Managing Managed Care II: A Handbook for Mental Health Professionals

by Michael Goodman MD, Janet Brown RN CPHQ, Pamela M. Deitz LCSW

Overview

Managing Managed Care II: A Handbook for Mental Health Professionals, Second Edition, provides an easy-to-learn, easy-to-use method for documenting and communicating the necessity, appropriateness, and course of treatment for managed care review. Using the Patient Impairment Profile method, practitioners can convincingly convey a clinical rationale for treatment, efficiently track progress over time, and demonstrate favorable patient outcomes.

Keeping pace with the evolving and expanding presence of managed care, the authors have extensively revised and enlarged the previous edition. New clinical research on the validity and reliability of the impairment terminology has produced a much-improved, clinically valid, and statistically reliable impairment lexicon. Detailed severity rating qualifiers, reference lists of patient objectives, and a useful glossary have been added. All regulations have also been updated.

Managing Managed Care II is reference and valuable resource for mental health practitioners and for the individuals who monitor and review treatment. By providing concise, relevant, and outcome-focused treatment information, practitioners become proactive participants in managed care while adeptly articulating the value and quality of their services.

Product Details

ISBN-13:	9780880487726
Publisher:	American Psychiatric Association Publishing
Publication date:	06/01/1996
Series:	Managing Managed Care II Ser.
Edition description:	Second Edition
Pages:	264
Product dimensions:	6.00(w) x 9.00(h) x 0.90(d)
Age Range:	18 Years

About the Author

Michael Goodman, M.D., was a clinical psychiatrist in private practice in Beverly Hills and Pasadena, California. Dr. Goodman has 14 years of experience as a physician adviser with the former California Professional Standards Review Organization and its current successor, California Medical Review, Inc.

Janet A. Brown, R.N., C.P.H.Q., is a consultant in quality, utilization, and risk management with psychiatric and medical-surgical, acute and ambulatory health care organizations, all of which are now positioning for managed care. Ms. Brown is the author of The Quality Management Professional's Study Guide, now in its 10th edition, and serves as an instructor for quality management professionals preparing for the certification exam. She has chaired the National Healthcare Quality Educational Foundation and is the 1995–1996 president of the National Association for Healthcare Quality.

Pamela M. Deitz, L.C.S.W., M.F.C.C., is a psychotherapist in private practice. Ms. Deitz has continued to work in both agency and hospital settings. Her role as developer and clinical director of an adolescent treatment program heightened her awareness of and interest in the impact of managed care on all clinical disciplines providing mental health services.

Table of Contents

Introduction. The public demand for practitioner accountability. The need for a behavior-based common language of treatment. Patient impairments and the diagnosis. Patient impairments and the justification for treatment. Impairment severity and appropriateness of treatment. Treatment goals and patient objectives. Practitioner interventions and the treatment plan. Patient progress and the effectiveness of treatment. Managing the future of managed care. Glossary. Appendix A: Patient impairment definitions. Appendix B: Severity rating qualifiers (critical impairments). Appendix C: Patient objectives reference list (critical impairments). References. Index.

Editorial Reviews

This one is a particularly good one in terms of internal consistency, clarity, and case study illustrations. The discussions of the linguistic confusion regarding goals, objectives, and treatment plans in both managed care and provider sectors is both amusing and on the mark, and the authors' reformulations are lucid. Practitioners bewildered by the diversity of questions and standards used by their managed care plans or frustrated at their reimbursement denials will probably find the documentation method and suggested data structures helpful in reducing managed care denials.... [I]t represents a practitioner friendly approach to addressing managed care's oversight questions and makes an important step toward a common language for mental health services accountability.

Contemporary Psychology

Reviewer: John K. Larson, MD (Rush University Medical Center)
Description: This is a significantly revised second edition of a book, originally published in 1992, that is a collaboration of three authors — a psychiatrist, a nurse, and a psychotherapist — all of whom are actively seeing patients in a predominantly managed care setting. The authors support the position that medical necessity is based on a demonstration of functional impairment and that the mental health professional's role should focus on reducing the severity of that impairment. They provide a pragmatic classification system for assessing impairment, rating its severity, designing a focused treatment plan, and measuring outcome.
Purpose: The purpose is to enable practitioners to communicate more effectively in a managed care environment. However, the book is also provocative and stimulates a higher level of critical thinking in case formulations and in evaluating our effectiveness in our work with patients, regardless of theoretical orientation.
Audience: The book is targeted for all mental health practitioners, especially those who see patients in cost-conscious settings where communication with case managers is necessary. Psychiatrists working in consultation-liaison relationships with other physicians will also benefit from its pragmatic approach and lack of jargon.
Features: The book uses numerous case examples to illustrate major points, including impairment and its relationship to diagnosis, rating of severity, treatment goals, patient objectives, interventions, and measurement of progress and outcome. A description of proprietary software that incorporates the authors' approach to treatment planning is included. The book concludes with an extensive glossary incorporating an impairment lexicon, severity rating scales and qualifiers, a patient objectives list, and an excellent list of supporting references.
Assessment: This book can be enthusiastically recommended to those besieged mental health practitioners looking for a better way to advocate for their patients in managed care settings. Any practitioner will benefit from exposure to the critical thinking and jargon-free language elucidated by the authors.

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