Improving access to care with behavioral health insourcing
Effective November 1, 2023, Harvard Pilgrim Health Care, a Point32Health company, insourced its behavioral health program for commercial members. This is an exciting step for members and providers, as we have brought all essential functions in-house, to ensure a centralized, seamless process that enables people to get the care they need when they need it.
Understanding traditional behavioral health care sourcing
In today’s marketplace, almost all payors outsource their behavioral health offering and management to a vendor. When outsourced, the behavioral health benefit, provider network, service operations and analytics are all conducted separately, meaning that they do not have regular touch points with medical teams or access to the same member data.
Behavioral health insourcing at Point32Health
At Point32Health and Harvard Pilgrim, we know that best practice – whether you are a primary care office, an inpatient hospital or an insurer – is to have integrated, collaborative behavioral health and medical care to provide the most effective, comprehensive care.
“This insourced behavioral health model enables us to maximize an integrated approach to behavioral health care focused on the whole person, understanding that physical health and behavioral health are interdependent,” said Tracy Daugherty, behavioral health program manager at Point32Health. “Our behavioral health programming is guided by our mission to expand access to high quality care, advance health equity and optimize member experience through cost effective care.”
More simply put, insourcing means that Point32Health and Harvard Pilgrim colleagues handle everything that goes into our behavioral health care, from integrated member and provider service call centers, claims processing and payments, provider network management, care management, member and provider portals, regulatory and employer group reporting, and so much more. Before we switched to this model, these functions were handled by outside vendors, creating siloed processes that sometimes created unnecessary obstacles.
Here is an example of how this works in practice:
A member is enrolled in medical care management related to their diabetes, but they have developed neuropathy and become socially isolated and depressed. Working in the insourced model, the behavioral health and medical care managers are part of a single integrated care management team that utilizes a singular member data system. As a result, this member can be collaboratively evaluated for all their health needs and ensured that their behavioral health and medical health will be addressed by one integrated team. To help identify members of rising risk, the care managers can access claims data to look at medical, behavioral health and pharmacy claims holistically to identify if this is a trend for members with the same conditions and collaboratively develop a strategy.
The future of behavioral health insourcing
Although we are just two months into this new model, the teams at Point32Health and Harvard Pilgrim are already looking forward to how this solution can and will evolve. “On a day-to-day basis, our teams will continuously assess enhancements or other changes need to be made to best serve our customers,” said Gina DeRosa, director of integration for behavioral health at Point32Health. She added that our organization anticipates finding ways to make improvements in how we serve our members and providers:
- Expanding our provider network.
- Improving access to care through our service navigation, care management and community health worker teams.
- Improving digital experiences for members and providers via our website and portals.
- Leveraging advanced analytics to identify opportunities to reduce cost of care while improving access and quality of care.
Ultimately, an insourced model uniquely allows us to identify and reduce barriers to care for members of rising risk, by moving to a proactive rather than a reactive approach. With an insourced model that integrates behavioral health throughout the organization, clinical, analytics and operational teams can better collaborate to address and support all member health issues and respond to health trends earlier. Furthermore, it promotes a closer payor and provider relationship to improve service delivery to our members and support improved health outcomes.