Services

UMBH offers a variety of mental health services:

• Employee Assistance Programs
• Managed Behavioral Health Care
• Disability Management
• Utilization Management
• Third Party Administrator
• Disease Management
• Quality Improvement Programs

Employee Assistance Program (EAP)

The UMBH Employee Assistance Program (EAP) is a flexible, cost effective way for companies to provide valuable assistance to their employees while simultaneously meeting numerous federal, state, and local employment mandates. Our services include orientation and training for employees and supervisors, advice on human resource policy development, critical incident intervention with timely follow-up counseling, and advice on issues such as workplace violence, sexual harassment, Americans with Disabilities Act requirements, and government regulations. As with all UMBH products, we offer comprehensive management reports that show the value of your investment.

Our EAP service provides employees access to brief solution-focused counseling, referral services, wellness programs, and easy-to-use, confidential access to trained telephone counselors. Structured as a work-focused benefit, EAP covers such problematic issues as marriage and family counseling, legal advice, financial counseling, child and elder care counseling, and stress management.

Key services include

• Employee orientation and training
•  Supervisory orientation and training
•  Assessment and referral
•  Brief counseling
•  Critical incident interventions
•  Supervisory consultations
•  Quarterly reports evaluating the cost effectiveness of    purchased EAP services
•  Wellness programs
•  Weight management programs
•  Smoking cessation programs

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UMBH Managed Behavioral Healthcare Program

At the heart of our proactive approach is the UMBH managed behavioral healthcare program for employers and health plans. With an emphasis on early intervention and clinical excellence, we consistently deliver superior care at the least restrictive level. By working in a consultative manner with our providers and utilizing a continuous process of risk management, we ensure positive outcomes while controlling behavioral health care costs. UMBH also can arrange such flexible options as Preferred Provider Organizations (PPOs), Point of Service plans (POS), and Exclusive Provider Organizations (EPOs).

Our program allows members to easily access well-managed outpatient care by dialing a toll-free number. Our licensed care managers monitor quality treatment at all levels of care and are strong advocates of members’ rights and needs.

Comprised of University of Miami School of Medicine faculty and highly experienced community behavioral health professionals, our Quality Improvement Program assures that all medically necessary and appropriate care is delivered in a timely, cost-effective, and patient-friendly manner.

Key benefits include

• One monthly premium, providing a fixed annual cost for budgeting
• An extensive network of behavioral healthcare professionals and facilities
• Flexible, creative programs designed to meet the specific needs of each employer or health plan
• Close collaboration with Employee Assistance Programs
• A dedicated account manager who is accountable for program results and the satisfaction of each employer or health plan partner
• Toll-free hotline available to members 24 hours a day, 365 days a year
• Licensed, clinical case managers who monitor and coordinate all aspects of patient care
• Fast and accurate claims processing and adjudication
• Quality Improvement Program compliant with NCQA guidelines
• Outcomes research
• Quarterly reports that reveal cost-effectiveness of purchased managed  care services

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Disability Management Program

In 2000, U.S. employers spent over $340 billion in disability claims, benefit payments, and lost productivity. The majority of these costs are related to medical disabilities but an increasing percentage of claims involve psychiatric disabilities caused by behavioral problems such as stress or depression. Last year, over $20 billion in disability costs were attributed to depression alone.

To address these problems, UMBH has developed disability management programs that help employers reduce the financial and productivity impact of disability claims. Our Disability Management Program features workplace counseling for employees on psychiatric disability and outreach services such as legal and financial advice for employees on medical disability.

By addressing the behavioral and other issues that affect an employee's recovery, these programs help promote a faster return to work for employees.

Key benefits include:

• Reduced disability claims costs
• Less employee downtime
• Lower temporary staffing and recruitment costs
• Fewer cases of long-term disability
• Increased employee morale
• Quarterly reports analyzing the value of your investment in disability management services

The Disability Management Program is coordinated by licensed behavioral health clinicians with years of experience in their respective fields, and can easily be customized to enhance an employer's existing health benefits or integrated with our EAP and managed care programs.

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Utilization Management Program

The UMBH Utilization Management Program provides employers and health plans with assistance in the management of group health and workers’ compensation managed care services. Our pre-certification and concurrent review processes apply sophisticated clinical guidelines to determine the appropriateness of behavioral health services, as well as the delivery of the care setting and the length of treatment. Close monitoring by licensed behavioral health care providers ensures that the level of care for each patient is appropriate and that positive outcomes are maximized—all at demonstrated cost savings to the employer and health plan.

Key benefits include

• Management of inpatient and outpatient care for medical necessity
• Processing and managing denials and appeals for coverage authorization
• Pre-certification for inpatient admissions and outpatient utilization
• Case management by highly skilled and licensed behavioral health care providers
• Peer review and concurrent review
• Quarterly reports that analyze and show the value of your investment in utilization management services

UMBH Administrators presented two posters at the 157th Annual Meeting of the American Psychiatric Association (APA) in New York City with highlights of the Utilization Management Program results. In addition, 2 papers on the Utilization Management Program were published in peer reviewed journals in February and June 2005.

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Third Party Administration Services

UMBH also provides Third Party Administration (TPA) Services, which allow employers the flexibility of selecting specific administrative services. These include access to the extensive UMBH practitioner and facility network, eligibility verification, case management and utilization review, claims adjudication and payment, comprehensive statistical and savings reports, employee satisfaction surveys and outcome studies, and a comprehensive quality management program.

Key benefits include

• Complete access to UMBH’s extensive network of over 700 practitioners, 30 hospital facilities and over 100 Community Mental Health Centers (CMHC) throughout South Florida
• Discounted access rates negotiated by UMBH with each practitioner and facility
• UMBH-designed custom programs to meet the specific needs of managers and employees
• Licensed, clinical care managers monitor and coordinate all aspects of patient care, ensuring a clinically appropriate, cost effective outcome
• Toll-free hotline available to employees and managers all day, everyday
• Compliance with NCQA  guidelines, which safeguard the quality of services delivered
• Fully HIPAA compliant for privacy and confidentiality of data and documents
• Claims processing and adjudication with guaranteed rapid and accurate payment
• Quarterly reports analyzing the value of your investment in TPA services

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Disease Management

The UMBH Disease Management Program takes a proactive approach to treating individuals living with high-risk mental health or substance abuse diagnoses. Treatment for employees with these diagnoses is a challenge to manage and represents considerable cost to an employer. However through proper awareness, utilization, and dissemination of diagnosis-specific knowledge, as well as the best clinical practices, these diagnoses can be managed effectively and efficiently.

The goal of the UMBH Disease Management Program is to improve clinical, functional, and cost-of-care outcomes. This is accomplished by directly interacting with our members, their caregivers, and their healthcare providers, and by proactively managing the costs and resources associated with these complex diagnoses. The result is a positive return on investment for employers and health plans, not to mention a higher level of patient satisfaction.

Key benefits include

• Toll-free hotline available 24 hours a day, 365 days a year for enrolled members
• Development of individual care plans
• Disease management outcome reports
• Treatment compliance monitoring and counseling
• Adverse complications monitoring
• Compliance with NCQA guidelines, which safeguard the quality of services delivered
• Benefit management
• Coordination of ancillary services such as home health and behavioral health therapies
• Quarterly reports analyzing the value of your investment in disease management services
  

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UMBH Quality Improvement Program

The UMBH Quality Improvement Program strives to:

• Encourage the useful and efficient delivery of care, safety, and service that are obtainable, appropriate, and cost effective
• Institute organizational accountability and authority in the evaluation and improvement of healthcare and service to UMBH members
• To offer a method for UMBH's management to assess member concerns regarding benefits design, to offer feedback, and to resolve problems appropriately

As part of this continuous emphasis on quality, UMBH has undertaken several preventive health programs around areas of ongoing concern for our members and the employers who purchase their healthcare benefits. Among these programs are:

1. Attention Deficit Hyperactivity Disorder    (ADHD)

• UMBH has developed a preventive behavioral health program for parents of children and adolescents diagnosed with ADHD, which includes age appropriate information for children, adolescents, and adults, as well as for the member's healthcare provider.

2. Major Depressive Disorder (MDD)

• In an effort to assist providers in accurately diagnosing MDD, UMBH has put together a package of educational materials which includes assessment materials for providers as well as educational materials for providers to distribute to patients.

3. Targeted Care Management of Complex Disorders

• UMBH clients with acute care episodes of care are transitioned to the Targeted/Complex Care Management Program for follow-up, monitoring, and intensive case management. These case managers are licensed master's level behavioral health clinicians responsible for managing all aspects necessary to achieve a positive outcome.

4. Postpartum Depression Prevention Program

• In collaboration with AvMed Health Plan, UMBH has developed a pamphlet for distribution by AvMed Health Plan to enrollees in the MCO's prenatal program. The objective of the Postpartum Depression Prevention Program is to provide education to assist in the early detection and treatment of enrollees who are at risk of developing postpartum depression. This program was expanded to all of UMBH's contracted health plan enrollees in 2006.

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