Managed Care

Managed Care Organizations (MCOs) are taking a bold stance by implementing aggressive tactics that challenge the traditional landscape of healthcare access and delivery. The shift towards denying treatments and imposing resistance strategies is reshaping the dynamics between providers, patients, and payers.

Providers are feeling the impact of reduced residential stays, heightened patient deductibles, and a deliberate pushback against accessing essential health services. Despite mounting pressure from patients, employers, and behavioral health professionals for fair reimbursement practices, MCOs are steadfast in their approach.

Nationally, MCO tactics have evolved into punitive measures with low provider payments, delayed reimbursements, and contract terminations becoming commonplace. Fee-for-service agreements are being replaced with meager case rates to cut costs.

Profitability has taken center stage for Managed Care Plans as they focus on raising premiums, shedding unprofitable business lines, and exiting unproductive markets. Consequently, employer health plans witness significant premium hikes leading to limited affordable options for small behavioral health employers.

Public purchasers are blending various funding streams to manage consumer access while shifting administrative burdens onto consumers and providers alike. This complex environment demands providers to deliver healthcare services more efficiently to navigate through the evolving managed care landscape successfully.