Program Design: The Management Tools Your Organization Needs To Work With Managed Care Organizations

Program Design: The Management Tools Your Organization Needs To Work With Managed Care Organizations The NYAPRS Collective in Collaboration with the Managed Care Technical Assistance Center (MCTAC) Steve Ramsland, Senior Associate, OPEN MINDS December 11, 2014 2:45pm 4:00pm www.openminds.com 163 York Street, Gettysburg, PA 17325 Phone: 717-334-1329 - Email: info@openminds.com

Agenda Management Tools Needed To Work With Managed Care Organizations I. Essential Management Tool 1: Contracting Readiness Checklist II. Essential Management Tool 2: Marketing Capabilities III. Essential Management Tool 3: Managed Care Administrative Capabilities IV. Questions & Discussion OPEN MINDS 2014. All rights reserved. 2

Contracting Preparation Checklist: Administrative What systems are in place to secure and execute contracts with health plans -- and communicate those provisions to key staff? Are your internal administrative systems in place to assist and support the professional staff working with a health plan (intake, benefit verification, utilization management and billing systems) What systems are in place to track health plan authorizations, review managed care clinical criteria, and product appropriate service documentation? How much of your health plan revenue is being written off because there are no clinical or administrative systems in place to track utilization of authorized services? OPEN MINDS 2014. All Rights Reserved 4

Contracting Preparation Checklist: Financial Who are the largest health plans and payers in your market? Do you have a contract/relationship with those organizations? What are your unit costs and will contracting with a specific health plans cover those costs? What is your policy regarding copayments and deductibles? Are they being collected? What role does repayment play in the recovery process? How much revenue is your organization writing off because of no contract or being out of network? OPEN MINDS 2014. All Rights Reserved 5

Contracting Preparation Checklist: Clinical 1. Does your organization have a program model? Can your team provide data on the performance of that model? 2. Does your organization individualize the client s treatment? 3. Does your organization have the services available that a health plan would be interested in? (i.e. intensive outpatient, in-home crisis stabilization) 4. Does most of your professional staff have professional degrees and licenses? 5. Does your organization have room to accept the rapid stabilization, brief solution focused therapy philosophy -- and reconcile this philosophy with your mission? 6. Are the attitudes of your professional staff ready for creating programs that meet the needs of health plans? 7. Are your professional staff members open to new ideas and clinical approaches? OPEN MINDS 2014. All Rights Reserved 6

Most Health Plan Contracts Do Not Equal Revenue Marketing to referral sources and consumers essential to getting financial yield from contracts Consumer awareness and responsiveness to inquiries is key Developing and maintaining and managing relationships with referral sources Common communication vehicles: - Telephone - Online website, social media, email - In-person referral representative activities - Advertising campaigns for brand building - Community relations events for awareness OPEN MINDS 2014. All rights reserved. 8

Consumer Marketing: If Consumers Have A Choice Will They Choose You? Consider the consumer s perspective and what they would define as quality: - Communication (courtesy, respect, listening, explaining) - Responsiveness of staff - Outcome of treatment - Ease of access to your services - Do you deliver on your unique selling proposition? Why would consumer s choose your services over another type of intervention? What are consumer s telling others about their experience? OPEN MINDS 2014. All rights reserved. 9

Internet = Relationships Why Internet Is Important For You Google searches per month - 90 billion Health care is Google s # 1 legitimate vertical 60% of U.S. adults search for health on Google, Bing, or websites OPEN MINDS 2014. All rights reserved. 10

Consumer Marketing Is All About Endorsement & The Internet Endorsement whether online or interpersonal is critical factor Internet (and social media) is preferred communication vehicle OPEN MINDS 2014. All rights reserved. 11

Behavioral Health Searches = Revenue Program Monthly Searches Substance Abuse Eating Disorders Depression Autism 400,000 50,000 25,000 40,000 New Patients 4,000 500 250 400 Revenue/ Patient New Revenue/ Month $ 10,000 $ 30,000 $ 30,000 $ 30,000 $ 40 million $ 15 million $ 7.5 million $ 12 million OPEN MINDS 2014. All rights reserved. 12

Open Source Relationships Online = Reputation Open source is a computer term for software that anyone can use open to all Reputations are made on-line Not all bad lots of positive, lots of great interesting comments Need to form your online brand Ignore = invalidate Engage Listen Learn - great feedback loop Communicate OPEN MINDS 2014. All rights reserved. 15

Manage Referral Source Experience With Customer Relationship Management Tools Clinical Service Delivery Website Client Experience Call center CRM provides a holistic view of the customer across multiple channels including the website, call center, marketing campaigns, and referral development so that the organization can better market, sell, and service their customers and accounts of all types Admissions Referral Development Finance OPEN MINDS 2014. All rights reserved. 17

Six-Step Plan For Internet-Integrated Consumer Marketing 1. 2. 3. 4. 5. 6. The right services with the right positioning at the right price Address pull through issues with payers and referrals sources appropriate relationships established and maintained Marketing materials (print and online) convey the right message to consumers Make sure consumers in need find you web content planning, web site design, and web search optimization Maintain brand, reputation, and relationship with referral sources and consumers stakeholder engagement plan and team Plan to build customer web functionality that integrates with service -- the emerging CRM/EHR linkage OPEN MINDS 2014. All rights reserved. 18

Group Exercise: Consumer Pull Marketing Form small groups and consider the following: What efforts can you take to ensure that consumers find and choose you? Once consumers find you, how can you ensure that they ll return? Share: Your insights (and success stories) with the group OPEN MINDS 2014. All rights reserved. 19

Administrative Competencies For Working With Managed Care Organizations 1. Marketing and contracting functions payer contracting, referral development, and consumer choice 2. Systems to facilitate administrative processes of FFS managed care and value-based purchasing preauthorization, clinical criteria, documentation 3. Revenue cycle management -- billing and collections for both payer and consumer 4. Development of services that are customer-preferred in terms of value both payer and consumer 21

Reduce Cost Improve Outcomes Delivering Accountable Care Delivering Accountable Care Clinical Innovation Care Coordination EHR & Medication Management Meaningful Use Clinical Decision Support Information Exchange Primary Care Integration Population & Community Health Management Business Efficiencies Hosting & SaaS Revenue Cycle Management Managed Services Technology Partners OPEN MINDS 2014. All rights reserved. 22

Ten Health IT Tools To Succeed In Managed Care Population Health Analytics Health Information Exchange Risk Stratification & Predictive clinical analytics Remote monitoring Web-based consumer self-management Telehealth Patient Portal Automated Outreach Referral Tracking Electronic Health Record OPEN MINDS 2014. All rights reserved. 23

Group Exercise: Managed Care Operational Readiness Form small groups and consider the following: What steps do you need to take to get your clinical operations managed care ready? What steps do you need to take to get your administrative operations managed care ready? Share: Your insights (and success stories) with the group OPEN MINDS 2014. All rights reserved. 24

The market intelligence to navigate. The management expertise to succeed. www.openminds.com 163 York Street, Gettysburg, PA 17325 Phone: 717-334-1329 - Email: info@openminds.com