Please describe the manner and extent to which tiered and limited network products affect your organization, including but not limited to any effects on contracting and/or referral practices, and attach any analyses your organization has conducted on this issue. Describe any actions your organization taken (e.g., pricing changes) in response to tier placement and any impacts on volume you have experienced based on tier placement. Summary: Answer: The Commission has identified that spending for patients with comorbid behavioral health and chronic medical conditions is 2-2.5 times as high as spending for patients with a chronic medical condition but no behavioral health condition. As reported in the July 2014 Cost Trends Report Supplement, higher spending for patients with behavioral health conditions is concentrated in emergency departments and inpatient care. Summary: Please describe ways that your organization is collaborating with providers to integrate physical and behavioral health care services and provide care across a continuum to these high-cost, high-risk patients. Please discuss ways that your organization is addressing the needs of individuals to avoid unnecessary utilization of emergency room departments and psychiatric inpatient care. Please discuss successes and challenges your organization has experienced in providing care for these patients, including how to overcome any barriers to integration of services. There has been increased statewide interest in data reporting across all services, inclusive of behavioral health. Please describe your organization’s willingness and ability to report discharge data. Describe your organization’s efforts and experience with implementation of medical home (PCMH) model. Summary: What percentage of your organization’s primary care providers (PCPs) or other providers are in practices that are recognized or accredited as PCMHs by one or more national organizations? What percentage of your organization’s primary care patients receives care from those PCPs or other providers? Please discuss the results of any analyses your organization has conducted on the impact of PCMH recognition or accreditation, including on outcomes, quality, and costs of care.
Please describe the manner and extent to which tiered and limited network products affect your organization, including but not limited to any effects on contracting and/or referral practices, and attach any analyses your organization has conducted on this issue. Describe any actions your organization taken (e.g., pricing changes) in response to tier placement and any impacts on volume you have experienced based on tier placement. Summary: Answer: The Commission has identified that spending for patients with comorbid behavioral health and chronic medical conditions is 2-2.5 times as high as spending for patients with a chronic medical condition but no behavioral health condition. As reported in the July 2014 Cost Trends Report Supplement, higher spending for patients with behavioral health conditions is concentrated in emergency departments and inpatient care. Summary: Please describe ways that your organization is collaborating with providers to integrate physical and behavioral health care services and provide care across a continuum to these high-cost, high-risk patients. Please discuss ways that your organization is addressing the needs of individuals to avoid unnecessary utilization of emergency room departments and psychiatric inpatient care. Please discuss successes and challenges your organization has experienced in providing care for these patients, including how to overcome any barriers to integration of services. There has been increased statewide interest in data reporting across all services, inclusive of behavioral health. Please describe your organization’s willingness and ability to report discharge data. Describe your organization’s efforts and experience with implementation of medical home (PCMH) model. Summary: What percentage of your organization’s primary care providers (PCPs) or other providers are in practices that are recognized or accredited as PCMHs by one or more national organizations? What percentage of your organization’s primary care patients receives care from those PCPs or other providers? Please discuss the results of any analyses your organization has conducted on the impact of PCMH recognition or accreditation, including on outcomes, quality, and costs of care.