Article

Building Successful Partnerships With Managed Care Plans

With the support of the Blue Shield of California Foundation, the CIBHS DMC-ODS WAIVER FORUM creates a collaborative think tank to support county behavioral health and substance use disorder leaders in the planning and implementation of the Drug Medi-Cal Organized Delivery System. Working with the California Behavioral Health Directors Association (CBHDA) Substance Abuse, Prevention, and Treatment (SAPT) Committee, the second FORUM was held in December of 2016, to explore Building Successful Partnerships with Managed Care Plans. A prevailing challenge for individuals served by the public-sector safety net is their lack of access to physical and behavioral health services. With the expansion of Medi-Cal eligibility, health care is available to them for the first time; however, treatment for substance use disorders remains a carve-out and requires planned coordination. We will now need to build the on ramps and bridges between providers for these individuals to access coordinated care.

This Forum examined the current landscape in managed care in California and the implications of the DMC-ODS Waiver for Health Plans. Terrie Stanley, Vice-President of Medical Services for Care 1st Health Plan and previously with CalOptima, provided a primer on managed care. She highlighted the challenges faced by the Health Plans in coordinating mental health and substance use disorders treatment, and the opportunities and barriers ahead. Rhyan Miller, of the Riverside University Health System Behavioral Health and Substance Use Disorder Services (RUHS-BH-SUD), was joined by Arlene Ferrer and Laurence Gonzaga, Behavioral Health Managers, of the Inland Empire Health Plan (IEHP), to describe the evolution of and the current partnership between the Riverside County and the Inland Empire Health Plan.   

The Briefing Paper

RUHS-BS-SUD IEHP Memorandum of Understanding

APL 13-018 described the memorandum of understanding (MOU) requirements for coordination between Medi-Cal managed care plans and county mental health plans

http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2013/APL13-018.pdf

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