The keynote address by Peggy DeCarlis, Senior Vice President and Chief Operating & Innovation Officer for New Directions Behavioral Health, last week at The 2017 OPEN MINDS Management Best Practices Institute, reminded me of how policy and incentives trickle down from payer, to health plan, to provider organization, and to clinical professional.
New Directions serves as manager of behavioral health benefits for seven Blue Cross Blue Shield Plans, with over thirteen million covered lives. Her team manages the benefits of a broad swath of Americans, including those on Medicare, Medicaid Expansion, and commercial health plans, as well as those on the Patient Protection and Affordable Care Act’s health insurance exchange. Managing a large exchange population has changed New Directions strategy for its provider network. In her keynote address, Redesigning Behavioral Health For The Future: The New Directions Approach To Building A Better Care Delivery System, she spoke of how, over the past three years, New Directions has found that the exchange population resembles the Medicaid population more than the commercial population, with a higher rate of behavioral health issues, particularly opioid abuse, poor health self-management skills, social isolation, and significant issues with social determinants.
Her vision is to move the company’s behavioral health network from a traditional commercial network design with outpatient therapy and residential/inpatient coverage, to services that are specific to the exchange population’s particular needs. Such services are found in innovative community mental health centers across the country. In the addiction treatment area, she discussed expanding the network to include community-based, medication-assisted treatment models and in-home addiction support programs.
New Directions is using analytics to better understand the needs of segments of their population and to develop innovative support programming for them. For some of the population, they are expanding their behavioral health home (BHH) model. Included in this BHH model, which delivers warm hand-offs at discharge, in-home services and intensive case management, is the development of a bundled payment to provide episodic, post-discharge care coordination programs. The company is also considering innovative systems approaches to working with children and their families, with the goal of keeping youth in their family and community.
Additionally, New Directions is looking to make investments in housing support organizations as part of a broader Housing First orientation.
In the discussion session that followed her keynote, Ms. DeCarlis described the company’s planning process for making this network transformation. She is looking for proposals from provider organizations to deliver these new approaches in one of the seven markets (Florida, Arkansas, Alabama, Louisiana, Michigan, Kansas, and Kansas City) in which they operate. The proposals should include not only target populations and service description (including evidence-based practices) but also cost estimates, proposed performance measures, and estimated cost savings. To determine what new programs New Directions will proceed with, she said they are looking to establish pilot projects for proof of concept.
For executives of provider organizations looking to expand their work with health plans, our team at OPEN MINDS has extensive resources in our OPEN MINDS Industry Library:
- The Golden Rule Of Payer Marketing
- The Value Train Has Left The Station
- Five Questions To Ask To Build A Health Plan Proposal
- Getting That ‘Preferred’ Role With Health Plans
For even more, join me on September 27 at The 2017 OPEN MINDS Executive Leadership Retreat for the session, “Meta-Leadership In Action: Partnerships With Managed Care” led by my colleague and OPEN MINDS Senior Associate Ken Carr.