1/15/13. Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals. Webinar Organizer.

Transcription

1 Nuts and Bolts of Interfacing with Managed Care Organizations for Addiction Professionals Presented by: Jim Clarkson CEO of Via Positiva, LLC Webinar Organizer Misti Storie, MS, NCC NAADAC, Director of Training & Professional Development Using GoToWebinar ü Control Panel ü Asking Questions ü PowerPoint Slides ü Audio (phone preferred) ü ü 1

2 Presented By 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) A CE certificate will be ed 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. Study Aims & Webinar Objectives 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 2

3 Presenter Jim Clarkson CEO Via 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? 3

4 Integrated Care: From Silos. To Synergies. Integrated Recovery Systems 4

5 The connection is clear behavioral health co-morbidities drive physical health costs Ø 32% of projected increases in Medicaid expenditures will come from the 50% increase in mental health and substance abuse costs Ø Chronically ill costs are 75% higher for those with mental illness triple that cost if they have a substance abuse disorder Ø 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 Ø Dual eligible individuals have much higher substance abuse rate than Medicare population. Ø It is estimated that over 25% of healthcare costs are driven by behavioral health problems. Ø 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 5

6 Decision Making: How Managed Care Works The goal is equitable, efficient, effective and life enhancing systems at all levels. Decision Making: 1) Source Documents 2) Research and Professional Literature 3) Professional Experience 4) 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. ü Administration ü Finance ü Medical/Clinical ü Provider Relations ü Network Operations ü IT/DMA ü Claims ü Recovery and Wellness ü Quality and Compliance ü Customer Service 6

7 Strategies for Partnering with BHMCOs 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 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. 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 onsite utilization management. The Credentialing Process 1. Go to the BHMCO website 2. Click on Provider Home or Join Our Network 3. Obtain Provider Handbook 4. Obtain Credentialing Checklist and Application 5. Call Provider Relations With Any Challenges or Questions 6. Thoroughly, Completely and Accurately Complete Application 7. Don t take NO for an answer here s why 7

8 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 8

9 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. 9

10 Thank You! 29 Presented by Jim Clarkson Via Positiva, LLC (505) FREE WEBINAR: How Funding Works: Intention, Integrity and Influence January 24, 2013 from 1-2:15 Eastern Time! to register 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 ü New webinar monthly! ü Education is free to all professionals. ü CE credit available for purchase. adolescents, criminal justice, trauma and many more Information and Registration at: Or 10

11 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: or CE credit still available! The clinical tools you need. The customer support you deserve. That s why Orion Healthcare Technology is the preferred software vendor of NAADAC. Assessments and Screening Patient Placement Treatment Planning Progress Notes Discharge Summaries Insurance Billing Reporting and Tracking Prevention Tracking For more information: Click: Call: (800)

12 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) A CE certificate will be ed 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. misti@naadac.org sskarda@orionhealthcare.com Jim.Clarkson@prodigy.net Thank You for Participating! 12