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Case Study
Integrating Behavorial and Medical Health
Averaging more than 15 years of experience in the healthcare industry, our consultants have worked in a variety of management positions within commercial and government payer organizations, so we understand first-hand your challenges—including competitive pressures, organizational obstacles, and limited resources.
Case Overview:
A mid-sized, provider-owned payer decided the best way to integrate behavioral health with medical care was to insource its behavioral health services and develop more seamless workflows and care coordination. The payer asked one of the most experienced consultants at Change Healthcare Consulting, a consultant with more 20 years of experience running operations at both behavioral and medical healthcare organizations, to lead the effort to launch a new line of business. This engagement included standing up a new call center, establishing standard operations/processes (enrollment, claims processing, customer service, clinical services, appeals and grievances, etc.), developing all policies and procedures, hiring and training staff, and implementing the new operations using the client’s existing technology platforms.
Challenges:
The client outsourced all behavioral health functions for more than 10 years, so there was little behavioral health expertise in-house. This was a significant challenge when defining business requirements, developing integrated processes, and updating systems to support the new line of business. Hiring and training new staff was also a challenge, given the client’s limited knowledge of the behavioral health business. Lastly, migrating the business from the vendor’s system to the client’s systems proved difficult due to data integrity and interoperability problems.
Solutions:
The Change Healthcare Consulting team filled key knowledge gaps and helped the client document business requirements, train staff, and update systems to support the new line of business. The Consulting team also bridged the gap between the client and vendor to help overcome the data and interoperability challenges through coordination, communication, and execution. By solving key problems, Change Healthcare Consulting was able to help the client launch the new inhouse Behavioral Health line of business with no negative impact to service and performance standards.
Results:
The client’s behavioral health line of business was successfully insourced, went live on the goal date, and is now fully operational. Insourcing the Behavioral Health unit will strengthen the health plan’s ability to care for its members more comprehensively.
