I Hate You, I Love You, I Need You: Maximizing Your Relationship With Managed Care Jim Clarkson, MA, LADAC National Director, ValueOptions Grants Management Practice Administrator, ValueOptions Kansas

Mission and Margin

Partnering with Behavioral Health Managed Care

Behavioral Health Managed Care: How We Work Goal: Equitable, efficient, effective and life enhancing systems at all levels. Goal: Equitable, efficient, effective and life enhancing systems at all levels.Remarks: 1) Source Documents 2) Research and Professional Literature 3) Professional and Personal Experience 4) Cognitive analysis and Intuitive Reflection

Components of Most Behavioral Health Managed Care Operations & How to Partner with Each Provider Relations Provider Relations Medical/Clinical Medical/Clinical Finance/Administration Finance/Administration IT IT Claims Claims Recovery and Resiliency Recovery and Resiliency Quality and Compliance Quality and Compliance

Strategies for Partnering 1) Become DSM and ASAM Experts 2) Know your state’s service definitions 3) Develop professional relationships with clinicians doing authorizations/discharge 4) Use the appeals process vigorously 5) Investigate “Preferred Provider” status 6) Develop relationships with different departments

Strategies for Partnering (Cont’d) 7) Offer your expertise when possible/make presentations that are data driven 8) Utilize “Principles above Personalities” 9) Use “person first” language 10) Start with a “walk through” 11) Share your change projects and perhaps invite participation…share status and outcomes.

Creating Environments for Improved Outcomes

How Humans Know Eugene Gendlin, Ph.D., 1972 Eugene Gendlin, Ph.D., 1972 McMahon, Ph.D. & Campbell, 1972 McMahon, Ph.D. & Campbell, 1972 “The felt-sense is an inner knowing that is part cognition, part emotion, part physical sensation, part intuition…it is the fullness of knowing about something beyond just the words…”

Motivational Interviewing & Managed Care Developing Rapport Developing Rapport Developing Empathy Developing Empathy Rolling with Resistance Rolling with Resistance Elicit Change Talk Elicit Change Talk Identifies difficulties and helps to resolve these issues Identifies difficulties and helps to resolve these issues

Research The research of McMahon & Campbell shows that key ingredients in improved consumer services include a non-judging, non-shaming approach, a belief that the client has their own answers and their own unique path before them, an approach filled with compassion, teaching of experiences of awe and wonder as doorways to future possibilities, the teaching of patience to clients to learn and listen to their own inner geography. The research of McMahon & Campbell shows that key ingredients in improved consumer services include a non-judging, non-shaming approach, a belief that the client has their own answers and their own unique path before them, an approach filled with compassion, teaching of experiences of awe and wonder as doorways to future possibilities, the teaching of patience to clients to learn and listen to their own inner geography.

Research Continued Research has consistently shown that the personal qualities of the individual therapist are far more determinant of good outcomes than any particular model used (Luborsky et al., 1986) Research has consistently shown that the personal qualities of the individual therapist are far more determinant of good outcomes than any particular model used (Luborsky et al., 1986) Research also shows that the factors which lead to good outcomes focus on and incorporate client strengths, the development of a strong alliance with the client, and the creation of hope and expectancy (Miller, Duncan, Hubble, 1997) Research also shows that the factors which lead to good outcomes focus on and incorporate client strengths, the development of a strong alliance with the client, and the creation of hope and expectancy (Miller, Duncan, Hubble, 1997) What became clear over time was that far more important than professional credentials were the more subtle characteristics such as a strong desire to work with the clients and a willingness to use a manualized model. (Seeking Safety) What became clear over time was that far more important than professional credentials were the more subtle characteristics such as a strong desire to work with the clients and a willingness to use a manualized model. (Seeking Safety)

Prominent Treatment Centers Review Compassion, Warmth & Welcome Compassion, Warmth & Welcome Accurate Empathy Accurate Empathy Genuineness Genuineness Non-judgment Non-judgment Hope Hope Self-Efficacy and Client Choice Self-Efficacy and Client Choice Cultivating experiences of awe and wonder Cultivating experiences of awe and wonder Cultivating an attitude of gratitude Cultivating an attitude of gratitude Expectant waiting and listening Expectant waiting and listening Structure Structure Accurate information about the process Accurate information about the process

Five Principles of NIATx & Managed Care Understand and involve the customer Understand and involve the customer Understand and involve the customer Understand and involve the customer Fix key problems; help the CEO sleep Fix key problems; help the CEO sleep Fix key problems; help the CEO sleep Fix key problems; help the CEO sleep Pick a powerful Change Leader Pick a powerful Change Leader Pick a powerful Change Leader Pick a powerful Change Leader Get ideas from outside the organization or field Get ideas from outside the organization or field Get ideas from outside the organization or field Get ideas from outside the organization or field Use rapid-cycle testing to establish effective changes Use rapid-cycle testing to establish effective changes Use rapid-cycle testing to establish effective changes Use rapid-cycle testing to establish effective changes

Imagine…

Thank You! Jim Clarkson ValueOptions, Inc. (785)