Editor’s Note: The behavioral health case (below) illustrate how independent review services improve workflow and staffing issues. CLICK HERE for our white paper on the leveraging the value of Peer Reviews for organizational improvements.

At the start of 2014 when California’s Medicaid program took over management of mental health services from the state’s 58 counties. For Inland Empire Health Plan, a Medi-Cal managed-care plan, that meant going from being responsible for behavioral health benefits for 12,000 beneficiaries dually eligible for Medicare and Medicaid to more than a million enrollees.

Behavioral Health Case“Overnight we became responsible for all outpatient mental health services for our entire patient population,” said Peter Currie, a psychologist and clinical director of behavioral health at the plan, based in Rancho Cucamonga, as reported in Medicaid plans struggle to provide mental health services by Virgil Dickson

The Modern Healthcare article continues and focuses on the shortages of providers and their unwillingness to join health plans. behavioral health case

Challenges in the near future

Heading the wrong direction? Here is the unasked question. How will payers and providers build internal behavioral health capacity to meet care demand when there are barely enough to cover the actual care?

“Some of the highest vacancy rates are for psychologists. In 13 regional (VA) health care systems, 40 to 64% of psychologist positions are vacant. Nationally, about 21% of such positions are vacant.” – Meghan Hoyer, USA TODAY September 4, 2015

If some health systems struggle with a 50% vacancy rate for defined BH positions, Payers face even greater pressures for building their BH expertise.

Payers’ biggest challenge might be facing an inconsistent influx of complex claims for a growing list of chronic conditions taxing internal, medically-focused capacity.

Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year. NIMH link

70% of primary care visits stem from psycho-social issues.

As many as 32 million individuals will gain access to behavioral health coverage for the first time by 2020 according to HHS. Processing those claims with the accuracy enjoyed by medical claims is exciting and terrifying.

  • When should we hire? Should we hire?
  • What specialties and subspecialties do we need?
  • What are acceptable/unacceptable reimbursement metrics?
  • What service codes will cause the biggest headaches?

A solution for the Behavioral Health Case

BHM Healthcare Solutions face these situations every day, since 2002. We know the concerns and we built systems, processes, and the largest BH reviewer network to meet the challenges.

Recognizing the importance of consistency in behavioral health reviews launched BHM. It is here where we continue to shine.

Complex Reviews

With over 500 practicing clinicians in the full-spectrum of BH sub-specialties, our network developed a comfort level with codes for these nuanced diagnosis.

Our network’s experience, as active clinicians, bring a better, more practical understanding of chronic care planning. Raising First-Pass accuracy.

“BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations.” Cindy Ehlers, Chief Clinical Officer – Trillium (formerly ECBH)

When matching specialists is important, we meet your precise needs in the TAT you set.

Working with BHM relieves your team from

  • On-boarding and retention for low volume sub-specialists: Our vast pool means no down time because of open staff positions.
  • Scaling staff to meet processing needs and workflow: On-demand processing manages your expenses with more precision.

6 of the 10 largest health plans* trust BHM for behavioral health and medical peer reviews.

Our start-up time ranks among the shortest in the industry. Let BHM make a positive impact for your next fiscal quarter by contacting us today.

“Our organization has been very satisfied with BHM IRO services. The BHM team has done an excellent job and provided solid customer support. BHM is customer-centric and works hard to meet our needs.” Audrey Cantu, Director of Case Management – Gadsden Regional Medical