Managed Care 102 serves as an overview of today’s Behavioral Health benefit insurance plans.

1. Managed Care 102 serves as an overview of today’s Behavioral Health benefit insurance plans. Presenting …… Managed Care 102 Brought to you by The Psychiatric Hospital at Vanderbilt, Network and Business Development Program 2004

2. What is a “carve-out” • Managed Care Organizations (MCO’s) frequently opt to “carve-out “ the management of select services to specialty organizations • The most common “ carve-out” specialties are: • Dental • Vision • Transplants • Behavioral Health

3. What is a “carveout”, continued • When services are carved out, the MCO passes the financial risk and management of the service to the speciality organization(i.e. provider contracting, credentialing, Utilization Management, Claims processing, etc. • In the Behavioral Health arena, carveout organizations are referred to as Behavioral Health Organizations (BHO’s)

4. Overview of BHO carveouts

5. Current Contract status w/ BHO’s