Rose Leidl, RN, is an expert in managed care, and she concurs with the industry consensus that training in this field is a vital, nationwide need – one that is not being met.
Managed care has imperfectly defined the delivery of modern healthcare in the world, and managed care principals are the theoretical core of our modern healthcare systems. However, in the U.S.A, there exists a significant training gap among clinical and non-clinical healthcare professionals in terms of a boots-on-the-ground, working knowledge of managed care operations. Based upon her observations during audits of over 100 health plans, Ms. Leidl has decided that now is the time to do something about it.
Utilizing her firm’s physicians, nurses, mental health specialists and regulatory experts, who have a wealth of knowledge to share about managed care, Ms. Leidl is launching a Managed Care Academy (MCA). The curriculum will be based on the following major cornerstones of managed care operations – utilization management, quality management, enrollee grievances and appeals, and access and availability of services.
by Rose Leidl, RN, BSN; Patricia Schano, MeD; Annalisa A. Almendras, PsyD; Barbara Pawley, MPH, MPW
In California, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), also called “the Parity Act,” is rolling out under the auspices of the state’s Department of Managed Health Care (DMHC) in partnership with the consulting firm, Managed Health Care Unlimited, Inc. (MHU), a leading review agency for full-service and specialty health plans. California is one of the first states to implement MHPAEA, making the DMHC/MHU team an innovative collaboration.
MHU’s job was to assist and review the work of the health plans in their initial efforts to align the treatment and financial parameters of their medical, behavioral health and substance use disorder benefits. The task required in-depth teamwork and an effective working relationship.
Implementation began in early 2014 with a DMHC request for compliance filings from the 26 California health plans that offered medical and mental health/substance use disorder (MH/SUD) services at that time.