Providence Health Plan shifted from managing behavioral health through a vendor to in-house, a change that has paid off in a lot of ways, according to Paul Giger, MD, medical director of behavioral health.
Providence Health Plan, owned by Renton, Wash.-based Providence Health, has around 700,000 members.
Dr. Giger said the plan previously followed the "carve-out" model for behavioral health benefits, and contracted with Optum to manage its behavioral network.
However, among the downsides of the carve-out model is having less control over the member experience, he said.
"We really pride ourselves on being a member-centric organization," said Dr. Giger."Having this carved out to a third party who was a big, national for-profit, after a lot of deliberation, we determined it just did not fit with our mission and our aspirations as a plan."
Providence Health Plan shifted to integrated benefits three years ago. The plan is small enough to be able to identify individual members struggling to get a specific kind of treatment, and can identify patterns to improve network access, Dr. Giger said.
Behavioral health represents around 6% of the plan's spending, but it is the No. 1 thing that employers and members ask about.
Three years in, the integrated benefits are in an "optimizing mode," according to Dr. Giger. The plan helps reduce difficulties in getting into behavioral care and filling gaps in care.
"The No. 1 thing people want is access," Dr. Giger said. "They want to get in and they want to get in soon. That's certainly the signal we've gotten from the market and from members."
Around 90% of Providence Health Plans' members are in Oregon, Dr. Giger said. The company has a team dedicated to "pounding the pavement" to get mental health providers in the state in-network.
The company also works with Elevance Health's Carelon to manage networks outside of Oregon and provide telehealth services for members looking for virtual care or living far away from a network provider, he said.
The company also provides a telehealth behavioral health concierge program for members, Dr. Giger said.
In addition to telehealth resources, the plan provides members with navigation services to help members find the right kind of mental healthcare — whether that's counseling or more intensive treatments.
"It's kind of our SWAT team. They know the local market super well. It's hard to overstate how important that is," he said.