Partnership looks to curb mental health costs

new  approach: From left, Dr. James Sullivan, Butler Hospital's chief medical officer, and Ian Lang, executive director of Continuum Behavioral Health, are seen at Butler Hospital in Providence. / PBN PHOTO/ MICHAEL SALERNO
new approach: From left, Dr. James Sullivan, Butler Hospital's chief medical officer, and Ian Lang, executive director of Continuum Behavioral Health, are seen at Butler Hospital in Providence. / PBN PHOTO/ MICHAEL SALERNO

Health care industry leaders – Blue Cross & Blue Shield of Rhode Island, Care New England and Continuum Behavioral Health, among them – met more than two years ago to devise an innovative project for behavioral health care, called HealthPath.

The partnership radically changes the delivery of and payment for services for Blue Cross insureds with significant mental health issues.

Having an insurer, a health care system and a community health center charting how to deliver care for this population is an example of the state’s innovation economy, said Ian Lang, executive director of Continuum, the for-profit subsidiary of The Providence Center, now part of Care New England.

The partners identified clear-cut goals: Meet health care’s “Triple Aim” – improved health, improved quality of care and lower costs – for HealthPath participants, and generate savings to be shared among the partners and HealthPath participants. Using the evidence-based Assertive Community Treatment model – wraparound community-based services delivered by a multidisciplinary team – they expected to see fewer emergency department visits and inpatient hospitalizations, said Lang. “Early data show that we’ve made some real progress.”

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Ranging in age from 18 to 80, HealthPath participants may receive (at home or at HealthPath’s offices in Cranston, Providence and South Kingstown) unlimited services of psychiatric care, individual and/or group therapy counseling, medication management, vocational and peer support, and transportation. With a case manager coordinating treatment, each participant typically accesses six to 10 hours of care monthly, though per capita monthly use can reach 50 hours, said Lang. Treatment in the voluntary program generally runs six to 12 months. Representing a clear departure from traditional payment models, HealthPath assesses each participant a single monthly copay, capped at $40 (exclusive of prescription copays) for these bundled services.

HealthPath’s treatment team bridges patients’ clinical experiences between community-based and hospital-based treatment, said Dr. James Sullivan, Butler Hospital’s chief medical officer. “Individuals who will benefit from [these services] should be blind to what insurance card is in their wallet.”

One West Greenwich working professional is grateful for her Blue Cross card. Twenty years of progressively serious drinking caused her life to spiral out of control and led her to take a leave from work. Inpatient rehabilitations were followed by HealthPath, which she appreciated for its coordinated care and intensive supports. She completed HealthPath in April 2016; while she’s doing well at work, she still struggles.

“I don’t have the level of trust where I can be as open and honest as I was at HealthPath,” said Ann, who declined to give her last name. “I’d like to see more programs like this. The time and money invested really pays off.”

Is HealthPath meeting its goals? Lang said that participants are using medical, emergency department and medical-inpatient resources at rates lower than those of their Blue Cross comparison group, with markedly better readmission rates to Butler Hospital. HealthPath participants’ seven-day readmission rates decreased 27 percent from their rates in the year before HealthPath enrollment, although their 30-day readmission rates rose by 2 percent.

During the same two-year period, Blue Cross’ comparison group experienced a 7 percent increase and a 153 percent increase in seven-day and 30-day readmission rates, respectively. And, 82 percent of participants show improved Daily Living Assessment scores – measuring functionality at home, work and in society – while in HealthPath.

Currently treating 240 individuals, HealthPath has enrolled 745 people, half of whom have successfully completed the program. Per capita mean health care costs for successful participants are $2,185; for unsuccessful participants, $3,270, said Lang.

It took time to build the trust that was required to create and sustain HealthPath, said Lang, who credits Rhode Island’s small size for helping make that happen.

He says improvements include better coordination between HealthPath and Butler when HealthPath participants return to Butler; adding staff with expertise in substance abuse disorders; and establishing a “step down” program, HealthPath Connect, providing transitional support for participants’ leaving HealthPath.

Blue Cross opened HealthPath access to Medicare members and members with primary substance-use disorders, said Dr. Matt Collins, BCBSRI’s vice president of clinical integration.

“It’s early to tell what’s going to happen with these patients clinically and medically… when they graduate from HealthPath and return to more of a traditional treatment model. The metrics team is eager to have … follow-up data,” said Sullivan. •

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