Med-Psych Care Management
Optimizing Outcomes for Chronic High-Risk, “Missed” Members
Toney Healthcare’s Med-Psych Care Management (MPCM) program offers an integrated care management approach designed specifically for a subset of a population that has chronic physical health conditions exacerbated by underlying mild to moderate behavioral health conditions and psychosocial barriers (e.g., depression, anxiety, isolation, substance use). This interactive program combines data analytics, proprietary behavioral modification models, unique assessments and tools, and comprehensive outreach, engagement and intervention strategies to modify at-risk behaviors and ultimately reduce their impact on chronic illness to improve health outcomes, satisfaction and quality of life for these vulnerable members.
5% - 15% of the population drives 35% - 50% of total healthcare costs
Precise Identification Targeting “Missed” Members
While typical identification and stratification processes focus on physical conditions and risk levels, our comprehensive algorithms identify members who represent specific unmanaged risk, utilization and cost, driven by those individuals with modifiable chronic conditions affected by unaddressed psychosocial or behavioral health factors. While only comprising 5% to 15% of the population, these members drive 35% to 50% of total healthcare costs. Because their behavioral conditions are typically mild to moderate and they are not receiving adequate behavioral health care, these members are typically missed by care management programs. This can cause a significant negative impact to their health outcomes and well-being while driving up a plan’s total cost of care.
We assist your analytics team to implement a more comprehensive identification and stratification process that incorporates a wide range of data: volume, frequency, pattern and type of inpatient admissions and ER visits, comprehensive ICD-10 diagnostic categories and groupers, extensive CPT codes, key NDC code indicators (especially for exacerbating behavioral health disorders) and other information such as HCC, HRA, lab data and more.
Empowering Engagement and Interventions
After member identification, we leverage in-person and telephonic outreach to encourage participation in the program. Once these members consent to program participation and are engaged, we employ our proprietary Progressive Cognitive Resonance (PCR) approach for behavior modification and therapeutic care management.
What makes our MPCM program different from typical care management programs is our unique member-centric therapeutic interventional model that uncovers and manages the root causes of sub-optimal response to treatment plans and outcomes. Based on cognitive behavior therapy concepts, PCR is a collaborative and empowering care management methodology that delivers better outcomes, lower utilization and cost, and a positive return on investment (ROI). PCR offers:
A holistic approach that addresses physical, psychological, and social determinants of health
Member engagement that prioritizes member medical and behavioral needs and desires, goals and milestones to change perceptions and promote healthy behaviors
Bridge-building to providers, community resources, caregivers and plan benefits to facilitate adherence and help members stabilize and achieve their goals
Experienced, highly trained and licensed behavioral health clinicians (e.g., LCSWs) that become member advocates, supported by a team of nurses, medical doctors, psychiatrists and community health workers
Addresses root causes of chronic poor adherence and overutilization
When ready, and if warranted, members can be transitioned to other appropriate care management programs, typically after 6 to 9 months of engagement, with continuous monitoring for potential reengagement in MPCM as needed.
Why Toney Healthcare?
Deep expertise in physical and behavioral health integration
Industry-leading clinical operations resources
Highly effective Progressive Cognitive Resonance approach to care management
Extensive line-of-business expertise (Medicare Advantage, Medicaid, SNP, MLTSS, TRICARE, Commercial/ACA)
Episode-based billing enhancing quality of care initiatives can be counted toward MLR, with other billing models available
No recruiting or hiring burden
Medical and behavioral health support
Complete transparency and reporting by working within your information management system
Risk-based performance metrics
Impactful Outcomes with Provable ROI
While outcomes vary by population, this approach typically results in a 15% to 20% reduction in utilization and overall cost of care compared to similar, unmanaged populations. This is a significant savings especially considering that behavioral health averages only -10% of the total cost of care. The impact is primarily on the physical health side, achieved by addressing psychosocial barriers.
These results are possible because our approach helps each individual understand and appreciate emotional health, seeking care and reshaping their own behaviors to mitigate negative outcomes—which results in lower inpatient and ED utilization. This approach also has a positive impact on quality performance and member and provider satisfaction, and improves member self-efficacy and quality of life.
As part of our engagement, we will provide tools, methodologies and senior-level data analyst support to help your team with identification, monitoring, reporting and performance measurement to quantify outcomes and ensure adherence. All interactions leverage the plan’s systems for complete and immediate transparency of activities and results, eliminating the need for costly data transfer and oversight.
Plan Impact
15% to 20% lower inpatient and emergency department utilization
15% to 20% lower overall cost of care
Higher member and provider satisfaction
Improved health equity for underserved members and communities
Member Impact
Better understanding of condition and behavioral impact on health
Improved understanding and self-management skills to adhere to treatment plans
Positive behavioral changes to more healthy behaviors
Better outcomes, satisfaction and quality of life
Awareness and access to SDOH resources
Additional support to ensure scheduling and adherence to physical and behavioral health provider visits
Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.