Tim Murphy from US firm Beacon Health Strategies explains the model that targets the biggest spend and coordinates care for patients that need it most, improving outcomes and driving down costs
In 1996 Elizabeth Pattullo founded Beacon Health Strategies in a bid to address a problem that affects US medical insurance schemes and the NHS alike − the problem of “frequent flyers”.
‘What we do is bring mental health together with the medical and physical side of a patient’s care’
She wanted to try and improve the lives and cut down on the costs for those patients − often with both mental health conditions, co-morbidities and long-term conditions − who use health services more frequently than any other cohort of patients. They cost health services far more than other patients and are repeatedly using the system without any real improvement in their conditions year after year.
Beacon focuses on the poor, elderly and mentally ill and essentially acts like a smart logistics company, linking together existing resources to give patients exactly what they need, be it home visits by social workers, therapies or a lift to the shops.
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According to Beacon Health Strategies president Tim Murphy, the company was set up because the founders realised that while most medical insurance systems in the US, including the government schemes Medicare and Medicaid, were adept at providing critical management and secondary care, they were deficient in mental health care and the management of patients with long-term conditions.
‘We recognise the UK is not the US but both systems benefit by being informed about who would best benefit from coordinated care’
One thing that is important to understand about Beacon is that it does not directly deliver mental health care, rather it acts as an “integrator”, coordinating mental health services from different health and social care providers to ensure care effectively meets the needs of each person with mental health conditions.
Mr Murphy explains that when working with medical insurance clients, Beacon extrapolates patient data to identify where the biggest spend is.
He also credits the increasing sophistication of both Beacon’s own and medical insurance clients’ data warehouses, which helps it to identify exactly where its biggest spend is and where to focus its energy.
He says: “Those patients who have continuing spend year after year will have multiple chronic physical problems, but when you look at that cohort and include those with mental health conditions it is these patients who will on average cost two to three times more per year than those without a mental health conditions.
“What we do is bring mental health together with the medical and physical side of a patient’s care.”
Mr Murphy says that the company aims to seamlessly integrate its clients’ medical and disease management programmes, which he says have been proven to lower the total cost of care while measurably improving patient outcomes.
“Once we identify the patients in a client group that we think we could help, we approach them to ask them if they would like to allow us to become their advocate and work with their primary care doctors and their social workers to integrate care. Most of their care givers appreciate our assistance,” he says.
“Person-centred planning and good coordination of care is not necessarily new but the experience of it has become more regimented and having a logistics element ensures that people have an up-to-date treatment plan, that they are making progress and that they are getting to the right place at the right time.
“In a perfect world, medical providers would like to think they can handle all of this but in reality they realise they can’t. This is about synthetically creating the vertical integration of all the services patients need,” he adds.
A model for the UK?
In 2011, Beacon launched a UK arm in a bid to work with purchasers and providers of mental health services from the NHS and the private and third sectors.
Run by Dr Emma Stanton, a practising NHS psychiatrist in London, the company has already worked with a number of shadow CCGs and mental trusts on a consultancy basis analysing data on specific patient groups.
‘NHS patients still often fall between the gaps, especially those with complex chronic conditions and mental health issues’
“We recognise that the UK is not the US but both systems benefit by being informed about who would best benefit from having their care more coordinated,” Mr Murphy says.
“In the US, 9 million people, or 3 per cent of the population, consume 12 per cent of the healthcare dollars and their care costs average $20,000 a year, whereas the average person’s cost $4,000. We have to identify who these people are and tailor a care plan on their behalf.”
He says ultimately the company has come to understand that coordinating the care for people with mental health problems, who frequently also have other long-term conditions, in a systematic and logical way greatly improves outcomes and reduces costs.
In an ideal world, connecting and coordinating care in the NHS’s fragmented system also requires specialists to align services around the need of patients.
NHS patients still often fall between the gaps, especially those with complex chronic conditions and mental health issues, and it seems the NHS could do worse than try to follow Beacon’s example.