Regain Control, Recapture Margins,
Realize New Profitability and Enhanced Member Health Status

InnoPsych: The Journey to Integrated Health Care

Integrated medical-behavioral health care holds great promise for maximizing health care delivery outcomes while simultaneously optimizing the most effective utilization of health care resources. It is a journey that must begin with an awareness that the “carveout”, and even the “carve-in” model, have artificially divorced the interplay of medical and behavioral health factors to the disservice of members and payers. Exciting new integrated health care approaches that bring medical and behavioral health care back together now exist and the future holds multitudes of new discoveries about how best to impact the health of the whole person through existing and yet-to-be discovered approaches.

It is time to chart a new course. Corphealth can help you navigate the way. At your speed, with you at the helm, great destinations are ahead!

An Old Problem, An Old Solution

An old solution to an old problem…the behavioral health carveout is yesterday’s news. For more than twenty years, the carveout has been the quick and easy, but often times problematical solution to managing behavioral health care costs. When it was introduced, behavioral health care costs had jumped to 7-9% of health care costs. The carveout effectively reduced the costs of behavioral health care to 2-3% of costs. It solved the problem at hand. But times have changed dramatically.

Today’s marketplace requirements have called into question the carveout for certain payers? Why are payers still willing to:

• Give up control over this segment of their business?
• Give up margins for administrative services that are their specialty?
• Give up margins on risk by passing it off to another party to manage?
• Realize the risk attendant with doing business with companies of questionable financial strength?

Furthermore, the old solution is now the new cost problem - continued focus on direct behavioral health care costs that constitute only 2-3% of health care costs is misdirected.

Limited, in-house managed behavioral health care programs are no exception. Typically best described as medical management add-ons, in-house programs are usually designed to manage direct behavioral health care costs - another form of the old solution - at an administrative cost less than carving it out. Yet, even then, it is estimated that in-house programs spend approximately 20%+ more on direct behavioral health care costs than carveouts. And, in virtually all situations, there is no overarching plan for integrated medical-behavioral health care management.

A New Problem, A New Solution

The new problem is determining how to address the 60%+ of all health care costs that are impacted by behavioral health issues that are treated ineffectively or not at all. Only one of five individuals needing behavioral health care receives it through direct sources, while the other four seek assistance through their PCP or not at all. The costly impact of depression and other behavioral health problems on disease, condition severity, recovery and other factors is well documented.

The new problem is the new opportunity. Imagine impacting these costs by only 10%; over $8M in savings would accrue to every 100,000 member plan. To realize this, a new solution is required. The new solution is InnoPsych. The journey to integrated medical-behavioral health care begins.

InnoPsych: Navigating the Future Now

A multi-step process, InnoPsych transports the carveout (or carve-in) from the familiar approaches of the last twenty years to fully integrated medical-behavioral health care management. The steps are clearly defined and are taken at the speed the payer chooses. The steps build, one on the other, and include:

• Insourcing - payers regain control of the behavioral health benefits, taking back those responsibilities that you determine to be preferable - administrative tasks that you do well everyday. Corphealth takes care of the things that you choose to hand off. Insourcing positions the payer for the first time to be able to move toward integrated care management.
• Data Warehousing - now that the payer has the behavioral health claims, combining it with medical claims and PBM data feeds sets the stage for exciting discoveries that only the data can offer.
• Data Analytics - in conjunction with your own in-house data analytics expertise, MillimanUSA and Corphealth work in concert to find “solutions” that may exist in the data…ways to treat issues that generate better results…as well as “problems” that the data demonstrates exist…problems that need new solutions.
• Solutions Testing - recognizing that each payer membership population will have unique characteristics…and recognizing that existing and proposed solutions will require evidence of effectiveness…this step involves the piloting of various approaches on subpopulations of the membership to determine the success of various approaches. Study-based, you will know what works for your members…there will be no guesswork.
• Solutions Application - based on the testing of various approaches, the payer then chooses those approaches that demonstrate the best cost/benefit or that meet other needs at the time.

Insourcing: Back to the Future

Throughout the payer industry, outsourced services are being brought back in-house. Adeptness at performing administrative functions and managing risk, as well as the move to insourcing to increase profitability through retained margins have merged into a single force for change. PBMs, disease management, and population health management programs are examples of services that are being insourced at an increasing rate.

So, what about behavioral health? The business model of traditional managed behavioral care carveout companies is highly dependent on the economics of the carveout; consequently, there is no flexibility to offer payers an innovative insourcing option. To do so undermines their financial foundation and puts their very existence at risk. Consequently, insourcing has never been offered as an option. Several large payers have responded to this dilemma by acquiring managed behavioral health care companies. Corphealth, on the other hand, operates on a business model that is not dependent on the carveout.

InnoPsych brings behavioral health back in-house, back under payer control. The payer does what it does best…and Corphealth does the rest. The model capitalizes on the strengths of each to effect the most efficient and economical approach to the delivery of managed behavioral health care services.

The payer delivers any or all of the following service components that it presently excels in providing (Corphealth can provide any of these services that the payer chooses):

• Customer Service Management (Full Service, Clinical Only)
• Claims Management (Benefits, Eligibility, Repricing, Payment)
• Network Management (Provider Development, Credentialing, Relations)
• Quality Management
• Clinical Management (Utilization Management, Criteria, Policies and Procedures, Psychiatric Physician Support)
• Proprietary Systems Interface
• Fully Integrated Medical-Behavioral Health Care
• Management Support
• Implementation Support

Unfurling New Business Opportunities:

The Enhanced Value Proposition of Integrated Medical-Behavioral Health Care Management

Behavioral health issues are the common denominator of all medical conditions, chronic or otherwise. Bringing behavioral health care management in-house positions the payer to capitalize on the medical-behavioral integration opportunities that are impossible to realize in a carveout. Managed internally and simultaneously with medical care, major positive impacts on treatment outcomes for medical conditions as well as attendant cost savings can be realized.

Failure to address the behavioral health issues has been repeatedly demonstrated to result in more serious illness, poorer recovery rates, slower recovery time, increased use of pharmaceuticals, reduced compliance with treatment plan, exacerbation of chronic disease states, increased use of medical services and various other negative outcomes, all of which contribute to increased medical costs.

Corphealth, working closely with the payer, shepherds the development of the integrated medical-behavioral health care management approach. We will provide existing integrated products and services designed to accomplish the objectives of such integration or we will source and manage the delivery of approaches offered by specialty service providers. At all times, we are checking coordinates to make sure that we are on course, always with the payer as captain of their own ship.

Exciting solution components already exist, others are in development. More will be developed as a result of the InnoPsych process. Some examples of currently available approaches include:

Integrated Care Delivery - behavioral health care providers serve as immediately available resources for PCPs, a model developed by Nicholas Cummings, the father of managed behavioral health care. His approach, developed over 30 years ago was put on the back-burner by the carveout approach that met an immediate need. It’s time has come and its legacy will be positive: Significant cost savings through reduced utilization of unnecessary medical services and more satisfied members.

Psychopharmaceutical Medication Management - support of physicians prescribing psychotropics and intervention with members to insure correct dosing and compliance.

Chronic Disease Management - intervention into and treatment of co-morbid behavioral health issues such as depression are designed to work hand-in-hand with existing specific disease management programs.

Behavioral Health Disease Management - managing specified diagnoses according to DM protocols, not traditional managed care protocols

High Risk Health Coaching - cognitive behavior change process undertaken with members identified through use of a predictive modeling tool as being the most likely to utilize the most health care resources in the next 6-12 months…based on member health care perception.

At a time when payers are searching for enhanced value propositions, integrated medical-behavioral health care management emerges as an exciting horizon ahead…and to those who choose to truly chart a new course, InnoPsych can be your compass…or today, your GPS.

InnoPsych…
Discovering new worlds of opportunity everyday!