Managing Managed Care: Quality Improvement in Behavioral Health

Managing Managed Care: Quality Improvement in Behavioral Health

by Margaret Edmunds, Richard Frank, Michael Hogan, Dennis McCarty
     
 

ISBN-10: 030905642X

ISBN-13: 9780309056427

Pub. Date: 04/23/1997

Publisher: National Academies Press

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective

Overview

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations.

Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues.

The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened.

Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral health--federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Product Details

ISBN-13:
9780309056427
Publisher:
National Academies Press
Publication date:
04/23/1997
Edition description:
New Edition
Pages:
396
Product dimensions:
6.00(w) x 9.00(h) x 0.34(d)

Table of Contents

ACRONYMS xviii
SUMMARY 1(14)
1 INTRODUCTION
15(25)
Terminology Used in This Report
21(1)
Consumers and Families
22(3)
Practitioners
25(2)
Purchasers
27(2)
The Managed Care Industry
29(4)
Statement of Principles
33(3)
Organization of the Report
36(4)
2 TRENDS IN MANAGED CARE
40(36)
The Changing Health Care System
41(6)
Concerns with Managed Care in the Public Sector
47(2)
Behavioral Health in the New Marketplace
49(4)
Health Care Quality
53(8)
Quality Improvement and Quality Assurance
61(6)
Ethical Issues in Managed Behavioral Health Care
67(4)
Summary
71(5)
3 CHALLENGES IN DELIVERY OF BEHAVIORAL HEALTH CARE
76(46)
Extent and Impact of Behavioral Health Problems
77(10)
The Role of Primary Care
87(2)
Special Issues for Quality in Behavioral Health Care
89(4)
Developments in the Private Sector
93(2)
Quality and Consumer Protection Challenges
95(1)
Variability at the State Level
95(1)
Historical Perspective on Systems
96(19)
Summary: System Integration
115(7)
4 STRUCTURE
122(46)
Practitioner Issues
123(5)
Medicaid
128(2)
Medicare
130(1)
Substance Abuse Service Systems
131(4)
Mental Health Treatment
135(1)
Wraparound Services
136(5)
The Managed Behavioral Health Care Industry
141(1)
Workplace Services
142(6)
U.S. Department of Defense and U.S. Department of Veterans Affairs
148(4)
Care and Services for Children and Adolescents
152(4)
Care and Services for Seniors
156(1)
Indian Health Service
157(2)
Cultural Competence
159(3)
Rural Health and Managed Care
162(1)
Summary of Structural Issues
163(5)
5 ACCESS
168(16)
Importance of Assessing Access
169(2)
Measures of Access
171(3)
Need and Access
174(1)
Needs of Special Populations
175(3)
Measuring Access to Services Within Managed Care Organizations
178(1)
Summary
179(5)
6 PROCESS
184(42)
Quality and Accountability
184(5)
Quality Management in Behavioral Health Care
189(10)
Performance Measurement in the Public Sector
199(4)
Accreditation
203(14)
Information Infrastructure for Quality Measurement
217(1)
Role of Government in Quality Assurance
218(5)
Summary
223(3)
7 OUTCOMES
226(15)
Definitions of Success
226(2)
General and Specific Measures of Outcomes
228(4)
Links Among Structure, Process, and Outcomes
232(1)
Performance Indicators as Outcomes Measures
233(1)
Efficacy and Effectiveness
234(1)
Outcomes and Quality Improvement
234(1)
Criteria for Evaluating Outcomes Measures
235(3)
Summary
238(3)
8 FINDINGS AND RECOMMENDATIONS
241(14)
1. Structure and Financing
242(1)
2. Accreditation
243(4)
3. Consumer Involvement
247(1)
4. Cultural Competence
248(1)
5. Special Populations
249(1)
6. Research
249(1)
7. Workplace
250(1)
8. Wraparound Services
251(1)
9. Children and Adolescents
251(1)
10. Clinical Practice Guidelines
252(1)
11. Primary Care
253(1)
12. Ethical Concerns
254(1)
GLOSSARY 255(8)
APPENDIXES 263(94)
A Committee Biographies 263(8)
B Commissioned Paper: Can the Outcomes Research Literature Inform the Search for Quality Indicators in Substance Abuse Treatment?, A. Thomas McLellan, Mark Belding, James R. McKay, David Zanis, and Arthur I. Alterman 271(41)
C Commissioned Paper: Consumer Outcomes and Managed Behavioral Health Care: Research Priorities, Donald M. Steinwachs 312(24)
D Public Workshop Agendas and Participants 336(13)
E Liaison Panel Members to the Committee 349(6)
F Organizations That Submitted Written Materials to the Committee 355(2)
INDEX 357

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