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From The CriticsReviewer: John K. Larson, MD (Rush University Medical Center)
Description: This is a practical volume by the founder of a behavioral healthcare organization in New Mexico which, at the time of publication, managed mental health care for 300,000 individuals.
Purpose: The purpose is to provide an introduction to managed behavioral healthcare for readers who have little or no background in the subject.
Audience: The targeted audience includes clinicians and healthcare administrators in training, as well as seasoned clinicians preparing to work with managed care organizations.
Features: A relatively comprehensive overview of managed care is provided in a concise, readable style. The first few chapters introduce the reader to the history of managed care and the structural make-up of a typical managed care organization (MCO). Subsequent chapters deal with the relationship between providers of care and MCO's, including clinician qualities that are attractive to MCO'S, contractual issues, credentialing, and reimbursement. Profiles of six managed behavioral healthcare organizations are then presented, followed by ethical concerns and the author's view of the future. Finally, the text ends with four appendixes containing a sample capitation contract, a glossary, quality accreditation standards, and a comprehensive listing of managed care journals, newsletters, and web sites.
Assessment: This is an particularly successful effort to provide the reader with a broad but detailed overview of the current issues involved in providing mental health services in a managed care setting. The book is informative and of particular relevance to clinicians in training.