Behavioral Health

Why one insurer is expanding a mental health integration pilot statewide

May 8, 2019 2:25 pm

April 16—Early indications of savings and positive provider feedback led one Blue Cross plan to expand statewide a behavioral care telehealth program.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has been testing the use of new vendor technology that aims to go beyond increasingly common telehealth platforms for behavioral care by using predictive analytics to identify the primary care patients who need such services.

Using proprietary algorithms, the vendor takes claims data from Horizon and identifies members with an undiagnosed or undertreated behavioral health problem, said Suzanne Kunis, director of behavioral health solutions for Horizon Blue Cross Blue Shield of New Jersey. “This is a primary care physician-focused initiative,” Kunis said.

The pilot, launched in January 2018, involved over 1,200 primary care physicians and more than 550 behavioral health practices. The providers used an app to refer patients for behavioral health treatment and to continually communicate with each other, such as regarding the treatment plan and medication.

The approach was possible because BCBSNJ shared claims data with the vendor, which focused its algorithms to identify individuals with under-met or unmet behavioral health needs.

The health plan also uses predictive models that look for events like readmissions among enrollees at risk for behavioral health problems.

“I know for many, many years, primary care providers were afraid to do screenings, because they didn’t know what to do if the patient screened positive and how they would respond to that,” Kunis said at a briefing of the National Institute for Health Care Management (NIHCM) Foundation. “Now we’ve got this tool in place where we are actually giving them the opportunity to surface patients, get them into treatment, and know on an ongoing basis what’s actually going on with those patients.”

Since the pilot launched, the vendor identified more than 2,500 beneficiaries among the primary care practices who potentially could use a behavioral health intervention. Then, 1,700 enrollees were referred by their primary care provider through the vendor to connect with behavioral health treatment.

Additionally, “several thousand” other patients of those primary care practices, who were not BCBSNJ enrollees, were referred to behavioral health treatment through the program.

The financial benefit of such models is potentially enormous, according to Kunis, because costs are generally three times higher for individuals who have a comorbid mental health condition.

Driving the program’s expansion

Although the health plan does not expect to have finished the financial analysis of the program until the end of 2019, positive provider feedback has led it to expand the program statewide.

“There has been such great response to this,” Kunis said. “We have lots of testimonials from providers that are actually utilizing the system. We decided to scale this statewide and we will be doing so in the coming month, even while we wait for the demonstrative ROI.”

Early benefits of the program identified by BCBSNJ included:

  • Increased detection of at-risk members and connection to appropriate behavioral healthcare
  • Reduction in downstream behavioral costs (such as emergency department visits)
  • Closure of behavioral health gaps by equipping primary care providers with mental health case managers and ad-hoc psychiatric consultants
  • Improved coordination of referrals to in-network psychiatrists based on enrollee decisions and provider availability
  • Reduction in stigma

The expansion will make the service for remotely connecting patients who may need behavioral healthcare available to all primary care physicians in the state, whether or not they work with the health plan.

“We know that there are enough challenges in the primary care setting and enough priorities — and timing is not on our side — that we’re trying to make certain that it is easy for primary care physicians to be able to say, ‘I’ve got a patient, regardless of insurance, no insurance, what type of insurance,’ that they can actually surface” to the vendor. Kunis said. In turn, the vendor “will connect them to behavioral health practices.”

Another expanding mental health effort

The health plan has spent the last year and a half developing another model, known as an integrated system of care, that aims to address behavioral health issues, physical health, and the social determinants of health.

An early, small-scale test of the model found among a group of 1,326 identified patients, the 77 who sought behavioral healthcare had a:

  • 15% reduction in average per member per month (PMPM) costs
  • 34% average reduction in PMPM physical healthcare costs

A broader pilot is planned to launch this summer involving a behavioral health practice and a health system, and the model eventually may be expanded statewide.

“Again, small numbers, we understand that, but we think it definitely reflects evidence of that strengthened integration between physical health and behavioral health and really will improve overall outcomes and reduce overall cost of care,” Kunis said. “It’s been a journey getting to this point, but we’re really excited about the potential.”


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