New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy Christa Roberts Health & Wellness Strategist

New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy

Christa RobertsHealth & Wellness Strategist

© Cerner Corporation All Rights Reserved 2

Cerner at a Glance

Founded in 1979, based in Kansas CityRevenue 2009: $1.7BLargest standalone healthcare IT company in the world• 8,500 facilities with approximately 2300

hospitals• 3,400 physician practices covering 30,000

physicians• 600 ambulatory facilities• 700 home health facilities• 1,500 retail pharmacies

Countries: 25Associates: 7,800Average Tenure/Age: 5/34 YearsAssociate Mix: • 30% engineering• 30% IT services• 15% clinical• 25% sales & all others

All connected to common internet toolsHealth Plan Spend 2009: $55 MillionCovered Lives in 2010: 11,400• 5500 associate• 5900 dependents• 85% participation rate


Cerner Health & Wellness: Core Principles

Align with Cerner’s vision, mission, and culture

Build, support and promote a healthy and productive workforce

Provide comprehensive benefit offerings

Develop innovative and wellness focused benefits

Holistic view of health management:PreventionEarly detectionTreatmentManagement

Promote accountability and facilitate change:EducationToolsSupport


2010 Cerner Health Plan Design

Coverage Code Deductible Cost Share Annual OOP Max

Associate Only $1,400 15% up to $900 $2,300

Associate Plus One $2,100 15% up to $1,400 $3,500

Associate Plus Children $2,100 15% up to $1,400 $3,500

Associate Plus Family $2,800 15% up to $1,900 $4,700

High Deductible Health Plan Health Reimbursement Account (HRA) with $400 employer contributionNetwork:

BeechstreetDirect contracts (115 contracts, 3,680 providers)Out of network policy

100% coverage of preventive care100% coverage at the Healthe Clinic (Professional Services & in-house labs)Cerner typically covers 70% of the health plan premium.


Top 6 Conditions (2004-2007) Claims Data

1. Cancer2. Cardiac and Cerebrovascular Conditions3. Mental Disorders4. Spinal and Back Pain5. Arthritis and Joint Pain6. Asthma and Chronic Pulmonary Conditions

Make up 28% to 30% of total spending each year


Key Points: Mental Disorders - 2007

36% of LTD cases at Cerner cited mental disorders as the primary cause. (4 out of 18)

Almost 10% of plan members were treated for mental disorders in 2007

$1.4 million in medical and prescription

Anxiety and Depression make up 55% of all mental health cases at Cerner


The Mental Health Parity & Addiction Equity Act

The Mental Health Parity and Addiction Equity (MHPAEA) Act of 2008 Requires health plans to ensure that financial requirements (i.e. co-pays, deductibles) & treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the requirements/limitations applied to medical/surgical benefits

As a result of the MHPAEA requirements, Cerner made the following modifications to our plan:

Changed member share from 50% to 15% for Outpatient/Office Therapy PsychotherapyRemoved Outpatient Visit limitationsRemoved Inpatient Day limitation


Cerner’s Relationship with New Directions

New Directions Behavioral Health (NDBH)

Provides Mental Health, Substance Abuse, Financial, Legal, Elder Care ReferralsProvides 24/7 toll free number for assistance, this is a dedicated number for Cerner – Counselors assess and refer to EAP, or prior authorization and medical management for outpatient, Intensive Outpatient or Inpatient careWellness Classes – onsite and WBT’sMonthly Newsletter


Cerner & New Directions Behavioral Health

For the 2010 plan year, Cerner adopted a novel approach by working with New Directions to provide a single point of entry to associates for both their EAP benefits and the mental health plan benefits

Primary Goal:To assess and educate associates and to provide them with the most appropriate mental health provider or program

Consolidated EAP and Mental Health Plan benefits by adding prior authorization and medical management requirements through NDBH and in the KC metro area utilized the NDBH provider network

NDBH used a single call in number, triaged members as appropriate to either the EAP or the health plan benefit

Increased EAP therapy sessions from 3 to 6


EAP Modifications & Expected Savings for 2010

EAP rate increased from $1.61 to $1.76 ($.15 increase) per US Associate to an annual cost of $129,486.72 (an increase of $11,035.80)

Agreement between Healthe Exchange (TPA) and NDBH for cost $0.95 PPPM (Per Participant, Per Month enrolled in the health plan estimated at 11,000) for an annual cost of $125,400

Includes prior authorization and case management

Use of the NDBH network in the Kansas City area was expected to reduce cost that was projected to exceed $100,000 in savings

Prior authorization and more effective use of the EAP program was expected to also lower cost

Jan – July 2009 compared to Jan-July 2010 EAP usage up from 3% to 6% (National Average 4-6% per New Directions)9.4% referred on to outpatient counseling (historically 17-20%)


Decrease in Mental Health Claims comparing Jan-July 2009 to 2010

2009 2010

Total Patients Inpt & Outpt

19 17

Total patients in Office therapy

563 554

Total number of visits office therapy

3728 2858(23%)

Average # of visits office therapy

6.62 5.16(1.46)

Average Total cost per visit

$107.90 $83.65($24.25)

Average Plan cost per visit

$68.88 $38.67($30.21)

Average Patient cost per visit

$50.68 $47.60($3.08)


Communication Of EAP & Mental Health Benefits

Posters and SignageMy Cerner – Intranet SiteHealthe & Wise is one of many health centered groups on uCern (social networking)

Healthe & Wise consistently is in the top 10 of all Associate Only uCern groups for total activity on a monthly basis:

222 discussions

• 848 replies

• 23,889 total views

10 documents

• 2,890 total views

66 Blog Posts

• 7,900 views

Average of 6.5 responses per thread

1,233 group members

Total content views exceed 34,000

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Cerner’s Mental Health Coverage 2011

New Regulations for 2011New regulations were issued this spring that introduced the terms “Non-quantitative” versus “quantitative treatment limitations”. Both the definition of these terms and the potential impact of the regulations are still a source debate within the industry. A Non-quantitative benefit limitation is broadly defined as a limitation due to medical management activity or other requirements.

Proposed Language Change to Health Plan: Pre-Notification for Outpatient ServicesYour outpatient provider should pre-notify visits through New Directions after the 8th visit. Please ask your provider to complete this Outpatient Treatment Request (OTR) form. You may print the form and take it to your provider, or let your provider know that the form is available online


2011 Proposed Language Change Continued

Inpatient, Partial Hospital, and Intensive Outpatient Services

Contact New Directions for pre-notification before receiving inpatient, partial hospital, and Intensive Outpatient Program services New Directions will review your care while you are receiving it and work with your treatment team to make sure you have care after you leave the hospital. You will receive a response to the pre-notification request by mail within 48 hours unless additional information is requested. To contact New Directions for a referral or pre notification for behavioral health services or to receive a referral to a provider in your area: (toll free number)


Mental Disorders


Cerner’s Health Plan Coverage – Autism 2010

Applied Behavioral Analysis (ABA) This approach teaches social, motor and verbal behaviors as well as reasoning skills. ABA is considered by many researchers and clinicians to be the most effective evidence-based therapeutic approach demonstrated thus far for children with autism.

Cerner’s Coverage:Pre-authorization is requiredAge range 18 months to 7 years.Treating professionals must be licensed Annual maximum = $25KSpeech Therapy, Occupational Therapy and Physical Therapy coverage is up to $3500 annual cap


Autism – Missouri Bill

Goes into effect 1/1/2011

Limit of $40,000 annually for ABA unless treatment is ruled “medically necessary”.

Since all ABA treatment has to be ruled medically necessary, essentially there is no annual cap.

Coverage offered through age 18.

Health plans can only review treatment plans every 6 months unless provider agrees to more frequent review.

ERISA (ERISA § 514(a)) would preempt state based on the Plans ERISA and self funded status.


Autism - Recommendation

State of Missouri passed a law related to autism coverage; questions around whether we should adjust our coverage to mirror the law

Recommendation: Do not mirror law, but adopt the following changes

Raise funding cap to $30,000 Bundle Occupational Therapy, Physical Therapy, Speech Therapy Raise age cap to 18 years

ABA cap 25,000$ Total Autism cap (covers ABA, ST,OT,PT) 40,000$ Total Autism cap (covers ABA, ST,OT,PT) 30,000$ Therapy cap (ST,OT,PT) 3,500$ Total Plan Paid Per Member Per Year 28,500$ Total Plan Paid Per Member Per Year 40,000$ Total Plan Paid Per Member Per Year 30,000$

Current # of Children Utilizing Members 5 Projected # of Children Utilizing Members 8 Projected # of Children Utilizing Members 8Coverage up to age 7 Coverage up to age 18 Coverage up to age 18

Total Projected Plan Paid Costs 142,500$ Total Projected Plan Paid Costs 320,000$ Total Projected Plan Paid Costs 240,000$

Changes to current state: Changes to current state:- bundle ST, OT, PT - bundle ST, OT, PT- raise coverage age to 18 - raise coverage age to 18- raise cap to $40,000 - raise cap to $30,000Assumptions: Assumptions:- Utilizing member increase from 5 to 8 - Utilizing member increase from 5 to 8

Current State 2010 State Compliance Final Scenario for 2011


Challenges to Focus on in 2011

Removing prior authorization for behavioral health services poses several challenges that require monitoring:Ensure appropriate referral to a specialist (i.e. Psychiatrist, Therapist) and level of careEnsure appropriate coordination with PCPMonitor impact to overall health plan spend

Other considerations:Provide assistance to associates at a time when they may have impaired thinking Keep associates connected with our EAP and Case ManagementEngage family member(s) when needed


Questions?

Documents

New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy Christa Roberts Health & Wellness Strategist