Introduction to Beacon Health Strategies
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Introduction to Beacon Health Strategies April 28, 2011 PowerPoint PPT Presentation


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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. Medicare. Medicaid. Commercial. Multi-Sector Health Plans. Beacon is one of the largest MBHO serving public populations in the state of NY.

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Introduction to Beacon Health Strategies April 28, 2011

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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

Medicare

Medicaid

Commercial

Multi-Sector Health Plans


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 Partners and CCSI/NYCCP

  • Working with members and providers since 1998

  • Case Management and quality improvement partnerships with 7 county systems

    • Chautauqua, Erie, Genesee, Monroe, Onondaga, Westchester, Wyoming

  • NY clinical operationsbased locally in NY

    • UR, CM and Physician advisors

  • 7,000 contracted providers in NY State

3

Confidential


We provide a full range of clinical management services to our clients

Administrative Services

Utilization and Case Management

Population Health

  • Predictivemodelingand informatic case finding

  • Total care management

    • Co-morbid mental illness and chronic disease

  • Psychotropic drugintervention program

  • Depression health management program

  • Medical necessity review

  • 3-tiered case management program

    • Case consultation

    • Care coordination

    • Intensive case management

  • Follow-up after hospitalization “Aftercare” program

  • Agency/Courts/School care coordination

  • NCQA and URAC accreditation

  • Fully integrated BH management system

    • Financial

    • Clinical

    • Network

    • Claims

  • Network creation and management

  • Provider credentialing

  • Claims processing and payment

  • Call center operations

4


Beacon’s system of care was developed to serve deep-end patients in public programs

BH Inpatient Utilization – Days per 1,000 members

Beacon’s CoreBusiness


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 High Cost Cases - 2009

All MassHealth Members - 2009

+65%

  • 50,000 enrollees

  • $3.2 billion

  • 51% BH co-morbidity

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BH and Chronic Disease: A Volatile Cohort

Cost Variation of Chronic Diseases

8


Low

Low

High

High

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

Inpatient acute care

Crisis Stabilization

Responsive

Alternative levels of care

Enhanced Outpatient

CAITS

Service Intensity

IOP w/out Walls

Partial Hospitalization

Day Treatment

Intensive Outpatient

Office Based Care

Price of Unit of Service

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)*

After new services (2006-2009)*

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

(37%)

(54%)

(55%)

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More community care resulted in better value

SubCare

CSN

Service Expenditures – Per Utilizer per Month

RIteCare/Children

12


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

Co-location of BH on site increases penetration of specialty BH services…

…reduces psychiatric hospitalization

…and generates measurable medical cost offset.

13


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

% of Highest Cost* SPMI MembersReceiving County Services

SPMI Care Management Program(Buffalo, Rochester, Syracuse)

  • 59% decrease in ER utilization

  • 62% decrease in IPMH ALOS

  • 34% decrease in self-harm incidents

  • 32% decrease in of physical harm to others

  • 32% decrease in suicide attempts

  • 50% decrease in arrests

  • 44% increase in gainful employment

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Health Plans

Community Services

Providers

Beacon Integrated Partner Model

Government Partners

Families & Advocates

“Integrated Partner Model” stressed local knowledge and management

  • On-site at managed care plan

  • Beacon clinicians co-located with Medical Management team

  • After School Prgrms.

  • Rec. Prgrms.

  • Housing Svcs.

  • Mentoring Svcs.

  • Faith-based agencies

  • BH Specialists

  • Primary Care

  • BH in Medical Home

  • Hospitals

  • Diversionary Services

  • Mobile Crisis Teams

  • Schools

  • Mental Health

  • Child Welfare

  • Courts

  • Medicaid

  • DD/MR

  • Parent Advisory Cmte.

  • NAMI

  • Consumer Strategies

  • Education / Outreach

  • Peer Specialists

  • Parent Advocates

Beacon provides connective tissue in a fragmented system of care

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The top Medicaid health plans in America have chosen, and stayed with, Beacon

Top 10 Medicaid Health Plans

Beacon Client since ‘09

# 2. Boston Medical Center HealthNet Plan (HMO)

Beacon Client since ‘99

# 3. Fallon Community Health Plan (HMO)

# 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

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