Beacon Health Strategies, LLC August 2005

Introduction l Greetings and Overview What is a Managed Behavioral Health Organization? l A Managed Behavioral Health Organization (MBHO) is a company that works in partnership with health plans, Medicaid agencies, and / or state and local governments to ensure that members of a health plan or publicly funded health program such as Medicaid receive easy access to cost effective, high quality mental health and substance abuse treatment. Beacon Overview Who is Beacon? l Founded in 1996, Beacon is a locally owned Managed Behavioral Health Organization committed to serving a small number of respected customers in the Northeast

MH/SA Disorders are Challenging to Identify and Treat l Not as straightforward as compared to medical / surgical Identification, Prevalence and Treatment of MH/SA Services l Small number of individuals with complex needs drive costs o 3-5% of commercial dollar premium l According to the World Health Organization, 5 of the top 10 causes of disability are related to a MH or SA disorder l Complexity of need calls for even greater need to coordinate care with other systems l Frequent co-occurring issues (diabetes and depression, post-partum etc.) makes appropriate treatment harder to achieve

MH/SA Services are Not Always Clinically Appropriate and Can be Costly l Providers differ widely in terms of their MH/SA training and their commitment to practicing evidence based medicine often resulting in: o Over treating (more care does not equal good care ) o Under or mis-diagnosing o Inconsistent outcomes l Tendency of some payers to purchase services based on price rather than on outcome l Over time, length of stay has gone down and member wellness and satisfaction has gone up l Today, there are many treatment options in between traditional inpatient and outpatient care to improve appropriateness of care and maintain members in their community Appropriateness of Services

Challenges Ever Present in Gaining Access to MH/SA Services l Service availability issues o Issues in geographic distribution o Issues in provider specialty availability l Stigma associated with MH/SA conditions l Identification (self and primary care) l Uneven insurance coverage l Linguistic and cultural barriers Access to Services

How? l Identification and implementation of best practices l Driving improvements in access l Integration with medical and primary care and other systems l Organization and improvements to service delivery system l Monitoring heterogeneity of needs l Prevention and early intervention l Ensuring quality l Close coordination with stakeholders (consumers, MH/SA providers, PCPs, state agencies, service delivery improvement working groups) Companies Like Beacon Help Address the Issues