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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.
Nursing
Approximately one-quarter of the U.S. population is enrolled in HMOs or similar managed care health plans, and the proportion is increasing. But even though such plans dominate today's agenda for health care reform, good, quantitative information on the performance of managed care programs is scarce. In Promise and Performance in Managed Care, Donald Freeborn and Clyde Pope draw on the research literature and unique data sources to provide that information. Focusing on the human experience of managed care, the authors examine the effects of managed care on members as well as physicians--assessing whether members are satisfied with the care they receive, and how physicians evaluate their experience with managed care. After offering a brief history of managed care in the United States, the book addresses such questions as what determines the choice of a health plan, access to care, patient satisfaction, physician satisfaction, and the implications of these findings for the future of managed care. With the issue of health care reform in the forefront of national debate, the topics raised in Promise and Performance in Managed Care are particularly timely. Serving as both a standard against which to examine the effectiveness of proposed reforms and as a methodological "how to" for the evaluation of system changes, the book will be of interest to professionals and students of health policy as well as to HMO administrators and practitioners.