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Maine outsources
behavioral health management
(December
2007 Issue)
By Phyllis Hanlon
According to Brenda M. Harvey, commissioner of the Department of
Health and Human Services (DHHS), healthcare concerns are generating
lively conversation around the country. In Maine, the dialogue has
led to the appointment of APS HealthCare Midwest, a subsidiary of
APS Healthcare Bethesda, Inc., to administer the state's behavioral
health services.
Harvey reports that in the past, Maine had an "unmanaged system,"
in which the state contracted with individual providers for services
and reimbursement, both Medicaid and non-Medicaid funded. "There
was no continuity of care. Consumers often saw multiple providers
and dealt with multiple plans," she says. "There was no clear medical
home."
Maine's original idea to create a fully capitated managed care
effort received significant pushback from several entities in the
community. Acknowledging its inexperience in the area of managed
care, Maine decided to outsource management of its behavioral health
services and issued a request for proposal (RFP) to which approximately
a dozen firms responded, according to Harvey. "We looked at organizational
qualifications and experience, particularly with children with serious
emotional disturbance and adults with mental illness, technical
response and pricing/cost," she says. APS received "high marks"
in the evaluation and scoring process and earned the contract, Harvey
says.
Founded in 1992, APS Healthcare has served state governments since
1999 through its public programs division and has national experience
in managing care for Medicaid members, according to Sarah Clark-Lynn,
corporate communications manager. She adds that APS has collaborated
on the successful implementation of complex systems and has an excellent
reputation for quality improvement activities. "APS has programs
in 28 states and Puerto Rico including total population management
programs and behavioral health services," she adds.
In anticipation of potential roadblocks, DHHS initiated provider
training assistance programs last year. Harvey notes that Maine
has many small niche providers and previously did not have official
reporting requirements. "Provider readiness to engage is something
we paid attention to," she says. "We held mock utilization reviews
with individual organizations to help them understand what we expect
and to help them make preparatory shifts." Initially voluntary,
the provider trainings became mandatory to ensure that all mental
health providers comprehend the requirements.
Harvey and her department have not lost sight of the consumer in
this new process. "If consumers have the experience of services
being perceived or actually reduced, we'll pay attention to what
kind of due process is necessary," she says. Clark-Lynn says, "[APS]
services include retrospective review, prior authorization, continuing
stay review, provider relations and training, quality management,
customer 24/7 call center, analysis and reporting."
By appointing an outside firm to manage behavioral health services,
Maine is demonstrating its continued efforts to provide comprehensive,
consumer directed health care, Harvey says. "We're not just putting
in administrators to pare back costs. We're not ignoring family
and client participation and outcomes leading to recovery," she
says. "By default, we'll achieve continuity of care." Maine clearly
has adopted a policy of the right services at the right time and
intensity for the right duration and right cost, according to Harvey.
APS is slated to assume responsibilities for Maine's behavioral
health services this month (December 2007).
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