The “Next Generation” Behavioral Health Carve-Out

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

At the start of the year, I wrote about one of the emerging trends from 2021—”integrated care” is increasingly happening via integration of consumer data and financial incentives—with physical location of service delivery of less importance. With the pandemic-driven adoption of virtual primary care, ‘integrated consumer data’ is now a euphemism for ‘integrated care”.

Interestingly, virtual primary care and integrated consumer data are driving another phenomenon—the return of the managed behavioral health carve-out. The big difference—the new managed behavioral health carve-out is a tech-enabled carve-out. Technology plays two roles in the emerging ‘next generation’ carve-outs. First, with more treatment going digital, it is feasible for a behavioral health carve-out model to be fully integrated into the consumer’s health record—and to focus on reducing total costs of care. Second, analysis of consumer data using augmented intelligence (AI) has the potential to reduce the staffing requirements—and the costs—for managing behavioral health benefits.

We got an inside look at the new tech-enabled managed behavioral health carve-out from Caroline Carney, M.D. Chief Medical Officer at Magellan Health and president of Magellan’s behavioral health division. In her keynote presentation, A Time For Transformation: Reimagining The Partnership Approach For Behavioral Health, at the 2021 OPEN MINDS Health Plan Partnership Summit, Dr. Carney described Magellan’s current initiative—to create a digital integrated ecosystem that incorporates physical and behavioral health, pharmacy, medication delivery, and social determinants of health (SDOH). This new ecosystem aggregates data from various sources which is then used to drive targeted interventions with consumers. Magellan’s new approach also features a suicide-risk program, collaborative care, social isolation outreach, a wellbeing solution, resiliency training, a curated suite of health care-adjacent apps, eCBT, and high-risk care coordination.

The opportunities for this new approach are many. The push to integrate primary care and behavioral health has resulted in mixed results. While there are ‘best of class’ programs for every model, the actual experience and results of “integration” from the consumer perspective and payer perspective has not been great. There are challenges to interoperability and data sharing. Clinical professionals from different disciplines—medical specialties, primary care, and behavioral health—have communication problems—and the need to address social determinants has made that communication gap even more acute. And, a combination of data sharing issues, an absence of shared clinical criteria, provider organization readiness, and health plan system issues have made the integrated care landscape uneven.

The emerging Magellan model, the tech-enabled managed behavioral health model, has all the functionality of a traditional carve-out—fueled by a ‘whole person’ view of consumer health data. Behavioral health services are guided by this data—data on claims, prior authorizations, health risk assessments, laboratory test values, wearable and digital app data, EMR data, and consumer demographics. Dr. Carney said their teams will use any of the data a health plan, state, county or employer will share with Magellan—and more types of data typically result in more honed predictive findings. Magellan uses these data in four areas: improving patient experience, improving care team experience, improving population health, and reducing cost of care.

This tech-enabled approach starts with identifying high risk and rising risk consumers for outreach conducted by a team with experience in consumer engagement. Care managers use risk stratification to align the needs of members who have entered a high level of care to align the needs of members, using high levels of care management following discharge. Magellan’s system brings together predictive data and process flows designed for each level of stratification.

Magellan has tackled population-based interventions through NeuroFlow’s app-based screening tool and supports. The tools serve as a means for communication between care managers and consumers who are discharging from inpatient care. The tool allows for stratification and directs members to appropriate levels of care. Early results of this work have shown that both care managers and consumers have high levels of engagement, including early identification of suicidal ideation.

Magellan tackled population-based interventions through the NeuroFlow app-based screening tool and supports. The tool allows for stratification and directs members to the right levels of care.  Also drawing on the rich experiences with Magellan’s pharmacy segment, Magellan Rx Management, the whole health program finds individuals whose medication treatment may not be evidence-based. Outreach to providers has consistently shown declines in overall cost of care, particularly in emergency department and inpatient care. More importantly, dangerous care gaps are routinely closed, including polypharmacy and dangerous medication combinations.

I asked Dr. Carney how their program links with health plans that have care coordination contracts with primary care practices and their own behavioral health network. She said that while the health plans have their own system—for primary care and for behavioral health—they often don’t have the right tools for the whole picture of consumer health. First, Magellan will embed or link their care management services with the health plan. Secondly, Magellan will create linkages to primary care and other medical practices through NeuroFlow’s technology and Magellan’s care managers and affiliated psychiatrists. Dr. Carney says that the key is a customized, modular approach to help the health plan enhance their integration model. She said, “It’s a model that’s been reinventing behavioral health carve-out, and we have worked closely with some of our payers to engage them in reviewing the data to see where those opportunities are and to recommend the right set of solutions.”

The ability for systems to integrate consumer health data not only is changing how primary care/behavioral health integration is happening—it may also usher in a whole new era of behavioral health carve-outs fueled by analytics. For specialty provider organizations, the ability to ‘plug in’ to the emerging models for integration is the key for success with consumers—and the key to financial sustainability.