Amid a government shutdown over ACA subsidies and contentious “Make America Healthy Again” moves, Becker’s checked in with behavioral health payer and managed care provider Magellan Health’s CEO, Caroline Carney, MD, to glean her insights on how her organization is preserving value for its members.
“All of us are aware of potential changes coming in the federal programs, and our goal is to continue to make sure that members don’t receive any lapses in care, and they continue to get high-quality, high-value care,” she said.
While some insurers struggle with low network capacity, Dr. Carney said no Magellan members have complained about being unable to find a provider. For example, when the company took over a contract in Idaho, Dr. Carney said her team specifically promoted telehealth options to rural communities and expanded digital tools for members. She credited this “proactive” work to helping more people access care.
But some challenges in building behavioral healthcare value persist, like getting organizations to follow similar metrics.
“We have to align better,” Dr. Carney said, addressing metrics at the federal, state and health plan levels. “We can’t have that provider who is seeing individuals, no matter what their insurance coverage is, have to answer to multiple different masters.” For Dr. Carney, this issue is about the overarching structure that foments this discontinuity, not just a single provider.
Other challenges include getting clarity on data security and technology use — with some providers still not using electronic records — and unifying “separate systems of care.” These systems range from resources in the community behavioral health setting for those who are uninsured or on Medicaid to providers who take cash payments to providers who accept insurance.
“We’re not aligned in a provider community. The more we can bring those expectations together, the more we can align evidence-based care,” Dr. Carney said.
