“Better Practices” in Behavioral Health Benefits Management Stewart Beltz The Board of Pensions...

“Better Practices” in Behavioral Health Benefits Management

Stewart Beltz

The Board of Pensions of the Presbyterian Church (U.S.A.)

September 28, 2010

Topics• Presbyterian Church Board of Pensions

• Who we are

• “Better Practices” in Behavioral Health1. Vendor Service Integration

2. Integrated Benefit Administration

3. Coalition Purchasing

4. Custom Solutions– Autism & developmental disabilities

– Faith based provider recruitment

– EAP management consultations

The Board of Pensions of the Presbyterian Church (U.S.A.)

• An agency of the Presbyterian Church– Serve all U.S. Presbyterian ministers,

church workers and retirees• Church Pastors must participate• Other church workers may participate

– Provide DB pension, healthcare, LTD, death benefits, optional benefits and financial assistance

Demographics

• 17,000 Active “members” (employees)• 40,000 covered lives

• Ministers (65%) & Lay staff (35%)• Older (av. 52) Male (59%)• In 50 states, PR and overseas missions• Pastor salaries are modest (~$52,200)

• Benefits are important protection

• 11,000 Retirees on Medicare Supplement

Benefits Embody Presbyterian Values

• Stewardship– Proper use of the gifts of God's creation– Well-managed benefit plans

• Self-insured and fully funded• “Keeping our Promises”

– Strong sense of fiduciary responsibilities

– Community caring– Work ethic and personal accountability

• “Stewardship of Self”– Health– Financial– Vocational– Spiritual

Behavioral Health Benefits

• CIGNA Behavioral Health (CBH)• EAP: 1-6 session model

• Work Life Services: legal, financial, childcare, etc.

• Outpatient visits: $25 copay • Coinsurance for higher level care

• 80/20 (INN), 60/40 (OON) after deductible

• 2009 Utilization• EAP: 6.2%• O/P: 100 clients/1,000, 10.2 visits/client

48% in-network• I/P: 5 admits/1,000, 9.3 day ALOS

86% in-network

“Better Practices” in Behavioral Health

1. Vendor Service Integration

2. Integrated Benefit Administration

3. Coalition Purchasing

4. Custom Solutions

1. Vendor Service Integration

• Creating a member centric service model• Presbyterian “cultural sensitivity”

• Annual training with all front line service teams

• Vendor integration summit• Annual face to face working meeting• Identify collaborative improvement opportunities

• Vendor partner integration manual• Documents workflows, roles & handoffs

• Vendor hosted webinars• Ongoing cross training for all vendor partners

– EAP training, Prescription drug program, Case mgmt, etc.

Member Centric Service Model

Plan Members

1. Vendor Service Integration

• Creating a member centric service model• Presbyterian “cultural sensitivity”

• Annual training with all front line service teams

• Vendor integration summit• Annual face to face working meeting• Identify collaborative improvement opportunities

• Vendor partner integration manual• Documents workflows, roles & handoffs

• Vendor hosted webinars• Ongoing cross training for all vendor partners

– EAP training, Prescription drug program, Case mgmt, etc.

2. Integrated Benefit Administration

• Integrated Medical & MH Benefits• Unified deductibles & OOP maximums

– In network and Out of network

• Claims Cross Accumulate• Coordinated between CBHHighmark

• Satisfies Mental Health Parity

• Simplifies Benefit Design

3. Coalition Purchasing

• Church Benefits Association (CBA)– Jointly negotiated contract terms

• Presbyterians, Episcopalians, American Baptists, and 2 Lutheran Denominations

– Stronger voice for our members– Explore common challenges & solutions– Shared account management & service teams

• Comparative reporting and norms

– CBH developed expertise in serving needs of:• Clergy• Faith-based organizations

4. Custom Solutions

Autism & Developmental Disabilities

• Autism spectrum disorders, Down syndrome, Spina

bifida, Cerebral palsy, Intellectual disability

• Enriched benefits coverage• Applied Behavioral Analysis (ABA) therapy

• Additional speech, occupational and physical therapies

• Requires specialty case management & vendor

coordination

• Required a special definition of medical necessity

4. Custom Solutions

Faith Based Provider Recruitment

• 4,866 faith based counselors

• CBH Customized network better serves churches

EAP Management Consultations

• CBH Modified Management Referral Process– Better serves church organization’s structure

• Functions like the “HR consultants” to the church

• Staffed by an “ordained” LSW at CBH