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红领巾瓜报 Insights: Your source for healthcare news, ideas and analysis.

红领巾瓜报 Insights 鈥� including our new podcast 鈥� puts the vast depth of 红领巾瓜报鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Brief & Report

红领巾瓜报 and National Council for Mental Wellbeing release issue brief on diversity in the behavioral health workforce

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The third issue brief, in a series by 红领巾瓜报 and National Council colleagues that examines the workforce crisis facing the country鈥檚 behavioral health system, highlights the access and service delivery challenges presented and exacerbated by health disparities and inequities.

The brief focuses on the need to recruit, train, and retain a diverse workforce in order to reduce behavioral health disparities and engage populations with historic and structural disparities, in order to build trust with providers and in the overall healthcare system.

Outlining challenges and actionable solutions, the brief points to the Certified Community Behavioral Health Clinic (CCBHC) model as an opportunity for states and provider organizations to partner and address health disparities and social determinates of health for underserved and marginalized populations.

Additional briefs in this series are Behavioral Health Workforce is a National Crisis: Immediate Policy Actions for States and Immediate Policy Actions to Address the National Workforce Shortage and Improve Care

The following 红领巾瓜报 colleagues contributed to this series: Uma Ahluwalia, Heidi Arthur, Angela Bergefurd, Cammie Cantrell, Nora Carreras, Suzanne Daub, Gina Eckart, Gina Lasky, Juliet Marsala, Emma Martino, Sandra Oxley, Deb Peartree, Erica Reaves, and Doris Tolliver.

Blog

Early bird registration discount expires July 11 for 红领巾瓜报 conference on the future of publicly sponsored healthcare, October 10-11 in Chicago

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Be sure to register for 红领巾瓜报鈥檚 2022 Conference by Monday, July 11, to get the special early bird rate of $1,695 per person. After July 11, the rate is $1,895.

Nearly 40 industry speakers, including health plan executives, state Medicaid directors, and providers, are confirmed for 红领巾瓜报鈥檚 The New Normal: How Medicaid, Medicare, and Other Publicly Sponsored Programs Are Shaping the Future of Healthcare in a Time of Crisis conference, October 10-11, at the Fairmont Chicago, Millennium Park.

In addition to keynote sessions featuring some of the nation鈥檚 top Medicaid and Medicaid executives, attendees can choose from multiple breakout and plenary sessions on behavioral health, dual eligibles, healthcare investing, technology-enabled integrated care, social determinants of health, eligibility redeterminations, staffing, senior care, and more.

There will also be a Pre-Conference Workshop on The Future of Payment Reform: Delivering Value, Managing Risk in Medicare and Medicaid, on Sunday, October 9.

Visit our website for complete details: . Group rates and sponsorships are available. The last 红领巾瓜报 conference attracted 500 attendees.

State Medicaid Speakers to Date (In alphabetical order)

  • Cristen Bates, Interim Medicaid Director, CO Department of Healthcare Policy & Financing
  • Jacey Cooper, Medicaid Director, Chief Deputy Director, California Department of Health Care Services
  • Kody Kinsley, Secretary, North Carolina Department of Health and Human Services
  • Allison Matters Taylor, Medicaid Director, Indiana
  • Dave Richard, Deputy Secretary, North Carolina Medicaid
  • Debra Sanchez-Torres, Senior Advisor, Centers for Disease Control and Prevention
  • Jami Snyder, Director, Arizona Health Care Cost Containment System
  • Amanda Van Vleet, Associate Director, Innovation, NC Medicaid Strategy Office, North Carolina Department of Health & Human Services

Medicaid Managed Care Speakers to Date (In alphabetical order)

  • John Barger, National VP, Dual Eligible and Medicaid Programs, Humana, Inc.
  • Michael Brodsky, MD, Medical Director, Behavioral Health and Social Services, L.A. Care Health Plan
  • Aimee Dailey, President, Medicaid, Anthem, Inc.
  • Rebecca Engelman, EVP, Medicaid Markets, AmeriHealth Caritas
  • Brent Layton, President, COO, Centene Corporation
  • Andrew Martin, National Director of Business Development (Housing+Health), UnitedHealth Group
  • Kelly Munson, President, Aetna Medicaid
  • Thomas Rim, VP, Product Development, AmeriHealth Caritas
  • Timothy Spilker, CEO, UnitedHealthcare Community & State
  • Courtnay Thompson, Market President, Select Health of SC, an AmeriHealth Caritas Company
  • Ghita Worcester, SVP, Public Affairs & Chief Marketing Officer, UCare
  • Mary Zavala, Director, Enhanced Care Management, L.A. Care Health Plan

Provider Speakers to Date (In alphabetical order)

  • Daniel Elliott, MD, Medical Director, Christiana Care Quality Partners, eBrightHealth ACO, ChristianaCare Health System
  • Taylor Nichols, Director of Social Services, Los Angeles Christian Health Centers
  • Abby Riddle, President, Florida Complete Care; SVP, Medicare Operations, Independent Living Systems
  • David Rogers, President, Independent Living Systems
  • Mark Sasvary, Chief Clinical Officer, CBHS, IPA, LLC
  • Jim Sinkoff, Deputy Executive Officer, CFO, SunRiver Health
  • Tim Skeen, Senior Corporate VP, CIO, Sentara Healthcare
  • Efrain Talamantes, SVP & COO, Health Services, AltaMed Health Services Corporation

Featured Speakers to Date (In alphabetical order)

  • Drew Altman, President and CEO, Kaiser Family Foundation
  • Cindy Cota, Director of Managed Medicaid Growth and Innovation, Volunteers of America
  • Jesse Hunter, Operating Partner, Welsh, Carson, Anderson & Stowe
  • Bryant Hutson, VP, Business Development, MedArrive
  • Martin Lupinetti, President, CEO, HealthShare Exchange (HSX)
  • Todd Rogow, President, CEO, Healthix
  • Joshua Traylor, Senior Director, Health Care Transformation Task Force
  • James Whittenburg, CEO, TenderHeart Health Outcomes
  • Shannon Wilson, VP, Population Health & Health Equity, Priority Health; Executive Director, Total Health Care Foundation
Blog

Quality standards in addiction care

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Across the healthcare landscape, quality standards are in place to ensure patients are receiving safe, appropriate, evidence-based, and standardized care that is tailored to their individual needs and symptomology.   

A significant gap has long existed in the treatment of substance use disorders (SUD), as there was no standardized method to provide treatment based on an individual鈥檚 needs at that moment, meaning people seeking treatment often received care that was either too intense or not intense enough, preventing them from attaining sustained recovery.

To create standardized treatment protocols and build additional credibility around programs, the American Society of Addiction Medicine (ASAM) developed criteria based on a holistic, multidimensional assessment[1] to determine what level of care (LOC) an individual needs. This development was revolutionary as it was the first time the field agreed on established criteria. After 35 years of improvement and refinement, the ASAM Criteria has become the national standard.

Learn More about ASAM Level of Care Certification

While many providers have adopted the ASAM criteria, and most regulators and payers require its use to determine the LOC a person may need, a significant gap still persists in ensuring services are delivered with fidelity to the criteria. As a result, those seeking treatment for themselves or a loved one continue to face challenges identifying a setting that provides evidence-based treatment focused on their specific needs. 

To close this gap, ASAM partnered with CARF International, the leading accreditor of behavioral health services, to develop criteria that demonstrates providers are, in fact, delivering the LOC for which they are admitting persons. Programs that are providing can be certified for three levels including: 3.7- Medically Monitored Intensive Inpatient Services, 3.5- Clinically Managed High Intensity Residential Services, and 3.1- Clinically Managed Low Intensity Residential Services.

By achieving the ASAM LOC certification, residential treatment programs can establish themselves as high quality SUD providers and ensure future program licensing as well as future funding from states, and private and public payors. This certification demonstrates that facilities are delivering the appropriate care to the appropriate person at the appropriate time. 

Preparing for certification is different from preparing for licensure in that a program must take an in-depth look at their clinical practice to ensure alignment with the ASAM criteria.

Because of our long and proven track record of helping clients prepare for, and secure, NCQA, AAAHC and URAC accreditation as well as deep expertise in SUD programs and treatment, 红领巾瓜报 was selected by ASAM as a preferred partner to provide technical assistance and usher programs through the certification process as well as help address shortfalls and gaps in programs and care.

Our team has the right mix of clinical and operational knowledge, training, and frontline experience to guide clients through the certification process and help build better systems of care and accountability from the ground up.

红领巾瓜报 has the depth and breadth of services across the healthcare spectrum, and we are uniquely positioned to help organizations address gaps identified in the certification process and improve care by ensuring services are delivered in fidelity to the LOC at which a person presents.

红领巾瓜报 is able to provide a full complement of services and support to residential providers including ASAM LOC clinical expertise, developing policies and procedures, building and operationalizing clinical programs, and improving revenue cycle, operations, and as well as payor contracting strategies.

Certification is really step number one. Utilizing 红领巾瓜报鈥檚 鈥淪urvey Ready Model,鈥� we will identify ways to build quality into everyday practice allowing programs to stay on top of – and ahead of – requirements. 

For more information, contact our expert below.

[1] https://www.asam.org/asam-criteria/about-the-asam-criteria

Blog

Oklahoma to transition to Medicaid managed care

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This week, our In Focus section reviews a new Oklahoma law to implement Medicaid managed care by October 1, 2023. The law, signed by Governor Kevin Stitt on May 26, 2022, requires the state to issue a request for proposals and to award at least three Medicaid managed care contracts to health plans or provider-led entities like accountable care organizations.

Provider-led entities would receive preferential treatment, with at least one targeted to receive a contract. However, if no provider-led entity submits a response, the state will not be required to contract with one.

Goals of the legislation include:

  • Improve health outcomes for Medicaid members and the state as a whole;
  • Ensure budget predictability through shared risk and accountability;
  • Ensure access to care, quality measures, and member satisfaction;
  • Ensure efficient and cost-effective administrative systems and structures; and
  • Ensure a sustainable delivery system that is a provider-led effort and that is operated and managed by providers to the maximum extent possible.

Plans would provide physical health, behavioral health, and prescription drug services. Covered beneficiaries would include traditional Medicaid members and the state鈥檚 voter-approved expansion population, but not the aged, blind, and disabled population eligible for SoonerCare.

Plans will need to contract with at least one local Oklahoma provider organization for a model of care containing care coordination, care management, utilization management, disease management, network management, or another model of care as approved by OHCA.

Oklahoma will also issue separate RFPs for a Medicaid dental benefit manager plan and a Children鈥檚 Specialty plan.

Background

Oklahoma currently does not have a fully capitated, risk-based Medicaid managed care program. The majority of the state鈥檚 more than 1.2 million Medicaid members are in SoonerCare Choice, a Primary Care Case Management (PCCM) program in which each member has a medical home. Other programs include SoonerCare Traditional (Medicaid fee-for-service), SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium assistance program for low-income people whose employers offer health insurance). Prior efforts to transition to Medicaid managed care have encountered roadblocks, starting in 2017 with a failed attempt to move aged, blind, and disabled members to managed care.

More recently, in June 2021, the Oklahoma Supreme Court struck down a planned transition of the state鈥檚 traditional Medicaid program to managed care, ruling that the Oklahoma Health Care Authority does not have the authority to implement the program without legislative approval.

Contracts had been awarded to Blue Cross Blue Shield of Oklahoma, Humana, Centene/Oklahoma Complete Health, and UnitedHealthcare. Centene/Oklahoma Complete Health also won an award for the SoonerSelect Specialty Children鈥檚 Health Plan program, covering foster children, juvenile justice-involved individuals, and children either in foster care or receiving adoption assistance.

Link to

Blog

Behavioral health crises drive bipartisan action in Congress

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Agreement about the severity of the nation鈥檚 mental health and substance use disorder crises is rising above the partisan politics in Congress. In fact, these are among a handful of issues driving work on bipartisan legislation across all the key House and Senate committees with jurisdiction over behavioral health programs and policies this year.

On May 18, the U.S. House of Representatives Energy and Commerce Committee unanimously approved the 鈥淩estoring Hope for Mental Health and Well-Being Act of 2022鈥� (H.R. 7666). This legislation incorporates a collection of bipartisan bills to update and reauthorize over 30 Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) programs addressing the mental health and substance use disorder (SUD) crisis. The bill also advances initiatives to strengthen the 9-8-8 National Suicide Prevention Lifeline implementation efforts, invest in the crisis response continuum of care, and support strategic opioid crisis response plans among numerous other policies. Energy and Commerce is one of several House committees planning to advance behavioral health bills this year.

U.S. Senate committee leaders have been similarly engaged in developing bipartisan proposals to address mental health and substance use disorders. Senate Health, Education, Labor and Pensions () and committee leaders are expected to reveal their proposals as soon as this summer. The Finance Committee鈥檚 proposal will focus on Medicare, Medicaid, and Children鈥檚 Health Insurance Program (CHIP) policies and could reflect findings from the committee鈥檚 , 鈥淢ental Health Care in the United States: The Case for Federal Action.鈥� Similarly, HELP members Sens. Chris Murphy (D-CT) and Bill Cassidy (R-LA) the Mental Health Reform Reauthorization Act to extend several expiring mental health programs, which could be incorporated in that Committee鈥檚 comprehensive proposal. Across committees, there has been an interest in strengthening parity, supporting integration of primary and behavioral health care, increasing access to youth mental health screenings, scheduling fentanyl analogues, and easing requirements for prescribing Medication Assisted Treatment.

What To Expect

Congressional leaders have consistently expressed their desire to advance bipartisan legislation to address the urgent needs and gaps in the mental health and SUD care delivery systems, as well as support education and research.  While these are key areas to watch, the diminishing number of legislative days on the congressional calendar and climate surrounding November鈥檚 mid-term elections create uncertainty for the timing and scope of Congress鈥� work. It remains to be seen whether a package of health care proposals, such as reauthorization of the U.S. Food and Drug Administration鈥檚 user fee programs, the Cures 2.0 legislation to advance biomedical research, mental health and substance use disorder legislation, and the PREVENT Act could be sent to President Biden鈥檚 desk before the end of September.

红领巾瓜报 companies are supporting clients impacted by the policy changes being discussed and the program funding addressed in these legislative proposals. Understanding the landscape for federal change allows state and local governments and stakeholders to plan for and shape these opportunities. For more information, please contact our experts below.

Blog

President’s budget recommends significant investments in unity agenda issues

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This week, our In Focus section reviews President Biden鈥檚 for federal fiscal year 2023, released on March 28, 2022. The President鈥檚 proposal kicks off the Congressional budget process and negotiations on the annual spending bills for the federal fiscal year that starts October 1, 2022. The budget proposal highlights the Administration鈥檚 program initiatives and recommended legislative and regulatory changes. The President鈥檚 budget is merely a request of Congress, who drafts the actual budget resolution that will go into effect if passed.

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Brief & Report

Report examines the value of community behavioral health providers and their networks

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A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.

An 红领巾瓜报 team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).

Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.

New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:

  • Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
  • Warehouse and including data sharing requirements in future managed care contracts.
  • Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
  • Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.
Brief & Report

Second behavioral health issue brief focuses on workforce crisis and call for immediate action

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The (National Council) and 红领巾瓜报 have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.

The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.

Recommendations include:

  • Adopting transformative clinical approaches and team-based care
  • Identifying short-term actions and developing long-term strategies for improvement
  • Expanding the workforce to build a more robust provider pipeline
  • Increase adoption of in-person/telehealth hybrid models

红领巾瓜报 and the National Council colleagues contributed to the briefs and surrounding research.

Blog

Medicaid managed care: opportunities to address social determinants of health and equity

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This week, our In Focus highlights a new report prepared by 红领巾瓜报 (红领巾瓜报) on the potential for Medicaid Managed Care to enable states to address social determinants of health (SDOH) and health equity above and beyond what’s possible with traditional fee-for-service models. The report was released by Together for Better Medicaid, a coalition committed to building a better Medicaid system across the country.

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