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By Gary Humble | October 7, 2019 | Pinnacle Partners

What Are Some Takeaways from Ohio’s Behavioral Health Carve In Initiative?

What are Some Takeaways from Ohio's Behavioral Health Carve-In? We are now well over a year from when Community Medicaid Behavioral Health services were carved into the Medicaid Managed Care Plans (MCPs).  For many of our colleagues, MCP carve-in has been a struggle. We are in new environment going from one major payer and one [...]

By Gary Humble | October 1, 2019 | Pinnacle Partners

Managed Care Contracting: Beware of Unintended Consequences!

OK!  You Are Now Contracted with Medicaid Managed Care Organizations (MCOs)!  So, Where does Your Organization Go from Here?! The dust is settling..... the Medicaid MCO credentialing & contracting frenzy is now a distant (or not so distant!) memory for many behavioral health agencies.  So where do you go from here? Much of your organization's [...]

By Gary Humble | September 16, 2019 | Pinnacle Partners

Ohio’s Behavioral Health Community Medicaid Redesign: What are the Opportunities Revisited?

Community Medicaid Behavioral Health services have now been carved into the clients' Medicaid Managed Care Plan (MCP) for well over a year. As the system continues to move away from the the implementation phase of these Community Medicaid Redesign initiatives, behavioral health agencies must also continue to analyze these changes and its impact on their [...]

By Gary Humble | August 19, 2019 | Pinnacle Partners

Preparing Your Organization for Managed Care: Develop Your Financial Punch List

As our organizations continue to prepare for the various changes coming to the Community Behavioral Health Medicaid system, it is imperative that you take an internal assessment to gauge your readiness for managed care.  Before your organization contracts with Medicaid Managed Care Organizations (MCOs), it must conduct an internal  assessment to determine your readiness and [...]

By Gary Humble | July 20, 2019 | Pinnacle Partners

Prepare Your Organization for Managed Care: Develop Your Administrative Punch List

As your organization continues to adapt to the various changes implemented in the Ohio Community Behavioral Health Medicaid system, it is imperative that you take an internal assessment to continually assess your organization's readiness for managed care. It makes no sense to have a contract with Managed Care Organizations when your Agency is not prepared [...]

By Gary Humble | June 15, 2019 | Pinnacle Partners

Preparing Your Organization for Managed Care: Develop Your Clinical Punch List

As our organizations continue to prepare for the various changes coming to the Community Behavioral Health Medicaid system, it is imperative that you take an internal assessment to gauge your readiness for managed care. This assessment must be done before your organization contracts with the various Medicaid Managed Care Organizations (MCOs).  Once you've conducted your assessment, [...]

By Gary Humble | May 6, 2019 | Pinnacle Partners

Helping to Prepare Your Organization for Future MCO Clinical Audits: Introducing Our Newest Subject Matter Expert (SME) Christine Smalley, MA, LPCC-S!

As you know, Pinnacle Partners' mission is to assist behavioral health agencies not only to survive but thrive in our new managed care environment. We accomplish this by not only providing consulting and educational services but by working with a small, handpicked network of Subject Matter Experts (SMEs) that we know have the knowledge and experience [...]

By Gary Humble | April 15, 2019 | Pinnacle Partners

How to Work with Medicaid MCOs? Focus On These Three Areas

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 [...]

By Gary Humble | March 25, 2019 | Pinnacle Partners

Preparing For Future Managed Care Clinical Audits

Nothing brings terror to the heart of an Executive Director than to hear that a Managed Care Organization is coming to conduct a clinical audit! Remember, the Managed Care Organizations (MCOs) are charged with among other things, to "bend the cost curve" for their client, The Department of Medicaid.  Their mission is to ensure that [...]

By Gary Humble | March 15, 2019 | Pinnacle Partners

Pinnacle Partners’ Adds CARF Accreditation Subject Matter Expert To its Network

Accreditation.....for Community Behavioral Health Providers, it is another tool they should have in their toolbox if that Agency wants to remain in the managed care arena long term. Most commercial payers require some kind of accreditation if a behavioral health organization wants to offer higher levels of care (Intensive Outpatient (IOP), Ambulatory Detoxification, Residential Treatment) [...]