Breaking Ground through Provider Partnerships

CO PartnershipWe hear a lot about the value of relationships in our personal lives: they help people to live longer, deal with stress better, and experience better well-being. The same can be said for health care, where relationships take the form of partnerships. For Beacon Health Options (Beacon), this is especially true in Colorado where, for 22 years, Beacon and its partners have measurably improved the lives of the people they serve.

Why are partnerships effective? In brief, they encourage a dynamic to improve health care delivery systems by:

  1. Allowing for a deeper understanding of the local delivery system
  2. Designing a system of care around the member and eliminate unnecessary services
  3. Calling for a team-based approach to improving care that allows for adjustments in clinical or administrative design to promote evidence-based practices, deploy quality initiatives and change financial models
  4. Providing a unified voice regarding advocacy for services

As with successful personal relationships, these Colorado partnerships rely on mutual support and give-and-take.

What makes the Beacon provider partnerships in Colorado stand out is that they are ahead of the curve in establishing what Beacon promoted in its recent white paper, “Integration:” the placement of behavioral health into primary care settings and vice versa – the placement of primary care staff in behavioral health settings.

Public/private partnerships 

In Colorado, Beacon has several important partnerships. Two include one with Colorado Health Partners (CHP) and the other with Foothills Behavioral Health Partners (FBHP). Both are part of the carve-out behavioral health Medicaid contracts, known as Behavioral Health Organizations (BHOs), which accept state-direct contracts with the Colorado Medicaid authority – Health Care Policy and Financing (HCPF).

Much of these programs’ success is tied to flexible payment models, which allow discretionary funding for an integrated delivery system of care. 

As with successful personal relationships, these Colorado partnerships rely on mutual support and give-and-take. For starters, they accept full-risk for more than 616,000 Medicaid members in 48 of Colorado’s 64 counties. Beacon performs the administrative elements of the contract requirements, while the provider partners focus on the delivery side of health care and manage the risk.

A third relationship is a partnership with Federally Qualified Health Centers and Community Mental Health Centers in 19 counties in southern Colorado, serving 115K Medicaid lives as a Regional Collaborative Care Organization (RCCO). The RCCO, called Integrated Community Health Partners (ICHP), manages the membership through a care coordination model that focuses on key performance indicators, such as ER visits, postpartum depression and total cost of care.

Measureable success

The BHO partnerships have been successful in achieving Don Berwick’s Triple Aim in the following ways:

  • Holding nearly flat reimbursement rates for many years and through many contract iterations
  • Improving access to both community mental health centers and private clinicians
  • Significantly improving the quality of care delivered as evidenced by audit scores improving over a three-year period

Much of this success is due to a system redesign, with a focus on integration. CHP has deployed more than 90 sites with CHP staff placed into primary care settings to better integrate care. To improve care coordination, CHP centers include primary care to help those members who seek behavioral health services at CHP. FBHP also has bidirectional integrated care models with its safety net health clinic providers. It’s important to note that much of these programs’ success is tied to flexible payment models, which allow discretionary funding for an integrated delivery system of care.

ICHP has been highly successful as well. It averaged 98 percent on the independent state audits for the last five years, the highest average score of the seven Colorado RCCOs.

The future state

In 2018, it is expected the RCCOs and the BHOs will merge into one contract – the Regional Accountable Entity (RAE). Under this single contract, much of the specialty behavioral health services (BHOs) will be combined through a capitated integrated care coordination model to meet the Triple Aim’s goals. Of particular importance is that the RAEs will focus on the social determinates of health, as promoted in our “Integration” white paper. We look forward to continuing our mission into the next HCPF contract period to help people live their lives to their fullest potential.

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2 Comments. Leave new

Dr. Anne Toland
May 17, 2016 6:44 pm

could you let us know what audit tools you used

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Erica Arnold-Miller
May 18, 2016 3:39 pm

We are happy to share it! I’ll send it to you today.

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