Behavioral Healthcare Management (BHM)
Managing mental/behavioral health care (M/BH) is a different animal than managing healthcare for medical conditions, period! Determining appropriate treatment for M/BH issues is all about early engagement to determine the functioning level of the patient. The diagnosis is not the driving factor in effectively managing M/BH treatment.
As Utilization Management grew up on the medical side, it developed processes for managing medical conditions. Those processes have worked well in that area where diagnostic testing defines appropriate treatment. However, when those processes are applied to M/BH without diagnostic testing, they can cause the review process to become reactive and hands-off. This problem was not apparent when most self-funded health plans had significant limits on M/BH benefits. However, mental health parity has removed those limits and we are in a new world for M/BH treatment costs.
Active Care Management
Interface’s BHM engages Active Care Management to get out in front of M/BH cases and determine the functioning level of the patient. That allows the patient to be educated and guided to the appropriate level of care. From there, Active Care Management works with the facility to step the patient down to lesser levels of care as their condition improves. Not only is the step-down process less costly, more importantly, it allows the patient to be integrated back into the real world where they must learn to manage their issues, which leads to better outcomes. If the patient’s condition is not improving, other treatment levels and/or facilities are considered. Providers must be held accountable for improving the condition of the patient.
Interface’s BHM also provides a preferred network of facilities, psychiatrists, and psychotherapists. They are contracted through a credentialing process with agreed upon per diems that are all inclusive. For facilities, the per diems are all inclusive except for psychiatrist.
Another component of BHM is the claims review process. All claims for M/BH treatment are audited by Interface to ensure what is billed was authorized. Network claims are repriced. Then, claims are sent to the plan administrator for processing.
To learn more about the value of our BHM program, please contact us.Contact Interface