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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.
For both patients and providers, the words managed care are loaded with negative connotations, synonymous with inefficiency and bureaucracy. Forced to perform a delicate balancing act of offering the best possible care for their clients while carefully adhering to various managed care policies and procedures, providers in particular often wince at the prospect of having to deal with managed care companies, or MCOs. Fearing burdensome paperwork, low reimbursement rates, and denials of care, it's not surprising that a number of mental health professionals choose to limit their involvement with managed care companies-or eliminate it altogether. "My clients are all on different health plans; how can I keep the policies straight?" "Getting services approved is so time-consuming that I'm better off accepting only self-paying clients, aren't I?" "Do the benefits of working with MCOs really outweigh the drawbacks?" The answer, according to two industry insiders, is yes. If you know how to work with the system, the system can work for you. Mental Health Provider's Guide to Managed Care is the first handbook of its kind to offer clinicians a window into the inner-workings of MCOs. Authors Reich and Kolbasovsky candidly draw on their combined 37 years experience in the field to walk readers through all the major elements of how to successfully work within the system: marketing yourself and your practice to an MCO, getting onto a MCO's network, maintaining a good relationship and communicating with MCOs for quick service approval, reducing your liability, understanding your rights and responsibilities, getting paid, and more. Every issue—big and small—is covered, from capitation versus fee-for-service payment arrangements to evaluating which MCOs are a good fit to join, and everything in between. After explaining how to work with the system, the authors reveal how to put the system to work for you. Tips for building your practice through referrals, generating business through doctor collaboration, and understanding future practice opportunities are all covered.By demystifying the complexities of managed care and offering a unique, inside view of the process, this book mitigates the negative connotations associated with MCOs and exposes the hidden benefits of a seemingly burdensome process. Exceedingly reader-friendly and packed with insightful tips and vignettes, Mental Health Provider's Guide to Managed Care is one clinician's guide you won't want to be without.
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.
Successful practices outside of managed care result from developing personal passions, creating opportunities. . . and reading this book! Walfish connects the reader not only to real psychologists who have found a variety of niches but also to ready-touse strategies and practical references. You're sure to find several ideas to expand your practice.ùJana N. Martin, PhD, independent practice and Chief Operating Officer of the American Psychological insurance Trust --
Advice on Helping Your Loved Ones, from the medical director of the country's largest state mental health system and the mental health editor of The Huffington Post More than fifty million people a year are diagnosed with some form of mental illness. It spares no sex, race, age, ethnicity, or income level. And left untreated, mental disorders can devastate our families and communities. Family members and friends are often the first to realize when someone has a problem, but it is hard to know how to help or where to turn. Our mental health “system” can feel like a bewildering and frustrating maze. How can you tell that someone has a mental illness? What are the first and best steps for you to take? Where do you go to find the right care? The Family Guide to Mental Health Care is the first comprehensive print resource for the millions of people who have loved ones suffering from some kind of mental illness. In this book, families can find the answers to their most urgent questions. What medications are helpful and are some as dangerous as I think? Is there a way to navigate privacy laws so I can discuss my adult daughter’s treatment with her doctor? Is my teenager experiencing typical adolescent distress or an illness? From understanding depression, bipolar illness and anxiety to eating and traumatic disorders, schizophrenia, and much more, readers will learn what to do and how to help. Real-life scenarios and authoritative information are written in a compassionate, reader-friendly way, including checklists to bring to a doctor’s appointment so you can ask the right questions. For readers who fear they will never see the light at the end of the tunnel, this book gives hope and a path forward. As one of the nation’s leading voices on quality care in mental health, Dr. Lloyd Sederer has played a singular role in advancing services for those with mental illness. Now, the wealth of his expertise and clear guidance is at your disposal. From the first signs of a problem to sorting through the variety of treatment options, you and your family will be able to walk into a doctor’s office know what to do and what to ask.
Providing therapists practical solutions to managed care's erosion of their freedom to practice, this book presents a working blueprint for a private-pay psychotherapy practice. Dana C. Ackley casts out the distortions that have crept into many clinicians' thinking as a result of reliance on third-party reimbursement. Based on his own experience, he shows how you can serve clients--and yourself--better by developing real alternatives to the pressures and bureaucracy of managed care. In clear step-by-step detail, including practical exercises and checklists, sample marketing materials, and payment plans, the volume shows you how to: *Rediscover the economic and clinical value of your work *Discard assumptions that might block your progress *Educate yourself about the needs of potential clients *Market and sell your services effectively *Learn ethical, reasonable business-of-practice skills *Diversify into the rewarding area of psychological consultation to businesses. No matter what your clinical style, theoretical orientation, or practice history, you will benefit from the hard-won lessons Dr. Ackley shares in this book.
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. Although many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--as well as mental health research. The authors include some of the country's most noted psychologists with extensive experience in managed care. Their tone is optimistic rather than pessimistic; as they look at developments others have only deplored, they see potential roles and opportunities for growth for psychologists. In an era of dramatic health change, all those practitioners who are concerned about how to make managed care work for them rather than against them, will find this Guide essential reading. ALTERNATE BLURB A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. While many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--and mental health research as well.
Managed care is a revolution impacting the practice of clinicians throughout America. The Clinician’s Guide to Managed Behavioral Care, called “a survival kit” and “must reading,” helps clinicians develop and market professional services attuned to the needs of managed care systems, manage the utilization process, and reshape an office practice or hospital-based program to become more “managed care friendly.” It is newly referenced and updated for clinicians to continue to advocate for their patients and clients.The Clinician’s Guide to Managed Behavioral Care addresses how clinicians can develop and market professional services attuned to the needs of managed care systems, how to best manage the utilization review process, how to re-shape an office practice or hospital-based program to become more “managed care friendly,” and how to best advocate for patients and clients. Readers will understand the history and evolution of attempts to manage mental health care costs and services as well as the emerging clinical, economic, and social trends that will continue to fuel changes in the mental health field in coming years. Importantly, this guide sensitizes readers to the perspectives about mental health care benefits and the treatment field held by the payor community--insurance carriers, HMO’s, and self-insured employers. It allows readers to consider a payor’s view of how professionals can play a crucial role in providing quality services while helping control spiraling mental health care costs--costs that have escalated much faster than other segments of health care.Who can benefit from this book? Practicing psychologists, social workers, psychiatrists, substance abuse counselors, marriage and family therapists, Employee Assistance Professionals, psychiatric nurses, professional counselors, program managers, hospital administrators, and health care marketing professionals will find The Clinician’s Guide to Managed Behavioral Care and invaluable resource.It is often said that in the future, all in the treatment community will be involved in “managing care” and that the most successful clinicians and practices will be those most adept at working with managed care systems on behalf of their patients and clients. This book helps you understand how!Important topics in The Clinician’s Guide to Managed Behavioral Care: the changing marketplace for mental health/substance abuse treatment services assessing market opportunities in light of managed care influences clinical service needs of managed care systems clinical innovations: examples, case studies, vignettes strategies for managing utilization review marketing strategies for office-based practitioners hospital-managed care partnerships contemporary office management strategies to control costs consumers and managed care directory of America’s HMOs directory of America’s Managed Mental Health Care Companies glossary of key terms
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.