Transcript of Webinar:
2012-10-16 13.03 How to do the Managed Care Dance : What You Need to Know to Participate in Networks
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BEGIN TRANSCRIPT:
LAURA GALBREATH: We want to welcome to the SAMHSA-HRSA Center for Integrated Health Solutions webinar titled How to do the Managed Care Dance - What You Need to Know to Participate in Networks. As you may know the SAMHSA-HRSA Center for Integrated Health Solutions promotes the development of integrated primary and behavioral healthcare services to better address the needs of individuals with mental illness and substance use conditions whether seen in specialty behavioral health or primary care settings. In addition to national webinars designed to help providers integrate care CIHS is continuously posting practical tools and resources to the CIHS website providing direct phone consultation to providers and stakeholder groups and directly working with SAMHSA primary and behavioral healthcare integration grantees and HRSA funded health centers.
A couple of housekeeping remarks before we get started. Just a reminder that today's webinar is being recorded and that all participants will be kept in a listen-only mode. You can find the call in number for the webinar on the right-hand side of your screen. Questions should be submitted throughout the webinar by typing your question into the dialog box. And we will be able to share those with presenters when the time allows. If you experience any technical difficulties, please feel free to contact Citrix directly at
888-259-8414. Lastly the webinar slides will be posted the integration.samhsa.gov website by the end of today and a recording will be posted as well. Please make sure to provide your feedback to us by completing a short survey at the end of today's webinar. [0:01:43]
We're excited to have some great presenters here today and would like to invite Pamela Greenberg, President and CEO for the Association for Behavioral Health and Wellness to give a welcome and introduce our presenters for today.
PAMELA GREENBERG: Thanks Laura. And I'd also like to thank SAMHSA and HRSA for giving us this opportunity to talk with everyone today. As Laura said I'm Pamela Greenberg and I'm the president and CEO of the Association for Behavioral Health and Wellness. ABHW has the national voice for specialty behavioral health and wellness companies. Our member companies provide specialty services to treat mental health, substance use, and other behaviors that impact health to over 100 million people. I'm pleased to be here today along with two ABHW member companies, ValueOptions and Optum Health Behavioral Solutions. In this evolving healthcare environment BHO's are looking for new partners and we hope that today's webinar gives you some insight on how to dance with managed care. [0:02:38]
Our first speaker will be Jim Clarkson. Jim is Vice President of ValueOptions Grants Management Practice. ValueOptions is the nations largest private behavioral health and wellness managed care organization. Jim also managed the Healing Circle Wellness and Prevention Program at the Institute of American Indian Arts in Santa Fe, New Mexico, and served as development and training director for a private addiction and psychiatric hospital system. Jim is a certified NIATx Change Leader and is trained as a key supervisor for the Matrick (sp?) Institute, and he's also a certified mental health first-aid trainer, and for 25 years he's helped many Fortune 500 companies and public healthcare systems create environments for recovery and positive therapeutic outcomes. Jim's presentation will discuss the goal structure and components of managed behavioral healthcare organizations and also the credentialing process including the criteria and standards many behavioral health organizations use to select quality network provider partners. [0:03:39]
Our second speaker will be Deb Adler and Deb is Senior Vice President for Network Services for Optum Health Behavioral Solutions. She's currently responsible for coordinating all network functions such as credentialing, contracting, and data loading and maintenance for a network of over 100,000 providers assuring members have access to quality providers and a broad continuum of care. [0:04:03]
Deb has facilitated innovative network programs including implementing telepsychiatry programs to address member access needs and developing credentialing and operational requirements to incorporate peer and family run organizations as part of the array of network services. She has been instrumental in implementing performance-based contracting to the behavioral health network and identifying innovative approaches to promote provider use of online tools. Deb will address the range of reimbursement models used by managed care entities, and specific strategies, and key relationship points for partnering with BHO's particularly as related to primary and behavioral healthcare integration. And with that I'd like to turn it over to Jim.
LAURA GALBREATH: Great. Thank you. This is Laura and as we transition over to Jim we're going to start with two poll questions so that we can get a better sense of who you are on today's webinar and the role that you play in your organization. So please take a moment and give us a sense of what role best represents the position you play within the organization. If you're a group if you could just give us kind of a consensus for the group of individuals in the room that would be great. [0:05:18]
Thank you. Seventy-five percent of you have voted. We'll leave it open for just a few more moments. We'll go ahead and share those so it looks like about half of the audience are administrative. Next we have 26 percent executives and then further down and other as well as an only eight percent clinicians and one percent at peers. And the other question we want to ask as we get started is how knowledgeable are you about behavioral health organizations and their credentialing process? We have lots of folks from different audiences here today, and we just want to get a sense about your familiarity with the credentialing process. [0:06:16]
Thank you. We're about 70 percent. We'll stay open for a few more seconds so the rest of you can continue to vote. Thank you. So we see that about 50 percent of you are somewhat knowledgeable about behavioral health organizations and the credentialing process. Thirty-one percent are not very knowledgeable and 15 percent are very knowledgeable. So thank you for completing those. We have some more poll questions later on. And with that we will hide the results and then Jim it's all yours. [0:07:01]
JIM CLARKSON: Great. Thank you so much Laura. It's a pleasure to be here with everybody this afternoon. People from all over the country thank you for joining us. It's always a pleasure to work with SAMHSA and the HRSA Center for Integrated Health Solutions. Pleasure to join Laura from the National Council and the SAMHSA-HRSA Center for Integrated Solutions, and Pamela Greenberg at the Association for Behavioral Health and Wellness, and, of course, my colleague Deb Adler at Optum.
So our presentation today is how to do the managed care dance and as you guys know sometimes you lead and sometimes you follow. And we hope that this afternoon's presentation will be sort of a reintroduction maybe to behavioral health managed care organizations in this new behavioral health landscape that we find ourselves in. So some of you may be familiar with a document that was released by SAMHSA a year or so ago and it was called The Good in Modern System for Behavioral Healthcare. And one of the things that I wanted to just read from that document it talks about the good and modern system must incorporate the different functions that are performed within various parts of the mental health and addiction delivery system. General hospital, state mental health hospitals, community mental health centers, psychiatric, psychosocial rehab centers, self-guidance centers, private acute in-patient treatment facilities, licensed addiction agencies, (inaudible at 0:08:30) treatment providers, individually licensed practitioners, primary care practitioners, recovery peer organizations, all have a key role in delivering mental health and substance abuse services. [0:08:42]
It talks about in the public sector specifically individuals, families, and youth with complex mental health and substance use disorders oftentimes receive a plethora of potential funding sources from federal, state, county, and local funding. And it talks about how these multiple funding sources often result in a maze of eligibility, program reporting specifications that can create funding silos featuring complicated administrative requirements. It goes on to say that if services are to be integrated then dollars must also be intertwined in the same way that Medicaid will be required to streamline eligibility and enrollments. The good and modern system must either blend or brave funds in support of comprehensive service provisions to consumers, youth, and families. [0:09:32]
So you see on the slide in front of you there's sort of a complex maze of silos that sometimes look like what consumers may face when they are challenged with the behavioral or even physical health problem. And one of the things that we want to move toward, obviously, are synergies. And for those of us that have been in the payroll health business for a long time, even though this is a challenging time it's been really a delightful time to be a part of the behavioral healthcare world because we're starting to see partnerships. And some of you know the Albuquerque Balloon Festival just ended yesterday in Albuquerque and these are actually two giant balloons that are joined there at the fingertips. And they launch together and when they get to a certain altitude they break hands and kind of go off in their own directions. And it's just so wonderful to see synergies that are starting to happen. [0:10:28]
We have connections now really working connections between SAMHSA and HRSA and this notice from Medicare and Medicaid and the Innovation Center. Physical and behavioral health providers are coming together to provide more holistic approaches to the behavioral and physical health. On this call we have the Association of Behavioral Health and Wellness, the National Council on Community and Behavioral Health, and ValueOptions partnering with Optum Behavioral Health with my colleague Deb Adler. And so it's just really, I think, a sign that new partnerships in this field that we're in coming together on behalf of consumers, families, and communities. [0:11:12]
So in terms of just looking at a slide here that talks about systems and the different entities that can come together on behalf of individuals, families, and communities here in the center this is a slide to give credit to William White, a recovery management and recovery learning systems of care monograph; an excellent monograph. This is on Page 20 of the monograph and it just really kind of captures the landscape in terms of the individual being in the center with their assets and vulnerabilities. And one of the things we know is that a recovery oriented system of care counts a person's assets as well as their vulnerabilities. And you can see that around the individual there's a kinship network, family, culture, neighborhood. As we go out in the concentric circles we see recovery community organizations, recovery ministries, recovery industries, recovery schools, recovery homes, recovery support groups. As we go out to the next concentric circle we see health and social services which I think if this slide were created closer today probably those health and social services would be much closer to the middle as we talk about integrated care. Professional associations, national state policy, federal and state agencies and you can see as the concentric circle. [0:12:37]
And as I've used this a number of times it always brings to my mind a quote that I read that's attributed to Steve Jobs, and he talks about the companies and the organizations that stand at the intersection of IT, integrated technology, and the humanities will drive and indeed inherent the economies of the 21st century. And that's one of the things when we talk about the integration we're really looking at partnerships between behavioral health managed chair organizations such as ValueOptions and the others that are represented by the Association of Behavioral Health and Wellness partnering with providers, federal and state agencies, and all of these players that come together at the intersection of IT and the humanities. We're very good at humanities in terms of human services and we're developing, all of us I think together, a technology to be able to connect all these very important components of how to create environments for positive therapeutic outcomes for individuals, families, and communities. [0:13:52]
So the next slide really just kind of highlights possible ways that providers can partner with behavioral health managed care organizations because these are some of the things that we do. First of all connecting all of those entities that make up a health system of care. As we know we have to be able to identify and account for all the services that you provide, that we provide, that others provide. And so there has to be complex information technology systems to connect all of the entities that create a community of care. [0:14:34]