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HBI BEHAVIORAL HEALTH MANAGED CARE SOLUTIONS


          As a full-service behavioral health organization, Human Behavior Institute (HBI) has developed and implemented effective behavioral healthcare programs for both commercial and public health care plans, self-funded employers, union trusts, and third party administrators for over 30 years.  HBI offers solutions for many of the challenges related to the cost of behavioral health care without compromising the delivery of quality behavioral health services.

          HBI’s strategies have proven effective in improving access to mental health care, substance abuse and addiction recovery programs by implementing tailored programs that focus on the immediate needs of the members and the community while containing cost.  The cornerstone of our success is accessing care though HBI’s Provider Network and Staff-Model Clinical Services in conjunction with HBI Rapid Response™ and crisis management team while coordinating utilization and quality management with allied health care providers.

          Supported by over 30 years of performance in the field, HBI has direct insight to the development and implementation of quality behavioral health and addiction treatment programs through its staff-model clinics, allowing HBI to base its management decisions on a clinical rather than a business model.  This unique perspective enables HBI to create innovative programs that yield measurable results.

          HBI offers full and partial risk capitated behavioral health and substance abuse programs ranging from simple administrative services, network access, to full-risk models and assumptions of costs across the entire continuum of care.

 

HBI can offer the following services as a comprehensive package, or they can be individually unbundled and contracted for:

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Utilization Management

Human Behavior Institute (HBI) established its Utilization Management (UM) Program to guide the UM Department to comply with federal and state regulations, URAC, NCQA and community utilization standards.  HBI does not financially reward UM personnel for making UM determinations and ensures that there is not a conflict of interest with HBI personnel.  UM decisions are made based solely on appropriateness of care and existence of coverage.  The purpose of the HBI UM plan is to ensure that members receive quality mental health and addiction services in the most appropriate level of care and cost effective setting.  HBI Utilization Management is URAC accredited since 2007 and is rated among the top ten best in the country.

Provider Network

Human Behavior Institute’s provider network is one of the oldest and most qualified in the entire State of Nevada, including rural and underserved communities.  This network started in 1990 and initially provided services to the self-funded hotel industry.  Soon after, in 1992 HBI became the preferred network to large insurance groups such as HUMANA, Anthem Blue Cross Blue Shield, and other nationally recognized insurance organizations.    In July of 2007, HBI extended its services to the State of Hawaii, and in less than two years built the most extensive and qualified behavioral health network covering all the islands in Hawaii.  HBI has a proven track record of starting and establishing provider networks. 

Claims Processing and Adjudication

HBI claims are reviewed and processed within the timeframe set by regulatory standards of appropriate state and federal jurisdiction, and Division of Labor Regulations. HBI provides expedited automated claims processing assuring rapid and accurate payment with its full claims processing service or claims processing via a third party administrator.  HBI regularly meets and exceeds industry standards for claims timeliness and accuracy

HBI Rapid Response™

Also known as Crisis Mobile Team, HBI Rapid Response Team members include: PhD-Level Clinicians, RN’s, and Masters Level Clinicians; on-call 24/7 ready to spring into action and provide on-site evaluation and level of care recommendation. Our team of highly qualified professionals provides unparalleled assistance to hospitals and emergency facilities in providing crisis intervention and assessment with patients admitted to the ER or facility due to a psychiatric crisis situation.  HBI’s Rapid Response Team has been entrusted by major insurance plans and public health agencies in providing expedited mental health assessments to determine the appropriate level of care, so that individuals who have the dire need for psychiatric hospitalization get the treatment they require and those that don’t meet the medical necessity criteria don’t overcrowd the hospital facilities and are referred to lower intensity services such as outpatient mental health treatment and/or social and community assistance.

HEART™ (Home Enrichment and Rehabilitative Treatment) Program

When an individual is impeded by a physical or mental disability preventing him/her to seek behavioral health treatment, HBI’s HEART™ Program is the answer.  As its name implies, HBI’s HEART™ Program is designed to serve members at their home if they are physically or mentally unable to seek treatment in an office venue.  Whether their home is a traditional setting, a group home, a nursing home, foster care home, or temporary residence, HBI can meet their needs for behavioral healthcare services in their home.  This program focuses not just on the individual but also on the home and community support dynamics.

LifePoint™ Employee Assistance Program

HBI’s LifePointä EAP is designed to work with company supervisors, EAP counselors, benefits consultants, and the human resources department to develop optimal programs that are tailored to the needs of the company and its members.  Emphasis is not only on treating existing problems but also on creating awareness and teaching skills that an employee can utilize to minimize and prevent serious emotional and physical health problems at work and elsewhere. HBI believes in an interdisciplinary approach and is staffed with Licensed Psychiatrists, Psychologists, Clinical Social Workers, Marriage and Family Therapists, Case Managers, and Drug and Alcohol Counselors.

Spotlight™ Addiction Recovery Program

HBI started its Addiction Treatment and Recovery Program in 1992 to help adults (18 years and older) who are suffering from alcohol, drug, gambling and/or other addiction-related problems.  This program is designed to provide participants with a therapeutic “community” that interacts with their families and friends, addressing all aspects of their psychosocial and physical environment.  It addresses addiction-related issues of three different types of adults:  the addict, the “co-dependents”, and other adults raised in a dysfunctional family.

Centralized Intake and Triage

HBI’s quality management begins from the time patients call the intake department for information and referral.  Staffed with dedicated Intake Specialists whose sole function is to match members with the appropriate service and provider based on their demographic and preliminary clinical information, HBI also triages members and patients with potential high-risk cases, provides immediate crisis intervention by transferring the call to the supervising Psychologist, verifies plan benefits and eligibility, and provides a referral to a staff model clinician, a network provider, or community services – all done on the initial call!

Case Management

With over 20 years of experience, HBI’s Case Management is comprehensive and designed to manage and reduce mental healthcare costs without compromising services.  It encompasses coordination between behavioral and medical health care in order to help the patient heal medically and psychiatrically.  Patients with co-morbid conditions are introduced and guided through the system until they are discharged from treatment. 

Quality Improvement Programs

HBI's Quality Improvement Program is the umbrella under which all review and monitoring activities are conducted.  It is governed by the Quality Improvement Committee which meets monthly to review policies, utilization, credentialing, complaints, and clinical services delivered by HBI and its network.  HBI's Quality Management Committee members are consisted of: Behavioral Health Clinicians (Psychiatrists, Psychologists, Licensed Clinical Social Workers, and a General Practitioner M.D.), plan administrator representatives, behavioral health billing & office management representative, Provider Services Coordinator, and Certified UM-QM Registered Nurse.

Customized Management Reports

Combined with its staff-model clinical services and network access, HBI’s managed behavioral health care strategies are proven effective in developing and implementing quality behavioral health and addiction treatment programs with measurable outcomes.  Exceptional customized reports are prepared periodically and submitted in a presentation package for management, illustrating actual data on quality management, utilization management, claims processing, and any other relevant information based on the contracted managed care services above.

To schedule a more in-depth presentation of any of our behavioral health managed care services, please call HBI Executive Department at (702) 515-3602 or Contact Us.  We are here to help!