Managed Care & Health Plans

MANAGED CARE & HEALTH PLANS

Since 1989, Parker Dennison has worked with public and private sector managed care entities ranging from the very largest, national firms to non-profit regional and local managed care entities. Always operational in focus, our work has included assisting with bids including assessing provider network needs, care management strategy development, provider training needs and actual proposal management and drafting. Parker Dennison consultants have been key team leads for nearly a dozen public sector mental health, substance abuse, and child welfare managed care implementations including in Iowa, Massachusetts, Arizona, Texas, Maryland, Wisconsin, Kansas, Tennessee, and Colorado.  We have also assisted health plans with developing or enhancing internal behavioral health capabilities in preparation for fully integrated models under Medicaid waivers and healthcare reform.

New Mexico Medicaid Health Plan Integration

Assisted the largest Medicaid health plan in the state in all phases of implementing an 1115 managed care waiver that includes behavioral health, physical health, long term care services and supports, consolidation of twelve legacy waivers, and Medicaid expansion benefits. The scope of work included assessment of operational capacity buy or build decisions, all phases of procurement and contracting with a behavioral health administrative services organization, strategy and proposal development, and implementation assistance.

Kentucky Medicaid Health Plan Integration

Reviewed one of the top 25 provider-sponsored non-profit Medicaid managed care health plans in the nation for readiness to integrate behavioral health benefits into their book of business. The health plan was a consortium including a university physicians group, two non-profit hospitals, and an FQHC. Parker Dennison conducted a high-level review of the plan’s strengths and development needs in order to manage behavioral health benefits, helped design and adapt their case management, utilization management, provider relations, and member services models, and drafted a proposal to one of their key state clients demonstrating their enhanced capabilities to manage the full spectrum of benefits.

Health Plan Behavioral Health Assessments

Assessed health plan operational systems to determine readiness to manage behavioral health in competitive environments.  Evaluated buy/build decisions to enhance behavioral health management competencies, recommended development plans for improvement, and assisted with implementation.  When ‘buy’ decisions were preferred, assisted with all phases of behavioral health organization RFP/RFI development, proposal evaluation, contract negotiation, and implementation.

Massachusetts Behavioral Health Partnership

Assisted national managed care organization, ValueOptions, with the implementation of a statewide mental health carve-out in Massachusetts. Funding was primarily Medicaid , with a small portion of non-Medicaid state funding. Project activities included: provider network development, contracting and credentialing; plan for network gap analysis; interface with representatives from state agencies (Medicaid and Department of Mental Health); provider orientation and training; provider manual development; and recruitment and training of permanent staff.

Iowa Behavioral Health Managed Care Programs

Assisted national managed care organization, Magellan, with the implementation of two statewide carve-outs in Iowa. One project was for Medicaid mental health funding for all levels of care and the second was for substance abuse services, inclusive of Medicaid and non-Medicaid funding and the corresponding two state agencies. Activities on both projects included: provider network development and contracting; interface with state agency representatives; financial modeling for proposed non-Medicaid funding allocations for providers; and provider training.

Arizona Regional Behavioral Health Authorities

Participated in two types of projects for Regional Behavioral Health Authorities (RBHAs) in Arizona. RBHAs are responsible for a single system of care for behavioral health services in a region of the state, and for a wide range of funding and populations, including Medicaid and non-Medicaid for all ages, child welfare behavioral health, housing, vocational, federal block grant and county dollars. The first project was to assist national managed care organization, ValueOptions, with development of the winning proposal and implementation of a regional managed care carve-out inclusive of all behavioral health funding for Maricopa County, Arizona, which includes the Phoenix metropolitan area, as well as surrounding rural areas. Activities included implementation assistance in the areas of: provider network development, network management, contracting , and credentialing; provider training and manual development; claims and information systems; network needs assessment, coordination and distribution of housing and substance abuse funding; and interface with state agency representatives. The second project was to assist an incumbent RBHA, Northern Arizona Regional Behavioral Health Authority (NARBHA) in Flagstaff, with a successful proposal to continue its contract with the state during required re-procurement. NARBHA is responsible for approximately the northern half of the state, which is largely comprised of extremely rural and geographically isolated areas.

Kansas Child Welfare Managed Care Program

Assisted a partnership of a national managed care organization, ValueOptions, and a local provider with implementing a project in Kansas designed to privatize foster care functions and apply managed care technologies to the services and funding.