Managed Behavioral Health
Serving people when they are most vulnerable is the true test of effectively managing scarce resources while improving integrated care. For decades, New Directions has demonstrated the ability to serve those suffering from a mental illness and those impacted by trauma. We provide customized answers to individual challenges. The innovations we deploy offer the most cost-effective care, from integrated care coordination to specialty clinical programs.
The list below shows the component services included in the Managed Behavioral Health solution.
Finding the Right Fit
New Directions’ mission is improving health through change. The Utilization Management process promotes positive health outcomes by providing timely, appropriate and medically necessary services that ensure members get the highest quality of whole-person care. The Utilization Management process focuses on providing services in the most efficient and effective manner.
Case by Case, Member by Member
New Directions Case Management program is designed to deal with barriers members face in their progress toward self-management of health care and recovery.
The case management model used by New Directions focuses on two populations:
- Individuals diagnosed with Behavioral Health Disorders—those who have psycho-social barriers and functional disabilities that prevent them from adhering to behavioral health service plans, and
- Individuals diagnosed with both behavioral health and medical disorders (dual diagnosis)—those individuals experiencing functional disabilities related to their behavioral health diagnosis that prevent them from adhering to care plans for either condition.
To deliver the most value and achieve the best outcomes for members, New Directions takes a member-centric population health approach to case management that is inclusive of mental health, substance use disorders and chronic physical health conditions. Our model is based on the understanding that behavioral health disorders in dual diagnosis with physical health conditions are complex and demand collaboration between providers, members and their health plans.
A Hand Up
New Directions provides a comprehensive answer to Substance Use Disorder that is committed to facilitating a healthy life for our health plan partners’ population that struggles with substance abuse. The program’s foundation was built based on the results of a population health assessment, which identified trends in the nature of substance use disorder: where it occurs, whom it affects and the resources required to address the problem. The program reflects and maps the local substance use disorder phenomenon and guides the selection of evidence-based programs, practices and policies.
A Spectrum of Difference
Diagnosing and treating autism is a complex issue that requires bold, innovative solutions. That is why the New Directions Autism Resource Program has developed a holistic approach that integrates the efforts of families, providers and health care plans. This collaboration ensures that each member receives the right level of care at the highest standards, while delivering unsurpassed efficiency.
The Right Support System at the Right Time
New Directions places great emphasis on offering members comprehensive access to our broad network of caring behavioral health providers. We maintain strong, stable provider networks to mitigate crisis and disruption for members and those close to them. Our networks are built to produce better outcomes, timely innovation, cost-effective care, good access and thorough alignment with customers’ expectations.
Integrity Makes It Work
The New Directions Claims Integrity Program is an integral part of our compliance focusing on preventing, detecting and correcting instances and trends of fraud, waste and abuse. We recognize the impact fraud and abuse has on our clients, their members and the health care industry. The goal of the Claims Integrity Program is to actively protect the compliance, financial and reputational interests of our organization according to state and federal regulatory guidelines. Since fraud, waste and abuse are challenges that all health plans face, we extend the basic claims integrity referral program to our clients as a standard component of our Managed Behavioral Health. When potential fraud, waste and abuse activities are detected, notification is made to the New Directions Claims Integrity Department for further research and investigation. If your business wishes to place even stronger emphasis on claims integrity, we offer an optional, enhanced claims integrity service for organizations with a special need in this area.
Customize to Meet Your Needs
The components that follow are optional items that can be added to the Managed Behavioral Health solution to customize your plan.
Support for Managing Your Federal Programs
New Directions provides comprehensive behavioral health management solutions that are targeted to populations served through government programs. Medicaid, Medicare and Federal Employee Programs (FEP) add a level of complexity to behavioral health treatment payments that can be a significant hurdle in terms of maintaining operational efficiency. Having New Directions in your corner can help you successfully navigate these challenges. With our health plan partners, we have developed fully integrated systems of care that focus on early intervention, long-term prevention and wellness. Our government programs address the special needs of Medicaid, Medicare, Medicare Advantage and FEP.