Managed Behavioral Health Care Handbook

by Ross, E. Clarke

• ISBN13: 9780834217270
• ISBN10: 0834217279
• Format: Hardcover
• Copyright: 2001-05-01
• Publisher: Jones & Bartlett

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