IBM Saves Dollars by Integrating Services and Focusing on Behavioral Health

IBM’s Care Advocacy Model, which was developed by the company’s Mental Health Care Program, is successfully integrating its disease management, medical, pharmacy, disability, Workers’ Compensation, work/life programs, and behavioral health services to

• improve patient outcomes,

• reduce time away from work, and

• minimize the cost and impact of behavioral health conditions on the workplace and healthcare costs.

Preliminary results are positive. Last year the program generated savings of $500,000 in outpatient costs — $100,000 more than it generated in 2002. Juan Prieto, Health Benefits Program Manager at IBM, told Mental Health Works how it was done.

IBM’s Strategy

The Care Advocacy Model embraces a holistic strategy of care. “Given the high prevalence of depression and anxiety with numerous chronic conditions,” Mr. Prieto said, “it was important to develop a program that truly addressed patient needs.” He noted that behavioral health is not only the largest and fastest growing pharmacy expenditure, it is also a critical factor that can exacerbate problems in other medical areas, adding to costs and time away from work. IBM empowers its membership to make healthy decisions and be wise consumers of healthcare.

A survey of 772 employers conducted by the Integrated Benefits Institute (IBI) found that 85% of large employers, 69% of mid-sized employers, and 49% of employers with fewer than 500 employees have adopted at least one health and productivity management practice. IBI’s Full-Cost Study found that absence, disability, and absence-related lost productivity cost employers more than four times the cost of employee medical treatment, even when Workers’ Compensation medical costs were added in.

The Care Advocacy Model

The Care Advocacy Model promotes early identification and intervention for individuals who may have behavioral health problems co-occurring with other medical conditions. It also promotes care coordination across carriers, proactive outreach to prevent illness and wellness, and integration of medical, behavioral, and pharmacy data.

The program uses claims information, medication interventions, scientifically advanced surveys, etc., to proactively identify members who may be having behavioral health issues or may be at risk.

These members receive personalized outreach and (with their permission) a Wellness Survey that identifies at-risk individuals, potential comorbidity, and psychosocial stressors.

Comprehensive care advocacy then helps guide members to the appropriate level and duration of care. All individuals at high risk and individuals accepting services are carefully monitored to encourage a successful outcome. For reference, IBM's Care Advocacy Model generated $500,000 in savings in 2003.

“By addressing the behavioral health issues that affect recovery from medical illness and longterm health and by getting people who are at risk into appropriate services earlier, the program helps manage both medical care costs and related productivity loss,” Mr. Prieto said. “At the same time,” he added, “IBM provides enhanced, integrated care for its employees.”

Program Focus

The Care Advocacy Model focuses on coordination between IBM’s external vendors and internal programs. It includes the following elements:

• Care coordination with medical vendors, especially between the behavioral health vendor and major medical vendors

• Coordination with primary care physicians

• Analysis of pharmacy data

• Work/life support

• Short-term disability (outreach to employees on or at risk of disability)

• Outreach services (telephonic assessment, education, strategies to improve outcomes, and referrals to appropriate resources for at-risk patients).

Integrated Database

IBM uses an interactive and integrated database managed by Ingenix. Claims data from behavioral, medical, pharmacy, disability, and others are integrated into a “registry” of patients. In this way, individuals who may be at risk for a behavioral health disorder along with their medical condition can be identified and appropriate intervention made.

Member Identification and Outreach

IBM’s clinical approach requires that attention be paid to the overlap and interplay among the various aspects of their employees’ lives rather than isolating the employees’ physical conditions from their emotional health or their workplace life from their personal life.

Patients in need of behavioral healthcare are identified in the following ways:

• Health risk assessment;

• Medical claims analysis, followed by outreach;

• Medical department or EAP referral;

• Screening by disability personnel;

• Screening by Workers’ Compensation carriers, followed by outreach calls;

• Telephonic screening by medical plan nurses using behavioral health risk appraisal tools; and

• Referrals from primary care physicians and medical specialists.

Throughout the process, data are compiled from all appropriate third parties to coordinate medical management, member support, and finance.

Results

IBM was spending up to 30% of its total outpatient dollars on long-term outpatient cases. As part of the Care Advocacy Model, IBM initiated the Outpatient Care Management pilot in 2002. It focused on the long-term outpatient cases, 70% of which were electronically flagged for aggressive care management intervention. The result: outpatient costs went down by $400,000 in 2002 and by $500,000 in 2003. In addition, IBM saved money because vendor staffing could be reduced.

Mr. Prieto said that the program is going to cost 3% less in 2004 than it did in 2003 as a result of the bid procurement savings and the increased use of technology.

IBM’s behavioral health vendor United Behavioral Health reported these results supporting active intervention:

• 70% of individuals accepted a referral to at least one service offered through the outreach program. Overall rates of treatment within families increased from 2.2% to 8.8%.

• 95% of individuals were satisfied with the help received from the outreach program.

• The number of outpatient cases that later required acute or intermediate care was reduced by 50%.

• Medical costs declined when members used behavioral health specialty care.

IBM’s Next Steps

According to Mr. Prieto, the Care Advocacy Model is an ongoing, continuously evolving process within IBM. Some of the next steps for the program include:

• Partnering with IBM’s internal disability program to identify behavioral health conditions in those members not having a current behavioral health diagnosis.

• Providing support and outreach to any member who has a life status change, e.g., divorce, adoption, marriage, death, etc.

• Focusing on all admissions immediately and partnering with the facility to “step down” treatment as appropriate.

• Asking each member who accesses the Mental Health Care Program to complete a Wellness Survey.

• Using pharmacy data to proactively intervene with those members who have a psychotropic prescription but no behavioral health diagnosis.

• Partnering with medical vendors in identifying those members who access the medical program and who are at risk for behavioral health disorders.

• Educating members about consumerism, wellness, and prevention.

“We anticipate continued success in improving the quality and the affordability of healthcare,” Mr. Prieto concluded, “and we expect to achieve or exceed savings of $500,000 each year.”

About IBM

Invention develops and manufactures advanced information technologies, including computer systems, software, storage systems and microelectronics, while also offering professional solutions, services, and business consulting worldwide.

Last Updated: April 2004