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  • What’s Next For Health Plans & Their Behavioral Health Benefits In 2025?

    Listen to this fireside chat on the current pressing issues faced by payers and health plans in the year ahead – and how those issues will change how they manage behavioral health benefits.

  • How Social Determinants Of Health Are Shaping Health Plan Strategies For Whole Person Care

    This webinar focuses on the effects of the recent changes at CMS and the state-specific changes to Medicaid health plans on serving the consumer population with mental illness. In addition to the perspectives of the health plan executive panel, the webinar includes related health plan survey data from the Trends In Behavioral Health Series.

  • NCQA Releases Standards For Virtual Primary Care & Urgent Care Accreditation

    On August 1, 2024, the National Committee for Quality Assurance (NCQA) released accreditation standards for Virtual Primary Care and Urgent Care. The standards address the structural components of virtual care delivery, such as care coordination between clinical professionals and care settings, tracking outcomes, and identifying gaps and opportunities to improve. The standards are intended for…

  • CMS Unveils Person-Centered Primary Care Model, ACO Primary Care Flex, For Low-Revenue ACOs

    On March 19, 2024, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new accountable care organization (ACO) model within the Medicare Shared Savings Program (MSSP) focused on nurturing team-based, person-centered primary care. The five-year model, called ACO Primary Care Flex, will provide a one-time advanced shared savings payment and monthly prospective…

  • North Carolina Medicaid Tailored Plans For Behavioral Health Launch July 1, 2024

    On July 1, 2024, North Carolina Medicaid launched behavioral health Tailored Plans for beneficiaries with a serious mental illness (SMI), a serious emotional disturbance (SED), a severe addiction disorder, an intellectual/developmental disability (I/DD), or a traumatic brain injury (TBI). Enrollment, at 219,000 is 4.2% higher than the 210,000 that the North Carolina Department of Health…

  • Centene To Exit Medicare Advantage In Six States

    Centene plans to exit the Medicare Advantage (MA) marketplace for 2025 in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont. This decision affects Centene’s Wellcare MA line. However, Wellcare will continue to offer Medicare Prescription Drug Plans (PDPs) in these states. The decision does not affect Centene’s Marketplace or Medicaid contracts in these…

  • UnitedHealth Group Launches ‘Gold Card’ Program To Address Prior Authorization Requirements 

    Beginning October 1, 2024, UnitedHealth Group is launching a “gold card” program for provider organizations that are in-network for at least one UnitedHealth Group line of business. The goal of the program is to modernize and streamline the prior authorization process.  UnitedHealth said the program is intended to help physicians override prior authorization requirements to more quickly…

  • Volume 1: Trends In Behavioral Health Infographic

    Volume 1: The National Behavioral Health Landscape  The National Behavioral Health Landscape metrics demonstrate changes in coverage, population data related to payment for treatment, workforce changes, shifts in psychiatric hospitalization, and increasing access and coverage for people with serious mental illness (SMI). These are just a few key takeaways from Volume 1 of National Trends…

  • Volume 2: Trends In Behavioral Health Infographic

    Volume 2: State Behavioral Health Landscape  Volume 2 takes a deep dive look at how U.S. states differ in their delivery and financing of behavioral health services. Specifically, find state comparisons of population distribution among payers, how Medicaid financing rules differ from state to state for people with serious mental illness (SMI), and numerous state…

  • Volume 3: Trends In Behavioral Health Infographic

    Volume 3: Population Health Management & Service Innovation  For Consumers With Behavioral Disorders Volume 3 uncovers the latest trends in health plan innovation, accessing insights from a comprehensive national payer survey. Discover how technology, digital health, and social determinants of health are shaping the future of care.