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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cenpatico.comConfidential and Proprietary Information

Current Overview

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

http://www.kff.org/medicaid/upload/8278.pdf

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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.

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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


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


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


• 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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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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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…



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.


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]

alliance hill briefing may 4, 2012 healthcare integration: the behavioral health perspective

Documents

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integration of behavioral

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