Introduction to Beacon
Health Strategies
April 28, 2011
Beacon serves 6 million members in 14 states,
10 Medicaid programs and 50+ health plans
Medicaid
Medicare
Commercial
Multi-Sector Health Plans
2
Beacon is one of the largest MBHO serving
public populations in the state of NY
New York Foot Print
100%
625K
SSI / Duals
80%
• 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
60%
40%
New York Business Highlights
Medicaid
−Chautauqua, Erie, Genesee, Monroe,
Onondaga, Westchester, Wyoming
20%
0%
Confidential
• NY clinical operations based locally in
NY
Beacon's NY Enrollment
− UR, CM and Physician advisors
• 7,000 contracted providers in NY State
3
We provide a full range of clinical management
services to our clients
Utilization and Case
Management
Population Health
• Medical necessity review • Predictive modeling and
informatic case finding
• 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
• Total care management
- Co-morbid mental illness
and chronic disease
Administrative Services
• Fully integrated BH
management system
- Financial
- Clinical
- Network
- Claims
• Psychotropic drug
intervention program
• Network creation and
management
• Depression health
management program
• Provider credentialing
• Claims processing and
payment
• Call center operations
4
Beacon’s system of care was developed to serve
deep-end patients in public programs
BH Inpatient Utilization – Days per 1,000 members
5,000
4,432
4,000
Beacon’s Core
Business
3,000
2,000
1,735
1,093
1,000
461
PM
I
el
fa
C
hi
ld
W
S
re
N
CS
D
D
M
R/
Ad
ul
ts
F
Ch
i ld
le
ss
C
om
m
er
ci
al
0
75
TA
N
20
614
5
Quantified correctly, behavioral health
expenditures can be 20% of total spend
Obvious BH Expenditures
• Inpatient, outpatient and diversionary MH services
• Substance use services
• Primary behavioral health diagnosis
3-5%
Seriously Mentally Ill:
Medical Utilization
• 3x more likely to have 5 or more physical health IP
stays
• 4x more likely to have 5 or more ER visits
• 2.5x more specialist utilization (excluding BH)
• 3x more pharmacy cost (excluding BH)
3-5%
Chronic Physical Illness
Medically Unexplained
Symptoms
• 71% of top 3% of spenders are BH co-morbid
(exclude oncology, transplants, and geriatric end-oflife care)
• 69% of members with 3 or more chronics are BH
co-morbid
• 76% of “outliers” for major chronic disease states
are BH
•Chronic or unexplained pain
•Digestive disorders
•Unexplained pulmonary stress
10+%
3-5%
6
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
$8,000
100%
+65%
$6,935
80%
Other
Enrollees
$6,000
60%
$4,198
Other
Enrollees
$4,000
PMPM
40%
High Cost
20%
0%
Concentration:
High Cost
Enrollment
Spending
5.9%
55.2%
•50,000 enrollees
•$3.2 billion
•51% BH
co-morbidity
$2,000
$0
PMPM
Physical
Health Only
BH Co-Morbid
7
BH and Chronic Disease: A Volatile Cohort
Cost Variation of Chronic Diseases
8
High
Case Study: Value is driven by creating a care
continuum and coordinating step-up / step-down
Inpatient acute care
Crisis Stabilization
Service Intensity
Enhanced Outpatient
Responsive
CAITS
IOP w/out Walls
Partial Hospitalization
Day Treatment
Low
Intensive Outpatient
Office Based Care
Low
Price of Unit of Service
High
9
“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)*
80%
After new services (2006-2009)*
75%
66%
60%
40%
25%
20%
11%
4%
0%
4%
CSN
SubCare
RIteCare / Children
10
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
20%
(37%)
16%
15%
(54%)
11%
10%
10%
9%
5%
5%
0%
(55%)
4%
CSN
SubCare
RIteCare / Children
11
More community care resulted in better value
Service Expenditures – Per Utilizer per Month
CSN
$400
SubCare
$384
$200
ALT
$350
OP
RIteCare/Children
$80
$186
Alt
$68
OP
$300
ALT
$60
$150
OP
$250
$200
$150
$100
IP
$150
$88
INP
$40
$37
ALT
Alt
ALT
$100
$50
OP
$20
IP
OP
OP
$50
INP
IP
$0
Before
After
$0
Before
After
IP
$0
Before
After
12
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…
20%
…reduces psychiatric
hospitalization
8
…and generates measurable
medical cost offset.
$600
18%
$538
6
15%
14%
6
$400
10%
4
MH on
Site
4
Not on
Site
Not on
Site
5%
0%
2
Penetration Rate
0
Not
on
Site
$200
MH on
Site
INMH Days / 1,000
$173
MH
on
Site
$0
Inpatient
Medical
$96
$77 $87
$38
ER
PCP
13
Getting value from the current system – using
data to target services matters
% of Highest Cost* SPMI Members
Receiving County Services
40%
SPMI Care Management Program
(Buffalo, Rochester, Syracuse)
39%
•59% decrease in ER utilization
•62% decrease in IPMH ALOS
30%
•34% decrease in self-harm incidents
21%
20%
•32% decrease in of physical harm to others
•32% decrease in suicide attempts
•50% decrease in arrests
10%
•44% increase in gainful employment
0%
Enrollees
Inpatient MH
or CD
Inpatient PH,
MH, CD
654
704
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“Integrated Partner Model” stressed local
knowledge and management
• On-site at managed care plan
• After School
Prgrms.
• Beacon clinicians co-located
with Medical Management team
• Primary Care
Health
Plans
• Rec. Prgrms.
• BH in Medical Home
• Housing Svcs.
• Mentoring
Svcs.
• Faith-based
agencies
• Hospitals
Community
Services
Beacon
Integrated
Partner
Model
Providers
• Child Welfare
• Diversionary
Services
• Mobile Crisis Teams
• Schools
• Mental Health
• BH Specialists
• Parent Advisory Cmte.
Government
Partners
Families &
Advocates
• NAMI
• Consumer Strategies
• Courts
• Education / Outreach
• Medicaid
• Peer Specialists
• DD/MR
• 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
Top 10 Medicaid Health Plans
# 2. Boston Medical Center HealthNet Plan (HMO)
Beacon Client since ‘09
# 3. Fallon Community Health Plan (HMO)
Beacon Client since ‘99
# 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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