Partners Health Management Drives Better Outcomes for Members and Communities
New Portal Based on ForgeRock Identity Cloud Helps Providers More Efficiently Treat Members
The health care industry is rapidly changing for the better. Specific to North Carolina is a mandate called NC Medicaid Managed Care that includes an expansion of North Carolina’s first-in-the-nation public managed behavioral health system. As part of that system, Partners Health Management now manages mental health, intellectual/developmental disabilities and substance use disorder services for Medicaid recipients in central and western North Carolina. Beginning in December 2022, members will also receive integrated physical health and pharmacy benefits through Partners’ Tailored Plan. In the evolving health care landscape, more and more networks and providers are trying to create a 360-degree view of member information in order to offer more personalized care. Partners Health Management is going a step further. In addition to addressing traditional health care needs, the organization provides access to community services and supports available to members to aid providers in caring for the whole person – a member’s physical, behavioral and social needs. I recently had the pleasure of speaking with Partners Health Management Chief Information Officer Michael Kincaid and IT Support Services Manager Tracy Styles to discuss this truly ambitious and inspiring goal.
Q. Please tell us about Partners Health Management and your revamped portal.
Michael: We’re focused on providing positive outcomes for our members through a comprehensive network of providers. Providers submit their claims and get authorizations from us before they provide services and get reimbursed. With us, they receive authorization and then can submit a claim and check the status of that claim. If they can’t provide a specific service that is beyond their capabilities, then they can find another provider to help their patient. It’s all about providing the best possible care. We want to make this process as easy and efficient as possible.
Tracy: Partners Health Management is undertaking a plethora of new initiatives and activities. At the forefront, Partners is launching a Tailored Plan for Medicaid recipients, under which Partners will oversee integrated physical health, behavioral health and pharmacy services and access to care for folks with more complex health care needs.
Q. Can you elaborate on those types of additional services?
Tracy: Sure. Say I’m a care manager assisting a member who has multiple health needs like a developmental disability as well as some mental health and social needs. Those are pretty diverse needs. Under the current process, in order to get resources for all of these needs, there are a lot of applications you can use but they don’t really talk to each other. They don’t really have any inter-connectedness and our goal of creating a 360-degree view of members’ health hopes to connect those apps and that data so we can improve overall care.
In our vision with the new portal, a member’s care manager can go into one place and seamlessly move from different apps that provide information about all aspects of care. These applications include population-level health data for providers, claims and billing, training and guidelines for providers, care management information, and a directory of community resources available to members
Thinking about it from a whole person perspective, if you don’t have your basic needs met – such as safety, housing, and food – then you really don’t have the capacity to work on your physical health or behavioral health. By offering community resource information and access to service providers, we hope improve member health through a well-coordinated system of care. It’s evidence-based and essential in order to create positive outcomes for our members.
Q. How will the new portal be different from the existing portal? How will it help achieve these goals?
Tracy: We are using the ForgeRock Identity Cloud to help modernize our portal to improve service for the providers taking care of members. As part of that, we’re looking to make the experience as seamless as possible for the providers, allowing them to spend their time working with the members rather than trying to figure out technology or bearing an undue admin burden.
Michael: We want to make sure that our providers don’t have to do tasks over and over again in order to do their job. I am confident that with ForgeRock we can simplify that process; like removing repetitive signing in and out throughout the day. We want to give them a one-stop shop so they can get to everything they need in order to conduct business and take care of our members better and faster than before.
Q. Can you tell us some more benefits this portal will provide members?
Tracy: Partners’ providers are dealing with multiple apps that contain different types of information useful for their practices. Providers currently have different passwords for each app, which requires a lot of password management. Streamlining this process with one login so providers can move seamlessly among the apps will improve the utilization of the apps. This will, in turn, help speed care for members. Providers will spend less time on administrative tasks and trying to find and manage all the aspects of an individual’s services and supports. With the new portal, they will have a 360-degree view of our members in one simple access point.
The portal can also help providers deliver more affordable care. For example, a provider can look up a member’s pharmacy benefits and quickly identify the most affordable medication, like comparing generic versus brand medications. This assists the provider in giving care to members that is more attainable for them.
In addition to that, there are also applications that offer population-level informatics so a provider can look at their full patient panel and see how they’re doing through several different lenses, including giving wholistic views of their communities. Let’s say a doctor is seeing a high number of patients with diabetes within their population. They can look at A1C score (a test to diagnose prediabetes or diabetes) distribution or they can drill down into individual member-level data. With this data, they can not only treat individuals, but they can also refer members to Partners’ health education programs that drive improved health in their broader patient communities.
Another benefit is that we are creating a delegated account management model with ForgeRock which will greatly reduce the management burden for providers. Each of our providers will have local administrators within their office who will manage employee access – whether that’s someone at the front desk who is doing authorizations or someone who is handling billing and claims. Currently, it’s a manual, time-consuming process. With ForgeRock, we are streamlining the process significantly, which will improve efficiency and reduce administrative burden. It’s pretty streamlined for the provider’s local administrators as well as their IT departments.
Q. Why did you select the ForgeRock Identity Cloud?
Tracy: One of Partners’ biggest goals is to make the experience with the organization better for our members, providers and employees. We’ll utilize ForgeRock to improve that user experience overall. By streamlining the administrative process, Partners improves the provider experience and leaves providers with more time to care for our members. Assisting members to receive the best care possible is one way we fulfil Partners’ mission of “Improving Lives and Strengthening Communities.”
Michael: We have a hybrid cloud model. Most of our systems are hosted on the cloud, although we have a few on premises, too. We like the cloud for the availability and business continuity. When you’re cloud-based, you can basically connect from anywhere.
We’re also shoring up security. With the number of ransomware and cyberattacks increasing, we want to make sure that our organization, our providers and members are protected against these types of attacks. We’re looking into many different things, such as cloud firewalls (physical and logical) and our processes, procedures and policies. From top to bottom, we’re enhancing what we’re doing from a security standpoint.
Tracy: Single sign-on (SSO) is the core functionality provided by ForgeRock that will help us accomplish these goals. A primary advantage of ForgeRock is its ease of use. We considered several solutions on the market, but we found that ForgeRock was definitely the easiest to work with.
Also, the ForgeRock sales team was really excellent. We were able to get information and assistance very quickly. Now that we’re in the development phase, ForgeRock developers are helping us understand the deeper technical necessities and methodologies. ForgeRock’s health care expertise is really helpful in recommending different workflows and approaches that maximize our investment.
Michael: ForgeRock has been great to work with. They have done a great job handholding us, and we appreciate their health care expertise and the easy-to-use solutions.
Q. What's next for Partners?
Michael: We want to leverage ForgeRock as much as we can. Once we get the new portal up and running for providers, we plan on extending it to members. And I think there is a use for it internally as well, which will help drive efficiencies and ease-of-use.