What Functions of a Health Plan Can be Integrated?

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 .

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Intended Readers: Plan Executive Level Staff and integration solution providers considering further integration of physical and behavioral healthcare for members

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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:

  1. 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.
  2. 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.
  3. 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.

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