Reimbursement model recognizes improved quality outcomes and data-driven decision making
Magellan Health, Inc., today announced that its value-based reimbursement program for providers positively impacts behavioral health access and outcomes of its members. There is a continued focus on improving quality through value-based initiatives and the key metrics required to measure outcomes. Magellan’s value-based program, and its underlying measures of success, ensures members have access to a high-performing and available network of providers.
Magellan developed the program to address the twin challenges of increased demand for behavioral health services and industry-wide issues surrounding access to care. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 1 in 20 U.S. adults experience a mental illness each year.1 Among U.S. adults who received mental health services, 17.7 million experienced delays or cancellations in appointments and 4.9 million were unable to access needed care.
Magellan’s program incentivizes providers to improve behavioral health in a member-centric manner. This program is based on a behavioral health outpatient dashboard that evaluates providers on metrics spanning quality, outcomes, and access, which combine into an overall rating for each provider. Metrics include:
- Engagement and retention in outpatient treatment
- Number of new members accepted to the practice
- Utilization trends and patterns versus benchmark
- Maintaining community tenure for members
- Engagement for new members to their practice after a hospitalization
- Follow-up with existing members after a hospitalization
Magellan’s top-tier providers exceeded peer-based benchmarks across the metrics, including the following:
- 78% retention of members after an initial visit, ensuring a high-quality match for member needs and provider specialties with greater continuity of care.
- 100% follow up after hospitalization (FUH) rate for both 7 and 30 days for new and existing members, compared to an average of < 20% for new members and <95% for existing members.
- Fewer members admitted to higher levels of care and zero readmissions to higher levels of care.
“Magellan is not only recognizing our top-tier providers for providing quality care, but we are also sharing actionable insights with our entire provider community,” said Tim Daley, senior vice president, national network development, Magellan Healthcare. “Members of our provider community collaborated with Magellan’s clinicians to develop a dashboard that helps ensure the achievement of effective, quality care and outcomes. Our value-based program and metrics help address the need for access and engagement so that members receive the right care, the right way, at the right time.”
“We are thrilled that Magellan has identified Anew Era as a top-tier provider,” says John Peloquin, president and chief executive officer of Anew Era’s management company, Discovery Behavioral Health. “The addition of our outpatient psychiatric services division was created to expand our continuum of care. We treat a variety of conditions (e.g., depression, anxiety, PTSD, OCD, and more), provide evidence-based treatment options, and offer website links for online scheduling of appointments. By expanding our service lines and levels of care, we are giving patients a choice of when, where and how they receive treatment.”
About Magellan Health: Magellan Health, Inc. supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan's customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.
(MGLN-GEN)
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Contacts
Lilly Ackley, ackleyl@magellanhealth.com, (860) 507-1923
