Managed Care as a Catalyst to Improvement: How Managed Care Plans Support Population Health, Integrated Care and Systems Change
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.
Learning Areas:Administration, management, leadership
Social and behavioral sciences
Describe the need to promote health and behavioral health integration within health plans to improve population health. Explain the importance of integration and care coordination at the payor level to support integration at the provider level. Demonstrate how behavioral health integration can produce positive outcomes for systems and individuals (e.g., reduced use of emergency departments and hospital days).
Keyword(s): Leadership, Affordable Care Act
Qualified on the content I am responsible for because: Peter Currie is a clinical psychologist whose original practice was within psychiatric hospitals. He developed an innovative "Rapid Stabilization Program" to guide psychiatric hospitals to adapt to shorter lengths-of-stay. Dr. Currie designed, tested and implemented a multi-disciplinary network of behavioral health providers to HMOs in Southern California. Dr. Currie is the first Director of Behavioral Health for Inland Empire Health Plan, where he works to infuse behavioral health services into the established medical services.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.