Provider Networks

Creating Clinical Pathways Through Provider Networks

Bob Holm
Richard Brown
Linda McKinnon

Managing DCF SAMH Services to Create Systems of Care

Lucia Maxwell
PowerPoint | Alt. Models
October 9, 2009

Managing entities (ME)s as vehicles for the delivery of Evidenced-Based Practices (EBP)s (PowerPoint | Handout)

DCF Behavioral Health Contracting and Reimbursement: Current State Policy, Impact in Communities; April 2006 (PowerPoint)

Contracting with Community Managing Entities (PowerPoint)

DCF System Conversion and Medicaid Managed Care: The impact on provider contracting and reimbursement (PowerPoint)

PDF document taken from paper distributed by DCF on June 30, 2005

PDF - Summary of DCF Managing Entities Work Group Meeting

PDF - Additional DCF First Guidance Regarding Managing Entities/ Provider Networks

Consultant Resumés

• Barbara C. Corbett
  Consultant available with expertise in HMO/ PPO contract negotiation, Messenger Model negotiations for provider networks, Infomation Systems for provider organizations, establishing networks as Medicaid billing agents, and Tools for utilization management
  
  
• Thomas Lucking
  Thomas Lucking has provided training and technical assistance to the State office, provider networks and local agencies in Florida over the past 10 years. He specializes in helping behavioral health systems and providers address the organizational dimensions of Transition. Areas of expertise include: network development, clinical pathway development, planning, marketing, and profitability improvement. Thomas Lucking has provided behavioral health consultation services in 28 states as well. Previously, he was CEO of a large provider agency in Michigan

Thomas Lucking is a behavioral health consultant who has provided services in more than thirty states. He has facilitated the development of networks and reviewed the functioning of networks in many of these states. The questions included in this PDF document have been posed to him by those interested in behavioral healthcare networks.

PDF document summarizes recent legislation relevant to Provider Sponsored Networks, the benefits of PSNs, and FADAA's endorsement.

Want to know what’s going on with managed care and network development, in your district and across the state? Want to join discussions about clinical best practices in network service delivery systems? Join the password protected, threaded discussions on the FADAA web site: “Sharing the Tools to Success - Provider Sponsored Networks.” You can post a question or a statement, and come back later to check the responses from other FADAA members.

PDF Document provides sample questions.

District 8 Behavioral Health Network Readiness-Assessment and Recommendations
Thomas E. Lucking, EDS
August 2003

PDF document: District 8 is one of three Florida Districts piloting different methods to improve publicly-funded behavioral care services. The District 8 Pilot features the development of a provider-sponsored network that is augmented by an administrative services organization. The consultant reviewed documents that described District 8 service and payment trends and the development of the network. On June 9, 10, and 11 of 2003, he visited network providers, interviewed District 8 staff members, and met with representatives of network member organizations. This report describes the network’s readiness and presents recommendations for consideration by the Florida Department of children and Families (DCF), District 8, and providers.

Evaluation of Florida’s Mental Health and Substance Abuse System Redesign Strategies: Year 1 Report
Neil Jordan Ph.D.
Julienne Giard M.S.W.
Pat Robinson M.S.W.
Rebecca Larsen M.S.P.H.
Mary Rose Murrin, M.A.
June 2002

PDF document: Under contract with the Department of Children and Families (DCF) and in accordance with the requirements of Senate Bill (SB)1258, the Louis de la Parte Florida Mental Health Institute (FMHI), University of South Florida, is conducting an ongoing formative evaluation of the financing strategies authorized to be implemented by the legislation. The demonstration sites that were selected were DCF District 1, including Escambia, Okaloosa, Santa Rosa and Walton Counties and DCF District 8, including Charlotte, Collier, Glades, Hendry and Lee Counties. FMHI’s role is to help identify the most effective methods and techniques used to manage, integrate, and deliver behavioral health services as specified in the legislation. This report describes the progress achieved during fiscal year (FY) 2001-2002.

Evaluation Results of the Prepaid Mental Health Demonstration: Year 7 - Areas 1 and 6
David L. Shern, Ph.D. and the Evaluation Team
Louis de la Parte Florida Mental Health Institute
August 4, 2004

PowerPoint presentation is a briefing for the Substance Abuse and Mental Health Corporation.

PDF document from the Central Florida Behavioral Health Network poses 12 questions to consider in designing a Provider Sponsored Network.

PowerPoint presentation: CFBHN presentation from the FADAA conference in August, 2004.

PDF document summarizes CFBHN status as evaluated by the 2000 CSAT Technical Assistance Report, OPPAGA's 2001 report, and ASO development progress toward 2003 goals.

PowerPoint presentation is an overview of legislation relevant to Provider Sponsered Networks, the definition of a Network, Network benefits, core administrative functions, and more.

PDF document examines board membership vs. network membership vs. contracting.

Managed Care Organizations and Provider Networks: Challenges and Opportunities
Neal Cash, CEO
Community Partnership of Southern Arizona
November 7, 2003

PowerPoint presentation is an overview of the Arizona model of managed care and the challenges overcome to design the first public sector full-risk behavioral health care system in the United States.

PDF document: An important benefit of a behavioral health network can be the improvement of services delivered across disabilities. Developing improved services across disabilities requires recognition of different developmental issues, purchaser mandates, and consumer needs.

Substance Abuse and Mental Health: Network Design
Celeste Putnam, Deputy Secretary
Substance Abuse and Mental Health, Department of Children and Families

PowerPoint presentation summarizes the benefits of an integrated system of behavioral health care for DCF clients and Medipass recipients.

Implementation of SB 2404: the Managed Care Timetable

PowerPoint presentation reviews the policy issues and provisions of the Florida Legislature's SB 2404.

PDF document summarizes SB1258 in under three pages.

Evaluation of Florida's Medicaid Prepaid Mental Health Plans: Year 6 Report
David L. Shern, Ph.D. and the Evaluation Team
Louis de la Parte Florida Mental Health Institute
June, 2003

PDF document: For the past six years, under contract with AHCA, the Louis de la Parte Florida Mental Health Institute (FMHI), has conducted a series of integrated, multi-method evaluation projects designed to assess the effects of the Prepaid Mental Health Plan (PMHP) demonstrations on access, cost, quality, and outcomes of services relative to alternative managed care arrangements, and to the traditional financing arrangements that are in use in the rest of the state.

New State Initiatives in Medicaid and DCF Financing & Contracting

PowerPoint presentation is an evaluation of system changes mandated by the Florida Legislature, including MH/SA integration and inclusion of HMOs.

Contracting with HMOs

PowerPoint presentation summarizes the history of substance abuse versus mental health treatment and how current trends in treatment affect delivery of substance abuse services, including inpatient (PHP) vs. intensive outpatient programs (IOP).