In a time of disruption – both financial and technological – the ability to innovate is key to the sustainability of health and human service organizations. Typically, these innovations are focused on some part of the value equation, increasing the competitive advantage of the organization (see The (Inescapable) New Value Equation In Health & Human Services: Why It Will Determine Who Succeeds and Improve Your Value Equation: Planning For Turbulence In 2017).
But innovation is slow and takes hard work in the field. Answering the big question – what is the state of innovation in the health and human service market today? – has been the focus of a lot of my work in recent months (see ‘Agile Innovation’ Needed For The Challenges Ahead and Disruptive Versus Evolutionary Paths To Growth – The Strategic Question).
Recently I had the opportunity to speak to someone who is spending a lot of time thinking about innovation in the field – Peggy DeCarlis, MSSA, LCSW-C, Senior Vice President and Chief Operating and Innovation Officer of New Directions Behavioral Health. There were a couple of big takeaways from our discussion. Her role includes directing the organization’s clinical and network strategic focus, so it was interesting to consider her “top priorities” for innovation. She explained:
New Directions serves nearly 13 million commercial insurance members for seven Blue Cross Blue Shield Plans –1.5 million of those lives are Exchange or Medicaid Expansion members. For both populations we focus the majority of our resources on those who are complex and high cost, or at risk of becoming high risk. Traditional behavioral health networks are not structured for those members who need our support the most. The 50-minute hour and inpatient bed do not begin to address the complexity of health, substance use, mental health, and social needs these members exhibit. We have realized over the last several years that we need to change the landscape of our networks to address these members. We craft and map services to population need: substance use and co-occurring disorder members, kids and families, members with serious mental illness, and all of these populations who have medical co-morbidities.
To optimally serve these populations, we are looking for providers who can successfully engage with members and their support systems to reduce readmissions, address the social determinants that impact community tenure, and deliver evidence-based programs that produce member-centric, effective outcomes.
New Directions is evaluating provider organizations on their use of evidence-based practices. What are the specific practices you are looking for?
Two examples are evidence-based substance abuse treatment and evidence-based early identification and treatment of schizophrenia. The first includes an increase in the availability of Medication-Assisted Treatment (MAT) providers; and collaboration with treatment providers.
- Medication-Assisted Treatment: MAT for detoxification and/or maintenance can be provided in office-based settings by qualified physicians who have received a waiver from the Drug Enforcement Administration (DEA), allowing them to prescribe it. The availability of office-based treatment for opioid addiction is a cost-effective approach that increases the reach of treatment and the options available to patients. Research has shown that MAT is more effective when it includes individual and/or group counseling, with even better outcomes when patients are provided with, or referred to, other needed medical/psychiatric, psychological, and social services (e.g., employment or family services).
- Evidence-based early identification and treatment of schizophrenia, includes an increase in the availability/access to coordinated specialty care (CSC). CSC is a recovery-oriented treatment program for people with first-episode psychosis (FEP). CSC promotes shared decision making, using a team of specialists who work with the client to create a personal treatment plan. The specialists offer psychotherapy, medication management geared to individuals with FEP, family education and support, case management, and work or education support, depending on the individual’s needs and preferences. The client and the team work together to make treatment decisions, involving family members as much as possible. The goal is to link the individual with a CSC team as soon as possible after psychotic symptoms begin.
What is an example of a non-traditional partnership you’ve developed with a provider organization in your network?
We are the first managed behavioral health organization to work with traditional community-based mental health organizations (primarily CMHCs) to develop programming for the commercial market – both in Florida and in Kansas City. We have developed post-acute bundles of services that cover in-home therapy provided by a licensed clinician and targeted case management in a single rate. We currently have seven Florida behavioral health homes (BHH) and a similar program in Kansas City, to serve high-risk members. We also have a partnership with Genoa Pharmacy – again the first MBHO to work with them on the commercial side. For those that don’t know them, Genoa specializes in behavioral health and provides on-site pharmacy services through CMHCs. They act as a pharmacy extension of our case management team to enable med adherence.
To continue this discussion, be sure to join us at The 2017 OPEN MINDS Performance Management Institute on August 17 when Ms. DeCarlis delivers the plenary address, “Redesigning Behavioral Health For The Future: The New Directions Approach To Building A Better Care Delivery System.” The need for provider organizations to develop new and innovative answers to today’s most pressing questions is one of the top priorities facing today’s health care leaders.