Drug overdose deaths may be on the decline in parts of the U.S. for the first time in years, but the opioid epidemic is far from over. Contributing to the epidemic’s complexity is payers’ refusal to comply with state and federal parity laws and barriers to access medications for opioid use disorder (MOUD), according to […]
An unknown suspect fatally shot the CEO of major health insurer UnitedHealthcare on Wednesday. Brian Thompson, who was named CEO of UnitedHealthcare in April 2021, was shot at approximately 6:40 a.m. outside of a hotel in Midtown Manhattan, according to an NYPD press conference. Law enforcement described the attack as “brazen, targeted” in the press […]
The Centers for Medicare & Medicaid Services has prioritized equitable behavioral health care access, proposing a new rule to cap behavioral health costs for Medicare Advantage members. The proposed rule, scheduled to be published on Dec. 10, would require that Medicare Advantage in-network cost-sharing for mental health and substance use disorder (SUD) care not exceed […]
Lack of behavioral health parity has extreme consequences for patients. The inability to find in-network care for these services requires patients without the means to pay for health care out of pocket to forgo care or make “really tough life decisions.” “We’ve [heard] stories of members having to lose their homes because they have to […]
Behavioral health is a relatively young industry, which means providers are still hammering out how to produce the most productive long-term relationships with payers and investors. “There are headwinds in this business,” Daniel Krasner, chief marketing officer at Summit BHC, said at the Behavioral Health Business INVEST event this October in Dallas. “We can’t tell […]
Behavioral health’s odd-duck status requires a unique approach to the payer-provider dynamic. Historic challenges have demonstrated that payer-provider negotiations and partnerships require an approach fundamentally different from other types of business, even other health care segments. Often, involved parties need to alter their expectations to reflect reality instead of a vision of the future. For […]
Traditional fee-for-service reimbursement arrangements may be leading to increased costs for payers. That’s according to new findings from value-based care provider Cityblock Health, published in NEJM Catalyst. The study found that Medicaid and dually eligible patients enrolled in Cityblock’s behavioral health program exhibited an 11.5% decrease in total cost of care and a 19.7% decrease […]
The ongoing need for behavioral health services will be no surprise to anyone involved in the industry. Patients continue to have high rates of need and often present with greater acuity. This demand for behavioral health services was reflected across payers’ Q3 earnings calls. The result? Sky-high utilization levels. For example, David Cordani, the CEO […]
In 2015, the Centers for Medicare and Medicaid Services (CMS) reversed a longstanding policy that barred the use of federal Medicaid money for patients residing in addiction treatment and mental health facilities with more than sixteen beds. The policy switch was intended to better help people in facilities with substance use disorder (SUD), particularly those […]
Virtual pediatric behavioral health provider Fort Health is executing its partner-first, expand-after strategy, securing a round of funding while landing a new payer partnership. The New York City-based provider raised a $5.5 million round led by venture capital firms Twelve Below and Vanterra, Fort Health exclusively told Behavioral Health Business. The funds will be used […]
