When our company started moving from all cash-pay to third-party reimbursements several years ago, we all felt the pain. What felt daunting at times — changing internal processes and systems and training teams to do things differently — has paid off in ways we could’ve never imagined. Pivotal to this transition was our CEO’s vision of creating more access to care by lobbying CMS to add Opioid Treatment Programs to Medicare Part B.1 This shift not only made it possible for people who qualify to have the majority of treatment paid for by Medicare, but it also set the stage for the growing list of third-party payors covering our patients today — just in the nick of time.
The pandemic has created an unfortunate rise in OUD and our preparations building out a third-party payor system allowed more people to get treatment with fewer paying out of pocket — from 60% cash-pay patients in 2019 to 37% today. This not only kept us alive as a company, but it was also a fundamental driver of our growth this past year.
“The fact that we navigated the pandemic as well as we did is remarkable. Luck favors the prepared,” said Jay Higham, CEO of BHG. “It was a burn-the-boats-at-the-beach move. Had we not done that starting three years ago, we would’ve had a lot of layoffs this past year and many patients would’ve gone without care.”
Proof is in our people and patients
A key performance indicator to look at is our strong first 90-days retention rates. People who were able to use third-party payors were able to maintain their treatment during the most critical, foundational part of their recovery.
My charge here at BHG is to continue removing barriers so that more patients get into treatment and stay in treatment. Since Medicare now covers methadone, we have a compelling story for third-party commercial payors to follow suit by letting us be their partner in coordinating care. Because this is new territory for them, they don’t have a true understanding of what we do and what patients need for long-term recovery.
I spend a lot of time educating payors and talking to heads of state behavioral health departments. Some get it, some don’t. But our story is a good one, and the patient outcomes coming from our treatment centers are helping us take more ground.
“In an organization that is evolving to a higher percentage of third-party payors, it’s not just about getting the contracts. It’s also about the pull-through from new and existing contracts,” said Julie Koenig, RN, COO of BHG. “We’re adding an additional contract manager to focus on proactively supporting strategic parts of the country by creating partnerships with payors so that they see us as a resource. I’ve already seen it happen. We had a payor that was having a problem placing patients in Kentucky who wasn’t aware that we have seven locations across the state. Now, those patients are in treatment with us and the payor has our team as a resource for their members who need support and treatment.”
BHG’s progress with third-party payors
| 2019 | 2021 |
| – 60% cash-pay patients – 3 commercial payor contracts | – 37% cash-pay patients – 12 commercial payors – Medicare/Medicaid in all 50 states – 1 contract with a federal prison – 7 Medicare Advantage contracts |
I’m proud of the work we’ve accomplished to secure some of the largest commercial payors including UnitedHealthcare, Humana, Cigna and a growing number of regional Blue Cross Blue Shields and lesser-known plans. We’ve also established direct-pay contracts with large companies such as QuickTrip. These contracts represent thousands of lives in recovery because of our commitment to this operational change which was made even more difficult with an historic pandemic slammed on top of it.
What this means for you
- Increased patient access, more support and resources. We’re working hard to develop regional and state-specific contracts that work for different communities and set our Program Directors, teams and payors up to successfully provide full, complementary service.
- Creating, cultivating community partnerships. We’ve rolled out a community outreach plan to create business-to-business referral sources through drug courts, jails, law enforcement, hospitals, clinics and unique pathways where trusted relationships reside with those needing help. Through this, we let communities know we’re in network with all key plans.
- Elevated front desk roles to create better service, growth opportunities. Registration is now a part of the check-in process. We’ve standardized training, improved efficiencies and increased skill sets. We’re helping staff understand how important their roles are to serve as a guide in helping patients navigate their financial journey. Choosing the right plans and understanding all that goes with that is hard enough for any person. It’s even more overwhelming for people dealing with addiction. This is just as important to their recovery journey and clinical support.
As we continue down this road, remember how incredible you all are and what you’ve helped BHG accomplish. Our team is “out there” fighting for patients who don’t have the finances for treatment. We still have a lot of work to do, but we’re all playing a part in breaking down barriers and helping as many people as possible have a chance to restore their lives, strengthen their families and rejuvenate communities.
Source: