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Special Report
Contracting for Public Mental Health
Services Opinions of Managed
Behavioral Health Care Organizations
Implementation
and Ongoing
Administration
Focus group participants reported that many public payers view
the payer’s role in administering managed behavioral health
care programs as one of policing the MBHO. They endlessly
search for contract requirement violations through constant data requests
and surprise audits. In addition, agency staff may require significant
amounts of time from the MBHO management team, distracting the
MBHO staff from the work at hand.
Focus group participants believed that
some payers see vigilant monitoring and
punitive sanctions as the keys to a successful
program. However, they pointed to payers
who approach the contracted MBHO as a
partner as the agencies most likely to be
satisfied with contractor performance.
Arkansas, Iowa, Colorado, Massachusetts,
and Maryland all emphasize such a close
collaborative approach. This philosophy
produces a problem-solving atmosphere and
an environment in which both payer and
MBHO try to accommodate the needs of
the other. In Massachusetts, the payer has
daily face-to-face encounters with the
MBHO staff, reflecting a close collaborative
approach to program management rather
than one characterized by authoritative
supervision.
At the start of a new public sector program,
MBHOs frequently confront a public
payer that underestimates the time and management
expertise needed by the State or
local staff to manage the program. Management
tasks involve working with the MBHO
to develop necessary administrative procedures
and to ensure that implementation
tasks are prioritized appropriately and completed
effectively. Payers also must work
with or respond to questions from other
agencies, providers, and stakeholder representatives
on issues relating to the program
roll-out. The public payer should view startup
and implementation activities as a major
project management challenge. They should
ensure that the agency project director has
sufficient management experience to take on
the task. To better understand staffing needs
during start-up and after implementation,
the agency can interview other public payers
with similar programs.
According to study participants, part
of the skill of an effective project manager
entails the ability to identify priorities.
Contractor oversight during the initial
stages of implementation should focus on those areas most indicative of the program
essentials: Can consumers access services?
Are as many individuals receiving services
now as before the program? Are providers
being paid? Are phones being answered?
The representatives suggested that public
payers cannot expect 100 percent compliance with every requirement beginning on
the first day of the program. Agencies often
fall into the pitfall of focusing attention on
any requirement not being met immediately.
Addressing that requirement at the start
may distract MBHO staff from more fundamental
activities.
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