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Blue Cross to
manage behavioral health care
(April 2005
Issue)
By Phyllis Hanlon
Blue Cross Blue Shield of Massachusetts (BCBSMA) announced that
it would assume management responsibility for its local behavioral
health members. Those members were previously under Magellan Health
Services' supervision.
Blue Cross Spokesperson Susan Leahy says, "This decision is the
result of a yearlong review process. As a behavioral health strategy,
it makes sense to integrate with medical health services, since
we have a disease management program." She emphasizes that this
resolution is not reflective of past issues regarding claims rejections.
"Blue Cross is very pleased with Magellan's performance," Leahy
says. "Their overturn rate has decreased substantially."
During the next 12 months, Blue Cross will contract with behavioral
health providers to ensure a smooth transition. "We'll work with
Magellan providers who see our managed care members and work on
developing a provider network," Leahy says. She reports that provider
reaction to the change has generally been positive. "We underscore
in all our communications with providers that it's just local managed
care members that will be affected," she says. Leahy anticipates
a "seamless transition."
Barbara Leadholm, general manager for Magellan's Massachusetts
Care Management, echoes Leahy's sentiments. "The Blue Cross decision
is based on internal business priorities, but they are pleased with
Magellan," she says. "We intend to collaborate as we always have."
By using consistent approaches and processes, the transition should
be blind to provider and minimize any disruptions for the client
and the provider. "One part of the agreement is to make sure that
the networks are similar," Leadholm says. She indicates that although
Magellan will no longer have oversight of the local HMO product,
the company will still manage other members throughout New England.
According to Leadholm, clinicians have voiced a range of opinions
on this decision. "We've had a very positive working relationship
with many clinicians. Many of them were surprised and are trying
to understand what's behind it [the decision]," she says. "Most
are optimistic that it'll be minimally invasive."
Future effects of this new process are hard to predict, Leadholm
says. "In our experience, many health plans find that Magellan is
an effective partner. Some health plans will develop an internal
unit and then ask Magellan to come back for whatever reason. We'd
love for that to happen with Blue Cross. Our intention is to keep
all options open. We have enjoyed a good relationship with Blue
Cross. We've fostered that relationship by delivering good services
for the provider community."
Kalman M. Heller, Ph.D., of Needham Psychotherapy Associates, says
that Blue Cross's policy change is consistent with the actions of
other area insurers. "Apparently some companies are beginning to
recognize what many of us have been claiming for years - that the
overhead costs of micromanaging mental health services is no longer
good business. The big savings from many years ago are gone, i.e.,
the abuse of inpatient services," he says. Heller adds that Magellan
has evolved into a "reasonable organization to deal with."
Heller believes the adjustment will have little or no effect on
patients. "The impact on providers, of course, is unknown. BCBS
has generally run a smooth ship and has a history of modest but
regular cost-of-living-adjustment increases so I would expect that
to continue. The unknowns are in regard to fees (rumored to be increased)
and the authorization process," Heller says. "Bottom line - I don't
expect any problems, perhaps even some small improvements."
The transition will take place no later than Jan. 1, 2006, according
to Leadholm. Leahy says that the change will affect 460,000 members.
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