The Power of Integration Webinar

A wave of research continues to show that behavioral health conditions significantly impact chronic medical conditions and their costs. But integrating behavioral and medical care is easier said than done. The payoff is there, but payers, physicians and other providers face challenges putting the pieces together. How do you truly integrate care? How long before it really pays off?

In this webinar, leading experts in integrated care management will examine the merits of a holistic model when the goal is enhancing outcomes and shrinking medical costs.

Transcript

1. The Power of Integration: Blending Behavioral and Medical Care Webinar: September 29, 2015
2. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹2› Agenda • Welcome & Introductions • The impact behavioral health has on chronic conditions • Prevalence of co-morbid conditions and the cost impact • Opportunities for savings • Integrated programs with success • Managing members more effectively with an integrated approach • Identifying members with chronic conditions and psychosocial factors • Using a therapeutic model to manage members • Member case study using an integrated approach • Questions & Answers • Conclusion
3. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹3› Presenters Steve Melek, FSA, MAAA Principal & Consulting Actuary Milliman steve.melek@milliman.com Sam Toney, MD Chief Medical Officer and EVP, Clinical Integrity Health Integrated stoney@healthintegrated.com
4. The Impact of Behavioral Health on Chronic Conditions
5. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹5› Integrating Behavioral and Medical Healthcare Source: Kathol and Gatteau – Healing Mind and Body, 2007
6. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹6› 48.3% 12.7% 34.9% 5.3%
7. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹7› The Quality of Treatment In spite of effective treatments and evidence-based guidelines, only 1 in 5 individuals with depression who seek treatment are treated according to minimum standards (JAMA, 2003).
8. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹8›
9. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹9› Prevalence of Comorbidities Unützer, Jürgen. Integrated Behavioral Health Care. Powerpoint Presentation. Seattle , Washington. May 2, 2011.
10. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹10›
11. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹11› Findings from an Analysis of Comorbid Chronic Medical & Behavioral Conditions • Basis for analysis was detailed claim and membership files for Commercial, Medicare and Medicaid populations • Commercial and Medicare populations were divided into 4 cohorts: 1. No MH/SUD 2. Non-SPMI MH 3. SPMI 4. SUD • Total spending and per member per month (PMPM) costs were separated between Medical, Medical Rx, Behavioral, and Behavioral Rx
12. ‹12› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Impact of Comorbid Chronic Medical & Behavioral Conditions – PMPM Costs Population Behavioral Health Diagnosis Member Months Medical Behavioral Medical Rx Behavioral Rx Total Commercial No MH/SA 2,048,000,000 $280 $3 $53 $4 $340 Non-SPMI MH 278,000,000 $661 $23 $145 $74 $903 SPMI 47,000,000 $759 $128 $135 $175 $1,197 SA 22,000,000 $830 $73 $102 $67 $1,072 Total 2,386,000,000 $335 $8 $66 $16 $425 Medicare No MH/SA 508,000,000 $579 $3 N/A* N/A* $582 Non-SPMI MH 23,000,000 $1,369 $40 N/A* N/A* $1,409 SPMI 21,000,000 $1,222 $215 N/A* N/A* $1,437 SA 6,000,000 $1,291 $213 N/A* N/A* $1,504 Total 556,000,000 $640 $13 N/A* N/A* $653 Medicaid No MH/SA 437,000,000 $309 $4 $63 $5 $381 MH/SA 109,000,000 $757 $286 $172 $86 $1,301 Total 546,000,000 $398 $61 $85 $21 $565 Total No MH/SA 2,993,000,000 $335 $3 $55 $4 $397 MH/SA 494,000,000 $751 $100 $148 $86 $1,085 Total 3,487,000,000 $394 $17 $69 $17 $497 Per Member Per Month (PMPM) Healthcare Costs by Market Total Spending for Full Population (PMPM, 2012 Allowed Dollars)
13. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹13› Impact of Comorbid Chronic Medical & Behavioral Conditions – Total Costs by Market Population Behavioral Health Diagnosis Medical Behavioral Medical Rx Behavioral Rx Total Commercial No MH/SA $573,171 $5,628 $109,464 $8,833 $697,096 Non-SPMI MH $184,147 $6,502 $40,361 $20,507 $251,517 SPMI $35,408 $5,954 $6,312 $8,167 $55,841 SA $18,227 $1,596 $2,236 $1,473 $23,532 Total $800,317 $18,336 $157,038 $37,695 $1,013,386 Medicare No MH/SA $294,241 $1,619 N/A N/A $295,860 Non-SPMI MH $31,167 $914 N/A N/A $32,081 SPMI $26,142 $4,596 N/A N/A $30,738 SA $8,346 $1,379 N/A N/A $9,725 Total $355,559 $7,234 N/A N/A $362,793 Medicaid No MH/SA $134,920 $1,963 $27,710 $2,176 $166,769 MH/SA $82,655 $31,264 $18,759 $9,389 $142,067 Total $217,575 $33,227 $46,468 $11,566 $308,836 Total No MH/SA $1,002,332 $9,210 $137,173 $11,009 $1,159,724 MH/SA $371,119 $49,587 $66,333 $38,252 $525,291 Total $1,373,451 $58,797 $203,507 $49,261 $1,685,016 (Millions, 2012 Allowed Dollars) Total Spending for Full Population Total Healthcare Costs by Market
14. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹14› Impact of Co-morbidities for Medicare Condition No MH/SA SPMI Non-SPMI SA Arthritis $1,237 $2,109 $1,852 $2,010 Asthma $1,381 $2,227 $2,051 $2,325 Cancer $1,230 $2,117 $1,826 $2,083 Chronic Kidney Disease $2,677 $3,986 $3,772 $4,581 Congestive Heart Failure $2,230 $3,478 $2,882 $3,713 Chronic Obstructive Pulmonary Disease $1,598 $2,546 $2,335 $2,171 Diabetes (with complications) $1,740 $2,964 $2,755 $3,085 Diabetes (without complications) $811 $1,486 $1,379 $1,719 Hypercholesterolemia (with complications) $1,292 $2,465 $2,119 $2,302 Hypercholesterolemia (without complications) $676 $1,186 $1,043 $1,267 Hypertension (with complications) $1,608 $2,917 $2,438 $2,936 Hypertension (without complications) $822 $1,528 $1,326 $1,642 Ischemic Heart Disease $1,392 $2,659 $2,261 $2,634 Osteoporosis $1,052 $1,882 $1,627 $1,988 Stroke $1,567 $2,809 $2,400 $2,409 None $185 $665 $673 $821 Any Condition $971 $1,701 $1,561 $1,744 Total $582 $1,436 $1,410 $1,504 2012 Allowed PMPMs Impact of Co-mobidities (Medicare Population)
15. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹15› Impact of Co-morbidities for Medicaid Condition No MH/SA MHSA Benign/In Situ/Uncertain Neoplasm $686 $1,580 Cardio-Respiratory Arrest $4,798 $5,134 Cerebro-Vascular $2,052 $3,299 Cognitive Disorders $2,319 $3,552 Diabetes $1,066 $2,368 Ears, Nose, and Throat $488 $1,455 Eyes $587 $1,625 Gastrointestinal $843 $1,932 Genital System $662 $1,538 Heart $1,023 $2,134 Hematological $1,419 $3,003 Liver $1,328 $2,564 Lung $737 $1,912 Malignant Neoplasm $1,913 $3,185 Musculoskeletal and Connective Tissue $693 $1,624 Neurological $1,476 $2,365 Nutritional and Metabolic $815 $1,923 Pregnancy-Related $1,147 $1,669 Skin and Subcutaneous $598 $1,771 Urinary System $1,079 $2,395 Vascular $1,808 $3,375 Total $382 $1,301 2012 Allowed PMPMs Impact of Co-mobidities (Medicaid Population)
16. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹16› Value Potential for Medicare Figure 6b - Value Potential (Medicare Population) Condition SPMI Non-SPMI SA Total Arthritis $5,791 $5,042 $1,522 $11,929 Hypertension (without complications) $4,641 $3,987 $1,477 $9,620 Hypertension (with complications) $3,804 $3,616 $1,012 $8,114 Ischemic Heart Disease $3,322 $3,269 $993 $7,278 Chronic Obstructive Pulmonary Disease $3,157 $2,498 $945 $6,408 Diabetes (with complications) $2,733 $2,555 $594 $5,727 Hypercholesterolemia (without complications) $2,158 $1,495 $551 $4,034 Diabetes (without complications) $2,060 $1,405 $563 $3,842 Congestive Heart Failure $1,866 $1,538 $494 $3,740 Hypercholesterolemia (with complications) $1,725 $1,676 $392 $3,676 Cancer $1,614 $1,582 $453 $3,535 Asthma $1,320 $809 $584 $2,570 Chronic Kidney Disease $1,107 $1,159 $327 $2,522 Stroke $1,047 $1,224 $214 $2,453 Osteoporosis $570 $700 $125 $1,348 None $2,626 $1,889 $1,072 $5,318 Any Condition $11,635 $11,141 $3,699 $25,485 Total $14,260 $13,030 $4,771 $30,803 Value Potential (Millions, 2012 Allowed Dollars)
17. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹17› Value Potential for Medicaid Figure 6c - Value Opportunity (Medicaid Population) Condition Musculoskeletal and Connective Tissue Nutritional and Metabolic Ears, Nose, and Throat Gastrointestinal Lung Skin and Subcutaneous Heart Eyes Urinary System Genital System Hematological Neurological Diabetes Liver Vascular Benign/In Situ/Uncertain Neoplasm Cognitive Disorders Malignant Neoplasm Cerebro-Vascular Pregnancy-Related Cardio-Respiratory Arrest Total Value Potential (Millions, 2012 Allowed Dollars) Total $50,340 $43,519 $42,018 $40,341 $37,261 $34,738 $34,227 $29,592 $21,800 $19,410 $18,072 $16,792 $14,748 $14,511 $10,619 $866 $100,374 $9,201 $5,934 $4,103 $3,568 $2,390
18. ‹18› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Successful IMBH Programs Program Savings Multifaceted Diabetes and Depression Program (MDDP) $39 PMPM of medical savings over 18 months Pathways Program (for Diabetes & Depression $46 PMPM saved (or about 5% over 2 years) IMPACT Program (for Depression among the elderly) $70 PMPM saved over 4-year period (or about 10%) Missouri CMHC Health Homes • Independent living increased by 33% • Vocational activity increased by 44% • Overall healthcare costs decreased by 8% Observed Savings Between 9% and 16% of Value Opportunity
19. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹19› Average Annual Cost Savings Achievable Through Effective Integration Payor Type Member Months Allowed Claims Value Potential Cost Impact of Integration Commercial 2,386,000,000 $1,013,386 $162,366 $15,815-$31,629 Medicare 556,000,000 $362,793 $30,803 $3,347-$6,693 Medicaid 546,000,000 $308,836 $100,374 $7,103-$9,945 Total 3,487,000,000 $1,685,016 $293,543 $26,265-$48,267 Average Annual Cost Savings Achievable through Effective IMBH (millions)
20. Managing Members Effectively with an Integrated Approach
21. ‹21› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Identify Members Impacted by Psychosocial Factors • Claims • Health Assessments • Authorizations • Census /Discharge • Program Touches • Referrals
22. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹22› A New Approach to the Integrated Model • A new approach to member intervention – Dynamic Somato-Social Theory • It is not psychotherapy/interventions focusing on Depression, or Anxiety or even Somatoform Disorders or Factitious Disorders. The focus is not the BH condition. • It is not psychotherapy/interventions for Diabetes or Asthma, CHF or any other chronic physical condition. Dynamic Somato-Social Theory (DSST) is the evaluation and management of multidimensional psychological, social and physical health drivers in individuals with one or more modifiable chronic physical conditions.
23. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹23› Understanding Psychosocial Drivers in Members Physical Pain, Restricted ROM, Fatigue, Dyspnea, GI, Neurological Social Family, Peers, Community, Employment, Academic Psychological Emotional, Behavioral, Mental, Spiritual, Interactional, Cultural
24. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹24› Member Engagement and Intervention Personal Clinicians engage with members and perform interventions. • Dedicated one-to-one relationship between member and clinician to foster rapport and trust • Experts in understanding interplay between physical and psychosocial health (LCSW, LMHC) • Validate engagement via bio-psychosocial assessment • Personal clinicians supporting physician’s treatment plan • Support during Transitions of Care • Option to choose self-support interventions for those not ready to engage fully with a personal clinician
25. ‹25› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Therapeutic Interventions to Drive Change Drives Member Participation Measure – Engagement Rate Condition Validation Drives Member Trust/Satisfaction Measure – Engagement Rate/Satisfaction/CAHPS/HOS Condition Concentration Drives Member Knowledge/Literacy Measure – Health Literacy/Satisfaction/Participation Drives Member Perception/Behavior Change Measure – Increase in office visit compliance/Referral to Specialty Drives Behavior Change, Adherence, Nutrition & Tests Measure – HEDIS, Claims Based Mitigation of Utilization, Cost Mitigation, MLR Trends, Satisfaction
26. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹26› Member Case Study Rich is a 42 year old male with multiple drivers: Physical: • High Cholesterol • HTN • Diabetes • Obesity • Back Pain Social: • Single • College Degree • County Employee History of mutliple ER visits and IP admissions are not consistent with expected outcomes – underlying psychosocial drivers are implicated. Member is enrolled in Therapuetic Intervention Program with DSST.
27. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹27› Call #1 Intervention Focus and Results Reciprocal Engagement • Introduce/reassure/dedicated relationship • Listen/elicit barriers and desires • Establish Primary Goal – member-defined • Primary Goal – Job Promotion Condition Validation • Member-defined physical health condition(s) • Reiterate to member • Mutual agreement on specific physical condition(s) as focus of relationship • Diabetes – has been barrier to promotion – sick days Initial BPS Assessment • Performed during call Primary Goal Reiteration • Reiterate member-defined Primary Goal • Reiterate dedicated relationship • Rapport/reciprocal engagement/program retention
28. ‹28› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Call #2 - 3 Intervention Focus and Results Follow-Up Assessment (Psychosocial and Medication Assessments, Primary Condition Module) • Psychosocial assessment – reveals anger, entitlement, highly suspicious of health care system • Complete PHQ-9 – Score Of 4 (Subclinical Depression) • Clinician determines possible personality disorder with failure to adhere to treatment plan and possible sabotage of treatment plan • Secondary goal set – adherence to treatment plan/diet/activities Condition Concentration • Focus on conditions as a means to move through the intervention Concurrent Insight • Drives further engagement/trust Primary Acuity • Validate/educate member’s understanding of diabetic symptoms relative to sick days/poor job performance.
29. ‹29› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Call #4 - 5 Intervention Focus and Results Objective Identification • Clinician recognizes underlying personality disorder (DIAGNOSTIC BARRIER) as the driver of maladaptive behavior (poor diet and medication adherence). Diagnostic Action • Educate member as to possibility of anxiety related to health care and suboptimal communication with health care providers. Secondary Acuity • Member perceives suboptimal relationship with providers and anxiety of health care system as barriers to job promotion (Primary Goal).
30. ‹30› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Call #8 - 11 Intervention Focus and Results Perseverance • Continued pursuit of treatment adherence to realize resolution of both Primary and Secondary Goals. • Continued adherence of treatment plan drives positive outcomes as well as member satisfaction. Resolution • Full achievement of Primary and Secondary goals with no additional barriers identified. • Member graduates from program.
31. ‹31› PHONE: 877-267-7577 | WEB: www.healthintegrated.com Summary of Interventions Interventions • 11 clinical contacts over 10 months • Anxiety identified as barrier to adherence of treatment plan • Suboptimal communication style fueled by anxiety identified • Education on health conditions required Results • Motivation Improved – Member satisfaction increased • Self-efficacy Improved – Adherence to treatment plan • Reduced ER and IP utilization • Morbidity and Mortality Mitigated
32. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹32› Benefits of Integrated Therapeutic Model • Individuals with chronic illness tend to have psychosocial complications • Psychosocial barriers contribute to the vulnerability of members and concerns • A unique model of evaluation and intervention that finds and addresses root causes of utilization can drive savings, close care gaps and improve quality • The most meaningful results are those impacting the member directly: • Higher level of Self-efficacy • Higher level of Satisfaction • Improved Functionality • Improved Quality of Life
33. Questions?
34. ‹#› PHONE: 877-267-7577 | WEB: www.healthintegrated.com ‹34› Thank You • The slides from today’s presentation will be available and sent to all attendees. • Today’s session was recorded and will be available online. • Please provide your feedback in the survey. • Questions – contact marketing@healthintegrated.com.