What are Commercial Health Plans Doing to Improve Behavioral Health Care Quality?

1. What are Commercial Health Plans Doing to Improve Behavioral Health Care Quality? Ivan Khan, MD, MPH Director, Quality Initiatives

2. Agenda • Understanding the role of eValue8 in measuring health plan performance • eValue8’s Behavioral Health Module • What are your health plans currently doing?

3. eValue8 Overview • Nation’s leading evidence based health plan request for information (RFI) tool • Administered annually by National Business Coalition on Health (NBCH) to support Value Based Purchasing Strategies • Used by employers & coalitions nationally to assess health plan performance around value, not just cost • Over 350 questions in 7 clinical and non-clinical areas

4. How Employers Use eValue8 • Determine & compare how health plans are leveraging resources to improve member health status • Develop targeted strategies for improving value of health care • Collaborate with purchasers and health care providers to improve community health quality • Past eValue8 findings in Behavioral Health Module led to the formation of the Mental Health Task Force  One Voice

5. Participating Coalitions in 2010 Buyers Health Care Action Group (MN) Colorado Business Group on Health Florida Health Care Coalition HealthCare 21 (TN) Health Action Council of NE OH Memphis Business Group on Health Mid-Atlantic Business Group on Health Midwest Business Group on Health New York Business Group on Health Oregon Coalition of Health Care Purchasers Pacific Business Group on Health Puget Sound Health Alliance South Carolina Business Coalition on Health Wichita Business Coalition on Health Care (modified) Rhode Island Louisiana

6. 2010 eValue8 Participation inNew York, New Jersey, & Connecticut Health Plans Employers • HMO • Cigna NY • Cigna NJ • Cigna CT • PPO • Aetna NY • Anthem NY • Cigna NY • United NY • Pitney Bowes • Thomson Reuters • Citi • Skadden, Arps • Assurant • New York Public Library • Cleary Benefits Group • American Express • Con Edison • EMCOR • Montefiore Medical Center • Labor Health Alliance

7. eValue8 Collaborators Centers for Disease Control (CDC) Centers for Medicare and Medicaid Services (CMS) Substance Abuse and Mental Health Services Administration (SAMHSA) Agency for Healthcare Research and Quality (AHRQ) National Committee on Quality Assurance (NCQA) Joint Commission for the Accreditation of Health Care Organizations (JCAHO) URAC American Board of Internal Medicine (ABIM) eHealthInitiative (eHI) The Leapfrog Group Pennsylvania State University George Washington University

8. Non-Clinical Sections Consumer Engagement Provider Measurement Plan Profile (Accreditation, Value-based Plan Design, Administrative) 2010 eValue8 Content • Clinical Sections • Chronic Disease Management (Coronary Artery Disease, Diabetes, Back Pain) • Behavioral Health • Pharmaceutical Management • Prevention and Health Promotion

9. Behavioral Health Module • Focuses on disease management of depression, screening for alcohol problems and other points in the provision of behavioral health services: • Plan Organization • Member Screening • Member Support Depression • Practitioner Support • Performance Results

10. BH Module Breakdown • Plan Organization - Plan is expected to offer plan wide BH services, and timely clinical support 24/7 • Member Screening - Plan is expected to: • ID and track members for alcohol d/o and depression • Provide practitioners w/ tools for screening for alcohol and depression • Follow up w/ patients that present w alcohol related injuries • Member Support – Scoring emphasis placed on interventions that incorporate chronic care model. Plan is expected to: • Have a program to address medication compliance • ID and treat members with co-morbid BH and medical conditions

11. BH Module Breakdown • Practitioner Support: Plan is expected to: • Support providers with clinical guidelines, and comparative reports for alcohol overuse • Make available actionable clinical data to practitioners • Proactively engage practitioners in Disease Management program • Track prescribing of anti-depressant medications to assure appropriate assessment • Performance Results: Plan is expected to achieve HEDIS percentiles for each individual measure, maximum credit to those achieving >90th % • Initiation and engagement of alcohol & other drug dependence Tx. • MH utilization: % members receiving services- any FU after hosp for mental illness- 7 days & 30 days • Anti-depressant medication management – effective acute & continuation phase treatments • Members receiving any services

13. Anthem BH Key Findings • Total Score : 58% • Plan Organization: Own BH program, screens ONLY pregnant members, or those with chronic conditions for Depression & Alcohol overuse; treats all that are found positive. Employer buy up option to screen ALL members. • Member Screening: Recommends usage of screeners to all Non-BH practitioners, however does not monitor usage, and lacks screeners for child/adolescent Rx drug misuse. • Member Support: Low Depression ID rates (< 1% of members), low member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, no Interactive Voice Response (IVR), Financial Incentives to members in Behavior Change Therapy • Practitioner Support: Notifies practitioner for members ID’d, does not provide comparative reports to practitioners for depression or alcohol, • Performance Results: HEDIS scores > 90% for: Initiation of alcohol treatment. HEDIS 75-90% for f/u after hosp. for Mental Illness & Anti Depressant med mgmt.

14. Aetna BH Key Findings • Total Score: 68.5% • Plan Organization: Own BH program, ONLY those in DM or case mgmt program, pregnant pts, or previously ID’d patients are screened for Alcohol & Depression, Disease Mgmt component only available as a buy up for PPO products. 24/7 telephonic clinical support. • Member Screening: Has own program for depression screening in primary care for internists, peds, OB/GYN with 464 participating PCPs in NorthEast. However does not monitor usage, and lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures. • Member Support: Good Depression ID rates (4% of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, Interactive Voice Response (IVR), numerous med adherence services, no financial incentives for members. • Practitioner Support: Incentivizes practitioners to enroll members into DM program for alcohol & depression, supports office/practice re-design. Member-specific comparative reports with a wide variety of depression indicators are provided to non-BH, BH, and prescribing practitioners. • Performance Results: HEDIS scores > 90% for: Initiation of alcohol treatment. HEDIS 75-90% for f/u after hosp. for Mental Illness & Anti Depressant med mgmt, and f/u for children prescribed ADHD meds

15. United BH Key Findings • Total Score: 77.6% • Plan Organization: Own BH program, ONLY pregnant pts, or previously ID’d patients are screened for Alcohol & Depression. IDs high risk members with co-morbidities. Extended discharge f/u. 24/7 telephonic clinical support. • Member Screening: Recommends usage of screeners to all Non-BH practitioners AND monitor susage. Lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures. • Member Support: Poor Depression ID rates (< 1 % of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, NO Interactive Voice Response (IVR). • Practitioner Support: Incentivizes practitioners to enroll members into DM program for alcohol & depression; NCQA physician recognition, supports office/practice re-design. Member-specific NON-comparative reports for Depression & Alcohol • Performance Results: HEDIS scores > 90% for f/u for children prescribed ADHD meds . HEDIS 75-90% for f/u after hosp. for Mental Illness and for initiation of alcohol treatment.

16. Cigna BH Key Findings • Total Score: 79.3% • Plan Organization: Own BH program, with integration of employer, provider, and other clinical data. Rx data is used to ID potential members for case mgmt. All patients in DM program, and others ID’s with certain conditions are screened for Alcohol & Depression. 24/7 telephonic clinical support. • Member Screening: Recommends usage of screeners to all Non-BH practitioners AND monitor s usage. Lacks screeners for child/adolescent Rx drug misuse. Reimburses ED physicians for alcohol screenings in ED & trauma centers, and for intervention procedures. • Member Support: Poor Depression ID rates (< 1 % of members), average member participation rates for DM program. Provides member specific reminders for medication gaps, live outbound telephonic for appointments, Interactive Voice Response (IVR). • Practitioner Support: Member-specific comparative reports for Depression & Alcohol, which include med compliance info. Compares physician Rx prescribing to depression diagnosis rates, reimburses non-BH and BH practitioners for screening and mgmt. • Performance Results: HEDIS scores > 90% for f/u for children prescribed ADHD meds & for initiation of alcohol treatment . HEDIS 75-90% for f/u after hosp. for Mental Illness.

17. Impact of eValue8

18. Conclusion • NYBGH employers participate in eValue8 annually to assess their health plans in many areas • Past Behavioral Health results lead to One Voice Initiative and other collaborative QI in NYC • NYBGH eValue8 participating health plans have improved delivery of BH services over time in NY, NJ, & CT