Managed Behavioral Health Care Handbook

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ISBN: 9780834217270 | 0834217279
Cover: Hardcover
Copyright: 5/1/2001

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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.

Contributors

Foreword

Preface

xvii

An Overview of Managed Behavioral Health Care

(28)

E. Clarke Ross

Managed Behavioral Health Care Issues

(9)

Managed Care as Public Policy

(18)

Forms of Payment, Capitation, and Risk Management

(28)

Stephen P. Melek

Forms of Payment

(5)

Capitation

(10)

Risk Management

(11)

Conclusion

(2)

Clinical Delivery and Medical Necessity

(18)

Ian A. Shaffer

Daniel Lieberman

Introduction

(1)

Evolution of Managed Care

(2)

Goals of Managed Care

(1)

Medical Necessity

(4)

Obsessive-Compulsive Disorder

(1)

Personality Disorder

(2)

Variability in Behavioral Health Care Treatment

(5)

Future Goals

(3)

Integrating Behavioral Health and Primary Care: Finding New Solutions to Long-Standing Problems

(18)

Jerome V. Vaccaro

Christy L. Beaudin

Introduction

(1)

Definitions and Core Concepts

(3)

Controversies

(5)

Solutions/Models

(5)

The Future

(4)

Treatment and Coverage Decision Making in Managed Care: Patients' Rights under Publicly and Privately Sponsored Managed Care Arrangements

(66)

Sara Rosenbaum

Joel B. Teitelbaum

Introduction

(3)

Background and Overview

(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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Managed Behavioral Health Care Handbook

Summary

Table of Contents

Supplemental Materials

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