Managed care and mental health:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2000
|
| Schriftenreihe: | The psychiatric clinics of North America
23,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV S., S. 241 - 467 Ill., graph. Darst. |
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| 490 | 1 | |a The psychiatric clinics of North America |v 23,2 | |
| 650 | 2 | |a Programme soins organisés | |
| 650 | 2 | |a Services de santé mentale | |
| 650 | 4 | |a Managed Care Programs | |
| 650 | 4 | |a Managed care plans (Medical care) | |
| 650 | 4 | |a Mental Health Services | |
| 650 | 4 | |a Mental health services | |
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Datensatz im Suchindex
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| adam_text | MANAGED CARE A P Ml IAL HEALTH
CONTENTS
Preface xiii
Stephen M. Soreff
Understanding Managed Behavioral Health Care 241
Michael A. Hoge, Neil M. Thakur, and Selby Jacobs
Multiple perspectives from which to view and better understand
managed behavioral health care are provided. As a background,
the origins and evolution of managed behavioral health care over
the past 15 years are described. The core of the article contains a
description of 10 dimensions on which managed behavioral
health care initiatives vary. Using a case example, a guide to
assessing managed care initiatives on these dimensions is pro¬
vided to help clinicians to better understand the form and func¬
tions of managed care as it develops locally.
The Economics of Managed Care in Behavioral Health:
Basic Concepts and Incentives 255
William H. O Brien
The words managed care seem to send many seasoned behavioral
health care clinicians running for greener pastures. When the
costs for ongoing care increase, clinicians must tap the managed
care—insurance revenue stream to support patients expanded
treatment needs. If clinicians choose not to understand and be a
part of managed care networks, they could severely decrease
their ability to advocate for their patients in any arena outside of
their offices. This article provides a fundamental overview of
managed care with the hope of demystifying the concept of
managed care.
THE PSYCHIATRIC CLINICS OF NORTH AMERICA
VOLUME 23 • NUMBER 2 • JUNE 2000 V
Ethics in Managed Care 269
Jeremy A. Lazarus and Steven S. Sharfstein
The high cost of medical care has created a crisis in access and
quality of services and has led to rapid changes in the structure
and financing of health care services. Managed care and managed
competition are terms and techniques that have been invented in
an effort to get a handle on the escalating cost of care. The
financial pressures of health care on corporations and household
budgets have forced many of the changes that clinicians are
experiencing. The changing picture of treatment in the era of
managed care is discussed, including confidentiality, conflicts of
interest, informed consent, double agentry honesty, and the
doctor patient relationship.
Understanding the Intersection Between Quality
Improvement, Managed Behavioral Health
Accreditation, and the Private Practitioner 285
Gary J. Mihalik and Michael R. Scherer
Managed behavioral health care organizations exist to remedy a
perceived market failure in the delivery of health care. To do their
jobs well, these organizations must assume the stance of allocat¬
ing health care resources across populations, which presents a
dilemma for practitioners who are trained to maximize health
care outcomes for individual patients. Accreditation of managed
behavioral health care organizations serves to assure payers and
members that acceptable national standards of service and clinical
care delivery are being maintained. Compliance with accredita¬
tion standards requires that managed behavioral health care orga¬
nizations adopt quality measurement and improvement systems
that will affect practicing clinicians.
Monitoring Change in Behavioral Health Care: The Role
of the Center for Mental Health Services 297
Judith L. Teich
One of the strategic goals of the Substance Abuse and Mental
Health Services Administration (SAMHSA) is to improve man¬
aged care outcomes. This report from the Office of Managed Care,
Center for Mental Health Services, summarizes the results of six
SAMHSA projects. The studies discussed were selected because
they have yielded substantive findings. One nationwide evalua¬
tion showed increasing complexity in contracts between state
Medicaid agencies and managed care organizations, as states
move toward greater use of managed mental health and sub¬
stance abuse program arrangements and greater inclusion of per¬
sons with disabilities. A report from SAMHSA s Managed Care
Tracking System indicates that, contrary to predictions, most
public sector mental health and substance abuse programs are
Vi CONTENTS
managed by public sector agencies or public or private partner¬
ships rather than by private managed care organizations. Also,
an analysis of pre managed care Medicaid data on mental health
and substance abuse services in 10 states is serving as a baseline
to assess the effects of managed care on Medicaid mental health
and substance abuse program use and costs.
Medical Necessity and Psychiatric Managed Care 309
William E. Ford
The concept of medical necessity is a provision of commercial
insurance contracts and US government Medicaid requirements
that limits the payment to only services that are essential for
treating an illness, injury, or condition. Unfortunately, even simple
health care concepts are sometimes difficult to implement, espe¬
cially in areas as complex as psychiatric treatment. This discus¬
sion is designed to explore the ramifications of the concept of
medical necessity when applied to the treatment of patients with
psychiatric disorders.
Changes in Inpatient Psychiatric Utilization and Quality
of Care Performance Measures in a Capitated HMO
Population, 1989 1999 319
Ronald O Donnell, Dan Rome, Mark Godin, and
Paul Fulton
Managed behavioral health care approaches have significantly
reduced inpatient utilization and related cost of care, but the
relationship between decreased utilization and cost of care to
changes in quality of care performance over time remains in
question. The trends in utilization and quality of care perfor¬
mance measures over the course of 10 years of the Tufts Health
Plan Designated Facility Program, a model health maintenance
organization capitated program for inpatient behavioral health
care, are presented. The results indicate that substantial decreases
in inpatient utilization were sustained while quality of care mea¬
sures improved over time. The data support the Tufts Health Plan
Designated Facility Program as a successful means of balancing
cost containment with quality of care.
Alternative Treatment Programs: The Psychiatric
Continuum of Care 335
Robert K. Schreter
Until recently, psychiatric treatment was delivered only in 24
hour acute care facilities or outpatient practitioners offices. The
demand for cost containment has forced clinicians to develop a
continuum of care, alternative treatment programs arrayed be¬
tween the hospital and traditional outpatient settings. These treat
CONTENTS Vii
ment alternatives can be distinguished on the basis of service
characteristics, which describe program structure and intensity
and the range of available interventions and providers. New
clinical decision making support tools are making easier the
matching of patients with the services and levels of care that best
meet their needs. As clinicians have become more experienced
with the continuum, the identification of a set of principles that
can guide developers in the design of these systems of care has
become possible.
Clinical Status: Charting for Outcomes in Behavioral
Health 347
Susan V. Eisen
Assessment of mental health outcomes is rapidly becoming a
routine part of clinical practice across all disciplines and levels of
care. Empiric effectiveness data are required by government,
payer, and accrediting organizations. In addition to meeting re¬
quirements, outcome data may be useful to justify payer expendi¬
tures, guide quality improvement efforts, enable interprogram
comparisons, and facilitate payers and consumers choices of
providers. Six broad criteria should be met for outcome data to
be maximally useful: (1) selection of meaningful, reliable, and
valid outcome indicators that are feasible to implement across
multiple levels of care; (2) standardization of outcome indicators
and their operational definitions; (3) representative sampling; (4)
accurate and complete data collection; (5) appropriate data ana¬
lytic techniques; and (6) understandable feedback of results to
stakeholders. This article discusses the important aspects of these
criteria, describes the challenges faced by the field in meeting
these criteria, and suggests processes and systems to enhance the
potential usefulness of outcome data.
Mapping the Road to Quality Collaborative Patient Care
in a Behavioral Health Community Treatment Center:
Avoiding the Detours of Managed Care 363
Gretchen H. Homer
Tools and processes that are intended to meet regulatory stan¬
dards and requirements for the documentation of patient care in
a behavioral health community treatment center are described.
The Adaptive Practice of Psychotherapy in the Managed
Care Era 383
Peter W. Moran
The influence of managed care on mental health care services has
led to necessary adaptive changes in the delivery of psychother¬
apy. These changes reflect managed care s new definition of value
viii CONTENTS
and the changing parties that demand such service value. Service
adaptations do not necessarily emphasize theoretic change but
rather strategic change in service delivery so that such services
are cost effective and measurable, leading to high satisfaction for
patients, managed care management, and providers.
Developing Outpatient Mental Health Services for
Managed Care 403
Daniel Kirsch
A framework for designing outpatient psychiatric services in a
managed care environment is described. This article describes for
whom these services are being provided, a set of clinical princi¬
ples around which to organize them, and how to implement
them.
Private Psychiatric Practice in an Era of Managed Care 415
Gail M. Barton
Many psychiatrists who entered private practice before the era of
managed care know that it is not easy to earn a living today in
private practice. The author, on the other hand, has only her
experience practicing psychiatry in the public sector. The author
shares her experiences with managed care, including how to
make money in a managed care environment.
The Collaboration Between Psychiatry and Primary Care
in Managed Care 427
George N. McNeil, Jr
Primary care physicians have an important historical role in the
delivery of mental health care despite the evolution of psychiatry
as a specialty. Collaboration between primary care physicians and
psychiatrists has been limited by problems of access to psychiatric
care or consultation. Although managed care, in some forms, has
been successful in addressing this issue, it has largely served as
a new barrier to effective collaboration and to meeting the mental
health care needs of patients.
Geriatric Psychiatry and Managed Care 437
Gary S. Moak
Managed care organizations face daunting challenges in at¬
tempting to provide better care to elderly members. They must
manage the high cost of care for frail patients with multiple
chronic problems in a world of shrinking reimbursement while
creating innovative service delivery systems that overcome the
service delivery barriers that elderly patients face. Cost effective
treatment requires a continuum of care, in which geriatric psychi
CONTENTS ix
atry and primary care geriatric services are integrated in an ag¬
gressively case managed model. Managed care organizations
have the infrastructure and tools at their disposal to make this
work, but they must incorporate into their programs and ap¬
proaches expert knowledge of the unique clinical problems of the
frail, elderly population.
Training Psychiatric Residents in Managed Care 451
H. Steven Moffic
The controversy about managed care in general is reflected in the
challenges of training psychiatric residents in managed care.
Some consensus is emerging that all programs should provide
some amount of such education. Moreover, some principles and
strategies seem to exist that any program can adapt and use,
including neutral attitude, connecting managed care to related
educational endeavors, emphasizing cost effectiveness as a pri¬
mary value, providing a basic seminar series, and approaching a
core patient group using managed care management.
Index 461
Subscription Information Inside back cover
X CONTENTS
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| spellingShingle | Managed care and mental health The psychiatric clinics of North America Programme soins organisés Services de santé mentale Managed Care Programs Managed care plans (Medical care) Mental Health Services Mental health services Psychiatrische Versorgung (DE-588)4047677-7 gnd Managed Care (DE-588)4461436-6 gnd |
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| title | Managed care and mental health |
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| title_full | Managed care and mental health Stephen M. Soreff, guest ed. |
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