Within one year of its launch, the Integral Health Network of Southern Arizona (IHNSA), a clinically integrated network (CIN), reduced the medical loss ratio (MLR) by 12.1 points for a cohort of high-cost members attributed by the Medicaid managed care organization (MCO) Banner–University Family Care (BUFC). The MLR for the cohort dropped from 151.3% in 2022 to 139.2% in 2023, an 8% relative improvement.
IHNSA is a group of large multi-specialty behavioral health provider organizations that launched as a CIN in late 2022 in partnership with Alera Health, Inc. The group includes CODAC Health, Recovery & Wellness; Community Bridges, Inc. (CBI); Helping Ourselves Pursue Enrichment (HOPE) Inc.; Horizon Health and Wellness; and La Frontera Arizona, Inc., who worked closely with Alera Health to organize an integrated “ONEcare” CIN. Alera Health provides IHNSA with population health management support and tools so that IHNSA can deploy “system of care” solutions as if the CIN were operating as a single entity at scale. The tools include CIN management, contracting, actuarial and legal, as well as data analysis, reporting, technology, and system/practice transformation resources.
After IHNSA was formed, it contracted with BUFC, which attributed a cohort of members diagnosed with a primary or secondary behavioral health condition who were otherwise not engaging in outpatient primary care and who were among the highest-cost members enrolled in BUFC’s Complete Care plan. This cohort also drove most of the inflationary pressure on BUFC’s overall MLR. BUFC and IHNSA now plan to expand the number of lives attributed to IHNSA and intend to better align Banner Health’s primary care and hospital resources in coordination with IHNSA.
BUFC is a subsidiary of the non-profit Banner Health system that has operations in six western states. BUFC operates an Arizona Health Care Cost Containment System (AHCCCS) Complete Care plan and an Arizona Long Term Care System (ALTCS) health plan that serve the southern region of Arizona. The Complete Care plans provide integrated physical and behavioral health services. ALTCS plans provide long-term care services for individuals with disabilities. Between the two plan types, as of the end of December 2023, BUFC served nearly 300,000 members in Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, and Yuma counties. BUFC’s Complete Care contract started on October 1, 2018, and runs through September 30, 2025. Its ALTCS contract ran from October 1, 2017, through September 30, 2024.
In the announcement about the IHNSA outcomes, BUFC’s Chief Medical Officer Sandra Stein, M.D., said, “Achieving this reduction in MLR required coordinated efforts and innovative outreach strategies.” The focus was on engaging hard-to-reach populations and ensuring that they had access to timely and effective care. IHNSA is responsible for the total cost of care for its attributed cohort.
At the start of the arrangement, with support from Alera Health, the IHNSA members conducted assertive engagement, provided timely access to services, followed up on care gap registries, and collaborated with health care provider organizations and community partners. To engage the cohort, IHNSA relied on case management for outreach, case management for coordination, and used peer-support services for assertive community outreach and treatment engagement.
Many in the cohort had limited access to primary care and had a high prevalence of health-related social needs (HRSNs), primarily for housing and transportation. To ensure access to primary care, the IHNSA network organizations either provided services in their clinics or coordinated with third parties to provide primary care. To address the HRSNs, IHNSA partnered with community benefit organizations. The IHNSA members also provided health literacy education and support, coordinated behavioral/social/medical appointments, and responded to sentinel health events such as emerging diagnoses and crisis/inpatient events.
Nationwide, Alera Health works with health care payers, provider organizations, and community partners to operationalize and manage ONEcare networks that deliver comprehensive, inclusive, and informed whole-person care designed to improve health outcomes and reduce costs. To help the ONEcare networks prepare for value-based care contracts, Alera Health provides data aggregation, analysis, reporting, technology, and system/practice transformation resources. Nationwide, Alera Health’s ONEcare networks manage over 3 million covered lives. Each ONEcare network is augmented by Alera Health’s Care Optimization Suite, which allows real-time communication, referrals, and mobile consumer engagement.
For more information, contact: Renee White, Senior Vice President, Arizona Network Operations, Alera Health, 5100 Northcreek Road, Wilmington, North Carolina 28409; 910-417-8310; Email: rwhite@alerahealth.com; Website: https://alerahealth.com/
August 2025 00US25EUA0023