Nonprofit health plan Point32Health is prioritizing integrated care and value-based contracting as part of its overall behavioral health strategy.
The payer is doing this through partnerships and in-house integration between mental and physical health providers. Specifically, Point32Health has inked value-based contracts focused on autism and substance use disorder (SUD) care, and it plans to expand these contracts in the future. It has also worked with virtual care companies to provide behavioral health care across acuity levels.
“We believe strongly that by treating the whole person, you’re going to have better outcomes,” Jill Borrelli, vice president of behavioral health at Point32Health, told Behavioral Health Business. “And people are going to have a better quality of life, which is ultimately what the goal is.”
Point32Health was formed when Tufts Health Plan and Harvard Pilgrim Health Care merged in 2021. The health plan – which offers Medicaid, Medicare and commercial plans – has about 2.2 million members in the New England region.
We believe strongly that by treating the whole person, you’re going to have better outcomes
-Borrelli
While Tufts Health Plan always managed behavioral health in-house, Harvard Pilgrim’s behavioral health programs were managed by Optum. But that’s changing in July of 2023 when all of its behavioral health benefits will be brought in-house.
Borrelli said this could be a game changer for behavioral health and physical health integration.
“All of behavioral health will be in-sourced to Point32Health, which is really exciting because the whole focus of our program is integrated care,” Borrelli said. “To have all of our clinical teams and our claims, and our data and our call centers, all working on medical and behavioral health, at the same time, is how we start to treat people [holistically].”
A move toward value-based care
Part of Point32Health’s behavioral health initiative is moving towards more value-based contracts, where outcomes are tied with financial incentives.
“We have a few really exciting value-based financial agreements, where we are moving from the volume incentive reimbursement structure to focus more on quality,” Borrelli said. “So there are financial incentives for innovative, evidence-based clinical models that produce health outcomes.”
The payer is the first in the country to roll out a value-based agreement focused on treating children on the autism spectrum. Over the summer, it announced the partnership with autism provider Cortica, the deal covers Point32Health Massachusetts’ Medicaid and commercial health plans.
San Diego-based-based Cortica delivers services for children with autism and other neurodevelopmental conditions, and has 16 locations.
This partnership comes as rates of autism in the U.S. continue to soar. About 1 in 44 children are diagnosed with autism, according to the CDC.
“We’ve arranged with them that they don’t have to ask us for individual things, that they provide the treatment plan, and based on the member’s acuity level, there are different treatment protocols that they follow,” Borrelli said. “If they meet their quality metrics, which include both access and outcome, there is a bonus associated with it. We’re excited because, like I said, this is the first in the country arrangement like this.”
In addition to the autism space, the payer also has value-based contracts in the SUD space.
For example, in 2021, the organization announced that it teamed up with addiction treatment company Eleanor Health to develop a value-based program built on population health that provides comprehensive care to members of Point32Health’s beneficiaries covered by Tufts Health Plan’s Medicaid business.
“We, as an organization, really believe that by addressing people’s unmet behavioral health needs, ultimately, we’re going to reduce overall medical cost,” Borrelli said. “We’re going to improve. More importantly, we’re going to improve members’ health outcomes because there’s so much research that says someone who is depressed doesn’t have the capacity to work with a nutritionist to address their diabetes, or get to their PT appointment, or whatever it is because of that underlying behavioral health issue.”
Clinical integration
Integrating clinical care services is a big part of that move towards value-based care. Point32Health currently has a behavioral health care management program for all of its products, with the caveat that Optum currently provides behavioral health care to legacy Harvard Pilgrim members.
Depending on the need, the program offers different interventions across the acuity spectrum. There are specialized programs and addiction recovery care management for higher-acuity cases.
“We have peer recovery coaches that are part of the care management team, who will work with members who have lived experience and can work with members through their recovery to support them as they get into additional treatment,” Borrelli said.
Since behavioral health is closely tied to health outcomes, it makes sense to have the physical and behavioral health teams communicate on a patient’s progress, Borrelli noted.
“There are so many medical comorbidities with substance use, and again, our clinical teams are an integrated team,” Borrelli noted. “If a behavioral care manager is working with someone with substance use and is having medical comorbidity, it is a quick virtual walk to your neighbor’s desk to be able to either consult on the medical piece or engage a medical care management as needed.”
In addition to closely integrating services for patients with substance use disorder, Point32Health also has special programs for individuals with serious mental illness.
“We already have in place dedicated rounds where our [behavioral health] and medical physicians and clinicians, including psychiatrists, meet together to talk about members with this high acuity and who have serious mental illness,” she said.
Managed care programs aren’t necessarily what every patient wants. Therefore, in addition to integrating programs, the payer is also looking to give its members flexibility in how they receive care.
Recently, Point32Health made a deal with digital behavioral health company Valera Health to provide virtual care for kids and adults with mild to severe mental illness.
New York-based Valera offers virtual mental health care to high acuity patients. In October the company raised $44.5 million.
“We know not everything works for everyone. We want to have a really big menu for people to be able to access [care],” Borrelli said. “So maybe care management isn’t the right thing for someone with serious mental illness, but maybe engaging in telehealth with a Valera therapist is going to be the thing that gets them to that next place. And again, that’s how we’re thinking about all of our programs, as we’re building them. We want it across the acuity spectrum, we want different places for people to plug in, based on where they are. And we want to have a bunch of different modalities.”
Companies featured in this article:
