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9780834217270

Managed Behavioral Health Care Handbook

by
  • ISBN13:

    9780834217270

  • ISBN10:

    0834217279

  • Format: Hardcover
  • Copyright: 2001-05-01
  • Publisher: Jones & Bartlett

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Summary

Written by a team of nationally recognized authorities on managed care, Managed Behavioral Health Care Handbook guides you through specific strategies that characterize contemporary efforts made at managing behavioral health care, building a clear understanding of their role, and their effect in improving the quality of behavioral health care today, and in the future.From beginning to end, you will learn the core components of the managed behavioral health care process and gain invaluable insight into the numerous controversies and public policy issues.

Table of Contents

Contributors xi
Foreword xv
Preface xvii
An Overview of Managed Behavioral Health Care
1(28)
E. Clarke Ross
Managed Behavioral Health Care Issues
2(9)
Managed Care as Public Policy
11(18)
Forms of Payment, Capitation, and Risk Management
29(28)
Stephen P. Melek
Forms of Payment
29(5)
Capitation
34(10)
Risk Management
44(11)
Conclusion
55(2)
Clinical Delivery and Medical Necessity
57(18)
Ian A. Shaffer
Daniel Lieberman
Introduction
57(1)
Evolution of Managed Care
57(2)
Goals of Managed Care
59(1)
Medical Necessity
60(4)
Obsessive-Compulsive Disorder
64(1)
Personality Disorder
65(2)
Variability in Behavioral Health Care Treatment
67(5)
Future Goals
72(3)
Integrating Behavioral Health and Primary Care: Finding New Solutions to Long-Standing Problems
75(18)
Jerome V. Vaccaro
Christy L. Beaudin
Introduction
75(1)
Definitions and Core Concepts
76(3)
Controversies
79(5)
Solutions/Models
84(5)
The Future
89(4)
Treatment and Coverage Decision Making in Managed Care: Patients' Rights under Publicly and Privately Sponsored Managed Care Arrangements
93(66)
Sara Rosenbaum
Joel B. Teitelbaum
Introduction
93(3)
Background and Overview
96(7)
Key Concepts and Definitions
103(7)
Typology of Legal Issues Regarding Patients' Rights in the Area of Treatment and Coverage Decision Making
110(12)
The Consumer Bill of Rights and Responsibilities
122(1)
Conclusion
123(36)
Examples of Medical Necessity Clauses in Employee Health Benefit Contracts
129(3)
Selected Medical Necessity Standards in Medicaid Managed Care Contracts
132(27)
Private Purchaser Expectations
159(18)
Veronica V. Goff
Introduction
159(2)
Private Purchasers and the Growth of Managed Behavioral Health Care
161(1)
Turning Around Traditional Notions about Mental Health Insurance
162(1)
Employers Use Clinical Depression as a Window on Quality and Value
163(2)
Employer Innovations in Managing Total Behavioral Health Costs
165(2)
Ongoing Concerns about Managed Behavioral Health Care
167(2)
What Do Private Purchasers Want?
169(2)
Creating the Next Generation of Managed Behavioral Health Care
171(2)
Conclusion
173(4)
Public Purchaser Expectations
177(24)
Martin D. Cohen
Stephen L. Day
Background
177(3)
Public Sector Behavioral Health Managed Care
180(4)
What Public Purchasers Want To Purchase
184(9)
Case Studies
193(4)
Conclusion
197(4)
Persons with Serious Mental Illness, The Public Sector, and Managed Care
201(24)
E. Clarke Ross
Introduction
201(1)
The Public Interest
202(2)
Seamless Systems of Care That Include Integrated and Coordinated Delivery: Linkage between Medicaid and Public Mental Health Has Failed
204(1)
Adequate Services to Persons with Severe Mental Illnesses: ``Appropriate Payment Is a Critical Safeguard''
205(9)
Accountability Is Rarely Public
214(3)
Meaningful and Authentic Consumer, Family, and Enrollee Participation Is Rare
217(3)
Conclusion
220(5)
Persons with Addictive Disorders, System Failures, and Managed Care
225(42)
David Mee-Lee
Introduction
225(1)
Generations of Care for Addictive Disorders
226(1)
Complications-Driven Treatment
227(2)
Diagnosis, Program-Driven Treatment
229(3)
Individualized, Clinically Driven Treatment
232(3)
Clinical, Outcomes-Driven Treatment
235(4)
What Do Persons with Addictive Disorders Need?
239(5)
Improving Services by Learning from Past Systems Failures
244(5)
Where To Start in Getting There from Here
249(9)
Challenging Dilemmas and How Managed Care Could Help
258(9)
Performance, Quality, and Outcomes: Prospects for Consensus in the Behavioral Health Field
267(30)
John A. Morris
Neal Adams
Introduction
267(1)
Measuring Quality
268(1)
Who Owns Quality?
268(1)
Managed Care Concerns
268(1)
Ethical Issues
269(2)
The State of Practice
271(1)
The Kudzu Phenomenon
272(1)
Search for the Holy Grail
273(1)
Candidate Indicators
274(1)
Movement toward Consensus
275(1)
A New Language
275(6)
A Consensus Set of Indicators
281(7)
Application of the Consensus Set
288(1)
Critical Gaps and Other Initiatives
289(3)
Other Challenges to the Field
292(1)
Summary
293(4)
Consumer Satisfaction Teams and Other Third-Party Independent Accountability Entities
297(16)
E. Clarke Ross
Introduction
297(3)
Consumer Satisfaction Teams
300(5)
Facility and Program Monitoring Teams
305(2)
Ombudsman Programs
307(2)
Binding and Timely Clinical Review
309(1)
Independent Validation of Health Plan Performance Data
310(1)
Conclusion
310(3)
Can Provider-Sponsored Organizations Successfully Manage Care?
313(22)
Allen S. Daniels
Charles G. Ray
Introduction
313(2)
The Evolution of Provider-Sponsored Organizations
315(3)
The Success of Provider-Sponsored Organizations
318(1)
Stages of Development from Service Delivery (Providers) to Managed Behavioral Health Care Organizations (PSOs)
318(2)
The Structure of Managed Behavioral Health Care Organizations
320(6)
An Examination of Provider-Sponsored Organizations
326(4)
Conclusions: Can Provider-Sponsored Organizations Successfully Manage Care?
330(5)
Interest Group Competition and the Regulation of Managed Behavioral Health Care
335(24)
E. Clarke Ross
Competition among Interest Groups
336(2)
Domains of Accountability
338(1)
Foci of Conflict
339(2)
Market-Related Policy Options
341(1)
National and State Legislative Clamor To Regulate the Market Excesses of Managed Care
342(1)
Interest Group Approaches
343(1)
Managed Behavioral Health Care Organizations---A Unique Flexibility
344(4)
Proposed Legislative Consumer Protections
348(1)
Regulating Managed Care
349(3)
A Public Utility Model for Reform
352(2)
Conclusion
354(5)
Concluding Observations
359(8)
E. Clarke Ross
Major Issues
359(1)
Accomplishments and Challenges
360(4)
Summary
364(3)
Index 367(10)
About the Editor 377(2)
About the Contributors 379

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