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

Introduction to Beacon Health Strategies

April 28, 2011


Beacon serves 6 million members in 14 states 10 medicaid programs and 50 health plans

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

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

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

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

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

Quantified correctly, behavioral health expenditures can be 20% of total spend

3-5%

3-5%

10+%

3-5%

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Introduction to beacon health strategies april 28 2011

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

BH and Chronic Disease: A Volatile Cohort

Cost Variation of Chronic Diseases

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Introduction to beacon health strategies april 28 2011

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

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Diversionary service penetration increased dramatically across all lines of business

“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)*

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Admission rates amongst op utilizers dropped with the introduction of new services

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

More community care resulted in better value

SubCare

CSN

Service Expenditures – Per Utilizer per Month

RIteCare/Children

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Introduction to beacon health strategies april 28 2011

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.

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

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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Introduction to beacon health strategies april 28 2011

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

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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