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www.beaconhealthstrategies.com
Beacon Health Strategies, LLC
Medicaid Behavioral Health Presentation
Meeting With
January 25, 2008
www.beaconhealthstrategies.com
The commercial health insurance market is contracting…
Note: Employment-based insurance includes CDHPsSource: U.S. Census
0
50
100
150
200M
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Individual
Employment-based
1%
-3%
('93-'00)
CAGR
-2%
-1%
('00-'05)
CAGR
Total commercial insurance enrollment (millions)
2
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…with companies less likely to offer health insurance, especially small businesses
Source: Urban Institute
0
20
40
60
80
100%
<10 Emp
20012005
59%53%
10-24 Emp
68%63%
25-99 Emp
77% 75%
100+ Emp
88%85%
Changes in Employees’ ESI Coverage by Firm Size (2001 vs. 2005)
3
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0
20
40
60
80
100%
2003 2004 2005
Blues
Top10
Other
13.0%
14.0%
-29.0%
(03-05)CAGR
Low growth and margins have driven consolidation
Total Privately Insured Lives (2003-5)
0
700
1,400
2,100
1998
PPOs
HMOs
2,029
2005
1,080
Total Number of Health Plans
AveragePlan Enrollment: 86K 165KN=180 million lives
4
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Medicaid enrollment has been healthy during the same period
0
5
10
15
20
25
30
35
40
45
J une 2000 J une 2002 J une 2004 J une 2006Aged and Disabled Families
Medicaid Enrollment(in millions)
5
CAGR
2.7%
6.1%
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With Medicaid managed care growth particularly robust
Managed Care
FFS and Other
0
5
10
15
20
25
30
35
40
45
50
1990 1994 2000 2006
Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute (2007)
Medicaid Plan Type(in millions)
6
CAGR
17.4%
(1.6%)
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States have embraced managed care for more complex population
Source: National Academy for State Health Policy, June 2005 Report
States with Managed Care for ABD
9
40
0
10
20
30
40
50
1990 2004
7
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2,697
950
716
-
500
1,000
1,500
2,000
2,500
3,000
Commercial TANF ABD Special Pop
IP Admits/1,000
8
These more complex populations require active care management
www.beaconhealthstrategies.comwww.beaconhealthstrategies.com
Medicaid growth outstrips CPI and remains a cost concern
11.90%
7.20%6.50%
4.00%3.23%3.39%
2.50%2.20%
0%
5%
10%
15%
00-02 02-04 04-05 05-06
Aged and Disabled CPI
Overall Average Annual Total Medicaid Spending Growth
9Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute (2007)
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Employers and governments are pushing MCOs for the next generation of cost containment
0
2
4
6
8
10%
0
2
4
6
8
10%
1996
2.0
1997
3.3
1998
5.3
1999
7.1
2000
7.2
2001
7.7
2002
9.52003
7.4
2004
7.5
2005
7.42006
6.5
0
20
40
60
80
100%
InsuredLives
ChronicI llness
239M
MedicalExpenditures
$2.3T
CPI
Average Annual Increase in Medical CostsU.S. Incidence and Cost of Individuals
with Chronic Diseases
Managing individuals with chronic disease is the focus
10
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Co-morbidity is frequent in all of the “high-profile” diseases
0
20
40
60
80
100%
Asthma
BH
Co-M
orb
idC
hro
nic
Dia
gnosi
s
3,208
COPD
1,828
CHF
231
CAD
279
Diabetes
2,114
0
20
40
60
80
100%
AsthmaC
hro
nic
Dia
gnosi
sB
HC
o-M
orb
id
8,921
COPD
1,485
CHF
87
CAD
483
Diabetes
279
Adult Members (19+) witha Chronic Disease Diagnosis
Pediatric Members (18 or under)with a Chronic Disease Diagnosis
11
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The public segment, especially Medicaid, remains highly fragmented
0
20
40
60
80
100%
2006
Others
AetnaMMM
IndependenceGHI /HIPHealth
HighmarkWellPoint
Kaiser
Humana
UnitedHealth
7M
Source: CMS, 2006
0
20
40
60
80
100%
2006
Other
Humana,BCBS
LAHealthMolina
WellCareCentene
Amerigroup
UnitedHealth
WellPoint,
30M
Medicaid Managed Care Enrollment Medicare Advantage Enrollment
12
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Trends suggest continued Medicaid opportunity
• Eligibility expansions continue across the states– SCHIP and kids initiatives– Efforts to address the uninsured
• Outreach to the “eligible but un-enrolled” is improving and becoming more sophisticated
• Willingness by states to place “high risk” populations in Managed care
• Traditional limitations in the PCCP, state-run health plan model– IT, up-front investment, staffing, provider capture, role of doctors
• Management of chronic conditions is imperative
• CMS policy emphasis on “dollars following the individual” favors managed care
13
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Massachusetts
Rhode Island New York Ohio
MMCO Clients Two Two Two One
Commenced 1996 2001 1998 2006
Medicaid Members
165,000 90,000 280,000 530,000
PopulationsServed
TANFDisabled
SCHIPCommonwealth
Care
TANFDisabledCSHCNSCHIP
Foster CareDual Eligible
TANFDisabled
SCHIPDual Eligible
TANFDisabled
SCHIP
Services Full Suite (IPM) Full Suite (IPM) Full Suite (IPM) Specialty
Serving Medicaid members is Beacon’s primary expertise
14
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Beacon’s Medicaid health plan clients are the best in the nation
Beacon Client since ‘99
Beacon Client since ‘01
Beacon Client since ‘03
15
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Beacon’s best results are achieved through our Integrated Partner Model (IPM)
• Beacon brings its specialized behavioral health expertise into a plan’s organization
- Clinical and quality design and protocols- Integrated operational workflows
• Local management- Account manager responsible for all activities- Clinical manager runs clinical duties- Absorbs some or all local staff if appropriate- Maintain local/regional office structure if appropriate
• All activities supported by the company’s robust expertise and capabilities
- Leading clinical and quality department- Specialized care programs, including case management- FlexCare, a fully integrated care management system designed for
Medicaid behavioral health- Tailored analysis and reports- Network administration, members services and claims
“Carve-In” not a
“Carve Out”
16
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Care Management Approach – Member Centric
Responsive
Physical
Behavioral Social
• Holistic approach
• Consumer and family member participation
• Recovery and resiliency
• Cultural competency
• Coordinated care
• Integration and linkage
• Consumer rights and responsibilities
• Safety of consumers
17
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Continuum of Care Model
Responsive
Inpatient care
Crisis Stabilization
Acute Residential Care
Partial Hospitalization
FST/CSP
Day Treatment
Intensive Outpatient
OutpatientLow
High
Behavioral Health Risk / Status
Low
Hig
h
Serv
ice I
nte
nsit
y Observation Beds
18
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Integrated Partner Model (IPM) Case Study: Neighborhood Health Plan of Massachusetts
Neighborhood Health Plan of MA
170,000 members, 85% Medicaid
Innovative care management approach
Excellent HEDIS and consumer satisfaction results
Beacon Integrated Partner Model
On-site utilization management
Integrated case review teams
Aftercare, depression and case management programs
Joint disease management programs
Network, member and claims management
Best in classBH Expertise
19
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IPM implementation is improving efficiency both in BH and Medical expenditures
0
200
400
600
$800
Pre-IPM
I /P
Div
O/P
$664
0-6 IPM
$577
6-12 IPM
$369
0
250
500
750
1,000
$1,250
Pre-IPM
O/P
I /P
Rx
ER
$1,148
0-6 IPM
$1,063
6-12 IPM
$933
Behavioral Health PMPM Medical Expenditure PMPM
44% Decrease in BH 13% Decrease in Medical Spend
Complex Case Management
20
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Rapidly Improving Quality – Case Study
50
60
70
80%
2004
NY
MC
OA
vg.
Aff
init
y
68%
62%
2005
NY
MC
OA
vg.
Aff
init
y
70%
61%
2006
NY
MC
OA
vg.
Aff
init
yw
ith
Beaco
n
76%75%
Improvement in QARR/HEDIS Measures One Year After Beacon Implementation
• Beacon took over BH operations for a 200,000+ member health plan in Jan ‘06
• Absorbed existing health plan staff under Beacon clinical and process management
• 2007 - 7 Day Follow-Up after Hospitalization– Moved from bottom quartile ranking to
second quartile (21st to 11th)– Equal to statewide average score
• 2007 - 30 Day Follow-up after Hospitalization– Moved from bottom quartile ranking to
the second quartile (22nd to 10th)– Equal to statewide average score
New York City Implementation
21