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This report synthesizes the collective experiences of four managed behavioral health care organizations (MBHOs) that hold public sector managed care carve-out contracts. Four representatives of these MBHOs participated in a day-long focus group meeting, and two others were interviewed by telephone. Contents: Approach to the Study; Program Design; Financial Requirements and Reimbursement; Procurement Process; Implementation and Ongoing Administration; Recommendations of Focus Group Participants; Summary References; and Appendix: List of Focus Group Participants.
In recent years, State Medicaid agencies and other public sector entities -- in particular, State, county, and local substance abuse and mental health (SA&MH) authorities -- have increasingly been taking the initiative to purchase SA&MH managed care (MC) services from private sector org's. or specialized nonprofit agencies. This is a practical guide for public purchasers and others involved in the design and develop. of MC initiatives involving SA&MH services. Chapters: designing, procuring, and implementing a MC system; coverage; contracting for network services; the mgmt. info. system; quality mgmt.; financial issues; and consumer protections. Bibliography.
The rapid spread of managed care into public and community mental health systems is creating a dramatic transformation of traditional public sector settings. This radical change is affecting administrators, managers, and clinicians.Intended as a survival manual, this book begins with an overview of the history, concepts, ideology, and ethics of public sector managed care and then proceeds in focus from system to program management to clinical program levels. With a concluding section on advocacy, evaluation, research, and training issues, Managed Mental Health Care in the Public Sector examines how public sector managed mental health care can be approached with a positive spirit, an excitement about the potential to create dramatic and beneficial system changes, and a genuine interest in investigating the relative merits of every aspect of managed care systems.
State governments in the past decade have had to take on the problem of health care, with mixed results. This collection of 11 essays (of which two are an introduction and conclusion) by academics and policy makers consider the many issues that concern health care in the US and their effects at the state level, including managed care, health insurance expansion, mental health care, public health administration, and bureaucratic reactions to health policy. Hackey teaches health policy and management at Providence College in Rhode Island; Rochefort teaches political science and public administration at Northeastern U. in Boston. c. Book News Inc.
A descriptive examination of: (1) the structure & content of provider network agreements between managed care organizations (MCOs) & community mental health & substance abuse (MH/SA) treatment & prevention agencies, proving an assessment of provider contracts to identify the meaning of these instruments for MH/SA service providers, group purchasers, MCOs, individual consumers, & public policy makers; & 2) service agreements between State Medicaid agencies & MCOs for mental health & substance abuse treatment services, addressing enrollment, benefits & services, duties, & quality assurance.
"First Published in 1997, Routledge is an imprint of Taylor & Francis, an informa company."
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 healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.