North Central ACH hosted a panel discussion to share their region's knowledge and experiences regarding IMC transitioning. Below are the key takeaways BHT staff noted from the discussion.
- Contract negotiation is key. Negotiate the contract you want with MCO’s! Understand that they need you.
- Have money in the bank. Providers, both behavioral health and primary care, suggest that organizations either have built up reserves or a line of credit to continue operations if payment becomes delayed.
- Higher consultants. Strongly recommend working with a consultant to help with contracts.
- One thing at a time. Don’t recommend switching EHR/billing etc. systems at the same time as transitioning to IMC.
- Think about your EHR. When/If organizations change or implement an EHR, it was strongly recommended that the system that you choose is able to talk with EPIC which most primary care systems/providers use.
- Keep documenting. The MCO’s are not requiring the same demographic/client data that the RSN/BHO’s have but providers recommend to continue tracking, gathering, and keeping it anyhow. This is due to license requirements, and not knowing if the data will be required at some point in the future. North Central providers suggest having clinical staff operate as if nothing has changed in regards to clinical documentation. Providers do note that in working with the MCO’s there are less requirements overall in comparison to working with RSN/BHO’s. Less audits/monitoring etc.
- Keep staff informed. Since individuals on Apple Health can switch plans monthly, it was recommended that providers implement much more eligibility and billing oversight. Front line staff need to be really cognizant. There needs to be organizational tolerance and support for trial and error. Train staff who know how to work with MCO’s and then work with the patients-in regards to switching plans, as individuals will have lots of questions and staff need to be able to stay informed.
- Build relationships. Start building a list from the MCO’s of who does what at the MCO’s, key contacts, and build those relationships so that there are reliable contacts to answer questions and support the organization.
The Bright Side
- This transition has built great collaboration and has allowed agency case managers to do other things.
- This transition has been an additional benefit that organizations did not anticipate.
- Working together (BH, PC, SDOH) has really made a difference and improved relationships, referrals, and partnerships.
- Spokane providers can reach out to other providers in the North Central region—they are willing to be a resource!!!
- The MCOs offer good care coordination—driven by their desire to keep costs down.
- The MCOs have very active care managers that are doing great to connect and work with folks.
- The MCOs have been very quick with responses to requests and are very interested in being creative—they have lots of flexible funding. (In Grant county they developed a mobile office/outreach that goes around the county to serve individuals.)
- The MCOs are willing to sponsor trainings/community events.
- The MCO’s support creativity and would like things to be different and work better. Start asking! (Providers).
- MCO releases didn’t/don’t meet part two CFR/HIPAA standards.
- The MCO’s have brought together an advisory committee to discuss coordination, gaps, what’s working.
We wish we had known:
- Contract negotiation and the power that providers hold—should have hired a consultant.
- Understanding and knowing the State dollar side and processes (Beacon-BH-ASO).
- To involve as many staff as possible.
- What’s going will impact everyone in the organization—keep everyone informed.
- Leadership and organization be need to be available and attuned to staff frustrations and concerns and offer support, so they can answer questions to clients.
- Understanding authorizations and the process(s).
- Staff will need to understand medical necessity.
- Ask for information from the MCO’s/payers.
- The MCO’s don't know everything—do your own research and advocate for your organization.
- To negotiate and push back.
- This looks very different from the RSN/BHO environment.
- How much you will need keep staff informed!
- You may need to add staff (IT)—don’t assume that current staff can do what’s needed going forward.
- Will need to be flexible with staff, change is constant and staff may shift.
- You will want to have specific contacts within each of the MCO’s—building connections and relationship will be valuable.
- You don’t have to accept Medicaid contracts.
- Look 3-5 years out and look strategically and be able to demonstrate value to MCO’s otherwise there will be less providers as organizations didn’t prepare and can’t respond to the new environment.
- Clinically organizations should keep status quo and focus on the billing and data submission piece.
Access to Care
Has reduced barriers and reduced time to get folks into care. Family members who didn’t meet access to care-now the whole family can be served by the same provider. The MCO’s use Medical Necessity only-there are no levels. Clinicians decide who needs services. MCO don’t require specific assessment ( *CHPW Locus and cal-Locus*)
Still working on details. Only measure now, “how many BH patients are seeing their primary care physician.” Define for yourselves (organization). Very vague and negotiable at this time. Providers need to consider, “how much do we want to assume (diabetics etc) to increase capitated rates” as the more organizations assume the more money they can earn.
Providers in the North Central region have found that primary care is responding to behavioral health and connections. More aware and want loop closed—did person they refer get seen?
Still a work in progress. NC has a specific workgroup. Some data sharing going on between certain organizations. Get in front of data asap and work with the MCO’s who have created/offered some innovative and creative solutions. Share needs and barriers with them!