Managed Care as a Catalyst to Improvement: How Managed Care Plans Support Population Health, Integrated Care and Systems Change

Nationally, momentum is growing to achieve better outcomes and reduce costs by integrating health and behavioral health care at the service delivery and system levels.  Many States are promoting integration under Medicaid managed care, with the goal of more effectively managing and coordinating care for populations with complex, co-occurring health and behavioral health conditions. 

This presentation will share findings from an innovative multi-year project  managed by the Inland Empire Health Plan (IEHP), a Medicaid managed-care plan that piloted “integrated care” as a strategy to implement whole-person care management for high cost/complex patients within two large counties in California. IEHP piloted an intensive, fully integrated outpatient program by contracting a behavioral health agency to provide the full range of wrap-around services, while having access to the IEHP clinical information system to improve care-coordination. IEHP addressed care integration at the senior administrative and care management levels; a Behavioral Health Director was hired to work closely with the Chief Medical Officer and Care Management Director.  Multidisciplinary care management teams were then developed to enable close collaboration between medical (nurse) and behavioral health care managers. 

Results included reductions in Emergency Department visits and psychiatric bed days, yielding a 25% return on investment for the health plan.  This and other lessons learned from this pilot offer important considerations for health plans and providers regarding the level of coordination and infrastructure required to better manage and “bend the cost-curve” for high cost, complex populations.