"The Business" of Behavioral Healthcare | Behavioral Health Today

CMS Announces Comprehensive Primary Care Initiative

The Comprehensive Primary Care (CPC) initiative is a new CMS-led, multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care for all Americans. Primary care is critical to promoting health, improving care, and reducing overall system costs, but it has been historically under-funded and under-valued in the United [...]

New Illinois Parity Law Recognizes State Funded Addiction Treatment Providers

Community-based addiction treatment providers named specifically in law as covered providers

(Springfield, ILLINOIS) – In a move that raises the bar for addiction treatment advocates and legislators in other states, state-funded addiction treatment providers were specifically codified in to law as covered providers when Illinois Governor Pat Quinn signed the Illinois Mental Health [...]

ASAM Redefines Addiction as a Chronic Brain Disorder – More Medicalization on the Horizon?

MSNBC carried the following story today (August 15, 2011): Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

The American Society of Addiction Medicine (ASAM) just released [...]

Magellan Launches Integrated Health Homes in Iowa

The following press release is a very good indication of where the market is and where it is headed. The time for innovation and bold moves to reform health care and delivery systems is now. The time for new business models and entrepreneurship and leadership is now. As much as some states and [...]

Health Insurance Exchange Proposed Rules Released for Comment

Federal regulators released proposed rules concerning the implementation and governance of Health Insurance Exchanges – the new marketplaces established by the Affordable Care Act where individuals and small businesses can purchase health insurance. Behavioral health policymakers, payers and providers are encouraged to review the rule and comment within the 75-day window of opportunity. The [...]

Carve-out versus Carve-in: Considering the Advantages and Disadvantages

As you review the fundamental pros and cons of either approach, consider asking an expert for direction and guidance before making any decisions you might come to regret. It is this author’s humble opinion that while a carve-in may appear attractive for reasons having to do with short-term costs, in the long run, mishandling [...]

For-Profit Publicly Traded Medicaid Managed Care Plans Rack Up Higher Admin Costs

The Commonwealth Fund reports that for-profit publicly traded plans spent 14% of member premiums on administrative costs, while non-publicly traded plans owned by health systems, local providers and clinics spent 10% of premiums on administrative costs. Provider-owned and operated plans had the lowest administrative costs, with a paltry 8% of member premiums spent on [...]

Carve-In Making a Comeback?

One of the ten largest health plans in the country announced recently that it will be in-sourcing what it had previously out-sourced: Disease Management. A quick review of their rationale exposes some very compelling reasons to carve services back into the broader health plan suite of functions.

For starters, the health plan expects to [...]

Behavioral Health Providers Benefit From Health Systems’ ACO Feedback to CMS

There is a real hunger among mental health and substance use disorder treatment providers to understand the concept and machinations of Accountable Care Organizations. Understandably, ACOs are being tauted as the next generation of managed care and the solution to many of our health care system’s issues and concerns. The market is moving quickly [...]

Lamenting ACO Start-Up Costs and other Obstacles

Recently, the American Medical Group Association (AMGA) and the American Hospital Association (AHA) – two titans in the provider space – have balked at the proposed rules concerning Accountable Care Organizations (ACOs). At issue for both are the costs associated with start-up and annual operations of an ACO - costs the AHA pegs between $10M and $25M – [...]

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