Who Are The Stakeholders When Contracting For Mental And Behavioral Health Services?
When health plans contract with mental and behavioral health providers, several key stakeholders are involved. These stakeholders each have distinct interests and roles in ensuring the effective delivery and management of mental and behavioral health services.
Stakeholders collectively contribute to the ecosystem of mental and behavioral health services within health plans. Understanding their roles and interests is crucial for developing effective contracts, fostering collaboration, and ensuring that the needs of all parties are met. Recognizing and appreciating, not ignoring and depreciating stakeholders, is required to achieving a shared goal of delivering high-quality, improved health cost-effective care.
Here are the primary stakeholders:
Primary Stakeholders
1. Patients (Consumers):
Interests: Access to quality mental and behavioral health services, affordable care, confidentiality of health information, and positive health outcomes.
Role: Recipients of care, whose experiences and outcomes are central to evaluating the effectiveness of the health plan and providers.
2. Mental and Behavioral Health Providers:
Interests: Fair compensation, manageable administrative requirements, support for delivering high-quality care, and professional development opportunities.
Role: Deliverers of care, responsible for providing treatment and services to patients.
3. Health Plans (Payers):
Interests: Cost-effective care delivery, compliance with regulations, patient satisfaction, and maintaining provider networks.
Role: Funders of care, who design and manage contracts, reimburse providers, and oversee the overall management of mental and behavioral health benefits.
4. Employers:
Interests: Providing comprehensive and affordable health benefits to employees, reducing absenteeism and improving employee productivity, and managing health care costs.
Role: Purchasers of health plans for their employees, advocating for coverage that includes mental and behavioral health services.
5. Government Agencies and Regulators:
Interests: Ensuring compliance with federal and state regulations, safeguarding public health, and promoting equitable access to mental and behavioral health services.
Role: Overseers of regulatory compliance, including CMS (Centers for Medicare & Medicaid Services) and state health departments.
6. Taxpayers:
Interests: Efficient use of public funds, ensuring that Medicaid and other publicly funded health programs deliver value and positive outcomes.
Role: Indirect funders through taxes, with an interest in the effective and ethical use of public resources.
Secondary Stakeholders
1. Family Members and Caregivers:
Interests: Support for their loved ones receiving care, access to resources and information, and involvement in care planning where appropriate.
Role: Supporters and advocates for patients, often involved in care coordination and decision-making.
2. Advocacy Groups and Nonprofits:
Interests: Improving access to and quality of mental and behavioral health services, protecting patient rights, and influencing health policy.
Role: Advocates for policy changes, providing support and resources for patients and providers, and raising awareness about mental health issues.
3. Accreditation Bodies:
Interests: Ensuring high standards of care and operational excellence among providers and health plans.
Role: Certifiers of quality and safety standards, conducting assessments and providing accreditation to health plans and providers.
4. Pharmaceutical and Medical Device Companies:
Interests: Ensuring that their products are included in treatment plans and reimbursed by health plans.
Role: Suppliers of medications and medical devices used in mental and behavioral health treatment.
5. Independent Auditors and Compliance Officers:
Interests: Ensuring transparency, accountability, and compliance with contractual and regulatory obligations.
Role: Monitors and evaluators of financial transactions, compliance with regulations, and the overall integrity of health plan operations.
DISCLAIMER and PURPOSE: This discussion document is intended for training, educational, and or research purposes only. The information contained herein is based on the data and perspectives available at the time of writing. It is subject to revision as new information and viewpoints emerge.
For more information see: https://www.mentorresearch.org/disclaimer-and-purpose