Many of our clients are health plan professionals working in the health and human services space (including Medicaid plans and Medicare Advantage plans). The article below is based on our experience working with health plan staff who have succeeded in improving vendor management and procurement activities.
Reading Time: 3 minutes
Intended Readers: Medicaid Health Plan vendor management teams and executives
Tip 1: Invite more than you need
Its always good to have options. You should try to have at least two very strong candidates make it past the initial evaluation period. And in order to do that, you probably need at least 4 bidders to submit a proposal. And in order to have that many proposals, you probably need to invite 5 or 6 bid. Invite specific vendors you have initially vetted (versus a broad open call) when possible. This will mean more work on the front end of your procurement effort, but will lead to stronger proposals and more interested vendors.
Tip 2: Rely on references from your health plan peers
Your number one asset in this process is other health plans who have done business with the bidders. In the Medicaid space, most plan staff are less concerned about competition (except during MCO contract award cycles) and are more concerned about improving the delivery of services in the Medicaid program. Don’t be shy about asking your contacts in other plans for their opinion on vendors.
Tip 3: Hold a 1 on 1 pre-invitation discussion with each vendor
Remember your goal is high quality proposals. In order to provide those, vendors need to understand as much as they can about your goals for the project. In addition to the normal group Q&A call offered to vendors, consider offering 1 on 1 discussions to make sure vendors are aligned with your vision for the project. The number of vendors interested will dictate how much time you invest in this step. Its also recommended to conduct this part of the process with another trusted external consultant if possible. This step will minimize confusion over goals and scope before proposals are submitted, without adding even more workload to your operational staff.
How to get started implementing these tips
We assist clients with each of these strategies, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.
Knowing what to do is only the first step. Knowing how to implement these tips with your current team amid many other priorities is more complex. Here are a few other pointers on improving your options for your next vendor procurement:
Create a short list of invitees and gauge interest with them before executing your full procurement effort– List the three vendors that immediately come to mind, and have a half hour exploratory discussion with a small group from their team. This can help you rapidly identify any key changes or clarification needed to your requested project scope without the extensive resource cost of an RFI.
Assign an existing team member to own the procurement effort from a project management perspective OR hire an external consultant to focus on the effort- If your project is not too large, or not too complex, you can assign a team member to drive key work items that are often overlooked like scheduling and action item management.
Many of our clients are part of efforts to integrate behavioral health and physical health care in a variety of different models across the country. Regardless of the different governing structures for these services, plans have opportunities to optimize efforts to address the needs of the whole person .
Reading Time: 8 minutes
Intended Readers: Plan Executive Level Staff and integration solution providers considering further integration of physical and behavioral healthcare for members
Member Facing Services
Creating the most seamless experience for the members should be the highest priority for an integrated plan serving both physical and behavioral health needs. No matter where in the system of care the member accesses services, their physical and behavioral health needs should be screened, assessed and monitored.
Most integration opportunities begin with call center operations. As you think about your call center’s operations, do members need to call multiple numbers to get assistance with their behavioral health and physical health needs? Or are your call center work streams designed to meet both types of needs with one phone call?
Other opportunities for integration are found in member interaction points such as a single member manual explaining how to access both physical health and behavioral health benefits. Plans can also improve the member experience by using one set of forms for data collection, which can then feed into an analysis tool with a unified data model for both physical and behavioral health needs. Doing the work to build an integrated care data system that maintains a single source of truth record is one of the most important investments you can make to integrate care.
Carrying the same approach through to other member touchpoints is also critical, including self-service access to appointment scheduling, care plan tracking and grievances and appeals. Thinking about members as customers of your health plan who have needs and want to know where to go to get their needs met can help frame your approach to integrating these activities. Approaching integration from a member point-of-view eases the operational lift of your project and makes clear what activities should not be separate based by behavioral health and physical health needs.
Provider Facing Services
Similar to the approach for members, thinking about providers as a customers of the health plan helps identify opportunities where tasks may currently be unnecessarily separated between behavioral health and physical health.
Here are some troubleshooting questions to identify opportunities to improve the integrated care provider experience:
Can providers call a single number for both physical health and behavioral health assistance?
Can providers update their provider record in one place for credentialing, address changes, and phone number updates?
Can providers submit prior authorization requests and access claims information through a self-service portal?
When providers interact with the health plan, do they have the same contact person at the health plan for both physical health and behavioral health services?
Do you use a single standard credentialing form (NCQA or other) for credentialing physical and behavioral health providers?
Are network considerations and requirements the same for physical and behavioral health services?
Are quality metrics addressed across the spectrum of behavioral health and physical health needs?
Are the standards for review and documentation the same for behavioral health and physical health?
While the questions above can be overwhelming, keep in mind that making the necessary improvements to your provider relations functions is an ongoing process. If you focus on critical starting points like aligning to a single point of contact and creating additional self-service options, you can create some early wins in your integration project.
Integrated Technology Infrastructure
Having integrated technology solutions simplifies the workstreams needed to deliver quality behavioral health and physical health services . While the technology environment within each plan is different, most plans have a common basic technology infrastructure. Typical places where you can integrate your tech solutions include:
Using a single claims management system for both physical and behavioral health services
Managing all data in one data and analytics suite of products
Have care management staff use a single care management platform for both physical and behavioral health member management
Utilize a single call center platform
All of these assist with operating a more integrated plan by ensuring the member and provider experiences are simplified and unified in messaging during all interaction points.
How can you integrate behavioral health and physical health functions in your health plan?
We help a range of health plan clients navigate these challenges, and are happy to discuss supporting your efforts at any time.
Besides your own research into this topic, there are a few key tactics that can help you overcome some of the common challenges related to integration of behavioral health and physical health functions:
Develop a plan for integration of functions and identify the priorities and order based on a set of key criteria– The market that a plan operates within, the contractual and regulatory expectations/limitations, the readiness of key staff and partners will all be factors in determining which functions make sense to integrate now versus those that may need to wait.
Review the experiences of other plans around the country who have integrated functions – Many states now have plans with responsibility for both behavioral health and physical health services. There are lessons learned that can be leveraged in your efforts to integrate care delivered by your health plan. A review of the experiences of others in integrating particular functions could be helpful to you and your team.
Identify the ideal state for members, providers and support functions– Knowing where you want to be in each functional area and what is important will assist your team in prioritizing and making the right changes on the path to the ideal state.
Many of our clients are part of efforts to further integration of behavioral health and physical health care in a variety of different structures across the country. Whether you are a plan that is part of a state transformation effort, examining the potential for integration as a driver for quality improvement or working with providers to develop value-based payment for integrated care, there is a tremendous amount activity in this area.
Reading Time: 7 minutes
Intended Readers: Plan Executive Level Staff and integration solution providers
Key Topics: Environments, Categories of integration efforts, Operational components
The landscape of integrated care in states is varied and dynamic. There are many states that have already moved to integrate responsibility for behavioral health and physical health at the plan or community care organization level. Some others are taking steps in this direction and still others have not started to move on this particular area yet, but could begin the process at any time.
The most direct route for states to incentivize integration in their Medicaid programs is to procure the services together from a single integrated health plan. However, it is not the only way states are trying to advance integrated efforts. Some are acknowledging that there are populations within the integration effort that may benefit from special focus in a carve-out or similar structure. There are also states that have not taken concrete steps to structurally incentivize integrated care but are using existing contracts to push inclusion of all member issues in developing care plans and treatment.
Plans have to operate within the environment of the state(s) where they work. Is this state integrating behavioral health and physical health in its procurement of services? Is this state still managing the behavioral health and physical health in different plans or structures, but expecting plans to work together to advance larger goals? Is there no expectation for integration at the plan level, but, instead, opportunity for plans to work to advance integration at the provider level?
Category 1 – State Innovation Waivers (1915i)
States can bring integration efforts into the state through the use of Medicaid innovation waivers that allow them to leverage more creative payment structures to support the integration of behavioral health and physical health. Many states have done work in this area that has advanced the knowledge-base for integrated health services and identified potential avenues for further integration.
California is the most familiar example of a state pushing integration efforts through state transformation and Medicaid waivers. The CalAIM initiative is attempting to drive more integrated care, along with a combination of other initiatives. Currently, the state has a county-managed system with four different types of models. Those models do not easily facilitate integrated care, particularly when it comes to people with serious mental illness or substance use disorders.
Category 2 – State Procurement Driven Integration (1915c)
Several states have advanced integration through the procurement of health plans that are responsible for both the delivery of physical health and behavioral health services. These efforts give states direct levers to drive change and give plans flexibility in how they manage the various components of service delivery to ensure that costs remain manageable and outcomes are improved for their members.
Ohio and North Carolina have taken this procurement-driven approach in recent years, developing different delivery models, but both attempting to improve outcomes for members with behavioral health and physical health challenges and breaking down of silos between the service delivery systems. In Ohio, all behavioral helath services are now part of the responsibilities for the same plans that were previously managing physical health services. In their most recent procurement, Ohio also added a separate program to manage multi-needs children.
The State of North Carolina has gone through an extensive evolution of the management of behavioral health services – from a county-driven system, that is still in place in many states, to a regional “local managing entity” structure that brought together counties and leveraged the economies of scale, to those LME-MCOs merging and consolidating over the years, to a new model that will bring most behavioral health services under the same managed care plans who manage physical health, but individuals with more complicated behavioral health challenges being managed by “tailored” plans.
Plans that are operating under models where the state is attempting to integrate service management into its procurement of plan services have a clearer picture of what is expected and ability to deliver because of the dollars being included in the PMPM. These plans have to understand that the behavioral health provider networks are not on the same level as physical health provider networks in terms of sophistication of clinical service planning, electronic health records, documentation and claims processing. These integrated plans have the opportunity to help professionalize the behavioral health provider networks, but there is investment needed to support that work.
Category 3 – Plan Driven Integration Efforts
Plans have incentives beyond state priorities and contracts to drive integration efforts. Barriers to access, network management, utilization management and quality can also drive a need for better integrated care. These plan driven efforts can be identified through quality improvement efforts, contract compliance efforts or work in data analytics that identifies populations who are experiencing challenges that could be prevented with a more integrated service delivery system.
Category 4 – Facilitating and Supporting Provider Level Integration Efforts
At the level closest to members, plans are piloting a variety of initiatives to better coordinate and integrate care for behavioral health and physical health with hospitals, health systems, Federally Qualified Health Centers and Certified Community Behavioral Health providers. These pilot projects demonstrate a return on investment and show the value of integration in a concrete, tangible manner.
All of the operational areas within a plan can and should be involved in integration efforts, from the call center, to the care coordination team, utilization management, quality improvement, provider network management, data and information technology. All areas of plan operations have something to contribute to integration efforts.
How A Plan Can Enhance Its Efforts Toward Integration of Behavioral Health and Physical Health Services
Besides your own research into this topic, there are a few key tactics that can help you overcome the most common challenges related to integration of physical and behavioral health services. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be:
Better understand the state environment for your plan – What waivers has the state requested? What waivers have been approved? What is the procurement cycle? What are the governor and legislature discussing when it comes to Medicaid? Are there other drivers for integration?
Surface concerns your team has around integration and barriers that have been experienced in trying to advance integration efforts – An integrated care project will impact current workflows and business organization approaches. An initial listening-session series can save you a lot of time and mistakes.
Identify projects that could advance integration in your health plan that also solve other challenges within the plan – pilots with providers, data analytics efforts and analysis of member journeys and experience – When you get into a full-scale integration project, small-wins will be important to establish momentum. And alignment with multiple objectives will be key to sustain success.