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					Introduction to Beacon
Health Strategies

April 28, 2011
Beacon serves 6 million members in 14 states,
10 Medicaid programs and 50+ health plans

   Medicaid                 Medicare      Commercial




              Multi-Sector Health Plans




                                                       2
               Beacon is one of the largest MBHO serving
               public populations in the state of NY

               New York Foot Print                  New York Business Highlights

                                          • Working with Four Health Plan
                         625K               Partners and CCSI/NYCCP
   100%

                      SSI / Duals         • Working with members and providers
     80%                                    since 1998


     60%
                                          • Case Management and quality
                                            improvement partnerships with 7 county
                                            systems
     40%               Medicaid              −Chautauqua, Erie, Genesee, Monroe,
                                              Onondaga, Westchester, Wyoming
     20%
                                          • NY clinical operations based locally in
                                            NY
       0%
                 Beacon's NY Enrollment
                                             − UR, CM and Physician advisors


Confidential                              • 7,000 contracted providers in NY State
                                                                                3
      We provide a full range of clinical management
      services to our clients

  Utilization and Case
                               Population Health             Administrative Services
      Management

• Medical necessity review • Predictive modeling and        • Fully integrated BH
                             informatic case finding          management system
• 3-tiered case                                                 - Financial
  management program       • Total care management              - Clinical
   - Case consultation         - Co-morbid mental illness       - Network
   - Care coordination           and chronic disease            - Claims
   - Intensive case
     management            • Psychotropic drug              • Network creation and
                             intervention program             management
• Follow-up after
  hospitalization          • Depression health              • Provider credentialing
  “Aftercare” program        management program
                                                            • Claims processing and
• Agency/Courts/School                                        payment
  care coordination
                                                            • Call center operations
• NCQA and URAC
  accreditation
                                                                                       4
Beacon’s system of care was developed to serve
deep-end patients in public programs

             BH Inpatient Utilization – Days per 1,000 members


 5,000
                                                                          4,432

 4,000
                                 Beacon’s Core
                                   Business
 3,000


 2,000                                                            1,735

                                                   1,093
 1,000
                                             614
                                      461
             20      75
    0
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                                                                                  5
Quantified correctly, behavioral health
expenditures can be 20% of total spend


                                          3-5%



                                          3-5%




                                          10+%




                                          3-5%

                                                 6
                 Behavioral health co-morbidity drives cost in the
                 highest of the high cost cases

                                                                  Average PMPM Expenditure for
         All MassHealth Members - 2009                               High Cost Cases - 2009

                                                                                +65%
       100%                                                    $8,000

                                                                                         $6,935

        80%                     Other
                               Enrollees                       $6,000


        60%
                   Other                                                  $4,198
                  Enrollees                                    $4,000
                                                                                         PMPM
        40%
                                           •50,000 enrollees
                               High Cost     •$3.2 billion                PMPM
                                                               $2,000
        20%                                    •51% BH
                                              co-morbidity

                  High Cost
          0%                                                      $0
                  Enrollment   Spending                                  Physical     BH Co-Morbid
                                                                        Health Only

Concentration:      5.9%        55.2%
                                                                                                     7
BH and Chronic Disease: A Volatile Cohort


      Cost Variation of Chronic Diseases




                                            8
             Case Study: Value is driven by creating a care
High         continuum and coordinating step-up / step-down



                                                                         Inpatient acute care

                                                                   Crisis Stabilization

                                                           Enhanced Outpatient
Service Intensity




Responsive
                                                             CAITS

                                                 IOP w/out Walls

                                     Partial Hospitalization

                                   Day Treatment

                          Intensive Outpatient
Low




                    Office Based Care




                    Low                 Price of Unit of Service                   High


                                                                                                9
“Diversionary” service penetration increased
dramatically across all lines of business
       NHPRI Percent of OP Utilizers Utilizing Diversionary Services
                (Before and After Service Expansions)

                                                                   Before new services (2002-2005)*
 80%                                                               After new services (2006-2009)*
                       75%

                                           66%

 60%




 40%


                                                                   25%

 20%
                                                          11%

            4%                     4%
  0%
                 CSN                 SubCare            RIteCare / Children




                                                                                              10
Admission rates amongst OP utilizers dropped
with the introduction of new services
                                                         Before new services (2001-2004)*
                                                         After new services (2004-2007)*


       NHPRI Acute MH Admission Rates for Members OP Utilizers
 20%
         (37%)

       16%

 15%                            (54%)

                             11%
                                                        (55%)
 10%               10%
                                                   9%



                                    5%
  5%                                                        4%




  0%
             CSN               SubCare          RIteCare / Children


                                                                                       11
       More community care resulted in better value

                              Service Expenditures – Per Utilizer per Month


                CSN                             SubCare                       RIteCare/Children

$400   $384                          $200                             $80
        ALT                                  $186
                                              Alt
$350    OP                                                                      $68
                                              OP
                                                                                ALT
$300                                 $150                             $60

                                                                                OP
$250


$200                                 $100                             $40                    $37
                                                          $88
         IP           $150
$150                                          INP                                            ALT
                                                           Alt
                       ALT
$100                                  $50                             $20        IP
                                                           OP                                OP
                       OP
$50
                       IP                                  INP
                                                                                             IP
 $0                                    $0                              $0
       Before         After                  Before       After                Before       After




                                                                                                    12
           Creating “Health Homes” that incorporate BH
           results in quality gains and better value

 Co-location of BH on site increases
                                           …reduces psychiatric           …and generates measurable
             penetration
                                              hospitalization                 medical cost offset.
      of specialty BH services…



20%                                    8                          $600
              18%                                                            $538

                                                        6
15%                    14%             6

                                                                  $400


                                                4
10%                                    4                                         Not
             MH on
                                                                                  on
              Site                                    Not on                     Site
                      Not on                           Site
                       Site                                       $200   $173
                                              MH on
5%                                     2
                                               Site
                                                                          MH                  $96
                                                                           on                       $77 $87
                                                                          Site          $38

0%                                     0                           $0
             Penetration Rate                INMH Days / 1,000           Inpatient        ER         PCP
                                                                          Medical




                                                                                                              13
   Getting value from the current system – using
   data to target services matters

% of Highest Cost* SPMI Members                SPMI Care Management Program
   Receiving County Services                      (Buffalo, Rochester, Syracuse)

    40%          39%

                                             •59% decrease in ER utilization


    30%
                                             •62% decrease in IPMH ALOS

                                             •34% decrease in self-harm incidents
                                 21%
    20%
                                             •32% decrease in of physical harm to others

                                             •32% decrease in suicide attempts


    10%
                                             •50% decrease in arrests

                                             •44% increase in gainful employment


    0%
              Inpatient MH   Inpatient PH,
                 or CD          MH, CD

  Enrollees       654            704

                                                                                           14
      “Integrated Partner Model” stressed local
      knowledge and management
                           • On-site at managed care plan
                           • Beacon clinicians co-located
• After School               with Medical Management team             • BH Specialists
  Prgrms.                                                             • Primary Care
                                      Health
• Rec. Prgrms.                        Plans                           • BH in Medical Home
• Housing Svcs.                                                       • Hospitals
• Mentoring                                                           • Diversionary
  Svcs.           Community                             Providers
                   Services           Beacon                            Services
• Faith-based                       Integrated                        • Mobile Crisis Teams
  agencies                            Partner
                                       Model


• Schools                                                           • Parent Advisory Cmte.
• Mental Health                                                     • NAMI
                      Government                   Families &
• Child Welfare        Partners                    Advocates        • Consumer Strategies
• Courts                                                            • Education / Outreach
• Medicaid                                                          • Peer Specialists
• DD/MR                                                             • Parent Advocates



           Beacon provides connective tissue in a fragmented system of care
                                                                                         15
       The top Medicaid health plans in America have
       chosen, and stayed with, Beacon


                                    Top 10 Medicaid Health Plans


# 2. Boston Medical Center HealthNet Plan (HMO)                     Beacon Client since ‘09


# 3. Fallon Community Health Plan (HMO)                             Beacon Client since ‘99


# 4. Neighborhood Health Plan of Massachusetts(HMO)                 Beacon Client since ‘96

# 5. Blue Cross Blue Shield of Rhode Island (POS)                   Beacon Client since ‘03


# 7. Neighborhood of Rhode Island (HMO)                             Beacon Client since ‘01



          #2, #3, #4, #5 and #7 Medicaid Health Plans in America are Beacon Clients

                                                                                         16

				
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