Members with behavioral health conditions typically have a multitude of behavioral, medical, and social needs requiring extraordinary access, education, and coordination. While certain providers have successfully integrated primary and behavioral health care, collaboration between independent providers/specialties remains critical to ensure that care is timely and preventative.
Providers participating in a ONEcare Network assume responsibility as the “quarterback” of the member’s care. This provider will outreach and educate the member, schedule appointments, address social obstacles to care (transportation, housing, food, etc), draft/manage a wholistic health plan, and monitor outcomes, including supporting the member during periods of medical or behavioral health crisis. Alera Health supports the identification, targeting, and monitoring of high-priority members.
In exchange, the ONEcare Network collectively earns performance-based incentives for improving health outcomes and reducing the cost of care. These incentives pass down to the providers, allowing them to expand programs and staffing to support more members.
A Severe Mental Illness (SMI) is a lifelong condition that requires constant monitoring and maintenance. Members with SMI report difficulty in accessing primary and specialty medical care often delaying the identification of emerging disease. In certain cases, those with SMI also have difficulty maintaining employment and subsequently experience housing, transportation, and even food instabilities which impede their ability to stay connected with their care team. ONEcare Networks specialize in engaging this population in a variety of proactive services and programs.
Medical care can become complex, especially when suffering from 2 or more chronic conditions, at least one of which is a behavioral health condition. In an intertwined spiral, the behavioral health condition may add confusion or even despair such that a member has difficulty self-managing multiple doctors, medications, and treatment recommendations.
“Silent Sufferers” are often evident in the data with multiple recent hospitalizations and minimal engagement in outpatient care. ONEcare Networks take on the responsibility to proactively outreach and supportively educate on the importance of preventative medical and behavioral health care.
While children are typically physically healthier than older adults, the loss of a stable familial home is traumatic, and a nurturing care team can be a lifeline to stabilize mood and behaviors which compound efforts to reunite families. ONEcare providers are experienced in navigating social services, foster, medical, and behavioral health care in coordination with court systems and advocates.
Alera Health selectively invites capable and proven providers organizations to apply to a ONEcare Network. Once network adequacy is achieved, the ONEcare Network is legally formed as a CIN and Alera Health solicits value-based contracts with MCOs. The participating providers elect a Board of Managers to oversee the performance improvement activities of the network and ultimately hold each other accountable for individual and collective performance.
The workhorse of every ONEcare Network, the CQI Committee identifies priorities, evaluates and implements best practice, provides technical support, and monitors network performance. In addition, the CQI committee will promote shared resourcing and identify High Value Collaborators with which the network seeks to partner. Each CQI committee sends delegates to a National Quality Improvement Committee (NQIC) to expand and translate learnings nationwide.
Using the reporting and tools provided by Alera Health, each ONEcare network is able to focus resources on high-opportunity and impactable members to derive the greatest population impact. With these reports, providers are able to quickly identify “chase lists” for outreach, open preventative care gaps, high/rising cost claimants, complex polypharmacy, and even real-time reports on members presenting in the ED or an inpatient setting.
For payers, MCOs, hospitals, and even primary care CINs, a ONEcare network is a one to many connection to high-quality, integrated and standardized behavioral healthcare. ONEcare Networks provide timely and coordinated access to behavioral healthcare in exchange to reciprocal access to primary and specialty care. Hospitals who allow ONEcare providers to participate in discharge coordination find they can save up to 20-30% in uncompensated charity care related to behavioral health admissions. Finally, ONEcare and Alera Health partner with contracting MCOs; aligning benefits and network incentives to build resilient and effective integrated systems of care that benefit their entire membership
“52 Year Old Woman Suffering from Anxiety Disorder Receives First Mammography. . .Which Catches Stage 1 Breast Cancer. After Alera Health identified the woman as eligible for Breast Cancer Screening, a ONEcare provider outreached the woman 9 times, providing education and addressing the woman’s anxiety and paranoia about receiving her first mammography. Even after a phone call from a nurse practitioner, the woman flatly refused to schedule an appointment. Several weeks later in a moment of clarity, the woman called the provider and said she had changed her mind but only if the procedure could take place that day before she lost her nerve. While that provider did not have a mobile mammography clinic on site that day, another ONEcare provider did and the organizations quickly arranged transportation and successfully completed the mammography. Two days later, the radiologist reported finding signs of Stage 1 Breast Cancer which was imminently treatable since it was found early. Timely data and an organized and collaborative network of providers prevented a costly, if not deadly, episode of care.”