By Monica E. Oss, Chief Executive Officer, OPEN MINDS
There was quite a lot of discussion of health plan partnerships last week at our 2022 OPEN MINDS Strategy & Innovation Institute. Hossam Mahmoud, M.D., Regional Chief Medical Officer for Beacon Health Options, in his keynote From Obscurity Into The Spotlight–Telehealth’s Evolutionary Path In Behavioral Health & How Beacon Continues To Light The Way, spoke of emerging opportunities for ‘specialty telehealth’—for eating disorders, addictions, autism and more.
Douglas Nemecek, M.D., Chief Medical Officer – Behavioral Health of Cigna’s Evernorth, following his keynote, Filling In the Gaps: How Evernorth Is Driving Better Health For Complex Consumers, discussed Evernorth’s emerging Center of Excellence model and pilot initiatives with case rate reimbursement models. And, the Bayless Integrated Healthcare team—Silvia Garcia, Chief of Staff; Graham Johnson, Chief Financial Officer; and Dr. George Orras, Chief Clinical Officer—in their session, Preparing For CalAIM – Developing A Strategy For Sustainability & Success For Specialty Care & Primary Care In A Changing Medi-Cal Market, spoke to the success in reducing emergency room visits and hospital stays in their value-based arrangements with Mercy Care Plan. Bayless has been part of Magellan Health for the past year.
The frustration of many specialty provider organization executive teams is the uneven pace of the development of preferred relationships that open the opportunity for reimbursement based on performance. The data supports the perception. More primary care provider organizations have developed those relationships. And among specialties, behavioral health lags behind cardiology, oncology, and other areas in developing ‘non-fee-for-service’ relationships. The reasons are many. Lack of longitudinal consumer behavioral health spending data in many health plans. Lack of standardization of performance measures. Challenges in health plan contracting and payment systems.
But plenty of examples of robust and successful value-based arrangements in mental health, addiction treatment, autism services, children’s services, and I/DD support service exist. The challenge for provider organization executive teams is ‘staying the course’. Tracking the changing health plan landscape in their markets, maintaining relationships with changing health plan managers, and navigating corporate changes in ownership, policies, and procedures. For the short course on health plan partnerships, check out our most recent seminar, How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating & Contracting With Health Plans, and the seminar readings book, How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating, & Contracting With Health Plans.