Post on 26-Dec-2015
New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy
Christa RobertsHealth & Wellness Strategist
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Cerner at a Glance
Founded in 1979, based in Kansas CityRevenue 2009: $1.7BLargest standalone healthcare IT company in the world• 8,500 facilities with approximately 2300
hospitals• 3,400 physician practices covering 30,000
physicians• 600 ambulatory facilities• 700 home health facilities• 1,500 retail pharmacies
Countries: 25Associates: 7,800Average Tenure/Age: 5/34 YearsAssociate Mix: • 30% engineering• 30% IT services• 15% clinical• 25% sales & all others
All connected to common internet toolsHealth Plan Spend 2009: $55 MillionCovered Lives in 2010: 11,400• 5500 associate• 5900 dependents• 85% participation rate
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Cerner Health & Wellness: Core Principles
Align with Cerner’s vision, mission, and culture
Build, support and promote a healthy and productive workforce
Provide comprehensive benefit offerings
Develop innovative and wellness focused benefits
Holistic view of health management:PreventionEarly detectionTreatmentManagement
Promote accountability and facilitate change:EducationToolsSupport
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2010 Cerner Health Plan Design
Coverage Code Deductible Cost Share Annual OOP Max
Associate Only $1,400 15% up to $900 $2,300
Associate Plus One $2,100 15% up to $1,400 $3,500
Associate Plus Children $2,100 15% up to $1,400 $3,500
Associate Plus Family $2,800 15% up to $1,900 $4,700
High Deductible Health Plan Health Reimbursement Account (HRA) with $400 employer contributionNetwork:
BeechstreetDirect contracts (115 contracts, 3,680 providers)Out of network policy
100% coverage of preventive care100% coverage at the Healthe Clinic (Professional Services & in-house labs)Cerner typically covers 70% of the health plan premium.
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Top 6 Conditions (2004-2007) Claims Data
1. Cancer2. Cardiac and Cerebrovascular Conditions3. Mental Disorders4. Spinal and Back Pain5. Arthritis and Joint Pain6. Asthma and Chronic Pulmonary Conditions
Make up 28% to 30% of total spending each year
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Key Points: Mental Disorders - 2007
36% of LTD cases at Cerner cited mental disorders as the primary cause. (4 out of 18)
Almost 10% of plan members were treated for mental disorders in 2007
$1.4 million in medical and prescription
Anxiety and Depression make up 55% of all mental health cases at Cerner
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The Mental Health Parity & Addiction Equity Act
The Mental Health Parity and Addiction Equity (MHPAEA) Act of 2008 Requires health plans to ensure that financial requirements (i.e. co-pays, deductibles) & treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the requirements/limitations applied to medical/surgical benefits
As a result of the MHPAEA requirements, Cerner made the following modifications to our plan:
Changed member share from 50% to 15% for Outpatient/Office Therapy PsychotherapyRemoved Outpatient Visit limitationsRemoved Inpatient Day limitation
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Cerner’s Relationship with New Directions
New Directions Behavioral Health (NDBH)
Provides Mental Health, Substance Abuse, Financial, Legal, Elder Care ReferralsProvides 24/7 toll free number for assistance, this is a dedicated number for Cerner – Counselors assess and refer to EAP, or prior authorization and medical management for outpatient, Intensive Outpatient or Inpatient careWellness Classes – onsite and WBT’sMonthly Newsletter
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Cerner & New Directions Behavioral Health
For the 2010 plan year, Cerner adopted a novel approach by working with New Directions to provide a single point of entry to associates for both their EAP benefits and the mental health plan benefits
Primary Goal:To assess and educate associates and to provide them with the most appropriate mental health provider or program
Consolidated EAP and Mental Health Plan benefits by adding prior authorization and medical management requirements through NDBH and in the KC metro area utilized the NDBH provider network
NDBH used a single call in number, triaged members as appropriate to either the EAP or the health plan benefit
Increased EAP therapy sessions from 3 to 6
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EAP Modifications & Expected Savings for 2010
EAP rate increased from $1.61 to $1.76 ($.15 increase) per US Associate to an annual cost of $129,486.72 (an increase of $11,035.80)
Agreement between Healthe Exchange (TPA) and NDBH for cost $0.95 PPPM (Per Participant, Per Month enrolled in the health plan estimated at 11,000) for an annual cost of $125,400
Includes prior authorization and case management
Use of the NDBH network in the Kansas City area was expected to reduce cost that was projected to exceed $100,000 in savings
Prior authorization and more effective use of the EAP program was expected to also lower cost
Jan – July 2009 compared to Jan-July 2010 EAP usage up from 3% to 6% (National Average 4-6% per New Directions)9.4% referred on to outpatient counseling (historically 17-20%)
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Decrease in Mental Health Claims comparing Jan-July 2009 to 2010
2009 2010
Total Patients Inpt & Outpt
19 17
Total patients in Office therapy
563 554
Total number of visits office therapy
3728 2858(23%)
Average # of visits office therapy
6.62 5.16(1.46)
Average Total cost per visit
$107.90 $83.65($24.25)
Average Plan cost per visit
$68.88 $38.67($30.21)
Average Patient cost per visit
$50.68 $47.60($3.08)
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Communication Of EAP & Mental Health Benefits
Posters and SignageMy Cerner – Intranet SiteHealthe & Wise is one of many health centered groups on uCern (social networking)
Healthe & Wise consistently is in the top 10 of all Associate Only uCern groups for total activity on a monthly basis:
222 discussions
• 848 replies
• 23,889 total views
10 documents
• 2,890 total views
66 Blog Posts
• 7,900 views
Average of 6.5 responses per thread
1,233 group members
Total content views exceed 34,000
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Cerner’s Mental Health Coverage 2011
New Regulations for 2011New regulations were issued this spring that introduced the terms “Non-quantitative” versus “quantitative treatment limitations”. Both the definition of these terms and the potential impact of the regulations are still a source debate within the industry. A Non-quantitative benefit limitation is broadly defined as a limitation due to medical management activity or other requirements.
Proposed Language Change to Health Plan: Pre-Notification for Outpatient ServicesYour outpatient provider should pre-notify visits through New Directions after the 8th visit. Please ask your provider to complete this Outpatient Treatment Request (OTR) form. You may print the form and take it to your provider, or let your provider know that the form is available online
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2011 Proposed Language Change Continued
Inpatient, Partial Hospital, and Intensive Outpatient Services
Contact New Directions for pre-notification before receiving inpatient, partial hospital, and Intensive Outpatient Program services New Directions will review your care while you are receiving it and work with your treatment team to make sure you have care after you leave the hospital. You will receive a response to the pre-notification request by mail within 48 hours unless additional information is requested. To contact New Directions for a referral or pre notification for behavioral health services or to receive a referral to a provider in your area: (toll free number)
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Cerner’s Health Plan Coverage – Autism 2010
Applied Behavioral Analysis (ABA) This approach teaches social, motor and verbal behaviors as well as reasoning skills. ABA is considered by many researchers and clinicians to be the most effective evidence-based therapeutic approach demonstrated thus far for children with autism.
Cerner’s Coverage:Pre-authorization is requiredAge range 18 months to 7 years.Treating professionals must be licensed Annual maximum = $25KSpeech Therapy, Occupational Therapy and Physical Therapy coverage is up to $3500 annual cap
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Autism – Missouri Bill
Goes into effect 1/1/2011
Limit of $40,000 annually for ABA unless treatment is ruled “medically necessary”.
Since all ABA treatment has to be ruled medically necessary, essentially there is no annual cap.
Coverage offered through age 18.
Health plans can only review treatment plans every 6 months unless provider agrees to more frequent review.
ERISA (ERISA § 514(a)) would preempt state based on the Plans ERISA and self funded status.
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Autism - Recommendation
State of Missouri passed a law related to autism coverage; questions around whether we should adjust our coverage to mirror the law
Recommendation: Do not mirror law, but adopt the following changes
Raise funding cap to $30,000 Bundle Occupational Therapy, Physical Therapy, Speech Therapy Raise age cap to 18 years
ABA cap 25,000$ Total Autism cap (covers ABA, ST,OT,PT) 40,000$ Total Autism cap (covers ABA, ST,OT,PT) 30,000$ Therapy cap (ST,OT,PT) 3,500$ Total Plan Paid Per Member Per Year 28,500$ Total Plan Paid Per Member Per Year 40,000$ Total Plan Paid Per Member Per Year 30,000$
Current # of Children Utilizing Members 5 Projected # of Children Utilizing Members 8 Projected # of Children Utilizing Members 8Coverage up to age 7 Coverage up to age 18 Coverage up to age 18
Total Projected Plan Paid Costs 142,500$ Total Projected Plan Paid Costs 320,000$ Total Projected Plan Paid Costs 240,000$
Changes to current state: Changes to current state:- bundle ST, OT, PT - bundle ST, OT, PT- raise coverage age to 18 - raise coverage age to 18- raise cap to $40,000 - raise cap to $30,000Assumptions: Assumptions:- Utilizing member increase from 5 to 8 - Utilizing member increase from 5 to 8
Current State 2010 State Compliance Final Scenario for 2011
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Challenges to Focus on in 2011
Removing prior authorization for behavioral health services poses several challenges that require monitoring:Ensure appropriate referral to a specialist (i.e. Psychiatrist, Therapist) and level of careEnsure appropriate coordination with PCPMonitor impact to overall health plan spend
Other considerations:Provide assistance to associates at a time when they may have impaired thinking Keep associates connected with our EAP and Case ManagementEngage family member(s) when needed