Category: Reimbursement

Addiction Treatment Business

Addiction Treatment in 2024: Navigating Privacy Challenges, Telehealth Shifts, Reimbursement Reforms

By Morgan Gonzales |
Addiction Treatment Business logo illustrates Ria Health Funding article

The landscape of substance use disorder (SUD) treatment in 2024 was a tapestry of challenges, technological disruptions and unexpected breakthroughs. A staggering data leak exposed the personal information of 100 million patients. Economic pressures forced some SUD providers to retreat from certain state markets, and long-anticipated regulatory changes were once again delayed, leaving the industry […]

Autism Business News

Optum Reportedly Whittling Away at Medicaid Coverage for Autism Therapy

By Chris Larson |
Autism Business News logo for BCBA workforce data story

Optum is reportedly executing a multi-pronged plan to curb spending on applied behavior analysis (ABA) provided to patients covered by Medicaid. The insurer targets its Medicaid-contracted autism therapy networks in Arizona, Nebraska, Tennessee, Virginia, New Jersey, Indiana and Louisiana, according to a report by the nonprofit investigative journalism outfit ProPublica. The plan is a response […]

Commercial

Payers Navigate Behavioral Health’s Confusing, Growing Market

By Laura Lovett |
Speakers at INVEST Dallas

Payer partnerships are essential to successfully scaling a behavioral health organization. However, the landscape of those partnerships is quickly changing as payers deal with an uptick in behavioral health utilization and value-based care contracting grows in popularity. Additionally, payers are increasingly looking for a continuum of services. Historically, payers used a carve-out model for behavioral […]

Reimbursement

Brian Thompson, UnitedHealthcare CEO, Fatally Shot in ‘Brazen, Targeted’ Attack 

By Morgan Gonzales |

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 […]

Regulation

CMS to Limit Medicare Advantage Cost Sharing for Behavioral Health Services

By Morgan Gonzales |

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 […]

Addiction Treatment Business

‘Turbulence’ on the Way for Providers, Payers Post-Parity Ruling

By Morgan Gonzales |
Addiction Treatment Business logo illustrates Ria Health Funding article

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 […]

Reimbursement

‘We’re Just in the Second Inning’: Behavioral Health Providers Navigate Investor, Payer Relations

By Matthew Blake |
Speakers at INVEST 2024

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 […]

Commercial

Fixing the Growing Payer-Provider Divide in Behavioral Health

By Chris Larson |
Behavioral Health Business INVEST panel photo of Oceans Healthcare Forge Health HCSC executives

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 […]

Reimbursement

Cityblock Health Validates Value-Based Care Arrangement with 11.5% Payer Expense Reduction

By Morgan Gonzales |

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 […]