“better practices” in behavioral health benefits management stewart beltz the board of pensions...
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“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