The Beacon Difference – PCP/BH Provider Communication Program
THE PROBLEM
Despite widely held agreement that the integration of behavioral health (BH) and
primary care treatment supports the total health care needs of the member, Beacon’s
provider network was experiencing performance below the PCP/BH Provider Communication
benchmark requiring that 85% of all inpatient episodes document an exchange of information
to the member’s primary care practitioner (PCP).
Beacon’s root cause analysis revealed two main issues:
- Providers were frustrated by cumbersome communication forms and the frequent lack
of reciprocity in exchanging information with other treaters.
- Member’s reported privacy concerns and a general misunderstanding of the importance
of integrated and informed healthcare.
One additional barrier to communication Beacon identified was a high frequency of
members not having an assigned PCP in their community for the BH provider to communicate
with.
THE BEACON SOLUTION
Recognizing that providers, members and Beacon’s staff each play a pivotal role
in facilitating communication between BH providers and PCPs, Beacon undertook a
multi-pronged approached to improving communication compliance. The plan undertaken
included:
- Revising Beacon’s communication protocol based on member and provider feedback.
- Conducting a wide scale education campaign highlighting the importance of informed
treatment to members and providers.
- Enhancing Beacon’s Clinical Management Information System, FlexCare, to promote,
track and support communication compliance.
- Refining reporting to identify performance of high volume inpatient facilities and
identify members in need of PCP assignment.
Using information gathered when developing its plan, Beacon rolled out revised communication
forms in conjunction with journal articles highlighting the importance of communication.
Simultaneously, Beacon profiled all high volume inpatient facilities sharing with
them their facilities’ communication compliance rates as compared to the network
average and the contractual standard. In addition to working with providers, Beacon
partnered with its health plan partners to canvass members with information on the
benefits of communication and the handling of confidential health care information.
BEACON’S RESULTS
Through implementing its plan, Beacon was able to surpass its internal benchmark,
while simultaneously connecting over 300 members with a primary care provider before
their discharge back into the community. Beacon’s overall compliance rate for 2006
was 91%, up from 84% in 2005. By product, Beacon had the greatest communication
compliance results with the Medicare population at 97%