10 Myths of Health Care Reform Infographic

Posted on March 13, 2013 by Linda Ringquist

The Patient Protection and Affordable Care Act (PPACA) is sometimes referred to as the Affordable Care Act (ACA) or Healthcare Reform. This legislation was enacted in 2010 and provides effective dates for specific provision through 2014. 2014 is slated as the year of most significance as healthcare exchanges, for example, become effective. The past few years have been interesting including such events as the debt ceiling being reached, the fiscal cliff of 2012, and most recently the sequestration (across the board spending cuts). What are the conversations floating around the water cooler in terms of Health Care Reform?

Source: hitconsultant.net via HIT on Pinterest

If you need assistance with complying with the ACA, such as URAC accreditation assistance, becoming an accountable care organization, transitioning to managed care, or seeking PCHCH accreditation, please contact us.

BHM Healthcare Solutions – a healthcare management consulting firm

Visit our site: http://www.bhmpc.com/

BHM Healthcare Solutions Assists Western Highlands Network with URAC Accreditation

Posted on January 14, 2013 by Linda Ringquist

Summary: Western Highlands Network (WHN) in collaboration with senior consultants at BHM Healthcare Solutions was recently awarded URAC Accreditation in Health Utilization Management, Health Call Center and Health Network. The 3-year accreditation is a testament to WHN’s commitment to quality and efficiency of healthcare service provision and management.

Western Highlands Network (WHN) was recently awarded a 3-year URAC Accreditation for Health Utilization Management, Health Call Center, and Health Network. BHM Healthcare Solutions, a comprehensive healthcare management consulting firm, provided assistance to WHN that was pivotal in reaching accreditation success. URAC is the largest accrediting body for healthcare organizations and is recognized nationwide. URAC Accreditation is a symbol of excellence and commitment to the responsible provision of quality care.

Western Highlands Network connects the population it serves with mental health, substance abuse, and developmental disability care providers. This organization needed to become a Managed Care Organization (MCO) as specified in the Affordable Care Act. To make this transition, WHN first had to attain URAC Accreditation or it would not be permitted to continue delivering services.

Preparation for the accreditation process began with a comprehensive gap analysis to determine how the organization’s existing standards and practices compared to URAC specifications for the three modules. Using the results of this analysis, BHM’s URAC Accreditation Assistance Team developed a well-defined project plan and worked with the organization’s human resources team to assign specific tasks to a selected team of the organization’s staff members. BHM consultants prepared WHN’s team by conducting similar question and answer sessions they would encounter in the actual URAC surveys. “We are so pleased to have assisted Western Highlands Network reach their goal of accreditation,” states Mark Rosenberg, President of BHM. “WHN has long been committed to excellence,” he continued, “and we know that the new URAC Accreditation corroborates their promise to continue to provide the highest quality behavioral healthcare services.”

Company Info

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including accreditation, financial risk management, clinical operations, quality improvement, and denial management.

BHM Healthcare Solutions Assists Pathways LME (now known as Partners Behavioral Health Management) with URAC Accreditation

Posted on September 3, 2012 by Linda Ringquist

Pathways LME (now known as Partners Behavioral Health Management) partnered with senior consultants at BHM Healthcare Solutions to prepare for accreditation. Consequently, a 3-year URAC Accreditation in Health Network, Call Center and Utilization Management was awarded to them, demonstrating a commitment to efficient and superior provision of healthcare service and management.

Pathways LME, who recently merged with Crossroads Behavioral Health and Mental Health Partners, was awarded a URAC Full Accreditation (3 year) for Health Network, Health Call Center, and Health Utilization Management. BHM Healthcare Solutions, a comprehensive healthcare management consulting firm , assisted Pathways LME to achieve accreditation success. URAC is the largest accrediting body for healthcare organizations and is recognized nationwide. URAC Accreditation is a symbol of validation and excellence for an organization’s commitment to quality and accountability.

In July 2012, the merger between three organizations including Pathways LME, Crossroads Behavioral Health and Mental Health Partners became official. The new organization, Partners Behavioral Health Management will serve as a as a Medicaid 1915 (b)(c) Waiver site and will provide behavioral health management services for eight counties in North Carolina. The merger will allow local management of Medicaid Services and will enable the new organization to apply savings to expand services and to improve system accountability. Further, Partners BHM will be empowered to build partnerships with those being served, with providers and the community to develop a care network focused on local needs.

BHM’s URAC Accreditation Assistance Team, led by Connie Smith, conducted a thorough review of Pathways’ existing policies, procedures, reports, program descriptions and other data against the URAC standards. After detailing a project plan, BHM consultants worked closely with members of Pathways, including Janet Noblett, QM Analyst, to implement changes, where necessary, in order to help prepare for accreditation in the most cost-efficient manner possible. “We are thrilled to have been a part of Pathways LME’s goal of achieving accreditation,” states Mark Rosenberg, President of BHM. “This LME has long been committed to the delivery of quality behavioral healthcare services,” he continued, “and we know that the new URAC Accreditation will reinforce their pledge to continue in their pursuit of excellence.”

The History of URAC

Posted on June 22, 2012 by Linda Ringquist

Original source is the URAC website

URAC is an independent, nonprofit organization designed to promote health care quality through mediums such as accreditation, education and measurement programs. URAC provides benchmarking services which provide a symbol of excellence for organizations to validate their commitment to quality and accountability.

URAC’s mission statement is very simple and straight-forward.” To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.”

In the 1980’s, there was an awareness and concern looming over the lack of uniform standards for utilization review services. Utilization review is defined as the process of organizations making a determination of whether or not a health care service is medically necessary. As a result of this growing concern, URAC set out to improve the quality and accountability of health care organizations using utilization review programs. Many years later, the goal of URAC expanded to cover a larger range of service functions found in health care settings, including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services. Today, URAC accreditation and certification includes over 25 programs.

URAC was setup as an organization independent of any particular stakeholder group. The governing Board of Directors was established with representatives from affected groups such as consumers, providers, employers, regulators, and industry experts. Today URAC consists of more than 300 volunteers and 30 paid staff.

URAC is considered one of the fastest growing health care accreditation agencies world-wide. URAC is constantly reviewing and developing new standards to ensure that all stakeholders are protected.

With the importance and notoriety of URAC accreditation, BHM Healthcare Solutions provides URAC consulting services. A few our areas of expertise are: URAC PCHCH certified auditors, patient centered health care home accreditation, and URAC medical home accreditation. For additional information, please contact BHM Health Care Solutions at 1-888-831-1171 for a free consultation.

BHM Healthcare Solutions’ Service Spotlight – URAC Accreditation Assistance

Posted on June 21, 2012 by Linda Ringquist

BHM Healthcare Solutions is a healthcare management consulting firm serving health care enterprises nationwide. BHM stands for behavioral health management and as such is our area of expertise in healthcare consulting. Some of the services we provide include, but are not limited to, financial improvement, denial management, revenue cycle, physician advisor services, clinical operations/improvement, quality improvement programs, accreditation, behavioral health executive recruitment /interim staffing, and training. Our extremely competent team of healthcare management consultants is composed of experts in our field and we possess a wealth of knowledge and experience which we would like to share with you.

Today’s spotlight features our URAC accreditation assistance service. BHM has a 100% accreditation achievement success rate. URAC stands for Utilization Review Accreditation Commission. URAC is the largest accrediting body for healthcare and has accreditation programs which operate in every state. Attaining URAC accreditation can be an overwhelming task. Our team of URAC consultants provides services which range from strategic assistance throughout the process to completely guiding your organizational efforts. We can create a plan that is specific to accomplishing your goals.

BHM understands the complexities faced by healthcare organizations who are seeking accreditation, and our valuable guidance services can serve to break down the complex components of URAC accreditation into more management tasks in order to optimize your organization’s achievements.

BHM has successfully assisted dozens of organizations gain national accreditation and through this experience has honed the process so that it is maximally efficient and cost effective for your organization. Our unique process begins with a detailed analysis cross comparing the standards with organizational policies and procedures. This is an important step in determining how far your organization needs to go in order to achieve accreditation and which areas can be strategically targeted for improvement. Our URAC consultants can review all documentation to ensure that it meets standards, complete any necessary paperwork, and develop templates to be submitted in the preferred URAC format. Additionally, our consultants can assist you in navigating through Accreditnet, URAC’s software system. To make sure that all organizational members are fully prepared, we finalize preparedness with a mock audit exercise that will walk you through the onsite visit.

Additionally, we offer URAC accreditation assistance in patient centered health care home accreditation, URAC Medical Home Accreditation, and URAC PCHCH auditors certification. These will be the focus of our next service spotlight. For more information, please visit our accreditation webpage as well as our URAC-specific accreditation page. Please contact us today to setup a free initial consultation to see how we can assist you with your URAC accreditation consulting needs by calling 1-888-831-1171.

URAC News from the URAC Website

Posted on June 5, 2012 by Linda Ringquist

According to the Accreditwatch from March 2012, the following is a summary of the latest and greatest in URAC news. See the full stories on the URAC website.

URAC announced a new community pharmacy accreditation initiative to recognize excellence in single and multi-site independent and chain pharmacies. The initiative was in response to the push toward increasing quality improvement plans and the market desire to differentiate community pharmacies which provide patient counseling and education, medication therapy management and quality initiatives that improve care and reduce overall healthcare costs. An advisory group has been established which consists of participants from industry sectors including chain and independent pharmacies, pharmacy benefit managers, health plans, consumers, business coalitions, pharmacy associations and other health professionals and government representatives. This program will enable organizations to:

Support and document the role of pharmacists in community practice settings, which can lead to broader opportunities for reimbursement and incentives.
Establish consistent benchmarks and standards for pharmacy practice comparisons and organizational goal setting.
Get involved in health care coordination and care transitions.
Distinguish community pharmacy practice sites as leaders in quality and patient safety.

URAC announced excellence in hospital website transparency program. The purpose is to identify outstanding hospital websites that promote transparency of quality measures in a manner that is user friendly for consumers. The program consists of two parts.

An analysis of the website’s overall transparency
Evaluates applicants in terms of best practices for website transparency and reporting

All hospitals that meet a certain number of criteria in part one will receive An Acknowledgement of Excellence in Hospital Website Transparency.

URAC established the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). URAC was the first accreditation standards organization to add requirements to help plans ensure they are compliant with parity law. These standards require a parity officer to ensure the following are met:

Performance of a thorough review of federal and state laws, and regulations related to “parity of health care services, including MHPAEA
Performance of a detailed analysis of documenting compliance with MHPAEA
Provision of a detailed analysis demonstrating their behavioral health utilization management protocols do not have more restrictive treatment limitations than those applied to other medical conditions
Coordination with any contracted behavioral health carve-outs to ensure there are not more stringent quantitative and nonquantitative treatment limitations
Inclusion within certain informational documents for consumers and employer purchasers of descriptions of the processes and to ensure parity act compliance

Health Literacy Innovations Recognizes Plain Language Principles Strengthened in New URAC Disease Management Standards

In March 2012, this announcement was made. To achieve compliance, an organization needs to have written policies that:

Require consumer materials to be in plain language
Assess the use of plain language in consumer documents
Provide relevant information and guidance to staff that interfaces directly with, or writes content for, consumers

This standard recognizes health literacy as a critical issue affecting health care outcomes and costs, distinguishes plain language from health literacy and suggest that health organizations establish a target grade level to evaluate consumer materials.

For more information regarding URAC accreditation assistance, URAC PCHCH Auditors Certification, or URAC Medical Home Accreditation, please view these pages on our BHM Healthcare Solutions website. BHM is one of the top health accreditation consultants in the country and we would like to assist you with any of your URAC accreditation needs. Please contact us at 888-831-1171.

Consumer-Driven Health Plans – What Should You Consider When Choosing?

Posted on May 15, 2012 by Linda Ringquist

According to the Bureau of Labor Statistics, the combination of a pretax payment account with a high-deductible health plan is what is commonly referred to as a consumer-driven health plan (CDHP).⁷ In terms of payment methods, CDHPs are composed of a three tier payment system

A savings account
BHM Healthcare Solutions
Out-of-pocket payments
Insurance plan.

The first tier is a pretax account that allows employees to pay for services using pretax dollars. The account may be funded by the employer or the employee, depending on the type of account. The funds from this account can be used to satisfy the insurance plan deductible. The second tier is the difference, or the “coverage gap,” between the amount of money in the individual’s pretax account and the deductible. The amount that is not covered by the pretax account must be covered by the insured. If health care expenses exceed the deductible amount, then the third tier, the high-deductible health insurance plan, kicks in.

In an article from the URAC website, there are ten things to be considered when evaluating and choosing consumer-driven health plans and products.

Is the information regarding the consumer health driven plan available in a variety of formats and media? Is the information available in different languages as applicable? Is the information written in such a way that it can be understood easily, including to those who may have mental or physical impairments or disabilities?
Are all of the costs laid out in a manner in which deductibles, out-of pocket expenses, tax consequences and benefits are clear?
Does the information indicate clearly the details of the plan, including benefits and coverage, customer satisfaction results, and a directory of providers?
Is wellness and prevention data readily available and easily accessible?
Do you have access to a Health Risk Assessment which is evidence-based, reviewed by the organization’s top clinical staff, and provide feedback as to the health status and any recommendations to improve the current health status?
Does the plan provide data explaining the enrollees role and responsibility for making their own decisions for health care? Are there additional expert resources available to the enrollee to help answer any additional questions.
Are there specific instructions as to how to access assistance on a 24/7 basis through different media such as phone, email, and in person?
Is there a method for requesting a detail of the cost and quality for each provider?
Does the health plan provide assistance in making financial decisions about coverage gaps, managed care or review processes necessary for coverage and how to seek care once the personal health account has been exhausted?
Does the health plan reach out to those with chronic diseases to educate them about how to most effectively manage their health care?

BHM Healthcare Solutions specializes in URAC accreditation and URAC consulting. For more information regarding URAC accreditation assistance, please visit the URAC page of our website or call for a fee consultation call BHM at 1-888-831-1171 today!