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Mental & behavioral health
Milliman consultants are well versed in the intricacies of mental and behavioral health coverage and legislation and can provide guidance to clients on cost, utilization, and more.
We test health plan compliance with the quantitative and nonquantitative requirements of MHPAEA. Quantitative testing checks that financial requirements and quantitative treatment limits for mental health/substance use disorder benefits are no more restrictive than predominant levels for medical/surgical benefits. We also test compliance with nonquantitative treatment limits, including care management processes.
We evaluate and forecast the potential impact of current or future mental health and substance use disorder policy as well as quantify the prevalence, variation, or impact of emerging behavioral health challenges.
We evaluate the economic impact of integrated care, including developing financial support and staffing models, calculating return on investment, and researching the impact of medical and behavioral comorbidities on total cost of care.
We analyze outcomes of population health, disease management, substance use treatment, and other types of behavioral programs with the goal of identifying areas of improvement in program design and delivery.
We research aspects of the opioid crisis in the U.S., including prescribing patterns, ER usage, comorbidities, and excess costs. We also support and evaluate programs and other responses to the opioid epidemic.
We develop models to predict underdiagnosed or undermanaged mental health and substance use disorders from prior healthcare utilization patterns, demographics, prescription drug use, and other diagnoses.
We perform analyses such as projecting health costs and utilization by service category, evaluating budgets and rate adequacy, and estimating cost savings from programs or other interventions.
We design elements of risk management for behavioral healthcare providers in their contracting efforts, including but limited to capitation rates, risk sharing, incentive payments, and performance guarantees.
We analyze provider fee schedules for behavioral providers over time and compare them to area-specific and national benchmarks.
We evaluate behavioral healthcare costs and utilization metrics by service category against area-specific and national carrier data.
We perform financial analyses to project future costs and evaluate the adequacy of behavioral healthcare rates.
We develop healthcare utilization and cost projections for baseline periods and intervention periods to demonstrate cost effectiveness of new initiatives for payer contracts or government entities.
This paper studies the prevalence of mental health and substance use disorders within commercially insured families in the United States.
What has happened to utilization and costs for mental health and substance use disorder benefits as the mental health parity laws and associated rules were slowly rolled out?
Beyond the impact of the final rule, IMDs will continue to be a topic of interest to state policy makers as they bolster the continuum of behavioral health and substance use disorder services.
This study assesses the prevalence and costs associated with comorbid chronic medical conditions among individuals with diagnosed opioid use disorder (OUD) and opioid super-users without diagnosed OUD.
A discussion of trends, including recent federal and state laws affecting health insurance benefits for transgender individuals and health insurance clinical coverage policies related to gender reassignment surgery.
This paper presents a comparison of opioid prescription drug patterns among diagnosed and non-diagnosed opioid use disorder populations.
Over 25 million American adults report suffering from daily chronic pain. The increasing use of opioids in recent years has taken a human toll, leading to a rising number of overdose deaths and diagnoses of opioid use…
Many patients with opioid use disorder have complex healthcare needs, contributing to their significant healthcare costs.
The state of Colorado has implemented behavioral healthcare in primary medical care settings under a Centers for Medicare and Medicaid Services State Innovation Model Award.
Nonquantitative treatment limitations continue to be a source of difficulty for many health plans in attaining compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Final rules clarify how to comply with provisions of the Mental Health Parity and Addiction Equity Act of 2008.
Stoddard Davenport and Joseph Boschert discuss their latest research on opioid use in the United States, including underdiagnoses and how advanced analytics can help predict whether a patient may develop opioid use disorder.
Treatment for autism is now a required Medicaid state plan benefit under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
This brief scopes out the issue of homelessness and housing security and Medicaid’s role in addressing the issue.
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