McKesson Health Solutions recently launched new behavioral analysis criteria that it says can help providers and health plans deal with the increased demand for treatment for autism spectrum disorders as more people gain access to health insurance.
Like most behavioral healthcare services, autism treatment has steadily risen in both demand and cost over the last 40 years, with the average lifetime cost of supporting a person with an autism disorder reaching about $2.4 million, according to McKesson, citing figures from JAMA. And in 2014, the CDC reported that one in 68 U.S. Children were identified with autism spectrum disorder an increase of 30 percent compared to just 2012.
Part of the demand increase can be attributed to federal and state healthcare reforms that mandate greater access to treatment, coupled with more Americans now having health insurance as a result of the ACA, said Dr. Robert Small, associate medical director for behavioral health for McKesson Health Solutions, based in Boston.
While there are no curative treatments for autism disorders, early detection often leads to greatly improved behavioral development and reduced complications down the road, according to the CDC. That would seemingly provide incentive for payers and providers, especially now that such disorders are covered by the ACA and the Mental Heath Parity and Addiction Act.
McKesson is looking to improve the standards in determining treatments, using proprietary SaaS technology based on literature and validated by expert consensus that supports payers and providers.
Before now, most providers and health plans did not have a set of standards on treatment plans for autism spectrum disorders, Dr. Small said.
As such, McKesson rolled out its Applied Behavior Analysis through its Behavioral Health InterQual solutions. Dr. Small explained a bit about how the analysis works and how the criteria is developed:
All InterQual criteria, including the Applied Behavior Analysis criteria for autism spectrum disorders, is produced using a rigorous process. The development cycle is a systematic, critical assessment of the medical literature by a clinical development team with more than 60 physicians, registered nurses, and allied health professionals. Feedback is also collected from a clinical panel of over 650 experts. With regard to InterQuals behavioral health criteria specifically, it comprises the expertise of a multidisciplinary panel of psychiatrists, psychologists, psychiatric nurses, and social workers.
McKesson then takes the information and makes it available to clinicians through its CareEnhance Review Manager, a browser-based platform that it says helps automates and streamlines the care review process
It interactively guides care managers through the medical necessity review process using intuitive screens that feature either a Q&A or decision tree format, depending on the criteria at hand, Dr. Small said. Thats just the start of review managers capabilities and its role in automating and helping improve accuracy of the medical review processes.
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McKesson seeks to help payers and providers with early detection on autism disorders