Provider organization executive teams are trying to map out how to have better relationships with health plans to get better rates, more referrals, and shared financial incentives. Why? Because 62% of the insured population is already in some type of managed care plan—99% of commercially insured, 70% of Medicaid, 30% of Medicare, and 49% of…

Health plans are an increasingly important source of reimbursement for health and human service provider organizations, given that over 62% of the insured population is enrolled in some type of managed care plans. And, those reimbursements are increasingly in the form of some type of alternative payment models (APMs)—shared savings, shared risk, bundled payments, and…

2020 has been a year of significant decline in service volume and revenue across health care. Behavioral health organizations have lost, on average, nearly 23% of their annual revenue during the pandemic (see Member Survey: National  Council  For  Behavioral  Health Polling Presentation). As Monica E. Oss, chief executive officer of OPEN MINDS noted in her…

“Payers are not to be feared. And we need to stop looking at them as adversaries. Payers are on our side and care as much about consumers as we do,” said Beth Klawitter, Vice President of Payer Relations at Strategic Behavioral Health (SBH). She talked to OPEN MINDS recently about how specialty provider organization executives…

1. Define the services in the case rate

a)     Consumer profile – diagnosis, presenting problem

b)     Evidence-based practice models

c)     Possible range of service to be included with service definitions

d)     Length of time for each consumer to be served

e)     Expected effect of the service

2. Create models that estimate the “typical” consumer demand for…