PROVIDENCE – More than two years ago, on March 6, 2014, HealthPath was officially launched, a collaborative partnership between Blue Cross & Blue Shield of Rhode Island, Care New England and Butler, its psychiatric hospital, and Continuum Behavioral Health, a for-profit division of The Providence Center. [See link to ConvergenceRI story below.]

The goal was to create a patient-centered continuum of mental health care delivery, delivered by a team of psychiatrists, therapists and case managers, with customized services for each patient, paid for with one monthly co-payment.

Translated, the model of care sought to expand upon the model employed by many community health centers for behavioral health care and apply it to the commercially insured patient population.

The delivery of behavioral health and mental health care services were facing a conundrum of increased demand, higher costs and poorer health outcomes. HealthPath represented a “leap of faith” by both the payer and the provider, according to Ian Lang, the executive director of Continuum Behavioral Health.

“There was an opportunity to do this,” Lang explained, in a recent interview with ConvergenceRI, based in large part of the working relationship between Peter Andruszkiewicz, the former president and CEO of Blue Cross & Blue Shield of Rhode Island, and Dennis Keefe, president and CEO of Care New England.

“If you were to come in today and pitch the same program,” Lang continued, “I have no way of knowing what the response would be. I think that because we’ve worked together, because we’ve done it [for two years], we have levels of trust and engagement down through the organizations.”

The startup vision
To put the results from the past two years’ work in perspective, here is what was said at the official launch:

• The new initiative, according to Andruszkiewicz, grew out of the realization that no one can transform the health care delivery system alone. “Our customers are saying, we can’t pay any more. We’re paying you plenty. [Premium] levels have increased two and three times [the Consumer Price Index] for decades; it’s too much. Take the money you’ve got in the system and figure out a better way to create these new approaches. And that’s exactly what this collaboration is all about.”

Andruszkiewicz likened his relationship with Keefe as being that of “twin brothers from different mothers.”

• “We wanted to start first with the state’s most vulnerable population, the seriously mentally ill, the state’s must vulnerable population,” Keefe said, talking at the event in 2014. “I think you all know that the incidence of mental illness in Rhode Island is amongst the highest in the nation, if not the highest.”

What better way is there for us to invest our resources, Keefe continued, adding that he was particularly proud of the effort. “We’re starting at the right place. This is truly meaningful for Rhode Island, something that we’ll be able to look back on with pride and accomplishment.”

HealthPath, Keefe continued, demonstrated what could be achieved when leaders come together and agree to collaborate and cooperate to make a better health care system for all. “That’s the other thing that you’ll notice,” he said, with humor. “We actually like each other.”

By the numbers
Two years in, the numbers appear to tell the tale of an emerging success, Lang said, talking much like an executive from a startup company that has proven the validity of the concept and is looking at how best to scale up the enterprise.

“We have 220 people enrolled today,” Lang began. “We sort of fluctuate between about 220 and 240 people enrolled, depending on the month.

The majority of the HealthPath participants, about 170, he continued, come through the Blue Cross commercial insurance product. The remaining 40 or 50 are enrolled through the Blue Chip Medicare product. “About a year ago, we expanded into Medicare,” Lang said.

HealthPlan currently has three locations: one in Cranston near Sockanosset Cross Road, one on the grounds of Butler Hospital in Providence, and a third, smaller facility in North Kingstown.

“We’re made some real progress,” Lang continued. “We’ve shown that [by providing] this kind of wrap-around care, in a comprehensive approach, you can provide better care, to have better outcomes, and save money at the same time.”

In the old approach, based on volume not value, Lang said, providers were often restricted in what they could do by what they could bill.

If the only way to interact with your client is to have them come in for a 45-minute session, because you can’t bill for the phone call, because you can’t bill the visit to the house, it becomes problematic, Lang said.

“What we’ve shown is that by taking these restrictions away, allowing for the treatments to really focus on what the clients’ needs are, it does work,” he said.

The next stage
Lang said that HealthPath had a number of success stories, with really strong clinical outcomes, with a capability to begin to bend the cost curve.

The next stage, he told ConvergenceRI, “is using the data we have to drive our knowledge of what is working, and why it is working, and how we can be more replicable.”

That involves not just telling the story that this person came in, and this person was successful, Lang explained, but rather: what can we learn about the population being served so that we can make better decisions going forward.

HealthPath has two years of data, tracking participants, both for those who have failed to follow through, who have chosen not to engage in treatment, or have been discharged against the advice of clinician, as well as those who have been successful at reaching stability.

“What we are starting to see is that those in the successfully [stabilized] group is that they are costing the same amount during their time in HealthPath as people who are not participating in HealthPath,” Lang said. “We are basically breaking even.”

What is really exciting, Lang continued, is what is happening post HealthPath.

“Once they’ve been through HealthPath and been successful, the cost curve can be a couple of hundred dollars per month lower than the cost curve of a person who didn’t go through HealthPath,” he said.

“You are talking about savings in the neighborhood of a couple thousand dollars within a year of entering HealthPath,” Lang said. “And, if we’re successful, we really didn’t spend any more more money to take them into HealthPath [and provide wrap-around services.]

Moving forward
Lang framed the question that needed to be answered moving forward: why are some people successful and why are some people not?

“That’s really the next stage of what we’re trying to figure out,” he said. “Are there indicators we can look for?

Lang praised Blue Cross for their willingness to work collaboratively with HealthPath.

“I give Blue Cross a tremendous amount of credit. They took a real risk here, and they did it around a tough population,” he said. “They took a leap of faith, and that’s appreciated. It’s very hard to get a real partnership where you have the payer and the provider working together, all the time. We meet every two weeks with Blue Cross, looking at how we’re doing.”

The challenges ahead
Lang said that the commercial insurance market for behavioral health care was fragmented and that, as a result, it lacked a systemic approach to care, which often made it more difficult to bring innovation into the marketplace.

Also, because there is a lot of churn in the market, with customers switching insurance plans when they switch jobs, the upfront resources invested by an insurer in a program such as HealthPath can be at risk if the customer changes plans, Lang said. “It’s another reason why I give Blue Cross a lot of credit.”

In terms of replicating the HealthPath model, Lang said that there was some discussion about how it might be applied with substance use and also with adolescents.

Lang also cautioned against the quick fix of taking a short-term approach to behavioral health, based upon making investments by reducing hospitalizations to reduce overall costs.

“The payoff is long-term, not short-term, if you look at the data,” he said.

If you look at the data, he explained, maybe one out of every 10 people who need substance use treatment get it.

“But if you could increase that, so that 50 percent are getting treatment, one out of two, your system costs in the short-term are going to be extraordinary,” Lang continued. “The costs are going to spike, and then they will come back down. The question is: will people have the stomach to ride that out.”