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Webinar replay: Behavioral health: moving access to care and network adequacy into the 21st century
This webinar was held on September 7, 2023.
States, counties, health plans, and providers are asking how to meet the growing demand for behavioral health (BH) services. 红领巾瓜报 teamed with experts to discuss these challenges at our recent Quality Conference where we crowdsourced ideas for how to redefine and measure network adequacy, examining provider selection, community need, and measurement.
This webinar reconvened those panelists to continue this critical conversation, shared feedback on factors that lead to “adequate” provider capacity, and discussed the impact of new federal network adequacy standards.
The conversation won’t stop with this webinar. We’ll use our continuously crowdsourced information and material for our on Oct. 29, (the day prior to the start of the 2023 红领巾瓜报 Conference), making the connection between how large system reform in BH will shape how we think about network adequacy. We hope you’ll join us.
Learning Objectives
- Understand widely varying state standards for BH network adequacy and metrics — and validity concerns about how provider volume is assessed.
- Consider the true impact of BH provider shortage on care. (Reality check: we do not have enough BH providers and will not catch up at the current rate of training.)
- Learn about treatment engagement challenges and the need to establish criteria for discharge or discontinuation of treatment.
- Understand how extending BH workforce capacity with peer networks might ease shortage concerns.
- Hear about Delaware’s challenges and innovations to build an end-to-end ecosystem of care, shifting toward a journey rather than an episode of care.
- Learn about recent federal reform and new standards around network adequacy.
Speakers
Senior Vice President and Associate Chief Medical Officer, Commonwealth Care Alliance聽
Senior Vice President and Deputy Chief Medical Officer, UnitedHealth Group
Associate Deputy Director, Division of Substance Abuse and Mental Health, Delaware State Department of Health and Social Services
Learning the invaluable lessons of value-based care聽at 2023 红领巾瓜报 conference
If you search the term 鈥渧alue-based care鈥� on the internet you will find over 2.5 million hits on that term alone. No one would disagree with the need to provide value to patients and purchasers, but how we define value differs based on where we sit. Value is paying for outcomes, not volume of services. Value is ensuring that patients get the right care at the right time. Value is ensuring that purchasers pay a reasonable cost for the highest possible quality. Value is ensuring that healthcare is provided equitably and sustainably. Implementing value is even trickier than defining it, given the complexity of who pays for care and the challenges of measuring the outcomes we seek to reward.
From the top office of HHS to the back office of a health center and everywhere in between, 红领巾瓜报 leaders have been part of our collective journey to value: advancing policy and regulatory change, calculating risk and setting prices, crafting alternative payment models, integrating social services and behavioral health, and coaching industry leaders to make important changes to their business models to adapt to a more sustainable approach to American healthcare. These experiences 鈥� both successes and challenges 鈥� provide a unique perspective from which to advise clients on transformation of healthcare.
The 红领巾瓜报 2023 fall conference, scheduled for October 30-31, 2023, has thoughtfully curated several discussions to educate, enlighten and motivate attendees on industry standards and navigating the practicality of providing value in care, coverage, and patient experience in publicly funded healthcare:
Leading the Charge on Value, Equity and Growth: The Future of Publicly Sponsored Healthcare: Discuss how these public programs came to be the industry standard bearers and what this shift means for outcomes, affordability, policy, and the overall direction of U.S. healthcare.
Positive Change and the Growing Importance of Managed Care in Publicly Sponsored Healthcare: Discuss the future of publicly sponsored healthcare, outline promising initiatives aimed at improving coverage and care, and address key concerns over funding, policy, equity, and coordination between government, plans, providers, and members.
The Future of Delivery Systems: Achieving Operational and Financial Sustainability: Discuss a wide range of practical approaches to prepare for the future, including managing cash flow, optimizing the workforce, developing long-term reimbursement plans, improving operational efficiency, and addressing changes in government policy.
Real Talk from the Trenches of Value-based Payments: Learn about the advantages and pitfalls of value-based payments, with important insights from organizations that have made it work.
Navigating Change in Medicare Advantage: A Roadmap for Success: Discuss what Medicare Advantage plans must do to meet the demanding, new requirements 鈥� all against a backdrop of continued efforts to improve equity, access, outcomes, and cost.
In addition, a pre-conference workshop on behavioral health will be held the afternoon of October 29th, prior to the official start of the conference. This workshop will highlight the integral role of behavioral healthcare in improving patient outcomes across the continuum of publicly sponsored healthcare programs.聽聽
We are excited to engage with industry experts throughout these discussions about value-based care and forge a better path forward toward a more sustainable and equitable system of care.
红领巾瓜报 annual conference on innovations in publicly sponsored healthcare
Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth
Pre-Conference Workshop: October 29, 2023
Conference: October 30鈭�31, 2023
Location: Fairmont Chicago, Millennium Park
红领巾瓜报 has announced the preliminary lineup of speakers for its sixth annual conference, Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth.
Hundreds of executives from health plans, providers, state and federal government, investment firms, and community-based organizations will convene to enjoy top-notch content, make new connections, and garner fresh ideas and best practices.
A pre-conference workshop, Behavioral Health at the Intersection of General Health and Human Services, will take place Sunday, October 29.
Confirmed speakers to date include (in alphabetical order):
- Jacey Cooper, State Medicaid Director, Chief Deputy Director, California Department of Health Care Services
- Kelly Cunningham, Administrator, Division of Medical Programs, Illinois Department of Healthcare and Family Services
- Karen Dale, Chief Diversity, Equity, and Inclusion Officer, AmeriHealth Caritas
- Mitchell Evans, Market Vice-President, Policy & Strategy, Medicaid & Dual Eligibles, Humana
- Peter Lee, Health Care Policy Catalyst and former Executive Director, Covered California
- John Lovelace, President, Government Programs, Individual Advantage, UPMC Health Plan
- Julie Morita, MD, Executive Vice President, Robert Wood Johnson Foundation
- Anne Rote, President, Medicaid, Health Care Service Corp.
- Drew Snyder, Executive Director, Mississippi Division of Medicaid
- Tim Spilker, CEO, UnitedHealthcare Community & State
- Stacie Weeks, Administrator/Medicaid Director, Division of Health Care Financing and Policy, Nevada Department of Health and Human Services
- Lisa Wright, President and CEO, Community Health Choice
Publicly sponsored programs like Medicare, Medicaid, and the Marketplaces are leading the charge in driving value, equity, and growth in the U.S. healthcare system. This year鈥檚 event will highlight the innovations, initiatives, emerging models, and growth strategies designed to drive improved patient outcomes, increased affordability, and expanded access.
Early bird registration ends July 31. Group rates, government discounts, and sponsorships are available.
New experts join 红领巾瓜报 in April 2023
红领巾瓜报 is pleased to welcome new experts to our family of companies in April 2023. This diverse team brings significant expertise in Medicare, Medicaid, regulatory strategies, and managed care, strengthening 红领巾瓜报鈥檚 capabilities in healthcare consulting across areas like actuarial support, regulatory compliance, and strategic leadership in Medicare Advantage and Medicaid programs.
Advancing the national dialogue on improving access to quality care
Healthcare executives gathered with 红领巾瓜报 leaders in March to learn and share about new initiatives in quality improvement. Panels and discussions were led by esteemed experts, who provided important insight into the multitude of opportunities to improve quality and equity:
From the Experts: CMS has doubled down on its commitment to improve healthcare quality, equity, and access.
The 红领巾瓜报 Point of View: Current leadership in Washington has set very clear goals to improve health equity, aligning federal policy as a lever to improve healthcare outcomes. Federal dollars passed along to states are including new rules and objectives to improve quality in an equitable manner. Therefore, those applying for federal contracts and grants must include a strategy to improve quality, equity, affordability, and access.
From the Experts: Interventions need to be robustly evaluated to address equity and social determinants of health (SDOH).
The 红领巾瓜报 Point of View: Governments, care providers, and payers have been experimenting with approaches to SDOH, but the bar is now higher and results have to be measurable. New investments that address SDOH and aim to improve equity must include a strategy to measure and analyze results of interventions, including evaluation of critical subpopulations to address disparities. Although experiments will continue, we have reached the point where a robust analysis of outcomes is an expectation.
From the Experts: Quality is playing a central role in operationalizing equity.
The 红领巾瓜报 Point of View: While there are many reasons for disparities in health, quality metrics and programs must be designed to improve quality for all patients. Identifying inequities is only the first step; successful programs will advance equity by reducing barriers to care. Measurable quality programs should be designed for population health, but personalized for individuals with clear provider incentives to not only identify disparities but also minimize them. Quality is the tool by which we achieve health equity.
From the Experts: We are on the precipice of doing great things in quality.
The 红领巾瓜报 Point of View: Our ability to integrate data from multiple sources is finally getting to a place where patients can get the quality care they need, and providers can give the right care at the right time to improve outcomes. Policymakers have broken down barriers to data sharing, enabling a new economy of information sharing that promises to empower patients and reduce costs. It is no longer enough to have a separate IT or data strategy; anyone working to improve healthcare quality needs to have data strategies within and across every operational function across their organization.
From the Experts: Being rewarded for doing what’s right for the patient is central to continuous quality improvement.
The 红领巾瓜报 Point of View: Quality care for the patient means creating the right incentives for payment and care delivery that focus on outcomes and experience. Every point of care in the patient’s health journey needs to be evaluated and designed from the point of view of providing a quality experience. Not every patient has the same journey, and our healthcare system must meet them where they are, delivering for their unique needs. Convenience, personalization, accuracy, simplification, and affordability are nearly as important as clinical outcomes in the mind of most patients and addressing barriers to health can have clinical benefits.
红领巾瓜报 has a long history of working with clients to achieve their quality improvement goals including securing accreditation for both payer and provider organizations, driving clinical practice transformation, and improving the overall value of care. We strongly believe that there is no quality without equity, access, and measurement, and are investing in people and resources to support these needs. Together we are working with clients to advance value-based care, develop programs demonstrating quality, value, and equity in behavioral health, and implement new quality and accreditation programs to better serve their communities.
Learn more about 红领巾瓜报鈥檚 continuing work in quality and accreditation and join the conversation on LinkedIn and Twitter using #红领巾瓜报talksQuality.
红领巾瓜报 Acquires Crestline Advisors
Jay Rosen, founder, president, and co-chairman of 红领巾瓜报 (红领巾瓜报), today announced the firm鈥檚 acquisition of Crestline Advisors, an Arizona based healthcare consulting firm.
Founded in 2013, supports health plans, provider organizations, and state agencies with an array of services designed to help them navigate the changing healthcare landscape. The company鈥檚 team of independent consultants has an extensive track record of developing successful RFP responses, provider networks, and business development strategies to fuel client success.
鈥淐restline Advisors brings an impressive mix of expertise and relentless client focus 鈥� that delivers results 鈥� to 红领巾瓜报,鈥� Rosen said. 鈥淭heir ability to consistently develop winning proposal responses for Medicaid managed care organizations (MCO) complements our extensive MCO supports as we continue to expand the ways in which we serve our clients.鈥�
In addition to Crestline鈥檚 proposal response development and MCO network management and operations support services, the company also assists clients with regulatory and contract compliance, accreditation, and strategic planning for business development.
“Crestline has demonstrated a commitment to supporting health plans, providers, and states to improve healthcare for Medicaid beneficiaries,鈥� said Crestline CEO Susan Dess. 鈥淲e firmly believe that as part of the 红领巾瓜报 family of companies we will bring even more success to our clients and drive continued growth and development in Medicaid healthcare delivery.鈥�
Dess and Tim Mechlinski will continue to lead Crestline Advisors, an 红领巾瓜报 Company, as managing directors. Terms of the transaction were not disclosed.
About 红领巾瓜报
Founded in 1985, 红领巾瓜报 is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 20 locations across the country and over 500 multidisciplinary consultants coast to coast, 红领巾瓜报鈥檚 expertise, services, and team are always within client reach. Learn more about 红领巾瓜报 at healthmanagement.com, or on and .
About Crestline Advisors
Established in 2013, Crestline Advisors, LLC is a consulting company designed to support the needs of health plans, provider organizations, and state agencies. Crestline specializes in helping large and small organizations operate successfully and grow despite the constant operational, financial, and political challenges they face. Crestline uses its current understanding of industry drivers to strategize with our clients so they can respond timely and effectively to small, large, or enormous market-place changes. Learn more about Crestline Advisors at .
How will changes to Medicare Part C and D Star Ratings impact your plan?
What are your plans to minimize your risk to avoid dropping in your Star Rating or to plan a head to maintain or improve your Star Rating?
On February 1, 2023, the Center for Medicare and Medicaid Services (CMS) released the and included some key specifics on the upcoming changes to the Medicare Star Rating program. CMS is proposing changes that will align with the recently announced 鈥淯niversal Foundation鈥� of quality measures, a core set of measures that are aligned across CMS quality rating and value-based care programs. The Advance Notice also included information on substantive measure specification updates, new measure concepts, and the addition of measures to align with other CMS programs.
You can learn more about these proposed changes along with a blueprint for improving your Medicare Advantage Star Ratings at the 红领巾瓜报 quality conference on March 6 in Chicago. The working session 鈥淢oving the Needle on Medicare Stars Ratings鈥� will feature speakers ; John Myers, BS, M.Eng., VP of Health Quality & Stars, Humana; ; and Dr. Kate Koplan, MD, MPH, FACP, CPPS, Chief Quality Officer & Associate Medical Director Quality and Safety, Kaiser Permanente of Georgia
Moderators of this session are Mary Walter, Managing Director of Quality and Accreditation, and David Wedemeyer, Principal. Both have health plan legacy experience in Stars strategy, execution and getting results.
Objectives of this session:
- Overview of the CMS proposed changes and their impact on the Stars program
- Attendees will obtain a blueprint for improving Medicare Advantage Star Ratings, including the importance of ensuring executive management buy-in
- Discussion of how the use of data analytics can help plans to identify quality gaps, target interventions, and track improvement
- Strategies to avoid the type of siloed initiatives that often fail to achieve lasting results
- Speakers will also address the importance of quality in achieving market viability and financial
sustainability
Stay in the know about the upcoming proposed changes and develop your organization鈥檚 strategy in this interactive impactful working session. This session will allow attendees to integrate any learnings and take-aways into your Stars program to meet your overall Star Rating strategic goal.
Follow #红领巾瓜报talksQuality on and for more updates on Stars and quality initiative efforts throughout the year. View the full agenda and register for 红领巾瓜报鈥檚 first annual quality conference on March 6 in Chicago. Registration closes on February 21, 2023.
What is 鈥渁dequate鈥� behavioral health provider capacity?
At 红领巾瓜报, our subject matter experts get questions every day from people working in state agencies, counties, health plans and provider groups about how to 鈥渞ight size鈥� the behavioral health continuum to obtain equitable access for growing behavioral health demand. From legislatures to providers, improving access to mental health services is critical to improving overall health outcomes. It is time for behavioral health to create a specific definition of network adequacy that accounts for the complexity and nuance of access to mental health and substance use care. It is time to identify and define the factors that lead to 鈥渁dequate鈥� provider capacity, to ensure that the right level of care is available to individuals when they need care. Network adequacy in behavioral health needs an overhaul to meet the complexity that is driving access challenges.
Together let鈥檚 re-define what 鈥渁dequate鈥� means in behavioral health to ensure we build systems that meet the needs of communities. At 红领巾瓜报鈥檚 quality conference on March 6 in Chicago, the 鈥淒eveloping a Behavioral Health Quality Strategy鈥� working session will engage participants in an in-depth discussion on identifying factors to inform a more accurate definition of behavioral health network adequacy. Speakers will outline some of the core challenges in network adequacy and innovations they have used.聽 Attendees will work collaboratively in a structured exercise on three knotty challenges within network adequacy to identify factors that could improve measurement for states, plans and providers. The goal is for participants to walk away with tangible actions they can implement in their work on behavioral health access.
Please join our 红领巾瓜报 experts and our featured panelists:
And follow #红领巾瓜报talksQuality on and for more updates on behavioral health quality efforts throughout the year. View the full agenda and register for 红领巾瓜报鈥檚 first annual quality conference on March 6 in Chicago. Registration closes on February 21, 2023.
CMS creating a ‘Universal Foundation’ to align quality measures
Leaders at the Centers for Medicare and Medicaid Services (CMS) announced in the this month a new initiative called the 鈥淯niversal Foundation,鈥� which seeks to align quality measures across the more than 20 CMS quality initiatives. The implications for the broader healthcare system are immense.
At 红领巾瓜报 upcoming quality conference March 6 in Chicago, Dr. Lee Fleisher, one of the authors of the Universal Foundation initiative and, Chief Medical Officer and Director, CMS鈥� Center for Clinical Standards and Quality, will deliver the keynote address 鈥淎 Vision for Healthcare Quality: How Policy Can Drive Improved Outcomes.鈥�
Attendees will hear from industry leaders and policy makers about evolving healthcare quality initiatives and participate in substantive workshops where they will learn about and discuss solutions that are using quality frameworks to create a more equitable health system. In addition to Dr. Fleisher, featured speakers will include executives from American College of Surgeons, ANCOR, CareJourney, CareOregon, Commonwealth Care Alliance, Council on Quality and Leadership, Denver Health, Institute on Public Policy for People with Disabilities, Intermountain Health, NCQA, Reema Health, Kaiser Permanente, Social Interventions Research and Evaluation Network, UnitedHealth Group, United Hospital Fund, 3M, and many other organizations.
The Universal Foundation seeks to align quality measures to 鈥渇ocus providers鈥� attention on measures that are meaningful for the health of broad segments of the population; reduce provider burden by streamlining and aligning measures; advance equity with the use of measures that will help CMS recognize and track disparities in care among and within populations; aid the transition from manual reporting of quality measures to seamless, automatic digital reporting; and permit comparisons among various quality and value-based care programs, to help the agency better understand what drives quality improvement and what does not.鈥�
CMS has established a cross-center working group focused on coordination of these processes and on development and implementation of aligned measures to support a consistent approach. As part of this announcement, the group published a list of Preliminary Adult and Pediatric Universal Foundation Measures. This new quality program will affect clinicians, healthcare settings such as hospitals or skilled nursing facilities, health insurers, and value-based entities such as accountable care organizations.
红领巾瓜报 can help organizations improve their quality efforts in line with the new CMS Universal Foundation initiative. 红领巾瓜报鈥檚 more than 500 consultants include past roles as senior officials in Medicaid and Medicare, directors of large nonprofit and social services organizations, top-level advisors, C-level executives at hospitals, health systems and health plans, and senior-level physicians. Our depth of industry-leading policy expertise and clinical experience provides comprehensive solutions that make healthcare and human services work better for people.
To learn more about 红领巾瓜报 and Quality, follow #红领巾瓜报talksQuality on and . View the full agenda and register for 红领巾瓜报鈥檚 first annual quality conference on March 6 in Chicago. Registration closes on February 21, 2023.