Posts Tagged Self-Insured
Robert A. Mines, Ph.D., Chairman and Chief Psychology Officer
Thank you John Oliver and your staff for a significant public service on your show this week! Your commentary and excellent coverage of a major problem in substance use disorder and alcohol treatment will have an impact far beyond what the insurance and professional communities have been able to do.
MINES has patients who have gone out of network, received poor care, the payors have received outrageous bills, the patients are stuck with bills that can only result in medical bankruptcy and as you noted, people die in these disreputable facilities. A major component that you pointed out is patient brokering. When people Google substance abuse/use treatment, the top 20-30 are facilities, mostly in Florida and California, or are patient brokers. Reputable facilities in the person’s community do not even make the list. Then the facilities sometimes even pay the airfare to fly the patient to their facility and if the patient does not meet medical necessity for that level of care, the facility turns them out on the street to find their own way back to the state/community they live in.
You mentioned addictionologists as a resource for finding reputable care. In addition, Employee Assistance Programs as well as managed behavioral health services (insurance) are knowledgeable and informed about substance use and alcohol treatment. They know which facilities and programs are in network with the insurance and which ones do a good job.
Evidence-based treatment supports the use of a continuum of care from outpatient, intensive outpatient, partial hospitalization, residential and detox (medical and social detox). There are medications that also contribute to sobriety and health.
These are chronic illnesses/conditions that require the patients to cope with all their lives. Learning relapse prevention and adherence skills are essential.
If you decide to delve into this national problem further in a future episode, I would be happy to consult with you and your team.
The following clip may be not suitable for some work environments:
This is a link to a pdf of an article published by the Self Insurance Institute of America on predatory treatment facilities and managed behavioral healthcare strategies for helping the patients and the payors. http://www.minesandassociates.com/documents/Predatory_Facility_Article.pdf
Psychology of Performance – 42: Integration of Behavioral Health and Medicine in Self-Insured Organizations
There are many conditions, both acute and chronic, which have significant psychological components to them. It is well-documented that medical costs for diabetes, asthma, cardiac events, and others are significantly higher when there is a co-morbid diagnosis of depression, post traumatic stress, or substance use disorder. As a function of this relationship and the impact of the Affordable Care Act (ACA), there is a need for integrating behavioral health services.
The integration needs to occur at the strategic/systems and tactical levels. On the tactical side, there are already case studies in the public healthcare sectors and in Kaiser Permanente of placing mental health professionals in medical clinics and offices so the doctors and nurses can just walk a patient down the hall to see them once a psychological component has been identified. At MINES we are piloting a wellness coaching model for individuals who are identified by their healthcare provider as a pre-substance use disorder patient, through a Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant awarded to Peer Assistance Services.
At the strategic/systems level, integration has significant utility and challenges for self-insured organizations whether as an individual entity or a multi-employer trust. At this level, a key component is the ability for the various vendors to cross-communicate on these types of patients. This involves the ability to do data mining to identify the patients, having an intensive case management behavioral health specialist to be the point person, regular communication between the TPA, pharmaceutical vendor, medical utilization review, behavioral health utilization review and the medical/psychological personnel responsible for treatment. An obvious challenge is getting buy-in from all of these stakeholders. There is no incentive other than good patient care for any of these groups to cooperate with each other. To rectify this, incentives would need to be financial or contractual. Employers have leverage on the contractual side as it is their health benefit and their money. At the time of this blog, there are case-studies of organizations moving this direction; however, specifics are a long way from full integration due to the complexities required.
I would welcome your discussion and wisdom on this issue.
Have a day filled with extending loving kindness to all those you encounter,
Robert A. Mines, Ph.D., CEO
Most companies throughout America fall into one of many different industry segments, with each segment typically having a non-profit association that provides support and disseminates industry information to its members.
Associations are typically nationally run, some by outside organizations, with their members located throughout the country and sometimes Canada and Mexico. Some associations have sub-segments that create even more special or focused associations, such as a health association that also has heart and prenatal sub-associations. Associations provide companies with the opportunity to talk and meet on various topics and issues that they run into, helping them grow their business by better understanding opportunities.
MINES and Associates is a business psychology firm that specializes in behavioral health care– or more specifically mental health, substance abuse, and psychotropic drug usage. I just attended the annual Self Insurance Institute of America’s Annual Conference in Chicago where companies come together to talk about health insurance benefits. Participating in these associations and conferences is extremely beneficial as we are able to learn about and determine the types of products and services that employers need for their employees.
While employee deductibles and copayments have increased consistently over the last couple of years, the services provided are improving. Employees are getting more for their money. Specialty health care is able to focus on a specific health issue and address it with unique drugs and care. What this means to the employee is quicker recovery and less time spent in doctor’s offices.
MINES Behavioral Health Case Management is a perfect example. Behavioral health issues are typically treated by health care workers who spend up to 90% of their time on medical and surgical issues. They don’t have the experience and knowledge of mental health issues to effectively provide the best treatment possible. We are seeing our business grow as employers add MINES’ behavioral health care expertise and network of qualified providers to their benefit plans.
With 30 years of experience and over 50,000 providers in our network, MINES knows Behavioral Health. We are constantly learning and improving our offerings to our clients. If your company doesn’t offer you some of the behavioral benefits noted above, ask your HR Department to look into MINES & Associates.
Senior Sales Executive