Posts Tagged managed care
MINES & Associates innovative opioid complex case management program helps manage treatment, control costs, and combat predatory facilities amid growing opioid crisis
MINES & Associates (MINES), a nationally recognized business psychology firm, helps self-insured organizations with its innovative Opioid Complex Case Management Program aimed at improving treatment and reducing costs of opioid abuse treatment cases. The program counters the egregious exploitation of clients by predatory treatment facilities.
MINES has been at the forefront of managed care services, providing complex case management services that produce cost-effective care in the least restrictive settings. MINES has saved its self-insured clients tens of millions of dollars while ensuring that the patient has received appropriate care.
MINES accomplishes this through an aggressive complex case management protocol designed to communicate directly with the patient and their family regarding costs, treatment, expectations for the facility regarding pre-certification, concurrent review, discharge planning, and long-term aftercare. MINES limits the number of UAs, mitigates costs to usual and customary or Medicare percentages, requires immediate discussion of discharge planning and family involvement, and re-integration into the patient’s community. These patients require long-term aftercare and support from case management.
MINES complex case management protocol functions as a patient advocate service to help patients navigate the treacherous array of predatory facilities, where, in some cases, case rates can run from $100,000 to over $1,000,000when care costs should be in the $9,000 to $30,000 range at a credible facility. The patient is often compromised by their drug use and cannot make informed choices regarding their own care. The patient’s family often does not understand the patient’s in network/out of network benefits and may just “google” treatment without precertifying care. MINES helps them cut through all the lies, misinformation, and noise to get the appropriate level of care needed.
About MINES & Associates
For over 37 years MINES & Associates has been a nationally recognized, award-winning business psychology firm that provides a variety of services to employers including employee assistance programs (EAP), managed mental healthcare, organizational development services, wellness programs, behavioral risk management, disease management, PPO services, and other behavioral health programs serving a diverse portfolio of clients nationwide.
Please visit www.minesandassociates.com for more information on MINES.
To Your Wellbeing,
The MINES Team
For full press release visit: https://goo.gl/pLMv1E
Happy Holidays from BizPsych! We typically have several requests this time of year to present our “Thriving with the Holidays” seminar for client companies. Surprisingly, this year we have had only one request, from our sister division in Las Vegas. Is it possible that there may be less acute stress this year in many organizations? Is there still much stress, but no time? Perhaps our past years’ efforts have cured all holiday stress (Nice fantasy…)? The holidays are a wonderful time for so many of us. Yet, for many people, the holidays bring an increased stress level that can take away from that delight. For some it’s actually a depressing time of year for a variety of reasons.
The cornerstone of our recommendation about coping or thriving with holiday stress has to do with setting balanced and reasonable expectations of ourselves and of others. There are cultural expectations that can lead to stress and disillusionment, i.e. “we should all be blissfully happy, have beautiful and significant presents for all, and be ever cheerful.” This probably does not work for all of us 100%. We can, however make meaning, be grateful, have authentic interactions, and celebrate what we believe in. One of the ways we can accomplish this is to set meaningful and realistic expectations for the holidays.
A number of years ago I worked out an optimal holiday stress management strategy formula called “Holiday Stress Math.” It is not rocket science, so please enjoy:
Holiday Stress Math
Holiday Stress is a function of: Expectations (E) vs. What Really Happens (WRH)
If E are H (High) and > WRH = HS (High Stress Holiday)
If E are L (Low) and < WRH = LS but DOL (Low Stress) (Depends on Luck)
If E are L (Low) and = WRH = LS but NGT! (Low Stress) (Negative Good Time)
If E are H (High) and = WRH = MS, PGT but HRI(Medium Stress) (Positive Good Time) (High Risk Investment)
BPRE (Best Possible, Realistic Expectation) = WRH(What Really Happens) = GRE (Good, Realistic Holiday)
Have a meaningful and reasonable stress holiday.
Peace and Joy,
Vice President, BizPsych
In the past, I have had a hard time remembering how daylight savings worked. Why? Because I would always recall the time I insisted on wearing my tennis shoes to go bowling and I flew down the alley and landed flat on my face. In my mind, falling was forever synonymous with falling forward and making face plants. Hence, the reason why I‘ve had such a hard time learning (and remembering) that it was fall backward and spring forward.
Then, I finally came up with an easy way to make the distinction clear. The word “fall” has four letters in it and so does the word “back.” Ever since I discovered this handy-dandy way to remember, I’ve been able to get it right!
Now that we’re into daylight savings time, I’ve had to ask myself:
Are there any other areas of my life that could benefit from a slight recalibration?
Am I getting a less than desirable outcome than I would prefer? And if so, is it because I am perpetually stuck in thinking the same way in a given situation?
Do I need to change my perspective and see things in a different light?
Is there a better way for me to think about things that would make my life easier and create less heart burn? Am I still making unnecessary “face plants” because of my stubbornness?
Daylight savings creates a slight shift. The nights become longer and the days become shorter. We’re reminded that the holidays are just around the corner. We start to notice that the mornings are a little chillier while the grass and car windows show slight signs of frost. We grab our sweat shirts and start looking for our favorite sweaters. We even begin to notice the displays in the grocery store are different. There are multiple signs and signals shouting: “change is in the air!”
So, I ask, “Why wait until the New Year comes to make resolutions that promote positive change and wellbeing?” Daylight savings is a great reminder that we can always make recalibrations and adjustments and, there is always time to make a slight shift to get a more desirable outcome. How often do you feel as if you’ve just won the lottery because you’ve been given the luxurious “gift of time?” Even though it’s just a slight move on the clock’s hand that creates the change, I encourage you to think of it as an invitation; an invitation to stir things up a little, create a shift in your thinking, change your rhythms, and challenge your beliefs. Then, during the long hours of the night, as you watch the hands on the clock go by, you can celebrate all of your successes that will make it easier to spring forward into action the next time we change the hands of time.
Just remember, if your organization needs a few recalibrations or you want support with making a few refinements the professionals at BizPsych are here to support you with executive coaching, training, and organizational development.
Marcia Kent, MS
We have all been touched in one way or another by the recent rash of violence in our communities. One tragedy seems like an anomaly and we tend to be able to put it in context as such. But when another occurs we start experiencing it as out of control and as a new norm. We start to carry a pervasive ill-ease. The experience of these tragedies may trigger a variety of stress reactions for different individuals. Some of these could be profound and require the need for professional help, be it medical or psychological. At the least, the general ill-ease most of us are experiencing may also compound the numerous other external stressors we encounter in our work and personal lives.
These stressors especially compounded by the senseless violence of recent shootings cannot help but affect us, in many ways, as well they should. In our modern world, stress is here to stay. We can learn to set more effective boundaries, we can better manage our time, we can shut out the painful images, but in most of our work and personal lives we will continue to be barraged by external demands and stressors. By focusing on stress, we often invite stress.
We offer a new approach. As we have learned in the Critical Incident Support Services (CISS) field, promoting emotional resilience gives those experiencing a specific trauma a more positive response than focusing on the trauma and stress. Emotional Resilience is our ability to “bounce back” from adversity and challenge. This does not mean we can remain unaffected by stress and setbacks. What it means is by strengthening our resilience we improve our ability to cope with set backs and recover more quickly. Emotional resilience traits can be learned and practiced. We would like to share some of the characteristics of emotionally resilient people as an invitation to practice – especially at this time of shared sorrow and tragedy. Some of the characteristics of emotionally resilient people are:
- Emotional and Physical Awareness: They understand what they’re feeling and why. They understand how their emotions are affecting their behavior and performance. They understand the absolute connection between mind and body – emotions and physical health. They support physical health by practices such as exercise, relaxation, healthy nutrition, and increased mindfulness in the moment – awareness of emotional and physical states.
- Perseverance: Whether they’re working toward outward goals or on inner coping strategies, they’re action-oriented – they trust in the process and don’t give up. They carry on in the face of setbacks and obstacles.
- Internal Locus of Control: They believe that they, rather than outside forces, are in control of their own lives. They know the limits of control and focus on the areas of life they can control.
- Optimism: They see the positives in most situations and believe in their own strength. They are able to view events as time-limited versus permanent. They are able to view events as specific and not pervasive. i.e. “all or none.” They are able to not personalize negative events by defining themselves by these negative events.
- Support: While they tend to be strong individuals, they know the value of social support and are able to surround themselves with supportive friends and family.
- Sense of Humor: They’re able to laugh in spite of life’s difficulties. They are able to respond to serious situations with appropriate seriousness, but not take themselves so seriously that they get in their own way.
- Perspective: Resilient people are able to learn from their mistakes (rather than deny them), see obstacles as challenges, and allow adversity to make them stronger. They can also find meaning in life’s challenges rather than seeing themselves as victims.
- Sense of Mission: Being connected to your spiritual side has been connected with stronger emotional resilience. This has to do with being connected to a higher purpose than oneself, and could be a sense of purpose or mission.
This is not an absolute list of Emotional Resilience traits. However, focusing on one or all of these traits and developing ways to practice them may be a positive way to help cope with the recent trauma that we all have experienced, as well as the common and extraordinary stresses we experience regularly. It may prove more effective to focus on strengthening one’s positive resilience than “combating” stress. Over the past couple years, BizPsych has offered emotional resilience programs in a large variety of settings and situations with very positive results and response. Please consider what you might need to enhance and exercise your resilience at this time.
Patrick Hiester MA, LPC,
Vice President of BizPsych
A division of MINES and Associates.
I recently attended an annual dinner/forum for a local non-profit group which focused on Drug Abuse Prevention. We’ve all heard, or experienced first-hand, the devastating effects of drug abuse on family, employment, education, and just about every other facet of human life. What we don’t always hear about are the amazing efforts by some making an incredible impact on prevention. By taking small steps to identify risk factors, especially for our youth, we can have a tremendous impact. At the forum, one of the panelists made a great point about how parents and doctors don’t ask the difficult questions, and often times because they are afraid of the answer, or maybe they are suffering themselves. Why do our doctors have no problem asking us about our diets and suggesting cholesterol screenings, but very seldom ask us a simple question like, “How are you feeling emotionally?” or, “Does your child seem to be fitting in, and participating in a healthy way?” When we look at diabetes and heart disease compared to major depression or substance abuse disorders only a small fraction of those suffering from behavioral disorders are actually being diagnosed and treated compared with their medical counterparts.
As the prescription drug epidemic continues to rise we need to do more in the area of prevention. Here are some wonderful resources for prescription drug abuse prevention from our friends at Peer Assistance Services:
Manager, Business Development
In over 35 years of working with people on making change, improving their performance, and living more fully it is still interesting to me how many people persist in doing the same self-defeating actions over and over despite saying they want to improve, grow, or change for the better (whatever that means). So the following are four questions worth asking yourself if you want to improve your performance in some area of your life.
- Situation Questions – Tell me about your life? How is it working now?
- Problem Questions – Can we be specific about what is not working? Are you concerned about your current quality of performance?
- Implication Questions – What happens if you don’t do something different?
- Need-Payoff Questions – If you act and it improves – how does that impact your life?
Take time to reflect on these questions, write down your answers, and be curious about where this may take you. If you find yourself resisting the questions or process, look more deeply into that instead.
It’s up to you….as they say “no one can do your push-ups for you.”
Exchange love and happiness with everyone you meet today.
Robert A. Mines, Ph.D.
CEO & Psychologist
The book, Spark, by John J. Ratey, M.D. is the holy grail of research applications related to the interaction of exercise, neuroplasticity, and performance. The information on brain chemistry changes in the areas of learning, addictions, anxiety, depression, women’s issues, ADHD, and aging is priceless. The essence of the book is that the data indicated the brain is able to create new neuronal connections, grow new nerve cells throughout life, manage major psychological conditions, pain conditions, and learning is significantly enhanced through exercise. Ratey stated that “exercise is the single most powerful tool you have to optimize your brain function”- based on hundreds of research studies (p.245). Ratey suggested that the more fit you get (regardless of where you start), the “ more resilient your brain becomes and the better it functions both cognitively and psychologically. If you get your body in shape, your mind will follow” (p. 247).
How much is enough? Ratey stated that walking is enough. Low-intensity exercise is at 55 to 65% of maximum heart rate, moderate is 65-75% and high intensity is 75-90%. “The process of getting fit is all about building up your aerobic base” (p.251). Ratey goes on to discuss the role of strength training and flexibility as important elements of optimizing your brain chemistry and hormone levels.
What does this have to do with optimizing your performance at work and in all areas of your life? Everything! Get started today and stick with it.
Have a day filled with optimal brain chemistry,
Robert A. Mines, Ph.D.
CEO & Psychologist
I ran across some interesting information on the role of niacin, depression, and alcoholism in performance at www.doctoryourself.com. It is well documented that depression and/or alcoholism may negatively affect performance across just about any domain one can perform in. In the treatment of depression and alcoholism there are very effective cognitive-behavioral psychotherapy interventions. In addition, exercise and medication may add additional therapeutic effects. The role of nutrition may have further potentiating influence.
According to this site, Bill W., the founder of AA, was successfully treated for depression with 3,000 mg of niacin a day. Unfortunately, this information has not been widely discussed or published in the media. I would be interested to hear from any of you who have used niacin as a means of treating depression or alcoholism and what your results were. Please let us at MINES know.
Have a day filled with mindfulness,
Robert A. Mines, Ph.D.
CEO & Psychologist
Towers Watson recently released this report highlighting some coming trends in the areas of comprehensive benefits as it relates to multi-national organizations. A summary introduction emphasizes a couple of interesting points regarding the information that they collected in their survey.
- Emphasis on and reasoning for worker health varies by region
- Wellness programs are growing in popularity
- Communicating employee health and safety strategy is critical
These three points stood out to us as well. Behavioral health got a lot of attention through the survey results, underscoring the important work that we do and its impact on the overall costs of health to an organization.
The gulf between communications with top-level leaders and the dispersion of that information downward sounds to be a case for our BizPsych friends as the information disparity seems to be great, globally. Further, while the fact that wellness programs are growing in popularity may not be of any surprise to anyone here, the priorities that these multinationals place on various components of a wellness program are.
If you find any other interesting articles on the subject, feel free to share those through the comments!
‘Til next time…