The Illinois Behavioral Health Home Coalition LLC (IBHHC) is a consortium of six providers in Illinois: Bridgeway, Inc., Chestnut Health Systems, Crosspoint Human Services, Heritage Behavioral Health Center, Human Service Center, and Mental Health Centers of Central Illinois. Like many healthcare providers, these six providers have organized themselves as a provider consortium for value-based purchasing arrangements focusing on high-cost members who have multiple behavioral health, substance use and chronic health conditions.
With a desire to improve care and demonstrate value to payers and stakeholders, IBHHC took the initiative to come up with a solution to address the needs of this population. The first step they took was to define the characteristics of a high user:
- 2-3 inpatient episodes in less than 6 months
- 2 or more ED visits in less than 6 months
- MLR 300-2000 percent based on claims
- 3-5 chronic co-morbid conditions
- Substance Use Disorder
Next, they sought out a strategic managed care partner. After talking with several health plans, the IBHHC partnered with Molina to conduct a pilot program with the 79 individuals who met the defined criteria.
Molina’s willingness to step up to the task and be the first health plan to share full claims data in the state of Illinois with Relias set them apart as a health plan leader. Sharing raw claims data to support providers via the Relias data analytics engine required leadership, trust, and true partnership. Molina remained actively involved throughout the pilot program making them an especially valued partner. The support of Molina’s leadership was essential to getting the pilot program off the ground.
Half of the group had one or more behavioral health diagnoses and a large portion had been treated in the ED rather than in a more appropriate ambulatory setting suggesting a lack of good care coordination and care access resulting in higher costs and higher rates of readmission.
With support from Molina, IBHHC adopted an analytics solution, Relias Analytics, to identify variation and gaps in care for the individuals within the high user population and to access the advanced decision support technology to improve the care provided to those individuals.
The pilot resulted in significant reduction in inpatient admissions (down 57 percent), emergency department visits (down 31 percent), and total cost of care (down 40 percent) from pre- to post- period. Based on the PMPM savings, annual savings for the studied group of 79 members is estimated at $1 million.
Relias Analytics allowed the IBHHC to:
- Identify high users within their patient population
- Discover the top 20 multi-morbid conditions driving costs
- Identify 9 persons alone who accounted for 45 hospital admissions and 116 ED visits
- Decrease costs by 40 percent