The opportunity
Unnecessary behavioral health hospitalizations can adversely affect member experience, clinical outcomes and costs. To help reduce these hospitalizations and better partner with local mental health authorities (LMHA’s), UnitedHealthcare Community Plan of Texas designed a shared savings program to reward providers delivering strong behavioral health care that results in better outcomes for members with serious mental illness. Currently, the Andrews Center, the Burke Center and Spindletop LMHA’s are participating in the program.
The innovation
Together, UnitedHealthcare, Optum and LMHA’s developed a shared savings program that creates incentives for providers to reduce in-patient behavioral health costs for attributed membership1. Quality measures such as medication adherence and 7 and 30 day post hospital follow-up results are aligned to the program as an additional way for LMHA’s to achieve incentive payments.
Value Based Shared Savings Results:
The Shared Savings Model saw a year-over-year reduction of admissions from 903 to 783
Length of stay (ALOS) from 7.99 to 7.41
13.29% reduction to inpatient costs
2,545 members attributed
$47,369 bonus earned by providers
Next evolution
UnitedHealthcare continues to evolve and advance valued based programs. We are currently working to design and implement total cost of care integrated behavioral health homes which will focus on members with Severe Mental Illness and Substance Use Disorder diagnoses. The program will include analysis of all medical and behavioral costs to determine shared savings, and provide a per member per month risk payment to providers for members enrolled in the behavioral health home.
Behavioral health home provides six core services to patients:
- Comprehensive Care Management
- Care Coordination
- Health Promotion
- Comprehensive Transitional Care
- Individual and Family Support Services
- Referral to Community and Social Support Services
1Defined as having 2 or more claims in a 1 year look back.
