Med-Psych Care Management
Toney Healthcare’s proprietary Med-Psych Care Management program supports individuals with chronic conditions exacerbated by underlying, undiagnosed/untreated mild to moderate behavioral health conditions and psychosocial barriers. These vulnerable, “missed members” typically make up 5-15% of the population and drive 35-50% of total healthcare costs.
They are “missed members” whose needs, challenges and barriers are not addressed, and who do not engage and respond to traditional care management services. We manage these members through our specialized therapeutic intervention model (called Progressive Cognitive Resonance or PCR) that is based on Cognitive Behavioral Therapy and gets at the root psychological, social and physical drivers of poor health and avoidable utilization.
By engaging, these members are supported to improve self-efficacy and treatment compliance resulting in lower healthcare utilization, better quality and health outcomes, and a positive return on investment.
The program is delivered via our Insource Partnership method, with our team operating on your system and employing our unique interventions.
How it works:
Precise Identification - algorithms and analytics support to identify the right population
Dynamic Engagement - leverage of the plan’s current member and provider communication processes or our own telephonic and field-based engagement specialists to execute proactive awareness and engagement and re-engagement strategies.
Empowering Interventions - a holistic approach that addresses physical, psychological, and social determinants of health and includes member + clinician care plan development
Impactful Outcomes - meaningful, measurable results, ROI methodology and analytics support
We typically see 15- 20% reduction in inpatient admissions and ED visits as well as positive impact on quality and member and provider satisfaction.
Why Med-Psych Care Management
A high percentage of members with chronic physical conditions…
Have comorbid behavioral health diagnoses (as high as 67%+ based on condition)
Are not in treatment with BH providers
Behavioral health comorbidities negatively impact:
Treatment plan understanding and adherence
Physical and BH utilization and costs (current/future)
Health status, quality of life and ability to access available community and support resources
The vast majority of BH issues…
Are treated by PCPs with minimal time resources and BH training rather than behavioral health providers
Have prescriptions written by PCPs (>70% of BH Rx is prescribed by PCPs)
MPCM-eligible members typically:
Are not enrolled in other care management programs
Are not seeking treatment by BH providers
Have increased utilization and healthcare costs with PMPM costs 2-7X greater
MPCM Delivered via Insource Partnership Model
Program and staff managed by dedicated THCC Senior Clinical Director
MPCM team participates in department meetings, trainings and updates as an integrated clinical unit
Activities, progress and outcomes fully transparent within health plan’s system at any time
Identify
We provide our proprietary member identification protocols for your analytics team’s use
+
Data Analyst support as needed
Engage
We leverage your current member & provider communication channels
+
our Engagement Specialists
Intervene
Our seasoned, behavior change clinicians manage your psychosocially compromised, chronically ill members using our PCR approach & your system
Impact
We help you develop reports from your system on activity, interventions, utilization & satisfaction and provide our ROI methodology
+
Data Analyst support as needed
