Magazine article Behavioral Healthcare Executive

The In-Network Advantage

Magazine article Behavioral Healthcare Executive

The In-Network Advantage

Article excerpt

Before Retreat Premier Addiction Treatment Centers accepted its first patient in Lancaster County, Pa., in August 2011, CEO Peter Schorr had made up his mind: His new venture was going to workwith insurers as an in-network provider.

Many in the field might consider it a risk, but Schorr says he felt going in-network was actually the safe bet.

"This was a conscious decision I made before we opened," says Schorr, a 36-year veteran of the addiction treatment field. "One of the reasons is, obviously, it opens up your market much more broadly, and you can take many more patients. The reimbursement is less than out-of-network benefits, but the reward is that you do have a much larger pool to grab from among those who have contracted insurance."

As providers are plagued by the unknowns of being outof-network-when they will receive reimbursement or how much-going in-network could become an advantage for many within the field who seek sustainability through reliable reimbursement.

While in-network providers can receive lower payments from insurers than those out of network, contracts negotiated with insurers reliably deliver the expected payments for specified treatment. Bill for agreed upon services, receive agreed upon reimbursement. It's a model that stabilizes budgets and helps providers map out strategies to sustain their businesses.


An estimated 38 million people in the United States had access to behavioral healthcare and benefits through their health plans as of 2014, according to a whitepaper1 published in 2016 by Americas Health Insurance Plans (AHIP), an advocacy group for health insurers. For their part, insurers say they are actively trying to bring more behavioral healthcare providers into their networks, but haven't always found treatment centers willing to participate.

"Health plans regularly assess the adequacy of their provider networks to ensure that members have timely access to behavioral healthcare while accepted metrics are used to track and improve patients' outcomes," says Cathryn Donaldson, AHIP director of communications. "However, there is a welldocumented national shortage of behavioral health providers, coupled with many behavioral health clinicians who refuse to participate in health plan networks, resulting in patients having to pay out-of-pocket for treatment or forgo it altogether."

Still, even for Retreat and other willing providers, the path to going in-network isn't always smooth. Overcoming that hurdle comes down to having the ability to prove your value and demonstrate the delivery of successful outcomes. Insurers seek providers with a track record in evidence-based practices and those who take a holistic and coordinated approach to care, Donaldson says.

"Some plans have created behavioral health homes and are leveraging patientcentered medical homes to ensure more integrated care," she says. "Others are embedding behavioral health providers in primary care doctors' offices to help identify these conditions and improve outcomes."

However, Donaldson says, readily available information on the quality of facilities is significantly lacking, including data on patient outcomes.

"Overall quality measurement for even the more common behavioral conditions is less well developed than for comparable general medical conditions," she says.

In its efforts to align with insurers, Retreat has found success by illustrating its competitive differentiators and by hosting insurers on-site to demonstrate its programs, at both its Lancaster County facility as well as its second location in Palm Beach, Fla. …

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