Ask the Consultants

Improving Relationships - Develop personal relationships with MCO staff making decisions about referrals and authorizations. Just as trust is critical in our personal relationships, it's also important in business relationships. Schedule meetings with the MCO staff or better yet take them to lunch. Educate them about your internal controls, interest in cost controls and patient satisfaction. Let them know your focus is on providing the best care possible at the lowest possible cost. This will be a great opportunity to build and improve relationships, and your efforts will pay future dividends. One practitioner reported good success delivering doughnuts to case managers at a company referring clients to him.

Attitude - Recognize you probably have philosophical differences with MCO's and make sure those differences do not surface in your daily communications.

Service - Although MCO's are focused on cost, they understand patient satisfaction and quality are important to purchasers and regulators. Give them some help by setting up your own patient satisfaction program and feedback results to them. The MCO's will appreciate the information.

Contracting With Risk Groups - Don't forget there are other sources for the MCO's business. Many large groups and IPA's have accepted risk for all primary and specialty care. They may have the same concern about mental health costs as the MCO. Approach them the same way you would the MCO.

Taking on Risk - The best way to get the attention of MCO's is to consider accepting "risk" for mental health services. This involves receiving a flat per member per month (PMPM) fee for all the mental health needs of the subscribers. This is often accomplished by the MCO "carving out" mental health from other risk contracts. Do not enter into this process without substantial research. Here are some things to consider:

• Make sure you have some idea about the utilization of the subscriber population.
• Know where subscribers live so you can provide local therapy.
• Consider passing some of the financial risk to your clinicians.
• Don't forget about hospital care and outpatient medication therapy.
• Limit or eliminate your risk for out of area emergency care.
• Consider options to face-to-face care such as increased use of telephone consultations.
• Be aware MCO's will focus on patient complaints in risk arrangements. Make sure clients have access to a complaint line, and resolve all problems internally.
• Consider some level of re-insurance for expensive care.
• Seek assistance from consultants who know the financial pitfalls of this business. It is always more expensive to fix a broken system then set it up right in the first place.

Employee Assistance Programs (EAP) - Although many employers offer limited mental health coverage, EAP's seem to be gaining favor. Consider packaging a program for your MCO to sell as an add-on to employers. EAP's defined benefits reduce your risk, and are an excellent source for private paying patients. As with any risk program there is downside potential, so get help setting up your EAP.