Behavioral Health Parity at Group Health Cooperative

Mike Quirk, DirectorGHC Behavioral Health Services

NBC May 28, 2009

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Three Ps

PurposeInform you about GH’s History, current status of BHS with particular attention to parity in the context of our role with PC and use of Lean

Process30 minute presentation followed by discussion

PayoffLearn from one another and get an insider’s view about the application of parity in a large health care organization

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Summary of what you are going to hear about BHS

From 20+ yrs ago being a loose federation of team based private practice clinicians

To carve out model carve in delivery system with a specialty population focus – last 20 yrs

To an emerging multi-payer, parity responsive, primary care supportive provider of standardized specialty services in a mixed model

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BHS Today as a microcosm of Group Health

7staff model clinics 2 entry and triage centers Centralized administration office Health Plan functions

Marketing RFIs, appeals and denials, care management, accreditation and report cards

Contracted networks

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Permeating Themes Organizational Adaptation set against a landscape of….

Internal Factors Changes in the

company Primary care

initiatives The role of the

medical group

External Factors

Managed care Parity both for

chemical dependency and mental health

Popularization of Lean

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GH’s History with a little bit about BHS

62 yrs ago formed by a grass root effort led by local clinicians & working people who wanted prepaid organized care

King Count Medical Society refused to admit GH MDs which interfered with receiving hospital privilege

Washington Supreme Court made an unanimous ruling against KCMS in ’51, and put them on probation for 3 years

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GH’s History with a little bit about BHS continued

1956: 40K enrollment; 1967: 100K, corresponding with formalization of MH coverage

1988: 350K enrollment; 1991: 470K, corresponding with MH cottage industry and related “re-organization”

1989 – 2009: 500 to 600K; BH managed care oriented delivery business that is organization wide

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BHS proving we can do parity

Early preparation via 1990’s strategic plan, collaboration via The HMO Group, benchmarking with Milliman, TP, NCQA, and KP

White Paper re: being parity ready

GH banner of Affordable Excellence: BH evolving to a balanced score card (Budget, trend, access, patient satisfaction, HEDIS, Permanente’

satisfaction, Gallup)

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The benefits and limits of being an integrated program in a carve-out era

Epidemiological Intelligence and Division of Labor

Roadmaps vs Primary Care General Consultation

Emergence of EPIC – the electronic medical record

NCQA’s accreditation standard for coordinated care – QI 11

Challenges re: CD Role of eValue8

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Backdrop of GH as the BHS Platform

The ups and downs of Vision 2000 The new Strategic Plan – Growth,

Affordability, Quality, and People Growth again with Choice Refining and maturing the Group

Practice * Medical Home* Content of Care * Care Management via the Health Plan

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How Lean helps

Initial forays with production centers like DME, Rx and Lab

CHS’ study of the Factoria Medical Home

Senior Leadership decision to employ Lean for both strategic deployment and operational excellence

BHS preparation for parity with standard work thru care management

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Lean made simple The mental models

Patient expectation, standards, standardized work, stabilization, measurement, and improvement

PDCA Rapid Process Improvement Workshops to

maximize design about staff involvement and leadership engagement

Leadership rounds – respectful and courteous Socratic dialog with follow up assignments

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Lean made complex

The organizational challenge - balancing factors – innovation and standardization

The manager’s challenge - paradox of producing good results with control and autonomy

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Lean – Medical Home

Behavioral goals Relationship with the patient,

containment of appropriate care, & division of labor with specialty

Elements Call management, virtual medicine,

chronic care management, pre-visit prep, disease management, and manager standard work

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PC & BHS Convergence : ParityNarrow focus

BHS care management Internal care management, external care

coordination & Medicare Care Management

PC chronic care and disease management External care coordination platform for

next tier BH diseases & HEDIS outreach; internal care management and Medicare – evolve to dual diagnosis

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PC & BHS: Collaborative Modelbroad focus

1. Local re-familiarization 2. Electronic enhancements with EMR 3. CD becomes the new depression 4. Care management system from the

previous slide 5. Prioritization of specific initiatives –

adolescence, Suboxone

All of this is reinforced by eValue8

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BHS Business Plan “Four adaptive issues with strategic deployment”

Change in coverage Intensive services

Change in relationship with delivery system RVUs & CD; PC initiatives and

collaboration Change in how we get paid

Choice, patient self pay, Health Plan/Delivery System, and Parity

Change in how we do our work with Lean

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BHS Business PlanMeta thoughts

Response to and a container of uncertainty, and a source of uncertainty as managed experiments

Relates to GH’s Affordable Excellence A – PMPM, economic scorecard, run rates E – Access, satisfaction, HEDIS

Role of manager evolves to daily management systems and leading promoting adjustment via engagement, plans, etc.

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How we are doing so far

1st and foremost adaptive leadership challenge – seeing progress

2nd decrease in beds, increase in care management

3rd performing well to $ trend considering parity has been staggered since 2006

4th access and patient satisfaction holding steady

5th population HEDIS via eValue8 part of the Medical Home design

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What I have learned so far

First “who” – leadership; hire for it at all levels, develop it and reward it

Organizationally it is about the “social contract” about the costs and benefits of BH care

Economic model defines what success is

Credibility is essential in and outside of the organization