Behavioral Care Management
The old ways are less effective in today's environment. The behavioral health care market needs new strategies that coordinate and combine the best of traditional utilization management approaches with innovative, emerging solutions.
Magellan Behavioral Care Management does just that.
Designed to promote our members' behavioral health and wellness while containing costs for our customers, our proactive approach treats the whole person, fully integrating for the first time care for both the mind and body.
Key features of our program include:
- Collaborating with medical insurers to coordinate and integrate behavioral health care with medical care
- Coordinating access to a full continuum of mental health and chemical dependency services, with care delivered in the most clinically appropriate, least restrictive settings
- Managing provider practice patterns to monitor quality and reduce administrative costs
Our program goals include:
- Controlling costs and maintaining quality by reducing unnecessary or inappropriate behavioral health care through evidence-based medical necessity determinations.
- Improving medical integration at all levels of the behavioral health care treatment experience.
- Identifying members at risk for behavioral problems due to corresponding medical conditions, illnesses and/or family members demonstrating similar behavioral health problems.
- Supporting customers' accreditation efforts and improving their scores (URAC).
The Fundamentals: Care Management & Claims
When a member calls us, they speak with a compassionate, professional care manager. These licensed mental health clinicians are responsible for the assessment and referral process and all treatment authorizations. By providing easy access to care, matching patients with the most appropriate providers, and coordinating and facilitating the transition from one level of care to the next, our care managers help deliver more positive outcomes.
Once care is delivered, Magellan continues to provide service on the back-end through claims payment. We regularly meet or exceed standards for claims timeliness and accuracy.
Medical Economics
A unique way in which Magellan is approaching behavioral care management is through the analysis and identification of actionable information to effectively manage care and improve quality outcomes. Magellan's Medical Economics Unit uses predictive modeling to calculate early on who will be heavy service users.
The use of medical economics means a more expedient return of the member to an increased level of productivity, more appropriate consumption of benefits, and an overall increase of behavioral health care ROI.
Prevention & Coordination
An early leader in prevention programming, Magellan's medical and clinical staff collaborates with health plans and employers to analyze the population, understand its unique needs and then develop and implement programs to meet those needs.
We reach out through our award-winning educational materials to members and primary care physicians to facilitate understanding and improve coordination of care. We stress screening to catch problems early, before they develop to a severity that has a negative impact on quality of life and increases the overall cost of care.
Intensive Care Management (ICM)
Another core element of Magellan Behavioral Care Management is our focus on supporting acute patients. By targeting high-risk members, ICM focuses on helping them achieve and maintain the proper treatment. Recent data from our ICM Outcomes Study show that members' functional health improved significantly within the first 60 days of treatment.
Experienced care managers, timely and accurate claims payment, effective use of data, prevention programs and intensive care management make Magellan Behavioral Care Management stand apart in the industry.