ICYMI: Business Acumen Center Weekly Update

In last weeks Business Acumen installment, I profiled ANCOR member Woods Services located in Langhorne, PA.  This provider is piloting integrated care though a Primary Care Coordination model.  You can click on this link if you missed the original report.  This week I am going to share information about two other promising practices, both based in Harrisburg, PA.

This week we are focusing on an ACO created by ANCOR member association, RCPA.  RCPA is a provider association that represents providers of I/DD, Behavioral Health and Long Term Care services across the state.  In 2016 the members formed RCPSO, a services organization positioned to contract with payers for specific services provided by its members.  It is comprised of over sixty I/DD agencies and over forty providers of Long-Term Care in the elder services arena.  They are currently coordinating contracts for vocational and employment services for Centene; services for Traumatic Brain Injury; and Long-Term Care service coordination for elders through AmeriHealth. 

RCPA’s experience in these alternate payment models dates back to 1995 however when they formed CBHNP, a managed care entity that was owned by behavioral health providers.  This MCO was very successful in coordinating services and managing the care for Pennsylvanians with behavioral healthcare needs because it was operated by behavioral health providers who deeply understood the care and support needs of the people they served.  This entity operated for over twelve years and was eventually sold to AmeriHealth/Caritas in 2008.

The best practice implications identified here is that provider owned/led ACO or MCO models which are mission driven and grounded in a deep knowledge base of the target population offer an alternative to traditional, commercially owned MCOs .  They have proven success and consideration should be given to replicating some of the key elements of the initiative.