Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective.
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Transcript of Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective.
Alliance Hill BriefingMay 4, 2012
Healthcare Integration: The Behavioral Healthcare Integration: The Behavioral Health PerspectiveHealth Perspective
•Introducing CenpaticoCenpaticoo Part of Centene Familyo Innovative MBHO
•Centene Philosophy: Centene Philosophy: Integration for Special Populations
o Fluid Integrationo Understanding Behavioral Health Home
•ChallengesChallenges
Outline
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Specialty Health Solutions
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Focus on integrationFocus on integrationof behavioral and physical of behavioral and physical health and ancillary health and ancillary servicesservices
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Cenpatico OverviewWhat We Do
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• MBHOMBHO: We are a “Managed Behavioral Healthcare Organization”
NCQA Accredited: NCQA Accredited: Quality Organization
Core ServicesCore Services: We focus on delivering behavioral health services to members through our coordination activities, clinical oversight, and our network providers.
• SchoolsSchools: Private Day Treatment for children in K-12 (AZ)
• Specialty Therapy & Rehabilitation Services: Specialty Therapy & Rehabilitation Services: Deliver coordination and utilization management for Physical, Speech, Occupational Therapies for our health plans
• INNOVATION: INNOVATION: Cenpatico is always focusing on expanding our services. Through our behavioral health expertise, we also deliver services for children in foster care and have begun community re-entry programs.
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Medicaid recipients Medicaid recipients with Behavioral with Behavioral
Health Disabilities Health Disabilities = = 15% 15% of all of all recipients but recipients but
account for account for 42% 42% of Medicaid of Medicaid
spendingspending
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Persons With Chronic Psychiatric Disabilities in
Medicaid
Healthcare IntegrationThe Behavioral Health Perspective
Source: Kaiser Commission on Medicaid and the Uninsured Issue Paper. (Feb 2012) People with Disabilities and Medicaid Managed Care: Key Issues to Consider. Retrieved on 2/17/2012 from:
http://www.kff.org/medicaid/upload/8278.pdf
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Healthcare IntegrationThe Behavioral Health Perspective
Persons with Behavioral Health Disabilities Require Significant Care
Source: Hamblin, A., Verdier, J., & Au, M. (Oct 2011). Technical Assistance Brief: State options for integrating physical and behavioral health care. Integrated Care Resource Center.
cenpatico.com8Confidential and Proprietary Information
1. Higher rates of diabetes, hypertension, heart disease, acute respiratory disorders
2. Psych meds and weight gain
3. Inability to adhere to treatment plan
4. Presentation confuses treatment
Healthcare IntegrationThe Behavioral Health Perspective
Here’s What That Means…
•Seriously Mentally Ill (SMI) correlates Seriously Mentally Ill (SMI) correlates with higher rates of numerous Physical with higher rates of numerous Physical Health conditions Health conditions
•SMI and Substance Use Disorder (SUD) SMI and Substance Use Disorder (SUD) can contribute to physical health can contribute to physical health conditions and/or complicate their conditions and/or complicate their treatment; and treatment; and
•Comorbid (physical & behavioral health) Comorbid (physical & behavioral health) conditions can result in conditions can result in inappropriateinappropriate utilization and higher than necessary utilization and higher than necessary medical costs medical costs
Interaction of Physical & Behavioral Health Conditions
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1.1. UnlikelyUnlikely to seek out preventative or primary medical care
2. Typically receive physical health services through emergent care emergent care when conditions are more advanced
3. Receives services through the community mental community mental health system health system versus a Primary Care Physician
Healthcare IntegrationThe Behavioral Health Perspective
• Access for SMI• Greater training and
engagement of Primary Care Physicians (PCPs)
• Improved prescribing patterns
Source: Dickey, B., Normand, S.T., Weiss, R.D., Drake, R.E., & Azeni, H. (2002) Medical morbidity, mental illness, and substance abuse disorders. Psychiatric Services, 53, 861-867.
Behavioral Health Home Behavioral Health Home Access for Persons w/ Chronic Psychiatric Disabilities
Typical Health Home Typical Health Home Access for Persons With Chronic
Psychiatric Disabilities
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Healthcare IntegrationThe Behavioral Health Perspective
Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) Enrolled in Integrated Care Management (ICM) 30 Days or More
Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI.
Result: $3,629,493.85 in 2011 Behavioral Healthcare
Savings
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Healthcare IntegrationThe Behavioral Health Perspective
Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI
Note: ER refers to Emergency Room.
Result: $873,223.55 in Non-ER Medical Expenses and $150,068.90 in Emergency
Room (ER) Expenses
Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) Enrolled in ICM 30 Days or More
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CenteneCentene fundamentally focuses on delivering serviceservice excellenceexcellence in three key areas whether Behavioral or Physical Health led :
Clinical Effectiveness
Provider Education
Payment Integrity
Persons with SMI/SUD and the ABD population need a fluidfluid system of care that ensures accessaccess and qualityquality first based on their needs…
Healthcare IntegrationThe Behavioral Health Perspective
cenpatico.com13Confidential and Proprietary Information
1.1.Work Force Issues in BH Work Force Issues in BH - Shortage of psychiatrists, especially child/ adolescent specialists is acute.
2.2.Eliminate the limitationsEliminate the limitations for Behavioral Health Providers to access Health IT Funds.
Healthcare IntegrationThe Behavioral Health Perspective
GREATEST CHALLENGES
Thank you!Thank you!
SAM DONALDSON, PH. D.SAM DONALDSON, PH. D.
President & Chief Executive OfficerPresident & Chief Executive Officer
504 Lavaca St., Suite # 850Austin, Texas 78701
512.406.7200 office | 512.431.5894 cell | [email protected]