Health Plans

Carved-Out Mental Condition Benefits

Reduce Total Claims and Administrative Costs by Insourcing and Integrating Mental Condition Benefits with Medical Benefits

It is not possible for general medical health plans to capture total claims cost reductions from integrated service delivery support, especially in members with the highest health service use, unless they "own" and manage the behavioral health business on all members as a part of their medical insurance products, including claims adjudication. For health plans that still carve-out their behavioral health business, Cartesian Solutions, Inc.™ experts can help them insource and then integrate physical and behavioral health benefits and associated business practices during a phased transition. Through Cartesian Solutions, Inc.™ transition support, it is possible to bypass the common yet unnecessary step of creating an independent "behavioral health product" internally. The general medical health plan can proceed directly to a consolidated physical and behavioral health product (see Table below), saving both administrative and claims costs in the process.

Independent versus Integrated General Physical and Mental Condition Care Delivery & Payment Practices for Discrete Members
	Independent	Integrated
Health System
Interaction of Physical and Mental Health Systems	little	uniform
Health Plans
Patients Identifiers	separate	single
Payment Pool	two buckets	single bucket
Contract Benefit Descriptions	disparate	unified
Network of Providers	medical vs. mental health	all in one
Member and Provider Support	separate call-in #s	one call-in #
Approval Process	disparate	uniform
Case Management Support	discipline specific	cross-disciplinary
Coding and Billing	separate payment rules	consistent process
Claims Adjudication	separate processes	unified on a single server
Data Warehousing & Actuarial Analysis	segregated	consolidated
Clinical Care
Practice Locations	separate	co-located
Services Delivery	segregated	integrated
Clinician Collaboration and Communication	rare	routine

If this describes your situation...

Contract with one or more external behavioral health vendors for management of behavioral health claims
Do not include behavioral health in any general medical insurance products

In addition to performing the assistance noted in the bullets for health plans in general, Cartesian Solutions, Inc.™ can help

Shorten insourcing and integration time by

Trunkating the development of a transition plan
Providing ongoing support to an internal project manager
Streamlining organizational and work process changes

Avoid costly mistakes during the transition process
Maximize health enhancement for health plan members and total health cost savings for the health plan

(It should be noted that when general medical health plans are considering closing their association with an independent managed behavioral health organization (MBHO), they most often do not wish the MBHO to know that they are considering doing so. Cartesian Solutions, Inc.™ can assist the general medical health plan discretely perform its opportunity assessment and develop a transition plan, if desired. It has the behavioral health expertise to help internal "medical" personnel gain the needed knowledge base to be able to assume accountability for the integrated product. It can also train and guide needed "new" behavioral health hires as they partner and assume leadership positions with general medical colleagues while implementing a "total health" offering. Transition to an integrated system is a several year process, which affects virtually every division in a health plan.)

For more information or to set up an appointment contact: Mary Kathol, Director of Project Implementation.

Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com

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