Well, the results are in. A survey of the health plans focused on their management approaches for better serving consumers with behavioral health disorders and complex support needs brought a few results that surprised even me. The big takeaways? Specialty care coordination, access, and value-based partnerships are at the top of the list.
The survey results were published in a just-released report, Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System, issued (and available at no charge) from the collaborative efforts of Otsuka America Pharmaceutical, Lundbeck, and our team at OPEN MINDS. This is the second survey of every U.S. health plan—commercial, Medicaid, and Medicare—and for strategists, a great snapshot of where health plans are now compared to just 24 months before. Here is a summary of some of the “big picture” findings.
Innovative approaches to care coordination are growing—Health plans are investing in specialized approaches to managing the care coordination of consumers with complex needs. The proportion of health plans reporting specialty care coordination programs increased from 23% to 73% in two years. There were also increased use of behavioral health readmission prevention programs (from 15% to 89%) and emergency department diversion programs for (from 15% to 58%).
Moving beyond pay-for-volume—Value-based benefit reimbursement for behavioral health and for complex consumers continued to increase. The health plans reporting using some pay-for-performance reimbursement increased from 86% of all health plans to 93%. But the more important development was in the use of reimbursement models with more risk. Bundled payments have increased from 39% to 59%; 60% of health plans reported using case rates and 64% had some form of provider capitation.
Consumer access to behavioral health is key—Developing access strategies that help consumers get behavioral health services faster is high on the list. Eighty-five percent of health plans are using telehealth and 70% have instituted “quick access” programs; 78% are providing support for appointment scheduling.
And, beyond improving access for consumers who self-identify with behavioral health needs, 84% of health plans reported having strategies to identify consumers with behavioral health needs (compared to 16% in 2017) and promote early intervention. This reflects a growing trend to use analytics to identify those consumers, with 90% of health plans making an investment in population health-focused analytic systems.
For consumer engagement, think technology—Health plans are increasing their investment in consumer engagement, with significant increases in engagement-focused technologies. Fifty-nine percent have adopted some type of engagement strategy for consumer with complex needs, 35% of health plans reported investing in on-line tools (up from 21% in 2017). Investment in mobile apps went from 9% to 38% in the same time period, and consumer self-management tools are up from 15% to 23%.
Investment in initiatives to improve quality of care for consumers with behavioral health conditions growing—In addition to these investments in care coordination, access, and engagement, health plans also reported investing in several programs to improve quality of care. Health plans reported exploring a number of concepts: behavioral health centers of excellence (85% of plans), patient-centered medical homes (86%), peer-directed service credentialing (51%), peer-directed service network inclusion (51%), provider rating transparency (53%), provider cost transparency (52%); and narrow tiered network designs (63%).
At this point in time, the programs that health plans put in place to serve consumers with chronic conditions and complex needs are critical to provider organization strategy. There are two related reasons—most of those consumers get their health services through a health plan and those consumers use about 90% of the service resources.
So, what are the implications for provider organizations strategy? First, consumer performance metrics are critical to be a preferred health plan partner—how easily (and fast) can consumers get appointments? How engaged are those consumers in managing their health? And, the ability to accept non-traditional reimbursement (performance-based, value-based, etc.) is a requirement—particularly for competing for contracts for the more innovative programs. Lastly, the impact of technology on the consumer care continuum continues, with more disruption to traditional services models ahead.
For a very deep dive, download your own copy of the new survey results—Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System. And for more on marketing to and managing your relationships with health plans, check out these resources from the OPEN MINDS Industry Library:
- The Impact Of Opioid Use Disorders & The National Response
- Adjust Your Strategic Sails!
- Getting On The Marketing Plan Path
- The New Board Conundrum—Managing Value
- The Five-Step Process To Demonstrate Your “Performance” To Health Plans
- Becoming A ‘Blue Chip’ Provider Organization
- The OPEN MINDS Health Plan Partnership Summit: A Guide To Developing & Negotiating Partnership Agreements With Health Plans
- From Pain Point To Revenue
- Selling Social Services To Payers & Health Plans: A Step-By-Step Approach
- Health Plan Business Development For The Entrepreneurial Provider Organization—Step-By-Step
For more on adapting to the fast-paced change in today’s health and human services field, join me on September 12 for The 2019 OPEN MINDS Executive Leadership Retreat session, “Executive Strategic Role Becoming The Agent Of Change For Your Organization”, featuring Joseph P. Naughton-Travers, EdM, Senior Associate, OPEN MINDS.