Managed Care at Pine Rest

Pine Rest's External Relations Department represents Pine Rest Hospital Based Services and Professional Practice Group and Pine Rest Joint Operating Agreement in all negotiating and contracting with insurers, Managed Care Organizations (MCOs), and Managed Behavioral Health Organizations (MBHOs).

Contracting
Pine Rest and Pine Rest Joint Operating Agreement (the Joint Operating Agreement with Saint Mary's Mercy Health Center), have over 50 commercial managed care contracts. These contracts include local HMOs, local PPOs, state, regional and national insurers, MCOs and MBHOs. Community Mental Health systems in Michigan contract for Medicaid inpatient services like an MCO does for commercial business. Pine Rest has good relations with CMHs and has 34 CMH contracts representing 59 Michigan counties. Pine Rest remains the preferred behavioral health provider system in west Michigan.

Values - Access and Integrity
Pine Rest values working closely with Managed Care purchasers so patients and referral sources have access to Pine Rest services while working within their insurer's or employer's benefit plan.

Pine Rest is interested in long-term relationships that emphasize quality care that is cost-effective and appropriate. Pine Rest has remained successful in its 90+ years because of its ability to adapt to changes and new pressures while maintaining its quality, reputation and integrity. There are MCOs with whom Pine Rest has not contracted due to incompatibility with Pine Rest's values as well as satisfactory reimbursement. We regret when we have to take this position but it is essential to survival and to retain our integrity.

Packaged Services
Pine Rest offers the unique opportunity of packaging the hospital based services with the professional services through it's staff. Furthermore, Pine Rest's broad continuum of inpatient hospitalization, partial hospitalization, intensive outpatient services and outpatient services throughout our 16 west Michigan clinics and two clinics in Iowa allows for alternative placements recognizing individual clinical needs and circumstances.

Pine Rest External Relations Department also coordinates clinician credentialing and panel participation for all of its clinicians working throughout the Pine Rest system. This involvement streamlines the process for MCOs, insurers and clinicians alike.