News: BCBS plan targets behavioral health to reduce total cost of case

In October 2021, Horizon Blue Cross Blue Shield of New Jersey announced that its Neighbors in Health program had reduced total cost of care (TCOC) while increasing needed behavioral health services. HealthLeaders reported that Horizon credits integrated data and advanced analytics for "identifying patients at risk upstream, providing insights on best timing and type of intervention, and reducing cost and utilization." The plan seeks to continue these first-year results by making these strategies part of its overall value-based care solutions.

Horizon's behavioral health initiative uses multiple, disparate data sources, structured and unstructured, to look backward and forward. Using "advanced analytics," Horizon identified probable high-cost members and generated risk scores to link patients with providers, programs, and community resources.

Specific populations aided included mothers at risk for postpartum depression, members with inpatient behavioral health admissions, and younger members at risk for conditions like schizophrenia. For the latter group, Horizon reported shorter times between initial psychotic episodes and subsequent treatment. Horizon reported an overall "25% reduction in total cost of care and a 60% increase in utilization of behavioral health resources."

Focusing on behavioral health's role in TCOC reduction is an important component of not only the Horizon program but a larger industry concern: that a small percentage of patients represent the highest costs and that a majority of this group include those with behavioral health conditions.

In their white paper, Allen J. Karp, Horizon's executive vice president of healthcare management and transformation, and Sheila Talton, CEO of Horizon's platform partner Gray Matters Analytics, cite the following 2020 Milliman study statistics:

• 10% of study participants generated 70% of overall costs.
• Of this 10%, 57% had documented behavioral health diagnoses and/or treatments.
• Only 4.4% of TCOC was spent on behavioral health treatment across the entire study population.

These statistics begin to demonstrate how prevalent, costly, and paradoxically under-addressed behavioral health conditions are, HealthLeaders reported.

Karp and Talton say that the "fundamental problem" is a "lack of behavioral health quantitative data in the right format for traditional reporting and analytics systems. The inability of organizations to access, digitize, and integrate behavioral health data makes it virtually impossible to treat the whole person."

If this is the problem, what is the solution? According to Karp and Talton, "advanced analytics" that are as integrated as the behavioral healthcare they are designed to facilitate.

On the data side, this includes a combination of clinical, claims, social determinants of health, and other historical member information. Combined with natural language processing, artificial intelligence, and other aspects of the Gray Matters platform, these data combine to identify populations most at risk and the resources that may help them most.

Editor’s note: This article was originally published by HealthLeaders. Additional ACDIS coverage of behavioral health can be found here.