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Managed care health plans are designed to control healthcare costs by controlling which healthcare providers members can access in addition to managing the utilization of services to reduce unnecessary treatment. Today, there are three primary types of managed care plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans.

Why Managed Care Matters:

Managed care impacts clinical, financial and executive roles in different ways. States and providers are at different stages in the transition to managed care and value based care. Before entering into managed care contracts, executive teams at behavioral health organizations need to accurate assess costs and forecast the expected revenue and risk.

How You Need to Adapt:

To adequately prepare for the demands of managed care, clinicians and executive teams need to implement technology solutions that can give them insight into the costs associated with treatment and the ability to monitor service utilization enterprise-wide.

[Webinar Recording] Navigating the Path to Value-Based Care

Navigating the Path to Value-Based Care: The Journey to Improved Clinical Outcomes Client engagement is top of mind for many behavioral health and human service providers. Finding ways to cut through the noise of and connect in meaningful ways that improve clients’ path to care while addressing necessary business challenges can be overwhelming. In this […]

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[Webinar Recording] The Art and Science of Treatment Planning

Treatment plans are essential to the delivery of quality and effective care. While there are evidence-based best practices you can incorporate into your treatment plan (the science), it’s also important to leverage your own clinical judgement and experience (the art) and specialize your treatment plan to meet the needs of your individual client. By taking […]

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[Tool] A Managed Care Checklist for Agencies that Support Individuals with Intellectual & Developmental Disabilities and Autism

Assessing your technology’s capacity to handle the increasing demands of managed care is a smart move. Managed care requires quality measurement and improvement, performance trend analysis, and sophisticated integration between clinical, billing, and administrative work. This tool will help you assess your organization’s technological readiness for the demands of a managed care world. Fill out […]

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Webinar: Strategies for Integrating Outcomes into Your Clinical Practice

If you work at a behavioral health and human services organization, you likely collect a wide variety of client data throughout the treatment process. Having that information on hand is important, but are you actually putting that data to work? Simply measuring and monitoring outcomes isn’t enough. By using that information to help inform and […]

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[Tool] How to Select the Best EHR

Whether your behavioral health or human services organization is dealing with the requirements of data integration, right-sized utilization, multiple payment models, increased complexity in reporting, or other changes related to value-based care, your electronic health record system is essential to your work. It makes sense to review your technology choices from time to time, especially […]

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How to Transition Your Agency From Fee-for-Service to Value-Based Care

Navigate Changing Reimbursement Models With These Industry Best Practices One of the most profound changes in recent years is related to changing reimbursement models with the industry continuing to shift away from fee-for-service contracts to value-based care. Instead of tying revenue to the sheer volume of care provided, government and commercial payers have transitioned to […]

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5 Powerful Traits That Successful Value-Based Care Leaders Share

There is little doubt within the healthcare industry that the emphasis on quality over quantity will likely continue to gain momentum. While most payer contracts still largely favor a fee-for-service model today, the U.S. Department of Health and Human Services (HHS) is working to accelerate this change with the goal of transitioning 50 percent of […]

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[Tool] Scaling the Managed Care Mountain

A checklist tool for behavioral healthcare leadership teams adopting value-based care As your organization adapts to changing payment models and an increased focus on outcomes, you know the transition to managed care is complex. Successful adoption of value-based care and new payment models requires a team-based approach. This tool outlines the key responsibilities and roles […]

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[Tool] Managed Care Checklist

Assessing your technology’s capacity to handle the increasing demands of managed care is a smart move. Managed care requires quality measurement and improvement, performance trend analysis, and sophisticated integration between clinical, billing, and administrative work. This tool will help you assess your organization’s technological readiness for the demands of a managed care world. Fill out […]

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