Concise Guide to Managing Behavioral Health Care Within a Managed Care Environment

Overview

How can behavioral health clinicians provide managed care in an ethical, professionally satisfying way while also dealing with managed care organizations (MCOs)?

This concise yet powerful volume will jump-start clinicians in their search for effective answers. Unlike other managed care guides, which tend to view the clinician-managed care relationship as inherently adversarial, this groundbreaking pocket guide (another in American Psychiatric Publishing's Concise Guides series) ...

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Overview

How can behavioral health clinicians provide managed care in an ethical, professionally satisfying way while also dealing with managed care organizations (MCOs)?

This concise yet powerful volume will jump-start clinicians in their search for effective answers. Unlike other managed care guides, which tend to view the clinician-managed care relationship as inherently adversarial, this groundbreaking pocket guide (another in American Psychiatric Publishing's Concise Guides series) views resource management as a basic function — indeed, an ally — of ethical clinical practice. True managed care both improves the quality of clinical care and protects community resources. It even stimulates patients to become more active managers of their own care.

The author, speaking from extensive first-hand experience as both network provider and MCO administrator, asserts that clinicians must know how to manage care themselves to effectively persuade insurance companies to pay for treatment. Toward that end, the author details the practical tools clinicians need in just five chapters: • Chapter 1, Managing Care Ethically, discusses basic principles and methods for making clinical decisions about behavioral health care when resources are limited and methods for communicating these decisions to patients and MCOs. • Chapter 2, Managing Nonacute Care, applies the principles and methods from Chapter 1 to providing non-acute, usually outpatient, services. • Chapter 3, Managing Acute Care, applies the principles and methods from Chapter 1 to providing acute crisis or inpatient services. • Chapter 4, Marketing to Managed Care Organizations, details strategies for negotiating contracts to often unreceptive MCOs who consider their networks full, showing how clinicians can enhance their market value by filling MCO needs.• Chapter 5, Managing Utilization Review, offers insights on overseeing the clinical work of colleagues and shaping the health care system, assuming that care managers are professionally obligated to help patients receive the care they need and deserve without intruding on the clinician's role, and that the best management manages least, taking responsibility for efficient resource utilization and ongoing system improvement.

This practical guide is more than just a handbook for successfully navigating MCO procedures and market dynamics; it also shows that the outcome of truly managed care can be just as satisfying and effective as care provided with infinite resources.

Invaluable to clinicians in everyday practice, this remarkable guide with its unique insights, collaborative approach, and case examples will also find a wide audience among clinical administrators in private and public MCOs who train network clinicians and utilization managers.

American Psychiatric Publishing

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Editorial Reviews

Behavioral Healthcare Tomorrow
This brief work on managed behavioral healthcare features many references and well-documented scripts fro use in discussions with patients, payers, and clinicians.... [T]his book is considered a useful reference for a newcomer who might feel stymied by some of the lingo and logistics of managed care.
Doody's Review Service
Reviewer: Nishad J. Nadkarni, MD (Rush University Medical Center)
Description: As managed care organizations (MCOs) make significant inroads on delivery of mental health systems, clinicians need to be cognizant of various specific practice issues in this area, which this book introduces.
Purpose: The author feels that a lack of understanding on the part of clinicians regarding navigation through the complexity of managed care negatively impacts patient care and clinician satisfaction. A concise guide to the relevant issues needs to be provided.
Audience: A variety of mental health clinicians as well as administrators will find this book of particular use and relevance.
Features: Although physically as small as a pocket book, this material is presented in a highly relevant and concentrated manner, which is both user-friendly and free of "business-speak" jargon. Topics include issues in acute vs. nonacute care, and utilization review. A comprehensive and pertinent list of end-chapter references guides the reader towards further study in these areas. Some further emphasis on medicolegal issues should be made in subsequent volumes.
Assessment: The enormous importance of this book is belied by its small appearance. A major problem with work in this field in general is a reliance on business-oriented verbiage that clinicians find difficult to understand. In this respect, this book succeeds admirably in discussing these issues in a clear and cogent manner. This book should be read and referred to frequently by clinicians involved in the delivery of mental health in a managed care environment.
From The Critics
The guidelines for provisions by HMOs for psychiatric care are outlined in a direct, pithy format in this pocket-sized volume. Bennett (a physician in Massachusetts) discusses the ethics of managing care, the rules for nonacute and acute care, marketing oneself to a HMO, and how to advocate for good care. Annotation c. Book News, Inc., Portland, OR (booknews.com)

3 Stars from Doody
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Product Details

  • ISBN-13: 9780880487382
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 5/28/2002
  • Edition description: 1ST
  • Pages: 104
  • Product dimensions: 4.25 (w) x 6.50 (h) x 0.30 (d)

Meet the Author

Michael Isaiah Bennett, M.D., is Medical Director at Mental Health CaseManagement, Plymouth, Massachusetts.

American Psychiatric Publishing

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Table of Contents

Managing care ethically. Managing nonacute care. Managing acute care. Marketing to managed care organizations. Managing utilization review. Index.

American Psychiatric Publishing

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