Rahul Rajkumar Profile picture
Jul 13, 2020 21 tweets 13 min read Read on X
Behavioral health (BH) care is in crisis – but payers have the opportunity to shape a better future. Payment reform can create a #BH system that is flexible and responsive, especially during times like now. THREAD @Health_Affairs @HobbsKnutsonMD healthaffairs.org/do/10.1377/hbl…
The crisis:
⬆️Rising suicide rates
⬆️Increases in drug overdose deaths
⬇️Substantially lower life expectancy among people with serious mental illness
One major problem: Access to #BH care is limited.
1⃣There’s a shortage of #BH providers.
2⃣Many #BH providers don’t join insurance networks due to low reimbursement.
3⃣Evidence-based #BH treatments exist, but not enough providers deliver these interventions with fidelity.
Less than 50% of Americans with #BH disorders access care. And when they do, the quality of the treatment may be questionable. samhsa.gov/data/sites/def…
Our long-term strategy is focused on improving #BH access, quality and efficiency. Our 5-step approach is:
1⃣Eliminating our carve-out
2⃣Integrating care
3⃣Increasing payment through value-based reimbursement
4⃣Deploying point solutions at scale
5⃣Measuring impact
Eliminating our carve-out: Many payers contract with managed #BH care organizations effectively “carving out” management and reimbursement for #BH services so they are separate from physical health.
This legacy structure is the OPPOSITE of offering whole person health. The carve-out causes fragmented delivery and perverse incentives to reduce the use of mental health and substance use disorder services.
To remove the carve-out, @BlueCrossNC simply added #BH to its existing functions. All #BH staff directly report through the same management structures as physical health. Case managers, nurses and physicians on our team now review physical and #BH cases together.
Removal of third-party vendors = streamlined ability to implement changes for members and providers. E.g., in response to #COVID19, we were able to change our policies to increase access to #BH care (including telehealth!) in line with our #COVID19 strategy for physical health.
Integrating care: We aim for 90% of our network primary care practices to deliver integrated care by 2022. Integrated care is THE workforce multiplier for #BH.
A broader population can access #BH care by how we proactively enable primary care providers (PCP) to delivery first-line #BH treatment @quartethealth
Value-Based Payment in #BH: To drive efficiency and align with our overall transition to value, we are tying increased reimbursement for #BH providers to improved access, quality and totally health care costs. Performance is rewarded through two different value-based contracts:
1 - Basic pay for performance: This model is upside only, limiting financial risk for smaller practices. Based on performance, #BH providers can earn an additional 10% of their annual reimbursement.
2 - Advanced payment model where we share accountability with providers for #BH quality and total cost of care: This reimbursement model is designed for larger multidisciplinary practices that address a variety of #BH disorders.
Rapid scaling of point solutions: Substance use disorders (SUD) are major drivers of poor health and high cost in @BlueCrossNC membership. For our commercial members with #SUDs, total health care costs are 3-5x higher than the general population.
To @BlueCrossNC, high medical expenses suggested an inadequate supply of providers in more cost-effective outpatient and community-based settings. That’s why we helped launch @EleanorHealth, a comprehensive provider of outpatient #SUD treatment.
This model involves in-person and virtual care and the delivery of medication and therapy to address opioid and other #SUDs, as well as co-occurring mental health conditions such as depression and the effects of trauma. @EleanorHealth aims to grow to 10 clinics in #NC by EOY.
Measuring Impact: @BlueCrossNC is measuring the impact of these interventions both in isolation and collectively across our membership, using a quasi-experimental approach. To start, we’re measuring changes in #BH service use.
We’re expecting increases in outpatient services and reduction in avoidable use of emergency departments and inpatient units by 2021. Prior to #COVID19, based on national estimates, we anticipated a 152% return on #BH investments through medical expense savings.
We’re in our second year of this long-term strategy to drive improvements in #BH access, quality and efficiency. This is only the beginning. @BlueCrossNC @quartethealth, @EleanorHealth, @HobbsKnutsonMD, @scottheiser, @azaleakim, @araopatel27

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More from @RahulRajkumar11

Sep 30, 2020
During a pandemic there can be glimmers of light. I am proud to announce that we have brought production of #N95 masks (beginning to end) to #NC. THREAD

mediacenter.bcbsnc.com/news/made-in-n…
The #MadeinNC collaboration will produce nearly 2 million N95 respirators per year to fill the unmet need for #NC frontline health providers during #COVID19.
Since the onset of #COVID19, demand for N95 respirators and other PPE has outpaced current global manufacturing capabilities. N95s are still scarce and many health organizations confront the issue of counterfeits and price gauging, among other obstacles.
Read 8 tweets
Aug 13, 2020
🥁Drum roll please ...The 2019 results are in. Kudos to @ConeHealth, @DukeHealth-@PDCDuke
, @UNC_Health_Care, @wakehealth, and @WakeMed (WKCC), as well as @AledadeACO who share our vision for better, more affordable health care. We did it! 🎉 THREAD mediacenter.bcbsnc.com/news/blue-cros… Image
Under #BluePremier in 2019, @BlueCrossNC’s value-based care program, providers across 5 health systems & practices affiliated w/ @AledadeACO served 536,000 members.
These health care providers also generated an estimated $153 million through cost savings, quality improvements and slowing the rate of spending on health care. 👏👏
Read 14 tweets
Aug 6, 2020
Important piece in @nytimes summarizing the promise and challenges ahead for #telehealth by @ReedAbelson. Privileged to join the conversation.

As I stated here, despite the promise, there’s a lot we don’t know about #telehealth. THREAD

nytimes.com/2020/08/03/hea…
We need to understand how it delivers value to patients by improving outcomes, quality, and affordability of care 2/
If the right hand is #telehealth, the left hand is #valuebased payment (including #PCPCapitation) - the method of how we pay matters a lot in motivating the behaviors we need to see in our delivery system. 3/
Read 17 tweets
Jul 28, 2020
📣‼️Good news – we've extended the deadline to Aug 14th for the financial support program 💰for independent primary care practices (Accelerate to Value).

We've received a lot of great questions. Here are answers to the top 6 to help make the smart decision to apply:

THREAD
Q1: How is the Accelerate to Value application connected to joining a Blue Premier ACO?

Answer: These are two *separate* applications. Accelerate to Value is a program that gives you upfront payments 💰 to stabilize practice revenue during #COVID19.
The Accelerate to Value application is due August 14th ‼️

As part of this program, you will need to join a Blue Premier ACO by December 31, 2020. It’s a separate process with that ACO. You have the next 5 months to consider your options for Blue Premier ACOs to join.
Read 11 tweets
Jul 20, 2020
📣 Today we can report #somegoodnews for sustainability of our health system. THREAD. mediacenter.bcbsnc.com/news/primary-c… Image
We are on a mission to make health care better, safer, and more affordable by transforming the health care delivery system in North Carolina.

Step 1: Change the way we pay for health care.
One of our goals is that, by 2023, every @BlueCrossNC member will have a Blue Premier provider that is accountable for their total cost of care and quality. Accountable care = better care, better experience, more efficient care.
Read 13 tweets
Jul 14, 2020
‼️ ATTN: Independent Primary Care Physicians,

If you’re in need of financial support 💰, we’ve got a program for you.

Deadline to apply is July 31. Application takes only 10 minutes - don't delay apply today. ⌛️

THREAD

bluecrossnc.com/accelerate-val… Image
The primary goal for this program is to provide upfront financial support that can help independent primary care practices weather this crisis. To do so, we will provide supplemental payments 💰 to stabilize @BlueCrossNC revenue at its pre-COVID-19 level.

3 step breakdown:
Step 1: Eligible independent primary care practices need to apply for the program by July 31. The application is non-binding and takes less than 10 minutes. bluecrossnc.com/accelerate-val…
Read 16 tweets

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