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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.
Written for health care executives, physicians, nurses, policymakers, health services researchers, and scholars, Remaking Medicaid offers a vision of the future to which conscientious policymakers and provider organizations, working together, can aspire.
Examines the extent to which states are implementing Medicaid prepaid managed care programs for disabled beneficiaries, & the steps that have been taken to safeguard the interests of the three stakeholder groups (disabled beneficiaries who may be less able than others to effectively advocate on their own behalf; the prepaid care plans which are concerned about the amount of financial risk involved in treating people with extensive medical needs; & the states & Federal government, which run Medicaid, which totaled $159 billion in FY 1995.
A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.
America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.
Capitated managed care plans, which deliver medical services for a fixed per-person fee, are an increasingly common part of Medicaid, the federal-state health care program for certain low-income individuals, including adults & children in families, & aged, blind, & disabled people. This report: examines the implications of the Balanced Budget Act (BBA) of 1997 provisions defining this population; provides an update on the number of states enrolling children with special needs in capitated health plans, & assesses the steps the Health Care Financing Admin. has taken to establish appropriate safeguards for this population. Charts & tables.
Medicaid, the public health insurance program for low-income people, covered nearly 60 million Americans, or about 1 in 5, for at least some time during FY 2008. Under the Patient Protection and Affordable Care Act (ACA), beginning in 2014, Medicaid will expand to cover nearly all Americans with income below 133% of the federal poverty level, reaching an estimated 16 million uninsured people, mostly adults, by 2019. Since the early 1980s, states have relied increasingly on managed care arrangements to serve their Medicaid beneficiaries. Two-thirds of Medicaid enrollees now receive most or all of their benefits in managed care, and many states are expanding their use of managed care to additional geographic areas and Medicaid populations. Given Medicaid's large and growing coverage role and the increasing dominance of managed care in the program, this current profile of Medicaid managed care (MMC) offers a key policy resource.