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ABHW Member Company Spotlight – Beacon Health Strategies

Over the next several months, ABHW will be spotlighting member companies for the Perspectives section of the website. Interviews conducted with ABHW's members will highlight programs and initiatives they are offering; preparations underway for the implementation of the Patient Protection and Affordable Care Act (ACA); and other current topics of interest.

ABHW conducted an interview with Timothy Murphy, Chief Executive Officer of Beacon Health Strategies. Mr. Murphy joined Beacon in 2007 as President and is responsible for leading the company's strategic and operational planning and management. Prior to joining Beacon, Mr. Murphy served as the Secretary of Health and Human Services for the Commonwealth of Massachusetts.

Beacon Health Strategies is a nationally recognized managed behavioral health organization with more than 700 employees dedicated to improving the health and well-being of its members.  Beacon's objective is to offer superior clinical management and care coordination for society's most at-risk individuals with serious mental health and/or substance use conditions.  For the past 16 years, Beacon has pursued a clinical management model that integrates its specialty behavioral health expertise with the physical and social care needs of its members.  Beacon's Integrated Partner Model locates its clinician and provider contracting employees in the local market of its health plan customers to ensure that its behavioral health expertise is provided in a local, culturally competent way.

Is Beacon applying any lessons learned from the Massachusetts experience as it moves forward with implementing provisions of the ACA?

During the last six years, Massachusetts learned that, when care is properly integrated and coordinated, there are positive results for individuals receiving subsidized health insurance through the state's Connector (referred to as an Exchange nationally).  Consequently, many states and health plans are analyzing and reviewing the Massachusetts experience, including Beacon's role in delivering integrated behavioral health care with its three health insurance plan partners serving this "reform" population.

An important lesson learned from the Massachusetts experience is that individuals with Mental Health/Substance Use Disorders (MH/SUD) comprise a significant portion of the newly insured population.  Historically, many of these individuals with MH/SUD conditions were uninsured for long periods of time as they did not qualify for Medicaid due to working periodically during a calendar year and thus earning too much income for Medicaid coverage. However, their illnesses usually caused gaps in employment that limited access to employer-based health insurance.  Because these individuals are often co-morbid with physical chronic conditions (e.g. diabetes), the development of integrated care management plans to address their unique behavioral health needs is essential.

Many health plans do not always have expertise in managing behavioral health needs, creating an onus on specialty behavioral health organizations (BHOs) to educate state policymakers, providers, consumers and their advocates, and health plans about the newly insured physical, social and behavioral needs and how to best manage their care in an integrated manner.

What are a few changes Beacon has made in preparation for ACA implementation on January 1, 2014?

There are a number of technical requirements that Beacon is working on with its health plan partners to comply with ACA. For example, Beacon is working to ensure that its customers' behavioral health benefits are appropriate for exchange listing.

An additional focus is the increased demand for the sharing of claims and clinical information among and between health plans and providers to best coordinate a patient's care. Beacon is investing in its information technology environment in order to best facilitate timely and tangible communications with its partners. For example, Beacon is constantly improving its data warehouse to handle increase data flows and allow for better analysis of data to assist providers and members to better coordinate care.  

What do you think the biggest challenges are for BHOs as we move forward with the ACA?

If ACOs emerge as expected, then BHOs will have a new business channel partner for its services.  The industry will have to demonstrate why working with a specialist behavioral company is advantageous to provider-led organizations (ACOs), which have limited experience working with third parties to help manage their patients' care.    

What are the behavioral characteristics of the new enrollees dual eligible population?

In the dual eligible population, we are seeing individuals with more pronounced behavioral health characteristics than with individuals in the generally insured population. To meet the needs of this medically complex population, providers must understand that in addition to clinical services, there is a need for community-based services.

In Beacon's experience, roughly a third of the duals under age 64 are classified as having a Serious Mental Illness (SMI), and almost two-thirds have a behavioral health diagnosis.  The dominance of mental health conditions should be a significant area of focus. For duals over age 65, 10 percent are classified as having an SMI, which combined means that approximately 15 percent of a typical dual eligible population can be classified with an SMI. Consequently, many health plans are embracing the need for specialty behavioral health care organizations.

ABHW

Perspectives

CONSUMER TIPS: NAVIGATING YOUR PRIOR AUTHORIZATION.

Behavioral health is complex. Untreated behavioral health conditions, including both mental health and substance use disorders, have a significant impact on individuals, families, friends, and employers. Individuals with mental health conditions and/or substance use disorders need access to evidence-based services - the care that, based on scientific research, has been shown to...

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