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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.

[Tool] 6 Tips To Succeed With MACRA MIPs

The annual MACRA program attestation period is feared by many providers, and no wonder. It’s a data-heavy, intensive process, but one that can provide huge benefits to agencies when done properly.  So how does Qualifacts help? Our CareLogic EHR supports 17 different measures with 17 different sets of data, all of which is monitored during […]

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Unburied Treasure: Mapping Your Way To Better Workflows With Analytics

We’ve all heard that you need to move from reporting to analytics. But is there a map to the place where the data drives the workday? This webinar breaks down the differences in, and the value of, both reporting and analytics: Practical examples for how to become a data-driven organization How to be successful in […]

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[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

How to Select the Best EHR: The 2020 Guide for Behavioral Healthcare Executives If you are a behavioral health or human services organization dealing with the requirements of data integration, multiple payment models, increased complexity in reporting, or other changes related to value-based care, making sure you have the right electronic health record (EHR) system […]

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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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