Payers Praise Advanced Analytics as a Way to Improve Behavioral Care, Rein in Spending

By Kyle Coward | January 17, 2022

Original Source

Health care spending for decades has risen significantly, and it is projected to soar past $6 trillion by 2028. With advancements in technology, logic would bear that data tracking systems could coordinate care better and thus reduce costs, especially benefitting behavioral health providers where demand for services continues to grow.

And yet, Sheila Talton says the behavioral health industry has a significant problem when it comes to care coordination.

“One of the challenges is with professionals that are treating physical health conditions not connecting the treatment with behavioral health specialists,” Talton, who is the CEO of Chicago-based health care analytics company Gray Matter Analytics, told Behavioral Health Business.

A major problem of coordination – according to Talton – has to do with organizations not implementing the right data collection systems that detail how costs on health care can be better spent, based on social determinants of health (SDOH). A good example she believes of a payer working to rectify the situation is Horizon Blue Cross Blue Shield New Jersey (BCBSNJ)

In 2020, Horizon BCBSNJ launched the Neighbors in Health program, which was a way for the payer to identify various social determinants affecting residents it covers throughout New Jersey.

The goal of Neighbors in Health was to use SDOH along with patient data to determine which members might be especially at risk of behavioral health problems. Partnering with Gray Matter in the program, Horizon was initially able to make findings among its member population that linked high-risk health status with certain zip codes where members lived.

In the program’s first year, total cost of care fell 25% while there was a 60% increase in behavioral health services. The program was also able to better help pregnant women be linked with resources for postpartum depression, along with shortening treatment wait times of individuals younger than 30 shortly after they experienced a psychotic episode.

“The ability to reduce costs and improve member outcomes is all driven through the projects that we work on with Sheila and our team on the analytic side, in order to find those most vulnerable members who carry high costs,” Allen Karp, the executive vice president of healthcare management of Horizon BCBSNJ, told BHB.

Karp said that he is in talks with other behavioral health payers in Blue Cross Blue Shield’s nationwide network to replicate the program in other locales. Talton also said that she has heard from various plans within the Blue Cross Blue Shield network to help them do the same, which she feels is reflective of their willingness to pay attention to certain SDOH factors like race.

“This issue is high on their list,” she said. “I would say it’s also been fueled by some of the awareness of the racial disparities connected to behavioral health.”

As health care moves more toward a value-based payment model, Karp added that it is very necessary for behavioral health payers and providers to employ advanced analytics in their care operations, lest they get left behind.

“In today’s world, without advanced analytics, you really will not be competitive,” he said.

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