I am attending the Scott and White Prescription Services 8Th Annual Conference. Dr Mike Forrester from BHM presented a thought provoking and at times anxiety provoking look at what the Federal Mental Health Parity Rules which were recently released. He covered the top 6 areas and how they will impact consumers, providers and payers. The focus was a general overview as well as some details on the pharmacy management component of these new rules that take effect plan years starting after July 2010. Dr. Forrester correctly predicts that this will be a game changer and that it will increase cost as well as complexity in an already complex area. It was very well received and the audience had a number of thought provoking questions. We will be release both the slide deck as well as a video of the talk as soon as available. Please sign up for BHM Healthcare Solutions’ newsletter to receive access to this very insightful and informative presentation.
Mental Health Parity Rules will be a game changer
April 29, 2010
6 Comments | 
Health Care Reform | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, health care reform, Health Insurance Companies, Healthcare consulting firm, mental health parity | 
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Posted by Mark Rosenberg
Keys to Understanding Possible Exceptions to MNC
April 28, 2010In yesterday’s blog we discussed medical necessity Criteria ( MNC) and stated that we would review MNC exceptions today.
Learn the keys to understanding exceptions related to Medical Necessity Criteria. Exceptions covered will include clinical judgment, geographic variance, accessibility of care and determination of what is “essential.” Exceptins to MNC are important to good quality care and quality health care management. Accrediting bodies such as NCQA and URAC address the need to make exceptions when clinically indicated. MNC are subject to different, yet equally defensible interpretations by different clinicians.
- Exceptions to standard MNC should be reviewed by a physician or peer reviewer based on accepted standards of good medical practice, and all details of the case should be provided to assist in the decision making.
- Exceptions may also be based on geographical variances in availability of treatment services. Cases for this can particularly be found in rural or medically underserved areas.
- When a medically necessary service is not available the patient will be able to either obtain outside services, or treatment at a higher level of care based on determination of what is “essential” for the optimal care of the patient.
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2 Comments | Clinical Operations Improvement | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, health care accreditation, health care consulting, Medical Necessity Criteria, MNC | Permalink
Posted by Mark Rosenberg
Clarifying Medical Necessity Criteria
April 27, 2010Our group is working with a number of clients currently and a key componenet wrking with both payers of healthcare as well as providers of healthcare is underrstanding and executing medical necesity criteria. Care managers often struggle over how to intrepret the criteria fairly and povider struggle at how to express the criteria that an idividual patient is exhibiting. Medical Necessity Criteria (MNC), one of the most vital aspects of healthcare and treatment, is still very ambiguous. Numerous definitions for MNC can be challenging for providers and practitioners to know just exactly how different interpretations can impact care. Please see the article in its entirety by Robert Levine that will outline what is essential to understand about Medical Necessity Criteria, and how personal interpretation maintains a role in treatment distinguishing between what is “beneficial” for consumer health and what is “essential.” Please sign up for our newsletter.
In tomorrow blog I will review MNC exceptions.
3 Comments | Clinical Operations Improvement | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, Denial Management, health care consulting, Healthcare consulting firm, Improving Health Care Profitability, Medical Necessity Criteria, MNC | Permalink
Posted by Mark Rosenberg
Military’s health care costs boomimg.
April 23, 2010I am attending and presenting at the Fall Managed Care Forum in Orlando and after a workout began to read the USA today. They reported that Military health care costs rose 167% from 2001 to 2011. The reported increase was due to two causes one the surge in behavioral and physical problems for troops that have been deployed multiple times due to two wars. The other that is most problematic is the rise in retiree costs. This is reportedly due to retired military leaving civilian insurance programs as the insurance companies and businesses prepare for and get realigned for the recently passed healthcare reform law. I suspect we will see more of this as the impact of the law and how businesses adjust and prepare for it.
US Miliary healthcare spending increased twice as fast as US healthcare spending as a whole. US healthcare spending increased by 84% over the same time period. US military spending on healthcare increased from 6% to 9 % of the military’s budget. They expect this to continue to increase. The Military is considering increasing the cost through fee hikes.
4 Comments | Health Insurance, financial | Tagged: Behavioral Health Management, behavioral health prevention, BHM, BHM Healthcare Solutions, health care consulting, health care reform, Health Insurance Companies, Healthcare consulting firm, USA Today | Permalink
Posted by Mark Rosenberg
Pay for Prevention: A Strategy for Healthcare Prevention Shows Promise
April 22, 2010With all the talk of healthcare or health insurance reform. There are lofty goals and a likelihood that cost will increase. We will need to think outside the bx to have any real impact on healthcare cost. An idea that focuses on personal responsibility and health as opposed to illness is Pay for Prevention. A few large employers are working on Pay for Prevention. Pay for Prevention is a new strategy aimed at eliminating chronic health conditions associated with bad behavior by offering monetary incentives for leading a healthy lifestyle. Recent studies have shown that 50 percent to 70 percent of the nation’s health care costs are preventable. Such costs are usually associated with bad behaviors such as diet, lack of exercise, and smoking. Healthcare providers, Insurers, and Employers are all jumping on board and the latest indications show that rewards for good behavior are much more effective than punishments for bad behavior.
1 Comment | Health Insurance, Healthcare Prevention | Tagged: Behavioral Health Management, behavioral health prevention, BHM Healthcare Solutions, health care consulting, health care reform, Healthcare consulting firm, Pay for prevention, reducing healthcare cost, wellness | Permalink
Posted by Mark Rosenberg
The unintended consequences of healthcare reform
March 31, 2010There has been so much written as well as discussed on the news about healthcare reform. We at BHM have begun the long process to fully evaluate the 2700 plus page bill and the impact to consumers, payers and providers of healthcare. The bill has other aspects that are attached that are not directly related to healthcare but that is a discussion for another day and blog. Most of what I have read about the bill was politically slanted either for or against depending on the political leaning of the reporting organization. I read, a few days ago, an article from Newsweek which I found interesting and wanted to share. From Newsweek one would expect to be leaning in favor of the new legislation. The article ” A Cost Control Mirage“ Obama is telling people what they want to hear about health care, not what they need to know by Robert J. Samuelson | Newsweek Web Exclusive.
The jest of the article is that healthcare reform as passed will increase cost with potential little improvement in overall health of the nation. Mr Samuelson begins to discuss the standard payment method used in this country ( fee of service) and how it pays providers for procedures and office visits when patients are sick. This payment structure possibly encourages increased utilization and does not encourage providers to help patients maintain or improve their health. He focuses on medical economics and the misperceptions that are held about health insurance reform. Until we can empower consumers with information and reward healthy choices, we will probably not see change. BHM’s April newsletter that will be addressing Behavioral Economics/Pay for Prevention. This will be released April 6, 2010. You can sign up and the newsletter will be emailed every other month.
16 Comments | Health Insurance | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, health care consulting, health care reform, Health Insurance Companies, Healthcare consulting firm, Newsweek, Robert J. Samuelson | Permalink
Posted by Mark Rosenberg
Choosing the Right Healthcare Management Consulting Firm
March 24, 2010I am often asked about how to choose or know if your organization has the right Healthcare consulting firm. Here are a few thoughts when choosing a consulting firm.
While the benefits of improving your healthcare organization by working with healthcare management consulting firms are apparent, it is important to choose the right company. The consulting company must understand the individual needs of your organization in order to provide the right information regarding growth, strategies and operational as well as financial performance. Years of experience is necessary along with proven methods that work.
There are many consulting firms to choose from, but making a wrong decision can put your organization two steps back rather than forward. The industry is fast-paced and dynamic and staying current with the regulations and competition is critical. Not only do health care organizations needs to reassess themselves from within, but to also understand the market and the choices made by governing bodies.
The ultimate goal of any organization is to improve its practices, identify new goals and provide better services. Everyone is in the race to improve healthcare and it all starts with healthcare management.
In an effort to make sure BHM is the right fit for your organization, we offer free initial consultations.
2 Comments | Services | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, Healthcare consulting firm | Permalink
Posted by Mark Rosenberg
Preparing for the changes in healthcare: Part 2 Operational Improvement
March 23, 2010Both healthcare providers and payers are under a lot of pressure due to rising costs as well as governmental requirements and regulations. To better serve their customers and to stay ahead of the challenges, health care enterprises must improve their operational as well as financial performances. Many organizations will have their own in-house consultants or management team, but not all. Any health care organization will benefit from seeking healthcare management consulting to improve their strategies and achieve their goals.
Congress passed health “insurance reform” on Sunday night and the President will sign into law shortly, we as both consumers of healthcare as well as those who work in healthcare will see changes as costs go up and government increases its regulatory role. It is also likely that reimbursement will decrease. It will be interesting to see how it all unfolds over the next few years but preparing for the future is now even more important. Not only is the financial aspects critical but making sure your healthcare organization is running at peak efficiency is critical.
Improving Operational Performance
The operational aspect of a health care organization must also be strengthened through the help of healthcare management consulting. With a strong backbone, organizations can implement the right programs and services. The organization can set new goals in order to increase effectiveness, efficiency and productivity.
With these elements in the right place, the programs can better serve the customers and provide higher quality care. With a new focus, the organization will meet government regulations and have enhanced ways of communicating with physicians and other health care professionals.
Leave a Comment » | Clinical Operations Improvement | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, cost effective, Health Insurance Companies, Healthcare consulting firm, Improving Clinical Operations, Improving Health Care Profitability, increased insurance premiums, Reduced Profits, reducing cost, reducing healthcare cost | Permalink
Posted by Mark Rosenberg
Preparing for the changes in healthcare: Part 1 Financial Improvement
March 22, 2010Health care organizations are under a lot of pressure due to rising costs of health insurance and governmental requirements and regulations. To better serve their customers and to stay ahead of the challenges, health care enterprises must improve their operational as well as financial performances. Many organizations will have their own in-house consultants or management team, but not all. Any health care organization will benefit from seeking healthcare management consulting to improve their strategies and achieve their goals.
Health care is a business and those running the show must understand how to manage the business. This means that administrative information, financial data and clinical data must be taken and analyzed in order to put the information obtained into new strategies and other actions. In other words, health care managers need access to this information in order to understand the nature of the business.
Improving Financial Performance
By working with healthcare management consultants, a health care organization will be able to better manage its operational costs, present new growth opportunities, and ultimately increase revenue. With better financial performance, an organization can provide better health care to patients and eliminate problems with cash flow.
Competition is high in the health care industry and optimized financial performance will put an organization above its competitors. With healthcare management consulting, an organization can have access to necessary tools and data analysis.
Leave a Comment » | financial | Tagged: Behavioral Health Management, BHM, BHM Healthcare Solutions, Financial Analysis, Healthcare consulting firm, Improving Health Care Profitability, Reduced Profits, reducing healthcare cost | Permalink
Posted by Mark Rosenberg
Key Areas of Accreditation Due Diligence
March 16, 2010Yesterday I had two interesting calls yesterday with potential clients. Both were required to be accredited but had some latitude about the specific accreditation body. They had a number of questions about which accreditation body that should chose. Below I have outlined a number of questions that an organization should think about when picking an accreditation agency.
The following areas are important to consider during an organization’s due diligence:
- Has the accreditation organization established an excellent reputation in the industry?
- Is the accreditation organization recommended by several respected professionals?
- Has the accreditation entity established a reasonable and competitive cost structure?
- Does the accreditation entity’s staff exude professionalism in every possible venue?
- Is the accreditation organization known for treating potentially accredited healthcare organization’s staff with respect
- Does the staff at the accreditation entity go the extra mile in collaborating with healthcare staff to interpret standards?
- Is there a formal, user friendly process for obtaining information related to interpretation of standards?
- Remember to review the standards to see if they are relevant to your organization, to ensure that no other accreditation entity provides a better match, and that the applicable standards are not prohibitive for your organization
3 Comments | Accreditation | Tagged: Accreditation Due Diligence, Behavioral Health Management, BHM, BHM Healthcare Solutions, CARF, COA, health care accreditation, Health Insurance Companies, Healthcare consulting firm, NCQA, URAC | Permalink
Posted by Mark Rosenberg
