Calculating future expenses stresses all managers and directors. In the ever-changing world of healthcare, making the time to accurately budget costs can cause headaches, nausea, dizziness, and palpitations. (Please do not operation heavy machinery while thinking about budgets.) Estimating the financial impact of the growing behavioral health gaps may be the final straw. Today's blog gathers data points from recent studies, reports, and presentations from around the healthcare industry and offers a starting point for your various budget models. Make the time to verify your models are sporting the most current data. Challenge your assumptions, because margins are thin and getting thinner.
The greatest need for mental health professionals are found in the more populated east coast and remote northern states. Large populations and rural settings significantly impact behavioral health staff shortages. The Health Resources and Services Administration (HRSA) released the most current data. The table shows the 10 states with the worst behavioral health professions clinical coverage, the national average, and the 10 states with the best BH coverage.
The largest health plans share more things in common than you might imagine. Striving for the high quality patient care comes to mind. How about striving for process efficiency? Absolutely. Integrating continuous improvements move these organizations ahead of the rest.
Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.
Level of Care Guidelines are usually derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS’ National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
The National Council for Behavioral Health and the National Council Medical Director Institute released a far-reaching report this month: The Psychiatric Shortage: Causes and Solutions. As a recognized leader in behavioral health reviews, this BHM Healthcare Insider Blog brings selections from the executive summary focusing on the behavioral healthcare shortages and solutions.
Healthcare organizations face challenges regarding reduction of their medical and administrative costs because regulatory and administrative demands are increasing. Payers and providers must evaluate new partner relationships and solutions for work processes and potentially outsource administrative functions in order to offer competitively priced services to patients. Successful delegation requires planning.
Managing behavioral health costs challenges the US healthcare system. The issues encompass many of the legacy processes and structures needing to be overhauled. Some interesting recently posted examples may show the way for the entire healthcare system. These come from both payers and providers.
An analysis of the California workers’ comp independent medical review (IMR) process used to resolve medical disputes finds that in 2016, IMR physicians once again upheld about 90% of utilization review (UR) physician’s modifications or denials of treatment, yet IMR volume continued to grow, climbing 6.5% last year.
The American Health Care Act (AHCA) made its debut. Not many people in government and healthcare industries expect quick passage of the AHCA in its initial form, but understanding the differences with the Affordable Care Act (ACA) sets a framework for how payers prepare for the final version. Fair to say, every organization must make adjustments and the pressures for building internal organization-level efficiencies increase.