Reimbursement could suffer
Boston Medical Center HealthNet Plan has contracted with Beacon Health Strategies to administer behavioral health programs for its MassHealth and Commonwealth Care members effective March 1. Beacon is inviting providers to join its network, but some providers are dismayed by the lower reimbursement rates being offered.
A licensed psychologist in western Mass., who asked not to be identified, says that compared with what he had been receiving from HealthNet, Beacon’s rate for an initial diagnostic interview was 26 percent less; for a family or couples session, 12 percent less; for an individual session, 10 percent less.
“The dilemma we all face is that these rates are rock bottom, but in this day and age, no one gives a hoot about mental health providers; they’re looking at premiums,” the psychologist says. “This is a significant setback.”
With this partnership, Beacon will manage behavioral health care for three of the five managed care organizations (MCO) used by Commonwealth Care. The other two are Fallon Community Health Plan and Neighborhood Health Plan.
Jennifer Hylton, M.Ed., Psy.D., who runs the for-profit Counseling & Assessment Clinic in Worcester and Fitchburg says Beacon’s lower rates are a problem not only for providers and clinics that have to do the same amount of work, but also for consumers that might drop to the bottom of waiting lists if another client has coverage that pays more.
“The person providing care is going to look at the bottom line dollar, but it’s the needy who won’t have equal access to care. And it puts an ethical burden on the clinic,” Hylton says.
“I don’t want to say we’re not going to see these clients,” she adds. “But we cannot fill our caseload just with them because we need to keep the place open. I try to pay my staff fairly because they need to make a living, too. It would be much easier for us if we were being compensated equally.”
Tim Murphy, MPP, president and CEO of Beacon, says the firm has a good track record attracting and retaining providers having negotiated relationships with more than 1,500 behavioral health providers in Mass., including 200 licensed psychologists.
As part of the new relationship with HealthNet, 332 new providers so far have agreed to join Beacon’s network, and others are having “active conversations” with Beacon as they see about signing on. He says when Beacon offers service agreements to new providers, it looks to the reimbursement structure and administrative and clinical protocols it offers existing providers.
“We are not privy to what contractual relationships HealthNet had with providers,” Murphy says. “As part of our contractual arrangements with 1,500 providers, we’ve obviously come to agreement on the proper rate to pay providers for their services.”
HealthNet would not comment on the switch beyond the letters to members and providers, available on its Web site, bmchp.org. It has 250,000 members.
Murphy says Beacon is attractive to smaller health plans that cater to public payers because it offers the ability to in-source a behavioral health department with the required information technology and sound medical management programs plus an advisory panel of psychiatrists and psychologists.
“We’re exclusively focused on mental health and substance abuse, so we can invest in our clinical programs to improve people’s health outcomes in the most cost effective way possible on behalf of the payers,” he says.
Elena Eisman, Ed.D., ABPP, executive director of the Massachusetts Psychological Association, says that whenever an insurer takes on a new major carve out contract, provider groups try to meet with representatives to address such issues as network membership, access to care and any changes to authorization or medical necessity procedures and/or criteria. Reimbursement rates are off limits, however, because of federal anti-trust law.
Still, she acknowledges, “Reimbursement rates across the board have gone in a negative direction.”
By Nan Shnitzler