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, you will need to develop a punch list of questions to ensure your organization is properly positioned for these upcoming changes.

This blog is dedicated to the third leg of the three legged stool of managed care readiness, your clinical punch list. Remember, if one of these legs is wobbly, then the whole stool is wobbly.

 Clinical Punch List
The following questions should be part of your organization’s overall clinical punch list:
  1. What is organization’s clinical treatment philosophy? Does your organization provide services through a program model or do you individualize the client’s treatment?
  2. Does your organization have services available that Managed Care Organizations (MCOs) would be interested in (SUD IOP, Intensive Home Based Therapy)?
  3. Does your organization’s clinical culture have “room” to accept the rapid stabilization, least restrictive environment philosophy and reconcile this philosophy with your mission?
  4. What are the attitudes of your clinical staff regarding managed care treatment philosophies?  Are they open to new ideas and clinical approaches?
  5. Have you researched the MCOs’ clinical criteria for the services your organization provides?

It is our hope that these questions will jumpstart your review process and provide food for thought as you develop your game plan to become managed care friendly.

 At Pinnacle Partners, we have over thirty five years of managed care credentialing and contracting experience.  We specialize in developing revenue management cycle processes to assist behavioral health organizations in working with MCOs.
Please let us know how we can be of assistance to your organization!