Navigating the complex landscape of managed care organizations (MCOs) can feel overwhelming for behavioral health agencies. However, these partnerships hold the key to enhancing service delivery and securing necessary and sustainable funding. With the right approach, you can transform this challenge into a valuable opportunity for growth and improved client care.
The Importance of Partnership with Managed Care Organizations
Managed care organizations are vital allies for behavioral health agencies, providing essential funding and support. For instance, agencies that report high levels of transparency and accountability have seen funding opportunities increase by up to 25%. Such partnerships can greatly improve client outcomes and create a strong support system. For example, MCOs can be a key part of the whole health ecosystem. MCOs are one of the entities int he system that can see almost all oft he system and can assist all of us in creating connections.
Effective communication is central to this relationship. Establish clear lines of dialogue with your MCOs to understand their expectations, which ensures compliance with funding requirements. Further, when you are in real partner ship with your MCOs they can navigate systems and issues that baffle you as a provider. When agencies and MCOs work hand-in-hand, both parties share the responsibility to create a collaborative effort that benefits everyone, particularly the clients.
Managing Credentialing and Contracting: The Right Support
For behavioral health agencies, managing credentialing and contracting with MCOs is a significant challenge. Hiring external experts can simplify this process, but it’s essential to ensure alignments with your organization's goals. The other huge issue with hiring out this service is expectation setting, the process for credentialing and contracting takes a long time. As providers we take a ton of risk in setting up services, hiring staff, and providing care. It is hard to digest that state approvals and MCO credentialing cause a canyon of issues for us. So, part of what we need to do is build the relationships early, give them booster conversations and compassion frequently, and ask for help as soon as we see an issue.
Before onboarding new help, thoroughly evaluate their understanding of MCO specifics. Agencies employing staff that are not deeply familiar with their mission or responsibilities have reported a 30% decrease in operational efficiency, emphasizing the need for alignment. Addressing this on the front end can markedly improve communication and efficiency. A well-matched team can reduce credentialing times and streamline service delivery.
Analyzing Agency Data: A Necessary Step for Efficiency
Regularly reviewing your agency’s data is crucial and often overlooked. By analyzing key performance indicators, you can spot trends that signal where improvements are needed. For instance, monitoring discrepancies between what credentialing companies claim and what MCOs provide can uncover hidden inefficiencies—potentially saving your agency thousands of dollars annually. I have seem this several times in agencies where they were being told all their staff were credentialed and the agency was all set with each MCO but when they talked with the MCOs they did not have all of the information that they need to properly manage you claims.
A proactive approach to monitoring performance metrics allows you to identify issues early, mitigating risks before they escalate into larger problems. This comprehensive oversight enhances decision-making and promotes smoother operations.
Your Project Management Process in Behavioral Health
Managing your agency effectively in cooperation with MCOs requires a clear project management process. Here are some crucial steps to implement:
Define Objectives: Align on mutual goals with your MCO to streamline efforts. Example, having monthly check in calls with a provider rep to ensure that your rosters are correct.
Set Milestones: Create measurable checkpoints to assess progress and maintain momentum. Create financial milestones for your agency to determine when you approach an MCO for a value based program or a rate increase, show them your values, reduce their bottom line and they will likely talk to you.
Resource Allocation: Identify the necessary resources, including budget and staff time, to achieve your objectives. Assess all of you spending, emotional, physical, technical, and financial and other hidden costs. Are you putting all of the resources int he right places? Do you have staff do the things that they are good at? Are you reassigning work when it things aren't working.
Continuous Monitoring: Regular reviews allow for adjustments in strategy as needed. Check-in, checkin-in, check-in. If you're not paying close attention to all aspects of the work being done, then you will lose sight and all of sudden it's hard to recover.
Feedback Loop: Establish a system for input from team members, MCO representatives, and clients to improve processes. MCOs are requierd to provide coverage and services, providers are required to provide high quality and responsible care, clients are responsible to be the leader of their wellbeing, advocate for their needs and wants, and tell us when we're messing up. There needs to be a nested bowls approach. The client is the first bowl, the staff serving them sit int he second bowl, the agency supporting those staff in the third bowl, the region or state where the agency is located int eh next bowl, then federal supports and national best practices are the final bowl. Information MUST travel across all the bowls.
A structured approach to project management fosters accountability and ensures that all stakeholders are informed and engaged.
The Role of Self-Compassion and Business Acumen
As you navigate the complexities of partnerships with MCOs, developing self-compassion and sharp business skills is crucial. Leaders who practice self-compassion are better equipped to handle stress, contributing to more effective decision-making in demanding environments.
Simultaneously, strengthening your business acumen is key to your agency's success. A solid grasp of financial management, market trends, and operational strategies can help you advocate for better roles and resources within the MCO framework. This blend of skills not only uplifts your agency but also enhances care for the populations you serve.
Final Thoughts
Successfully navigating managed care organizations is essential for the sustainability of any behavioral health agency. By establishing partnerships rooted in accountability, diligence, and shared goals, you can significantly enhance care delivery and operational efficacy.
Invest time and attention into choosing the right support for credentialing, analyzing agency data, and implementing effective project management practices. With self-compassion and business acumen as additional tools in your toolkit, you will be well-equipped to meet the unique challenges of this sector.
The journey to effective partnerships thrives on commitment to high-quality care and a deep understanding of each party's responsibilities. Engaging fully in this process will not only uplift your agency but also create a lasting impact on the communities you serve.
In gratitude,
Tiffany
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