-aways from the session.
Your organization needs to fit into the systems of care being designed by payers in specific geographies and plan types – This is the big strategic issue. What are payers looking for? My colleague Monica Oss has addressed this question, and the need for a winning “vertical” strategy (see Implementing Strategy With Rapid Innovation In Mind and The Disruption Of Strategy). If you work around integrated care long enough, you quickly realize that “when you’ve defined one integrated model, you’ve defined one integrated model.” Vertical positioning takes adaptability, knowing what your managed care partners are looking for, reviewing your strategic plan related to your competencies, and making the adjustments needed to perform in the model you choose.
Successful integrated care demands new tech functionality – Whether your organization is collocating a wide range of services, or managing them, the technology needed for both communication and analytics is changing. Our team has written extensively about the new tech requirements for integrated care and value-based purchasing (see Finding Success With Capitation, Care Rates, & Integrated Care: How Technology Can Reduce Costs & Promote Accountable Care and A Guide To Using Technology In Integrated Care Settings – Telehealth, Remote Monitoring, Online Therapy & More). Some of the key functions include having a single source of relevant clinical information for each consumer; the ability to analyze data; the facilitation of asynchronous collaboration; decision support for clinical team members; and, automation of administrative tasks to reduce overhead costs.
Quantifying your organization’s value to consumers and payers is essential – Both of your customers (the consumer and the payer) are looking for value in their health care service system. To compete, your organization needs to know your statistics and how your organization “stacks up” against others. (For more on how your executive team can approach competing on value, see The Shifting Health & Human Service Value Chain – The Strategic Earthquake and Integration Model Decisions Are Strategy Work At Its Most Fundamental).
Training of your clinical team needs an overhaul – Whether your team is now delivering a wider array of services, or managing care for consumers, the skill sets required are changing. We have covered some of the changing team training issues in Six Challenges To Primary Care Integration and Clinicians As Managers, In An Integrated Setting. Investing in developing the team that can make the new strategy a reality is another essential element.
Finally, what struck me in the session was that different payers are developing a wide array of care models. That makes market intelligence, payer market profiles, and strategy development a critical component of your investment decisions.
For more, on this topic, check out the white paper, What Primary Care Can Learn from Behavioral Healthcare (and Vice Versa). And, for more, don’t miss the presentation Integrated Care In Practice: How Primary Care Practices & FQHCs Are Providing Mental Health Services & Integrated Care Delivery, at the upcoming California Planning & Performance Management Institute.