Corporate Overview
Founded 1998

To provide a collaborative and coordinated approach to the administration and management of the HealthChoices Medicaid Managed Care initiative.

The Southwest Six Counties have created and maintained an oversight corporation known as Southwest Behavioral Health Management, Inc.  for the purpose of oversight of  the HealthChoices program and partnership with Value Behavioral Health of PA.  The corporation is staffed with an multi-disciplinary team whose roles are to serve the counties collectively and individually in their respective areas of expertise.  The corporation is governed by a Board of Directors including the MH/MR and Drug and Alcohol Administrators from each of the six counties and two Ex-Officio Board Members representative of the Mental Health and Drug and Alcohol consumers, families and/or advisory groups.

Corporation’s Background

Southwest Behavioral Health Management, Inc, is a non-profit corporation founded in 1998 by the Southwest Six Counties to provide oversight of the HealthChoices initiative.
SBHM, Inc is governed by a Board of Directors made up of MH/MR  and Drug and Alcohol Administrators.

Administration:

· Supports Executive Management Team with daily operations

· Coordinates and acts as liaison between Value Behavioral Health of Pennsylvania, County Staff, Corporate Board of Directors, HealthChoices Team Leaders and the Office of Mental Health and Substance Abuse

· Administers the overall function of the Corporation

Finance Department:

· Ensures the financial integrity of MCO through financial controls and the production of accurate and timely reports

· Oversees claims payable, claims processing, statistical analysis, financial reporting and cash management

· Reviews and monitors HealthChoices budget, which includes both medical claims and administrative expenditures

· Rate development and ongoing analysis of current rate structure

· Maintains financial reporting software unique to the SW6 counties

· Reviews and coordinates responses to all DPW financial correspondence

Management Information System:

· Ensures Value Behavioral Health of Pennsylvania maintains a comprehensive Management Information System to support the data integrity established by the Commonwealth of PA.

· Collects and analyzes HealthChoices data to ensure appropriate delivery of services

· Develops policies and procedures to work towards HIPAA compliance

· Verifies data on all DPW Reports

· Manages Corporate WAN/LAN

Clinical Department:

· Monitors member and provider network services to assure Value Behavioral Health of Pennsylvania’s compliance with HealthChoices and County contractual requirements

· Ensures consistency of clinical policies and procedures throughout the six counties

· Analyzes clinical data and make recommendations to address gaps in service, continuity of care, quality management, improvement and risk management

· Monitors and participates in the complaint & grievance process

· Monitors access to services and recommends appropriate plan of action

Special Projects:

· Assists in identifying and defining the need for special projects and initiatives based upon Consumer and County need as well as upon changing State, Local and Federal Initiatives and requirements

· Develops plans for project development and implementation which utilize and coordinate the resources and expertise within the agencies Clinical, Information Systems (IS) and Financial Departments

· Coordinates efforts, tracks progress and works to identify and resolve any issues

· Tracks Projects after implementation to assure customer satisfaction as well as outcomes

· Coordinates with committees, SBHM Management team, BH-MCO, Counties and SCA's in the development, review and approval of projects and initiatives

· Provides a wide range of management and administrative support activities in the day-to-day resolution of corporate operational issues