HomeMy WebLinkAboutItem 07 Approval of Terminating the City’s Mental Health Services Contract with Heartspoken/Gilstrap Counseling, Inc., Effective May 1, 2019 ocoee
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AGENDA ITEM COVER SHEET
Meeting Date: 02/05/2019
Item # 7
Reviewed By:
Contact Name: Gene Williford, HR Director Department Director:
Contact Number: (407) 905-3154 City Manager:
Subject Termination of the City's Mental Health Services Contract wit Heartspoken/Gilstrap
Counseling, Inc. effective June 1, 2019.
Background Summary:
The City's Health insurance agent, The Crowne Group, is recommending the termination of the City's contract
with Heartspoken/Gilstrap Counseling, Inc. due to the implementation by Florida Blue of a capitation program
on Mental Health and Substance Abuse coverage on group health plans like the City's.
Issue:
Effective January 1, 2018 Florida Blue began charging a "capitated" per member/per month rate to manage
behavioral health services. Currently, the City contracts directly with Heartspoken/Gilstrap Counseling, Inc.
Recommendations:
Terminate the City's contract with Heartspoken/Gilstrap Counseling, Inc. effective June 1, 2019.
Attachments:
Letter from The Crowne Group
Email from Florida Blue
Financial Impact:
The City will be required to pay $3.76 per member/per month for 2018 and $3.86 per member/per month for
2019. This will be required regardless of whether or not the City continues with Heartspoken/Gilstrap
Counseling, Inc. Termination of the contract with Heartspoken/Gilstrap Counseling, Inc. will result in financial
savings to the City of approximately $70,000 annually.
Type of Item: (please mark with an "x)
Public Hearing For Clerk's Dept Use:
Ordinance First Reading A Consent Agenda
Ordinance Second Reading Public Hearing
Resolution Regular Agenda
Commission Approval
Discussion&Direction
Original Document/Contract Attached for Execution by City Clerk
Original Document/Contract Held by Department for Execution
Reviewed by City Attorney N/A
Reviewed by Finance Dept. � � ('kj N/A
-.t.o e 7.-
The
he Crowne group
October 3,2018
Gene Williford
Human Resources/Risk Management Director
City of Ocoee
150 N Lakeshore Dr.
Ocoee,FL 34761
Re: Heartspoken/Gilstrap Counseling, Inc.
Mental Health Services Agreement
Dear Gene:
As you are aware, effective January 1,2018, FL Blue implemented a capitation program
on Mental Health and Substance Abuse coverage offered on your group health plan.
They implemented the program on all ASO groups to reduce the rising cost of mental
health and substance abuse treatment. The program covers all members enrolled on your
group health plan and the capitation fee is billed monthly on a per member per month
basis.
That said it is Crown's recommendation to discontinue the Mental Health. Services
Agreement with Heartspoken/Gilstrap Counseling, Inc. effective January 1, 2019. If the
City proceeds with Crowne's recommendation, this should be communicated to all
members to avoid disruption for anyone currently receiving services from Heartspoken,
perhaps at open enrollment this year.
Since Heartspoken/Gilstrap is not a part of FL Blue's network, any member that
continues utilizing them after the contract is terminated will be considered out of network
and could be balance billed after the appropriate deductible and co-insurance is applied.
If there are any questions,members can contact FL Blue directly to be advised on how to
find a provider that is covered in the network.
Sincerely,
Roxane Herbstsommer
Account Management
2770 Rew Circle,Suite 200 Ocoee,FL 34767 (407)654-5414 p(407)654-9674 f
1 i a
Bertling,Debbie
From: Williford,V.Gene
Sent: Thursday,December 07,2017 9:55 AM
To: Bertling,Debbie
Subject: Re:Florida Blue-Claims Invoice Capitation for BH/SA services
Thanks,
Sent from my'Phone
On Dec 7, 2017,at 7:14 AM, Bertling, Debbie<dbertling@ci.ocoee.fl.us>wrote:
Not sure if you got this email from Renee so I'm copying you on it.
From: Neal, Sharlene R [maiito:Sharlene.Neal@bcbsfl.com]
Sent: Wednesday, December 06, 2017 6:39 PM
To: Bertling, Debbie
Cc: Roxane Herbstsommer(rherbstsommer@crowneinc.com); Epp!, George
Subject: Florida Blue-Claims Invoice Capitation for BH/SA services
Hi
Behavioral Health and Substance abuse has become a significant concern for employers. For example,
Opioids are now the leading cause of accidental death in the U.S., Opioid addiction declared a state of
emergency in Florida, broader substance abuse treatment coverage with little oversight can result in
significant fraudulent substance abuse treatment practices, the diagnosis of Autism Spectrum Disorder(ASD)
has more than doubled over the last two decades...
New Directions Behavioral Health (NDBH)and Florida Blue partnered since 2011 to manage behavioral health
services and associated cost and quality. Effective 111/18 billing,ASO groups will be charged a capitated
(PMPM rate)amount for services on the claims invoice.
The risk arrangement with NDBH will work differently than some of our other capitation arrangements
- Provider claims will continue to be paid at a fee-for-service rate by Florida Blue to
minimize any disruption
Some services are not included in the PMPM rate. For these services, claims will be paid based on the FFS
allowance just as they have in the past. Examples include:
- Inpatient care for treatment of dementia
- Psychological testing performed by a medical provider
- Professional outpatient care for a mental health/substance
abuse diagnosis when performed by a primary care medical
provider
The new risk arrangement was developed with employer strategies in mind:
- Employers are looking for longer-term cost predictability that comes with a risk arrangement
PMPM rate provides protectionfrom unanticipated annual costs
- Risk arrangement is most appropriate to enable controls to hinder fraud, waste and abuse
Together,we are intensifying efforts to address the escalating issues impacting Behavioral Health in multiple
ways
1. Addressing the increase in fraudulent practices:
- Applying more scrutiny on providers being considered for contracting, expanding background
checks especially for residential treatment centers and sober home living
- Implementing new processes using data and analytics to identify fraudulent practices
1
More stringent reviews of medical records focused on delivery of and payment for appropriate
care which follow standards and protocols
• 2. Addressing cost and quality:
- Provider Rate Reduction Initiative
- Movement to a Risk Arrangement between NDBH & Florida Blue
In addition to the new financial arrangement, NDBH will be enhancing their utilization management approach
to drive higher quality and lower costs with a focus on medical necessity review for higher levels of care and
select outpatient procedures.
Please let us know if you have any questions or concerns
S. Renee Neal I Account Management Specialist
Office:407-833-7709 1 Fax: (407)804-4568 I Cell: (407)491-8871
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Shadrix, Craig
From: Frank, Robert
Sent: Wednesday,January 09,2019 4:06 PM
To: Elected Officials Distribution List (EODL)
Cc: Williford,V. Gene; Shadrix, Craig
Subject: FW: City of Ocoee and Heartspoken Counseling
This will be brought forward at the first meeting in February. Thanks
We had discussed canceling our contract with Gilstrap in November of last year, however there were some concerns
voiced about employees' usage of the services they provide and their ability to transition to new provider(s). We were
going to come back to the commission with a recommendation to reduce the number of covered visits or implement a
different co-pay or similar actions to reduce the cost, since Florida Blue now requires us to pay for their mental health
program for each health plan member, each month...thereby duplicating the services provided by Gilstrap.
We had issues with Gilstrap not providing sufficient information to our agent of record for employees and dependents
utilizing their services. Continued requests for this information, along with additional reports which would allow us to
audit their billing(see below) have gone on deaf ears. Gilstrap refuses to respond to our legitimate requests(per their
contract).
At this point, I am unable to a) determine that we are being charged for qualified employees and dependents, b)
determine usage parameters, c)establish the effectiveness of the contract to our health plan members, and d) audit
past costs as we do with all internal city expenditures.Since the contractor has no interest in providing contractually
required information to our agent, I will be recommending termination of the contract with Gilstrap Associates. Please
contact me if you have any questions or concerns.
From:Williford,V. Gene
Sent: Monday,January 7, 2019 11:51 AM
To: Frank, Robert<RFrank@ocoee.org>
Subject: Fwd:City of Ocoee and Heartspoken Counseling
Rob,
Gilstrap is not responding.
Gene
Sent from my'Phone
Begin forwarded message:
From: Ray Tomlinson<rtomlinson@crowneinc.com>
Date:January 7,2019 at 11:05:32 AM EST
To:Jessica Gilstrap<igilstrap@gnorlando.com>
Cc: Roxane Herbstsommer<rherbstsommer@crowneinc.com>, "rfrank@ci.ocoee.fl.us"
<rfrank@ci.ocoee.fl.us>, "Williford,V.Gene"<gwilliford@ci.ocoee.fl.us>, "gmillsaps@gnorlando.com"
<gmillsaps@gnorlando.com>
Subject: RE:City of Ocoee and Heartspoken Counseling
Jessica, we hope your 2019 is starting off well for you and your team.
I am sending this email to you today in that it has been over 30 days since I emailed on December 6,
2018, (see below this email) informing you of the City of Ocoee's request for information contained in
the 2nd paragraph of that email. At this point, we would like to expand the period information for the
monthly reports we have requested previously to be October 2016 through December 2018 (with names
of members, number of visits and cost per visit).
Please respond with your acknowledgement of this email, advising you of the City's decision to
terminate the current agreement. Further, if you have interest in working a possible alternative plan
with the City for your services, we need to be advised of such in writing this week. If you do have
interest in the possibility of retaining a working relationship, please let us know and we can assist with
the discussion of alternatives.
Should you have any questions or wish to discuss any aspect of the relationship, please let us know
before the end of this week.
Kindest regards,
Ray
•
Crowne Consulting Group
Ray Tomlinson
Crowne Consulting Group, Inc
2710 Rew Circle, Suite 200
Ocoee, FL 34761
0: 321-221-0665
F: 407-654-9614
M: 321-228-4575
rtomlinson@crowneinc.com
www.crowneinc.com
The information contained in this electronic message is privileged and confidential information intended only for the use of the individual or entity to
whom or which it is addressed.If the reader of this message is not the intended recipient,or the employee or agent responsible to deliver it to the
intended recipient,you are hereby notified that any dissemination,distribution or copying of this communication is strictly prohibited.If you have
received this communication in error,please notify us immediately by telephone or e-mail.Thank you.
From: Ray Tomlinson <rtomlinson@crowneinc.com>
Sent:Thursday, December 6, 2018 12:14 PM
To:Jessica Gilstrap<Igilstrap@gnorlando.com>
Cc: Roxane Herbstsommer<rherbstsommeri crowneinc.com>; rfrank@ci.ocoee.fl.us; Williford,V. Gene
<gwilliford@ci.ocoee.fl.us>
Subject:City of Ocoee and Heartspoken Counseling
Jessica, I hope and trust all is well with you. It was my pleasure to speak with Ginger Mil!saps on
Tuesday and find out she had joined your growing organization. I asked Ginger to leave my call-back
number with you so we can discuss what is needed by the City of Ocoee as we work through this
separation period in bringing the agreement to a close.As of noon today, I have not received any
contact.
The City has requested that our firm conduct an audit of activity as we compare what Florida Blue uses
to calculate the capitation fee the City has been and continues to be charged for mental health and
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substance abuse services. This will require that we have the following information from October 2016
through September 2018 (we are missing Visits and Members information from April through
September 2018 from your regular monthly reports). Once we have the complete information needed
(names of members and number of visits with dollar cost for each)for the period of October 2016
through September 2018,we will be able to complete our audit shortly after that.
The City is terminating the current agreement in place strictly from a cost perspective. It is our opinion,
after a few months of the City utilizing the Florida Blue's program,there could be a desire to return to
an agreement with your firm. If that is the case,we will have the necessary information,following our
audit,to validate the reason(s)to consider a return to an agreement for your services(i.e.,financial and
professional reasons,etc.)
Jessica, please advise when we can expect to receive the requested information. Should you have any
suggestions or questions, please let us know. We hope your 2018 will finish as your best year thus far.
Kindest regards,
Ray
Crowne Consulting group
Ray Tomlinson
Crowne Consulting Group, Inc
2710 Rew Circle,Suite 200
Ocoee, FL 34761
0: 321-221-0665
F: 407-654-9614
M: 321-228-4575
rtomlinson@crowneinc.com
www.crowneinc.com
The information contained in this electronic message is privileged and confidential information intended only for the use of the individual or entity to
whom or which it is addressed.If the reader of this message is not the intended recipient,or the employee or agent responsible to deliver it to the
intended recipient,you are hereby notified that any dissemination,distribution or copying of this communication is strictly prohibited.If you have
received this communication in error,please notify us immediately by telephone or e-mail.Thank you.
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