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:
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.
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:
Federal, state & local governments
Health and behavioral health care providers
Hospitals & health systems
Educational settings and academic institutions
Coalitions and advocates
Associations and foundations
Criminal justice stakeholders and facilities
Emergency management services (EMS)
Public health departments
Contact our experts: