Patient Advocacy & Cost Containment

MINES’ managed behavioral health services provide state of the art case management and population health management. With over 30 years of success, MINES has always been at the forefront of managed care services, providing complex case management services that produce cost-effective care in the medically necessary settings. MINES has saved its self-insured clients’ money while ensuring that every patient receives appropriate care.

MINES accomplishes this through a proactive complex case management protocol designed to communicate directly with patients and their families regarding costs, treatment, facility expectations regarding pre-certification, concurrent review, discharge planning, and long-term aftercare. Key components include:

MINES’ first priority is to ensure the patient receives the appropriate structure of care for their needs. MINES’ Case Managers act as advocates for patients to help them through the maze of services that are presented to them.

MINES helps ensure patients get medically necessary structures of care, while providing aftercare support for as long as the patient may need it.

MINES manages cost with two primary strategies. First, for inpatient care, the treatment episode itself is managed so that the patient receives the care needed and is not exploited by predatory facilities, or well-intended, yet ineffective or inefficient facilities. Second, MINES also provides significant discounts for outpatient care through its national PPO specialty network.

Due to changes in the Mental Health Parity Act, predatory facilities who are out of network have proliferated. These facilities charge exorbitant fees for all services. What used to be a $10,000 – $30,000 cost has rocketed to $150,000 – $1,000,000 per episode with no aftercare, high relapse rates and often unethical or fraudulent billing. MINES developed aggressive case management protocols to manage these facilities and to refer patients to appropriate facilities whenever possible.

MINES and the medical plan utilization review and case management teams work together as partners. Every behavioral health and substance abuse case is different, therefore, creating a seamless transition between the medical and behavioral health side of case management is critical. This ensures consistent communication between the two sides making it possible to coordinate care for optimal healing and improvement. MINES also integrates with on-site clinics, pharmacy benefits and pharmacogenetic testing partners. These collaborative efforts and data sharing enhances the ability for all to provide more effective individual and population health management.

Clients with chronic illnesses like addictions, and psychological diagnoses like bipolar disorder have life-long challenges. MINES provides ongoing case management support for patients at no additional cost to the organization. As we all know, these are conditions which can have recurrent relapses and non-adherence to treatment. MINES provides the safety net for them to get stabilized and back to their families and communities with as little disruption and expense as possible.

The Proof is in the Data

The opioid epidemic has sky rocketed out of network costs. MINES has been proactive in implementing aggressive case management protocols designed to get treatment for the patient while significantly reducing costs per treatment episode.

For example, prior to these protocols, predatory facilities were charging between $2,000 to $4,000 per day for UAs. On a 30 day stay, the cost for these UA tests alone would reach $60,000 to $120,000.

Under MINES the cost was dropped to $80.00 total for an initial UA and a discharge UA at usual and customary prices. Further significant savings were also realized through our other case management protocols.

For questions regarding these services, to utilize these services, or to request a quote, please contact MINES and Associates at 1-800-873-7138 or Email Us and a MINES Team member will be happy to assist you.