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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
Using GoToWebinar
Control Panel
Asking Questions
PowerPoint Slides
Audio (phone preferred)
www.naadac.org/education/webinars
www.myaccucare.com/webinars
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Obtaining CE Credit• The education delivered in this webinar is FREE to all professionals.
• 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15.
• If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for name of webinar)
▫ www.naadac.org/education/webinars
▫ www.myaccucare.com/webinars
• A CE certificate will be emailed to you within 21 days of submitting the quiz and payment (if applicable).
• Successfully passing the “CE Quiz” is the ONLY way to receive a CE certificate.
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
care?
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) [email protected]
FREE WEBINAR: How Funding Works: Intention, Integrity and Influence—January 24, 2013 from 1-2:15 Eastern Time!
Email [email protected] to register.
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www.myaccucare.com sskarda@orionhealthcare.
com
Feel free to ask questions
through the Questions pane.
Upcoming Free Webinars
• February 13, 2013 at 3pm-4pm EST – Defining Addiction Recovery
• 2013 Webinar Series
New webinar monthly!
Education is free to all professionals. CE credit available for purchase. adolescents,
criminal justice, trauma and many more
Information and Registration at:
www.myaccucare.com/webinars Or
www.naadac.org/education/webinars
Archived Webinars• Medication Assisted
Recovery: What Every Addiction Professional Needs to Know
• Building Your Business with SAP/DOT
• Screening, Brief Intervention and Referral to Treatment (SBIRT)
• Billing and Claim Submission
Changes
• Ethics
• Co-occurring Disorders
• Test-Taking Strategies
• Conflict Resolution
• Clinical Supervision
• ASAM Placement Criteria
• DSM-5 Proposed Changes
Archived webinars: www.naadac.org/education/webinars or www.myaccucare.com/webinars
CE credit still available!
www.naadac.org
The clinical tools you need. The customer support you deserve.That’s why Orion Healthcare Technology is the preferred software vendor of NAADAC.
For more information:Click: www.MyAccuCare.com
Call: (800)324-7966
Assessments and Screening
Patient Placement
Treatment Planning
Progress Notes
Discharge Summaries
Insurance Billing
Reporting and Tracking
Prevention Tracking
Obtaining CE Credit• The education delivered in this webinar is FREE to all professionals.
• 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15.
• If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for name of webinar)
▫ www.naadac.org/education/webinars
▫ www.myaccucare.com/webinars
• A CE certificate will be emailed to you within 21 days of submitting the quiz and payment (if applicable).
• Successfully passing the “CE Quiz” is the ONLY way to receive a CE certificate.
www.myaccucare.com sskarda@orionhealthcare.
com
Thank You for
Participating!
