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Public Sector: Managed Care Experience
CBHNP provides behavioral health managed care services for Medicaid and Medicare
Members across Pennsylvania and has recently expanded into Ohio. CBHNP provides solutions to the
public sector including state Medicaid programs and to Physical Health Managed Care Organizations
(PH-MCO) that serve the Medicare/Medicaid dual eligible population.
CBHNP tailors behavioral health care programs to meet the unique priories and program goals of state, county,
PH-MCO, and other public agencies. Our flexibility to meet the delivery system challenges of the public models
can be seen in the products CBHNP has developed for our clients.
To learn more about CBHNPs partnerships and program designs for the public sector, just click on a link below or scroll down the page.
CBHNP serves as the behavioral healthcare subcontractor for the Pennsylvania HealthChoices Medicaid Managed Care
Program in the Capital Area. Counties under contract in the Capital Area include Cumberland, Dauphin, Lancaster, Lebanon, and Perry.
In partnership with Health America and the Capital Area Behavioral Health Collaborative, CHBNP provides care management, Member services,
utilization review, provider relations, and quality improvement initiatives on a fully capitated basis. Services include a full range of
child and adult mental health and substance abuse services.
CBHNP began this partnership in October, 2001 and the program covers over 105,000 lives.
Some of the program highlights and accomplishments are:
- Care Management for Children’s Services: Changes in the structure of care management for children has improved service and increased
efficiencies and resulted in new care management positions that focus on specific treatments, specialized trainings for providers, and
presentations to parents new to the system.
- Specialized Care Management – This initiative focuses on specific treatments such as autism evaluation, referral, and treatment and children requiring
Residential Treatment Facilities and Crisis Residential Host Home services.
- Specialized Evaluator Training – This training is for licensed Psychologists or Psychiatrists to create comprehensive best practice evaluations,
provide recommendations for services, direct treatment planning, and goal development, and serve as a member of treatment teams.
- Parent Series – These presentations are for parents that are new to the system or want more information about the types of available treatment/services.
These are presented collaboratively with parents of children in services.
- Children’s Outcomes Monitoring Program: CBHNP and the University of Maryland-Baltimore developed this monitoring program to assure
that authorized services provide the highest quality of care to children. With the assistance of provider agencies offering two distinct levels of care, the
monitoring system called KIDnet was developed. This new system reports program performance and evaluation using collected treatment process data
while providing specific clinician and provider aggregate data.
- Care Management for Adult Services: Changes in the structure of care management for adults has focused on improved training and
incorporation of recovery principles and enhanced care management approaches for individuals experiencing multiple and/or repeated service needs. Improved access to ambulatory
follow-up care and increased performance improvement projects are the results of these efforts.
- Consumer Input: Consumer and family input is important to CBHNP to improve the care of our Members through Consumer membership in internal
committees or groups designed to gain specific input for services.
- Stakeholder Steering Committee – This Committee consists of CBHNP staff, Members, family members, advocates,
and providers. The Committee focuses on HealthChoices topics and collects and shares information to help CBHNP provide better care. For example their recent focus has been on
recovery and what CBHNP can do to ensure a recovery oriented system of care.
- Autism Advisory Group- This group was convened to explore parents concerns about availability of appropriate
care and ways to ensure timely access of services. With parents input, CBHNP improved community
education and helped parents better navigate the behavioral health system.
- Performance Improvements: Fully developed utilization management and quality improvement programs have been designed to meet
all regulatory and accreditation standards.
North Central Region Program
CBHNP expanded into the NorthCentral Region of Pennsylvania’s HealthChoices Program to provide behavioral health managed care services to the Medicaid
population in Blair, Bedford, Clinton, Franklin, Fulton, Lycoming and Somerset Counties. The programs began operations on July 1, 2007 and covers over 75,000 lives.
With CBHNP’s extensive experience in the HealthChoices Capital Area program, the transition to managed behavioral health care for the new counties was very successful.
The goals of the Office of Mental Health and Substance Abuse Services (OMHSAS) to improve access for Members, provide high quality services, and offer cost-effective treatment
and administration through a managed care approach, were met and exceeded by our mission driven philosophy to deliver high quality, cost efficient services 24 hours a day,
7 days a week to ensure uninterrupted coverage to the consumers of care.
Gateway Medicare AssuredSM Program CBHNP has partnered with Gateway Health PlanSM since January 2006 to provide the behavioral health services for their Medicare Advantage Plan,
Medicare AssuredSM which is a Medicare/Medicaid (full) dual eligible HMO program. The Plan currently covers twenty four counties across the state of Pennsylvania and four
counties in Ohio with membership of approximately 25,000.
CBHNP provides network development, 24/7 care management, Member services, utilization review, provider relations, and quality improvement initiatives to Gateway Members.
Some highlights and accomplishments of the program are:
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A joint Quality Improvement-Utilization Management Committee: This Committee meets monthly to review policies and procedures that impact all areas
of operations including:
- Network development
- Credentialing and re-credentialing
- Utilization management
- Quality improvement
- Delegation oversight
Unison Health Plan Program CBHNP entered into contract with Unison Health Plan to provide after-hours, weekend, and holiday coverage for Unison’s Medicare/Medicaid dual
eligible HMO program. CBHNP provides telephonic Member assistance including admissions and utilization management for Inpatient Services. This program covers over 55,000
lives in Pennsylvania and Ohio.
Unison Health Plan selected CBHNP as their partner because of our reputation for providing seamless, behavioral health services to the public sector and our commitment to quality
that has been embraced throughout the organization.
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