Quality of care standards are present for the medical community, funders, and providers alike. It’s time that empirically proven high-quality initiatives, tailored to the individual patient, with a holistic approach to benefit the family unit, are implemented in the realm of behavioral health, specifically Autism.
Even with processes in place to review for medical necessity, the framework does not support the complex needs of the provider or family attempting to obtain authorization for Applied Behavior Analysis services for a child with Autism, or the health plan attempting to determine progress, barriers, symptom severity, and dosage in a systematic, analytical way.
In this Webinar, Rethink’s Health Plan Solutions team will provide:
- A streamlined approach to utilization management processes.
- Tools for beneficiary support and family well-being.
- Open panel discussions between health plan representatives, Board Certified Behavior Analysts, and Licensed Social Workers who have seen the gaps between utilization and care management and evidence-based quality of care.
Part 1: Standardizing the ABA review process for Utilization Managers – April 7th, 2022, 1:00 PM EST to 1:30 PM EST
Applied Behavior Analysis as a covered benefit is a relatively new venture for Behavior Analysts.
Combining the large discrepancies between provider treatment plans, the array of severity of symptoms and treatment methods, unclear documentation and specific health plan requirements with complex medical necessity criteria, utilization managers are being set up with a subjective, inconsistent decision-making process.
Open panel discussion: Why standardized review processes are needed, including a testimonial from a health plan representative.
Part 2: Using data to monitor progress over time and ensure quality of care standards – April 14th, 2022, 1:00 PM EST – 1:30 PM EST
The purpose of Applied Behavior Analysis for children with Autism is to increase quality of life by decreasing symptomology.
This goal is agreed upon by providers, families, and payors alike. The trouble achieving best outcomes stems from inconsistency in the monitoring of individualized progress over time. By comparing previous and current treatment records, all involved are better able to determine clinically significant progress and potential barriers to treatment, thereby ensuring quality of care is provided. Taking that data a step further, synthesizing and benchmarking it, allows for the potential to meet quality of care standards and can lead to value based care initiatives.
Open panel discussion: Strategic Operations Leader/ former Corporate Vice President of Clinical Services discuss the importance of using data to monitor progress over time and ensure quality of care standards.
Part 3: Member Engagement for quality outcomes using Social Determinants of Health – April 21st, 2022, 1:00 PM EST – 1:30 PM EST
As the world continues to move away from in person appointments and toward technology, the ability to monitor and address Social Determinants of Health becomes increasingly difficult.
Caregiver outreach spans from ensuring health plan requirements, such as standardized testing, are met to providing education and resources. In order to maximize benefits of ABA therapy, there needs to be a holistic stance on supporting the family unit as a whole. Caregiver fatigue and behavioral health are often not considered when Care Managers are reviewing barriers to treatment and the best ways to allow the child and family to maintain and generalize the skills learned in ABA.
Panel discussion: How quality outcomes can be improved through member engagement when social determinants of health are considered.