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Areas of Experience/Expertise
Public Sector Behavioral Health
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 100,000 lives.
Some of the program highlights and accomplishments are:
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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 has been chosen as the Behavioral Health Managed Care
partner by Blair, Bedford/Somerset, Franklin/Fulton, and Lycoming/Clinton
Counties in Pennsylvania. The programs are slated to begin operations on July
1, 2007. Plans for this expansion are to create new satellite offices located
within targeted counties. Each satellite office coordinate specific county
needs with our Capital Area Operations Center.
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 three counties across the state
of Pennsylvania with membership of approximately 30,000.
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:
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Network development
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Credentialing and re-credentialing
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Utilization management
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Quality improvement
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Delegation oversight
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Program expansion: Program expansion is underway in four
counties in Ohio and is slated to go live in January, 2007
Unison Health Plan Program
Effective November 1, 2006 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 new program covers approximately 30,000 lives in Pennsylvania
and Ohio.
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