To say that the Managed Care carve in of Community Behavioral Health Medicaid services has been fraught with challenges may be a bit of an understatement.  I know that each stakeholder (Ohio Department of Medicaid, Medicaid Managed Care Organizations (MCOs), Community Behavioral Health Centers) is working hard to make sure that MCO clients are seen and that Community Behavioral Health Centers (CBHCs) are paid in an accurate and timely manner.

But as the administrative “fog” lifts from this initial phase of implementation, it is important that CBHCs recognize who their customers are and what they want.  One of those customers will be the Medicaid MCOs.  Organizations must understand MCOs’ “hot buttons”.  In short, they need to understand how they think and what is important to them.

For starters, MCOs will be very interested in accessengagement and treatment results of organizations caring for their members.
  1. How quickly do clients get seen at your agency?
  2. How quickly do clients engage in treatment?
  3. Do you have data to support how effective your clinical programs have performed?
  4. Do you have all of this information segmented by payer?
Behavioral health agencies should have answers to some of these questions now and must develop a proactive game plan to continually improve upon their answers.
Remember, MCOs are charged with providing their memberships with cost effective, high quality care through a network of contracted providers. Agencies will need to make the case that they not only belong in that network but the MCOs’ members are better served with that agency contracted as an in-network provider.
At Pinnacle Partners, we have over thirty six years of working in the managed care arena.  We understand MCOs’ hot buttons and know how to foster relationships that assist organizations in developing their long term managed care game plans.
Please let us know how we can be of assistance to your organization!