Webinar Organizer Misti Storie, MS, NCC NAADAC, Director of Training & Professional Development.

transcript

Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals

Presented by:

Jim ClarksonCEO of Via Positiva, LLC

The presentation will begin shortly. Welcome and thank you for your patience.

Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals

Presented by:

Jim ClarksonCEO of Via Positiva, LLC

Webinar Organizer

Misti Storie, MS, NCC

NAADAC, Director of Training & Professional Development

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The goals, structure, and components of managed behavioral health care organizations

The managed behavioral healthcare organization credentialing process, including the criteria and standards many behavioral health organizations use to select quality

network provider partners

Specific strategies and key “relationship points” for partnering with BHOs, particularly as related to primary

and behavioral healthcare integration

A range of reimbursement models used by managed care entities

Financing and sustainability strategies

Study Aims & Webinar Objectives

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Presenter

Jim ClarksonCEOVia Positiva, LLC

Nuts and Bolts of Interfacing with Managed Care Organizations: For Addiction Professionals

Audience Polling Question #1

What is the quality of your experience in working with behavioral health managed

Integrated Care: From Silos….

To Synergies….

Integrated Recovery Systems

The connection is clear—behavioral health co-morbidities drive physical health costs

32% of projected increases in Medicaid expenditures will come from the 50% increase in mental health and substance abuse costs

Chronically ill costs are 75% higher for those with mental illness—triple that cost if they have a substance abuse disorder

44% of dual eligible individuals have at least one mental illness—if more than one, costs are twice the average for the entire dual population

Dual eligible individuals have much higher substance abuse rate than Medicare population.

It is estimated that over 25% of healthcare costs are driven by behavioral health problems.

Psychotropic medications account for 23% of all drug expenditures.

The Medicaid Client: A Reintroduction

The new Medicaid member may not be what you’re used to:

• 60% will have a diagnosable mental health disorder

• 83% have 3 or more chronic health conditions

• Dual eligibles are highly complex; they have unique needs that require special expertise

• Half of disabled Medicaid enrollees with psychiatric conditions have claims for diabetes, pulmonary, or cardiovascular disease –significantly higher than those without psychiatric conditions

• Health improvement and cost reduction will not occur without the successful treatment of behavioral and emotional health issues.

• Traditional systems of care must be supported by community services and programs that offer appropriate alternatives based on Recovery and Wellness.

Behavioral Health Managed Care: A Reintroduction

PARTNERSHIP

• Relationship-centric

• Holistic health and wellness focus

• Federal, state and local Network Development and Management

• Innovative service and reimbursement models

• Person-centered focus and Recovery and Resiliency

INTEGRATION

• Integration of behavioral and physical health including pharmacy

• Integration of health records

• Coordination of available benefits

• Chronic Disease management

• Pharmacy Management

INNOVATION

• Provider partnerships and pay for performance programs

• Single Member Health Record

• Analytics/Outcomes

• Coordination of funding streams

• Telehealth

• Systems capable IT

Decision Making: How Managed Care Works

“The goal is equitable, efficient, effective and

life enhancing systems at all levels.”

Decision Making:

1) Source Documents2) Research and Professional Literature3) Professional Experience4) Cognitive analysis and Intuitive

Reflection

Audience Polling Question #2

Is partnering with managed care in the future a part of your sustainability plan for your

practice/agency?

Components of Most Behavioral Health Organizations and Partnering with Each

“Knowing the structure and purpose of each department and individual contacts within each make effective partnerships easier to

attain.” Administration Finance Medical/Clinical Provider Relations Network Operations IT/DMA Claims Recovery and

Wellness Quality and

Compliance Customer Service

Strategies for Partnering with BHMCOs

7) Offer your expertise when possible/make presentations that are data driven

8) Utilize “Principles above Personalities”

9) Use “person first” language

10) Start with a “walk through”

11) Share your change projects and perhaps invite participation…share status and outcomes.

1) Become DSM and ASAM Experts

2) Know your state’s Medicaid Plan and service definitions

3) Develop professional relationships with clinicians doing authorization/utilization

4) Use the appeals process vigorously

5) Investigate “Preferred Provider” status

6) Develop relationships with different departments

Preferred Provider Status

Characteristics

1. Use of EBPs and evidence of good clinical outcomes.

2. Evidence of accessibility.

3. Administrative efficiency including use of electronic claims submission.

4. Utilizations of customer satisfaction surveys.

5. Addresses cultural health disparities and works well within a system of care.

Benefits

1. Potential for increased referrals.

2. Free Continuing Education.

3. Training Discounts.4. Access to many

additional mental health resources, assessment tools, appointment and medication notification tools that can be shared with clients.

5. Ranges of options to do on-site utilization management.

The Credentialing Process

1. Go to the BHMCO website 2. Click on “Provider Home” or “Join Our

Network”3. Obtain Provider Handbook4. Obtain Credentialing Checklist and

Application 5. Call Provider Relations With Any

Challenges or Questions 6. Thoroughly, Completely and Accurately

Complete Application7. Don’t take NO for an answer…here’s

why…

ABHW Member Organization Credentialing Links

• Aetna Behavioral Health

• Beacon Health Strategies

• CBHNP PerformCare

• Cenpatico Behavioral Health

• MHN

• New Directions Behavioral Health

• Optum Behavioral Health

• ValueOptions

Addiction Professionals. Funding and Sustainability.

Evolving Opportunities

Addiction Professionals. Integration

Models.

1. The Coordinated Care Model.2. The Co-location Model.3. Fully Integrated Model.4. Recovery Oriented System of Care

Model.

Addiction Professionals. Evolving Reimbursement Models.

1. Self-Pay sliding scale.2. Contracts/Grants.3. Fee for Service (Claims-based).4. Performance based contracts.5. Case rates.6. Diagnostic Related Group Claims.7. Capitation.

Addiction Professionals. Strategies for Success.

1. Create massive value. 2. Apply for Managed Care Panels.3. Assess eligibility (funding streams and benefit packages) for

target population and do strategic business plan to capitalize.4. Become a Medicaid provider.5. Partner with Employee Assistance Professionals, local companies

and governmental organizations.6. Apply for grant notification services.7. Partner with physical health groups, health homes, medical

providers, ER and Urgent Care.8. Understand SBIRT/ROSC.9. Development and Sustainability Officer/Committee.10.Diversify—services and funding streams i.e. recovery coaching,

integrated funding streams, training etc. 11. Importance of Professional Trade Associations like NAADAC.

Thank You!

Presented by Jim ClarksonVia Positiva, LLC(505) 944-5284Jim.Clarkson@prodigy.net

FREE WEBINAR: How Funding Works: Intention, Integrity and Influence—January 24, 2013 from 1-2:15 Eastern Time!

Email Jim.Clarkson@prodigy.net to register.

www.naadac.orgmisti@naadac.org

www.myaccucare.com sskarda@orionhealthcare.

Feel free to ask questions

through the Questions pane.

Jim.Clarkson@prodigy.net

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Recovery: What Every Addiction Professional Needs to Know

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Changes

• Ethics

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• Test-Taking Strategies

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Assessments and Screening

Patient Placement

Treatment Planning

Progress Notes

Discharge Summaries

Insurance Billing

Reporting and Tracking

Prevention Tracking