Health Plans

Mixed Management of Mental Condition Benefits

Reduce Claims and Administrative Costs by Providing Consistent Integrated Mental & Medical Condition Products

Medical health plans currently operate on the assumption that physical and behavioral claims in members who have medical and mental health conditions do not interact. Further, they consider mental condition costs insignificant when compared to medical claims costs (4% versus 96% of their claims costs). For this reason, medical health plans contract for medical benefits yet allow independent contracts for behavioral health management of services for the same members. In the current reimbursement environment, independent physical and mental health business practices, whether carved-in or carved-out, do not capture the substantial claims cost savings potential created by integrating internal medical and behavioral work processes and a payment methodology that supports outcome changing mental health care in the medical setting.

If this describes your situation...

• Part of behavioral health claims are adjudicated internally (carved-in) and part are independently adjudicated by managed behavioral health vendors (carved-out)
• There is a desire to internally manage all behavioral health claims using integrated business practices

...Ways that Cartesian Solutions, Inc.™ can help in addition to assisting with internal integration of physical and mental condition business practices

• Use internal medical health plan claims data to assess lost opportunity for members insured by medical products with behavioral health claims adjudicated through external vendors
• Assist in actuarial projections for pricing of medical products when behavioral health is adjudicated through internal and integrated work processes based on "total" health-related costs (medical, mental health, and pharmacy)
• Establish the stepwise process through which externally managed behavioral health claims can become a part of internally integrated physical and mental condition business practices and then integrated with medical benefits
• Provide complexity-based integrated care management training and implement integrated medical and behavioral work flows
• Provide supervised project management during the transition process

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