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Crisis and Managed Care 

Managed Care Organizations (MCOs) are key partners in ensuring members have access to integrated physical and behavioral health care, which includes a robust, coordinated crisis care continuum. MCOs can also manage early intervention and help prevent crises and high-cost utilization through care coordination. 

CRISIS SYSTEM AND SERVICES 

Mental health and substance use distress has increased nationally and has been exacerbated by COVID-19. The Federal government in partnership with States and localities around the country are working to expand access to effective crisis interventions. The creation of the national 988 suicide and crisis hotline combined with new funding and guidance on mobile crisis services are critical to preventing and responding to behavioral health crises.

Health Management Associates (HMA) consultants have deep experience and expertise designing, operating, and overseeing crisis services. This includes a broad portfolio of current projects, working with a range of state and local policymakers, payers, providers, first responders, and communities to implement robust crisis continuums. 

Opportunities for MCOs 

MCOs can play an important role in informing how crisis services meet the needs of their members, and reduce high cost utilization of emergency departments and inpatient care. HMA can help you identify innovative ways to collaborate with States and community-based organizations to drive real access to crisis prevention and intervention services for individuals and families. This work includes building robust crisis continuum networks that include the full array of options, and best practices in crisis response including diversion from and alternatives to expensive emergency department and hospital visits.

This presents an opportunity for MCOs to play a pivotal role in driving better population health outcomes, expanded health equity, improved member experience, and to ultimately reduce the total cost of care.

Our Expertise and Capabilities: 

Evidence-based and leading edge clinical and operational practices

Cross-sector partnerships with law enforcement, emergency service providers and community partners

System change by connecting policy to practice

Defining and measuring key performance indicators and outcomes

Developing sustainable financing models (e.g., rate setting, reimbursement strategies)

Identifying effective workforce strategies including training and maximizing of multi-disciplinary teams (e.g., peers, behavioral health providers, nurses, licensed health care providers)

Maximizing virtual and technology interventions

988 state planning and implementation support

Designing and implementing crisis receiving and stabilization facilities

Conducting certified community behavioral health clinic (CCBHC) readiness and implementation support

Cross-sector crisis collaboration and partnerships, including emergency management services (EMS) and law enforcement

Crisis call hotline and 911 centers collaboration

Individuals with Medicaid and justice system involvement (e.g., 1115 waivers, reentry, and care coordination during transition from jail/prison into the community)

Approaches, programs, and strategies for individuals with complex care needs and high utilizers

Identifying cross-sector technology and information sharing solutions and best practices

Crisis transportation services and financing models, including least restrictive alternatives to law enforcement transport

How HMA can assist MCOs:

Strategic
Planning

Understanding emerging trends and federal and state policies that impact managed care plans, including maximizing funding streams at state and county levels, 1115 justice waivers and school-based mental health, and including key stakeholders in the planning process.

Design and Implementation

Adopting state Medicaid criminal justice reforms (e.g., in reach, care coordination, Medicaid eligibility); engaging local and county stakeholders in building partnerships with health plans; designing and developing requests for proposals (RFPs), procurement support and readiness reviews; and developing utilization management programs and care coordination strategies.

Training
and Support

Assessing benefit design, and developing standards for network development, management, and adequacy; identifying quality, key performance indicators, monitoring and compliance strategies; identification and implementation of evidence-based practices across the age continuum; and developing training standards and oversight. 

HMA Crisis Portfolio Clients:

Health plans

Federal, state & local governments

Health and behavioral health care providers

Hospitals & health systems

Educational settings and academic institutions

Coalitions and advocates

Associations and foundations

Investors

Criminal justice stakeholders and facilities

Law enforcement

Emergency management services (EMS)

Public health departments

Contact our experts:

Caitlin_Thomas-Henkel_Philadelphia headshot

Caitlin Thomas-Henkel

Principal

Caitlin Thomas-Henkel is a health policy leader with extensive experience working in clinical, government, and non-profit settings. She has collaborated … Read more
John_Volpe_NY headshot

John Volpe

Principal

John Volpe is an experienced senior health official with a demonstrated record of success at the intersection of health, social … Read more

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