How Lucet, Brave Health, Groups Recover Together See Population Engagement in Value-Based Care

Value-based care efforts in managed care that involve behavioral health could lead to better savings and health outcomes across entire populations. But to get there, payers should expect to spend more on behavioral health, and providers should expect to increase patient engagement. “There’s been a point of recognition that more behavioral health care is better,” […]

New CMS Demo Could Help Incarcerated Individuals Get More SUD Care

The Centers for Medicare & Medicaid Services (CMS) is rolling out a new demonstration that could help expand access to substance use disorder (SUD) services by allowing state Medicaid plans to cover incarcerated individuals before release. Specifically, the demonstration allows state Medicaid programs to cover a package of pre-release services up to 90 days before […]

Ophelia, CareSource, Gateway: Investing in Community Can ‘Start Moving the Needle’ on SUD Treatment

Community support often falls outside of the addiction treatment-managed care fee-for-service paradigm. Payers and providers alike know the importance of fostering community in addiction treatment, and it’s a key to effective treatment and long-term recovery. However, developing communities fall far beyond their typical scope of services. Regardless, innovations around managed and value-based care seek to […]

Which States Have the Most Behavioral Health Medicaid Benefits

The bulk of state Medicaid programs cover services to treat substance use disorders (SUDs) and outpatient services, but few cover crisis care services. That’s according to a new report by the Kaiser Family Foundation (KFF), which included survey responses from 45 states about their health benefits. In the survey, KFF provided state Medicaid officials with […]

How Point32Health Is Pioneering Autism, Substance Use Disorder Value-Based Contracting

Nonprofit health plan Point32Health is prioritizing integrated care and value-based contracting as part of its overall behavioral health strategy. The payer is doing this through partnerships and in-house integration between mental and physical health providers. Specifically, Point32Health has inked value-based contracts focused on autism and substance use disorder (SUD) care, and it plans to expand […]

Senators Call Out Aetna, Anthem BCBS, Humana, United Healthcare for Mental Health ‘Ghost Networks’

A bipartisan group of senators has called out large payers for their mental health “ghost networks,” which provide an inaccurate list of in-network providers. “Ghost networks” often list providers no longer in-network, accepting patients, or having closed their practice. The lawmakers noted that ghost networks could lead to mental health access issues and make it […]

CMS Singles Out Behavioral Health in Plan to Streamline Payment Between Primary Care, Speciality Care

The U.S. Centers for Medicare & Medicaid Services (CMS) is looking to streamline primary care-specialist care integration, which could make it easier for behavioral health providers to get paid. Medicaid programs may now directly pay consulting providers for interprofessional consultations, even when a patient is not present.  CMS informed state health officials of the new […]

3 Behavioral Health Medicaid Trends to Watch

Changes to Medicaid in 2022 repositioned behavioral health’s relevance to the program — and its importance to the behavioral health industry.  Medicaid is the single-largest payer of mental health services in the nation. And changes to the public health plan for vulnerable populations may further alter the business landscape, industry insiders believe. Medicaid, a collaboration […]

Behavioral Health Benefits Remain Key Focus for Medicaid Programs

State Medicaid programs continue to expand behavioral health benefits, especially for specific high-needs populations. Several states have rolled out new behavioral health benefits or enhanced existing ones. All the while, no states have plans to restrict behavioral health benefits during fiscal year 2023, according to a new survey of state Medicaid leaders from the Kaiser […]

Clarity on Digital Therapeutics Reimbursement Could Lead to More Behavioral Health Adoption

After years of reimbursement uncertainty, the digital therapeutics industry is beginning to see newfound clarity. Within the last year, digital therapeutics, which are evidence-based treatments delivered through software interventions to treat or manage a condition, have made inroads with both commercial insurers and Medicaid. Earlier this year, state Medicaid programs in Massachusetts and Oklahoma announced […]