The smoke has cleared and Ohio’s Behavioral Health Design initiative is now reality.  The new code sets, new Medicaid covered services and billing requirements are now in place.  Our system has now had approximately eighteen months to adjust to our new world.  But there is no rest for the weary!
Behavioral Health agencies have a new customer whose relationship will need to be valued and nurtured and one that will require constant attention.  That new customer is the Medicaid MCO.
The key to any customer service relationship is to find a need and fill it.  So, the question that begs to be asked is what do the Medicaid MCOs need from community behavioral health providers?
Remember, the Medicaid MCOs are contracted with the Ohio Department of Medicaid to manage health care costs of its Medicaid recipients, focusing on the delivery of high quality health care all the while, looking for opportunities to bend that cost curve.  Their Agreements include financial incentives in raising the “quality bar”of their respective memberships.  Medicaid MCOs need agency partners that understand their mission and that are looking for creative ways to assist MCOs in achieving these goals for their shared member/client.
In short, behavioral health organizations will need to develop a Managed Care Mindset, understanding their customers’ needs for both MCO and client, alike.
So, how does an Agency begin to develop a Managed Care Mindset?  First, look internally at your organization.  Is your organization able to define a “successful clinical outcome”?  If not, here are three questions that your agency must have answers to in order to develop that mindset:
  1. How fast are your clients seen for their initial assessment and subsequent treatment visits? (Access)
  2. How fast do your clients engage in treatment that your clinical staff has recommended? (Engagement)
  3. How effective are your treatment programs?  In short, are clients getting better because they are in your program as opposed to the agency down the road? (Results)
Knowing the answers to these questions now gives you insight as to how to improve these metrics in the future and will position your organization as an engaged, collaborative partner with the Medicaid MCOs, focused on high quality care for your shared client/member.
And looking to the future, all organizations will eventually be paid for the value of their services instead of the volume of services (traditional fee for service (FFS) model) that most are accustomed to today.  Organization must begin to develop a Managed Care Mindset if they are looking to thrive long term in our new managed care environment.
At G&M Consulting, we have over 37 years of managed care experience.  We understand Medicaid MCOs’ mindset.  Let us know how we can be of service to your organization!