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.

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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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. Fill out the form to download our managed care tech readiness checklist and assess your organization’s technological readiness for the […]

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Scaling the Managed Care Mountain, Part 2

Finance’s role in value-based care How do you create greater financial predictability for your agency in a value-based care environment? Billing and finance managers are being asked to manage the financial health of their organizations with less revenue predictability amidst much more complex payment models. In a fee-for-service payment model, the equation was predictable: staff […]

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Scaling the Managed Care Mountain, Part 3

C-Suite’s role in value-based care How do you navigate organizational change in a value-based care environment? In moving from fee-for-service to value-based care, C-level executives face a substantive organizational change management opportunity. The types of change they may address include: business processes, staffing models, revenue projections, program mix, and populations served, among other people, process, […]

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Scaling the Managed Care Mountain, Part 1

The provider’s role in value-based care Would you like to create a greater impact in the time you have with your clients? In the new healthcare economy, providers are being asked to do more with less, including spending less time with their clients. With as little as 15 minutes to deliver care to each client, […]

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