Sample Program Recommendations Report

Program Recommendations:

Behavioral Health Cost-Containment

provided by MINES & Associates www.MINESandAssociates.com

About MINES

MINES & Associates has been providing unparalelled cost-savings programs to organizations across the country for 30 years from Organizational Development and Employee Assistance programs to Managed Behavioral Health Care and Specialized Network Discounts.

We have a saying at MINES that we are here to “save lives and influence the course of human events.” With the growing costs of Behavioral Health, it’s never been more important to have a good partner that can help keep costs contained.

That’s where we come in.

We’ve partnered with organizations large and small, across all industries, to help them reign in

Employee Assistance Program (EAP)

A MINES’ EAP is designed to both assist employees and support the productivity and profitability of employers.

Programs may be specially tailored to fit the unique needs of each organization and their valued workforce.

Specialized Behavioral Health Network (PPO)

With MINES’ Network, organizations have access to providers at discounted rates across the country. Flexibility in network implementation ensures a great fit, and typical savings amount to up to 40% from prior years’ claims.

2‫ ׀‬PROGRAM RECOMMENDATIONS: Behavioral Health Cost-Containment

their Behavioral Health costs. It’s what we’re good at, and we want to help you, too.

This viewbook is meant to provide a little bit of information about the programs we offer and how we may be a great partner in providing an excellent cost-containment program for your plan.

We hope that by providing this information to you, we can identify what opportunities, if any, there are for us to work together. And if it doesn’t work out - that’s okay, too.

Take a look at our services outlined in the next few pages and feel free to contact us if you have any questions. We look forward to hearing from you.

Managed Behavioral Healthcare

MINES’ Managed Care programs ensure an organization’s employees recieve the utmost quality of care, while providing unparalleled cost savings. Our expert Case Management staff provide proactive outreach for all realms of care.

Organizational Development

Through their academic and business expertise, MINES’ sister company, BizPsych, provides consulting services, strategic organizational development, culture and change management services, and custom-designed training.

Are we a Fit for Your Clients?

At MINES, we strive to partner with client companies and organizations who we feel are a good fit for us; those to whom we can provide significant value. In order to identify this fit, we developed a tool called the Cost-Containment Behavioral Health Analyzer to help self-funded organizations gain an understanding of their behavioral health costs. It takes into account many pieces of information to develop a simple picture of very complex information.

While all companies may not be a good fit for our services, we believe everyone is a fit for our analysis. The analysis simply provides a clear look at the components of a company’s behavioral health plan, and allows us to identify ways we can help. If an organization is already doing a great job managing their Behavioral Health costs and doesn’t need assistance from us, that’s fine. But if there are significant ways in which we can help reign in their costs, that’s even better.

How does the Behavioral Health Analyzer work?

As a total package Business Psychology firm, we strive to provide a realistic view of all Behavioral Health costs and their interactions. In order to provide these results, quality data is required to produce an accurate savings report. The three main components are as follows:

Census When a census of an organization’s members is received, we consolidate the data down to zip codes and counts. This information is then matched against our network to determine the number of clinicians that we have in each area and what the average reimbursement rate for the various procedure codes are.

We can then determine what the cost of PPO Access compared to savings off of retail rates would be.

Claims Data and Plan Design By looking line-by-line at the claims data related to Behavioral Health, we can identify how much is billed and paid for each individual claim as well as identify how we might have been able to provide additional cost savings through Managed Care services. Depending on the organization’s plan design and requirements under the Mental Health Parity and Addiction Equity Act, they may only be eligible for Utilization Review for Inpatient claims. Whatever limitations a plan may have in place, MINES can work with it to provide additional layers of cost-containment.

EAP/MAP Program Information Organizations may or may not already have an EAP program in place, but in many cases, it may not be meeting the needs of the company when it comes to Behavioral Health cost-containment. While the EAP cannot be required for treatment, a well-promoted and easily-accessible EAP can help defer many of the individual therapy costs an organization faces by providing short-term, solution-focused therapy around matters of work and life.

PROGRAM RECOMMENDATIONS: Behavioral Health Cost-Containment ‫׀‬3

Sample Analysis Report

Upon the completion of the Analysis, a report is prepared outlining our program recommendations and providing a picture of expected savings after program implementation.

BEHAVIORAL HEALTH ANALYSIS RECOMMENDATIONS

PREPARED FOR: Organization ABC



NUMBER OF EMPLOYEES: 25,000

ESTIMATED EAP UTILIZATION: 5%

EMPLOYEE ASSISTANCE PROGRAM

In the claims data analysis, we’ve found that employees at Organization ABC have an average of 4.6 Individual Therapy sessions per employee; meaning that of those that accessed their benefits, each utilizing member used 4.3 Individual Therapy sessions to resolve their issue. With no prior EAP in place, it is our suggestion to implement an up-to-five session per year EAP program in order to cover these 4.6 sessions with free clinical sessions before going into the insurance benefit. With this program in place, we anticipate that 65% of Individual Therapy sessions would be resolved before needing to access the insurance benefit. With the data collected, we expect program costs for this EAP would be in the neighborhood of $550,000 per year – resulting in 24% savings in costs after program implementation.

4.6(90806) → 5 x 65%

Average number of Individual Therapy Sessions

CPT code for

Individual Therapy

SAVES… $727,673.77/year on Individual Therapy



EAP model that

Percentage of Individual Therapy

number of sessions

during the EAP

would cover average

cases that would be resolved

COSTS… $552,123.05/year

ROI… 24%

SPECIALIZED BEHAVIORAL HEALTH NETWORK

Regardless of Parity, a vast Specialized Behavioral Health Network provides discounts on all manner of treatment. With an implemented Specialized Behavioral Health Network (SBHN) you have access to discounted rates for treatment. As determined by our claims analysis, Organization ABC spent over $2,000,000 in Behavioral Health Care costs. Based on our national rates for the claim data received, we anticipate that our network rates would be approximately 26% less than the amount incurred. A savings of over $500,000 spread out over the cost of the program, at approximately $300,000, provides a 39% ROI. SBHN($2,028,723.11) → 26%

A Specialized Behavioral Health

Total amount

Organization ABC paid in

have saved Organization ABC

rates for your members

Mental Health Claims

based on average rates

SAVES… $527,826.74/year on Behavioral Health Costs



Amount our network would

Network provides discounted

COSTS… $322,770/year

ROI… 39%

MANAGED BEHAVIORAL HEALTHCARE

The on-set of the Mental Health Parity Act of 2008 required insurers to provide the same level of benefits for mental health and addiction services as they do for medical benefits. As Company ABC is parity-compliant – and as so does not allow for case-management of Outpatient costs – our analysis was focused on inpatient, residential, and IOP behavioral health and addiction services costs. In the analysis of these costs, we found that these higher levels of care were significantly under-accessed in comparison to the Outpatient treatment options available. Therefore, it would not make sense for Company ABC to utilize our Case Management services at this time, as the utilization is too low to justify the costs of the program.

4‫ ׀‬PROGRAM RECOMMENDATIONS: Behavioral Health Cost-Containment

What Now? As trusted adviors of your client’s Behavioral Health plans, we want to give you the

opportunity to provide them with great news when it comes to their bottom line. Contact us today to request a report, get more information, or just to ask us some questions.

10367 W Centennial Road Littleton, CO 80127 800.873.7138 www.MINESandAssociates.com