Policy makers and employers are recognizing the impact of mental health and substance abuse on businesses, communities and families. It is no longer uncommon for businesses to provide behavioral health benefits for employees.
By partnering with human service agencies and health plans, care management is designed to connect individuals with the best possible treatment and provider for their mental health and/or substance abuse needs. Without this essential mediator, mental health and substance abuse care can often slip through the cracks of the traditional health care management system.
Effective care management provides a comprehensive array of administrative services for behavioral health care that are customized to meet each partner's unique needs.
- Provider network development and management - recruit, credential and contract with providers; monitor provider performance
- Claims adjudication and payment - timely and accurate payment of providers based on organization-specific business rules for adjudication
- Program development - assist network providers in the development of custom programs and services to meet specific client needs through the use of best practice standards and clinical guidelines
- Care coordination - provide real-time, personalized assistance to partners regarding evaluation, referral and service/provider selection; ensure quick, easy access to services; masters level, licensed mental health and substance abuse professionals located on-site.
- Utilization management - determine the appropriateness of requested services according to national and local standards of care and level of care criteria; monitor utilization and associated costs; promote cost containment
- Data management - collect and analyze data; generate aggregate and client specific reports
- Quality assurance - ensure highest quality of care through ongoing treatment outcome evaluation and provider, partner and client satisfaction surveys
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Health Network