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What are Commercial Health Plans Doing to Improve Behavioral Health Care Quality?. Ivan Khan, MD, MPH Director, Quality Initiatives. Agenda. Understanding the role of eValue8 in measuring health plan performance eValue8’s Behavioral Health Module What are your health plans currently doing?.

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What are commercial health plans doing to improve behavioral health care quality

What are Commercial Health Plans Doing to Improve Behavioral Health Care Quality?

Ivan Khan, MD, MPH

Director, Quality Initiatives


Agenda
Agenda Health Care Quality?

  • Understanding the role of eValue8 in measuring health plan performance

  • eValue8’s Behavioral Health Module

  • What are your health plans currently doing?


Evalue8 overview
eValue8 Overview Health Care Quality?

  • Nation’s leading evidence based health plan request for information (RFI) tool

  • Administered annually by National Business Coalition on Health (NBCH) to support Value Based Purchasing Strategies

  • Used by employers & coalitions nationally to assess health plan performance around value, not just cost

  • Over 350 questions in 7 clinical and non-clinical areas


How employers use evalue8
How Employers Use eValue8 Health Care Quality?

  • Determine & compare how health plans are leveraging resources to improve member health status

  • Develop targeted strategies for improving value of health care

  • Collaborate with purchasers and health care providers to improve community health quality

    • Past eValue8 findings in Behavioral Health Module led to the formation of the Mental Health Task Force  One Voice


Participating coalitions in 2010
Participating Coalitions in 2010 Health Care Quality?

Buyers Health Care Action Group (MN)

Colorado Business Group on Health

Florida Health Care Coalition

HealthCare 21 (TN)

Health Action Council of NE OH

Memphis Business Group on Health

Mid-Atlantic Business Group on Health

Midwest Business Group on Health

New York Business Group on Health

Oregon Coalition of Health Care Purchasers

Pacific Business Group on Health

Puget Sound Health Alliance

South Carolina Business Coalition on Health

Wichita Business Coalition on Health Care (modified)

Rhode Island

Louisiana


2010 evalue8 participation in new york new jersey connecticut
2010 eValue8 Participation in Health Care Quality?New York, New Jersey, & Connecticut

Health Plans

Employers

  • HMO

    • Cigna NY

    • Cigna NJ

    • Cigna CT

  • PPO

    • Aetna NY

    • Anthem NY

    • Cigna NY

    • United NY

  • Pitney Bowes

  • Thomson Reuters

  • Citi

  • Skadden, Arps

  • Assurant

  • New York Public Library

  • Cleary Benefits Group

  • American Express

  • Con Edison

  • EMCOR

  • Montefiore Medical Center

  • Labor Health Alliance


Evalue8 collaborators
eValue8 Collaborators Health Care Quality?

Centers for Disease Control (CDC)

Centers for Medicare and Medicaid Services (CMS)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Agency for Healthcare Research and Quality (AHRQ)

National Committee on Quality Assurance (NCQA)

Joint Commission for the Accreditation of Health Care Organizations (JCAHO)

URAC

American Board of Internal Medicine (ABIM)

eHealthInitiative (eHI)

The Leapfrog Group

Pennsylvania State University

George Washington University


2010 evalue8 content

Non-Clinical Health Care Quality?Sections

Consumer Engagement

Provider Measurement

Plan Profile

(Accreditation, Value-based Plan Design, Administrative)

2010 eValue8 Content

  • Clinical Sections

    • Chronic Disease Management (Coronary Artery Disease, Diabetes, Back Pain)

    • Behavioral Health

    • Pharmaceutical Management

    • Prevention and Health Promotion


Behavioral health module
Behavioral Health Module Health Care Quality?

  • Focuses on disease management of depression, screening for alcohol problems and other points in the provision of behavioral health services:

    • Plan Organization

    • Member Screening

    • Member Support Depression

    • Practitioner Support

    • Performance Results


Bh module breakdown
BH Module Breakdown Health Care Quality?

  • Plan Organization - Plan is expected to offer plan wide BH services, and timely clinical support 24/7

  • Member Screening - Plan is expected to:

    • ID and track members for alcohol d/o and depression

    • Provide practitioners w/ tools for screening for alcohol and depression

    • Follow up w/ patients that present w alcohol related injuries

  • Member Support – Scoring emphasis placed on interventions that incorporate chronic care model. Plan is expected to:

    • Have a program to address medication compliance

    • ID and treat members with co-morbid BH and medical conditions


Bh module breakdown1
BH Module Breakdown Health Care Quality?

  • Practitioner Support: Plan is expected to:

  • Support providers with clinical guidelines, and comparative reports for alcohol overuse

  • Make available actionable clinical data to practitioners

  • Proactively engage practitioners in Disease Management program

  • Track prescribing of anti-depressant medications to assure appropriate assessment

  • Performance Results: Plan is expected to achieve HEDIS percentiles for each individual measure, maximum credit to those achieving >90th %

  • Initiation and engagement of alcohol & other drug dependence Tx.

  • MH utilization: % members receiving services- any FU after hosp for mental illness- 7 days & 30 days

  • Anti-depressant medication management – effective acute & continuation phase treatments

  • Members receiving any services


Anthem bh key findings
Anthem BH Key Findings Health Care Quality?

  • Total Score : 58%

  • Plan Organization: Own BH program, screens ONLY pregnant members, or those with chronic conditions for Depression & Alcohol overuse; treats all that are found positive. Employer buy up option to screen ALL members.

  • Member Screening: Recommends usage of screeners to all Non-BH practitioners, however does not monitor usage, and lacks screeners for child/adolescent Rx drug misuse.

  • Member Support: Low Depression ID rates (< 1% of members), low member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, no Interactive Voice Response (IVR), Financial Incentives to members in Behavior Change Therapy

  • Practitioner Support: Notifies practitioner for members ID’d, does not provide comparative reports to practitioners for depression or alcohol,

  • Performance Results: HEDIS scores > 90% for: Initiation of alcohol treatment. HEDIS

    75-90% for f/u after hosp. for Mental Illness & Anti Depressant med mgmt.


Aetna bh key findings
Aetna BH Key Findings Health Care Quality?

  • Total Score: 68.5%

  • Plan Organization: Own BH program, ONLY those in DM or case mgmt program, pregnant pts, or previously ID’d patients are screened for Alcohol & Depression, Disease Mgmt component only available as a buy up for PPO products. 24/7 telephonic clinical support.

  • Member Screening: Has own program for depression screening in primary care for internists, peds, OB/GYN with 464 participating PCPs in NorthEast. However does not monitor usage, and lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures.

  • Member Support: Good Depression ID rates (4% of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, Interactive Voice Response (IVR), numerous med adherence services, no financial incentives for members.

  • Practitioner Support: Incentivizes practitioners to enroll members into DM program for alcohol & depression, supports office/practice re-design. Member-specific comparative reports with a wide variety of depression indicators are provided to non-BH, BH, and prescribing practitioners.

  • Performance Results: HEDIS scores > 90% for: Initiation of alcohol treatment. HEDIS

    75-90% for f/u after hosp. for Mental Illness & Anti Depressant med mgmt, and f/u for children prescribed ADHD meds


United bh key findings
United BH Key Findings Health Care Quality?

  • Total Score: 77.6%

  • Plan Organization: Own BH program, ONLY pregnant pts, or previously ID’d patients are screened for Alcohol & Depression. IDs high risk members with co-morbidities. Extended discharge f/u. 24/7 telephonic clinical support.

  • Member Screening: Recommends usage of screeners to all Non-BH practitioners AND monitor susage. Lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures.

  • Member Support: Poor Depression ID rates (< 1 % of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, NO Interactive Voice Response (IVR).

  • Practitioner Support: Incentivizes practitioners to enroll members into DM program for alcohol & depression; NCQA physician recognition, supports office/practice re-design. Member-specific NON-comparative reports for Depression & Alcohol

  • Performance Results: HEDIS scores > 90% for f/u for children prescribed ADHD meds . HEDIS 75-90% for f/u after hosp. for Mental Illness and for initiation of alcohol treatment.


Cigna bh key findings
Cigna BH Key Findings Health Care Quality?

  • Total Score: 79.3%

  • Plan Organization: Own BH program, with integration of employer, provider, and other clinical data. Rx data is used to ID potential members for case mgmt. All patients in DM program, and others ID’s with certain conditions are screened for Alcohol & Depression. 24/7 telephonic clinical support.

  • Member Screening: Recommends usage of screeners to all Non-BH practitioners AND monitor s usage. Lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures.

  • Member Support: Poor Depression ID rates (< 1 % of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, Interactive Voice Response (IVR).

  • Practitioner Support: Member-specific comparative reports for Depression & Alcohol, which include med compliance info. Compares physician Rx prescribing to depression diagnosis rates, reimburses non-BH and BH practitioners for screening and mgmt.

  • Performance Results: HEDIS scores > 90% for f/u for children prescribed ADHD meds & for initiation of alcohol treatment . HEDIS 75-90% for f/u after hosp. for Mental Illness.


Impact of evalue8
Impact of eValue8 Health Care Quality?


Conclusion
Conclusion Health Care Quality?

  • NYBGH employers participate in eValue8 annually to assess their health plans in many areas

  • Past Behavioral Health results lead to One Voice Initiative and other collaborative QI in NYC

  • NYBGH eValue8 participating health plans have improved delivery of BH services over time in NY, NJ, & CT


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