Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. I. Successes and Challenges

01/01/2014

The stakeholders we talked with during this study noted that the new managed care arrangement encountered several successes and challenges.

They reported the following key successes:

  • Strengthening the provider network. OBH and Magellan have worked to increase the number of credentialed providers who can receive Medicaid reimbursement, and they continue to expand the network.

  • Developing a central point of entry into behavioral health services. Consumers have several tools for accessing services, and Magellan care managers can help consumers navigate services.

  • Developing a data warehouse that enables OBH and Magellan to track service utilization and monitor care. This common system allows Magellan to implement a range of quality measures.

  • Emphasizing evidence-based and promising practices. OBH and Magellan have taken steps to strengthen service definitions, disseminate practice guidelines, and put quality measures and incentives in place that encourage the delivery of evidence-based care, including ACT and psychosocial rehabilitation.

They noted several challenges that LBHP is currently working to overcome:

  • Coordinating physical and behavioral health services. There has not yet been any data sharing between Magellan and the physical health plans, nor have formal mechanisms for coordinating care yet been established. OBH and Magellan are undertaking quality-improvement initiatives to potentially share data between Magellan and physical health plans in order to facilitate better care monitoring and coordination.

  • Orienting behavioral health providers to Medicaid billing practices. Prior to this new managed care arrangement, many behavioral health providers did not submit claims to Medicaid. OBH and Magellan are working to ensure that behavioral health providers become more comfortable submitting complete and accurate claims to receive reimbursement.

  • Encouraging the use of a common EHR. While the introduction of the Clinical Advisor system has potential to facilitate monitoring and to improve the quality of care, not all providers have adopted this system. OBH and Magellan continue to work to encourage the system's use.

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