Managing Managed Care

Managing Managed Care
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 394
Release: 1997-04-21
Genre: Medical
ISBN: 0309175054

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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.

Handbook of Quality Assurance in Mental Health

Handbook of Quality Assurance in Mental Health
Author: Alex R. Rodriguez
Publisher: Springer Science & Business Media
Total Pages: 503
Release: 2013-11-09
Genre: Psychology
ISBN: 1468452363

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professional-standards-review organizations (PSRO) in defining quality of care for the Medicare program; it is a "shared responsibility of health professionals and government to provide a reasonable basis for confidence that action will be taken, both to assess whether services meet professionally recognized standards and to correct any deficiencies that may be found" (p. 14). Similar pronouncements have been made for the quality assurance activities of the Department of Defense's CHAMPUS program and of the 1980s successor to the PSROs, the federally designated peer-review organizations (PROs), established to ensure quality and utilization-efficient care for Medicare. Links between the federal and state gov ernments and between professional associations and private review entities have been developed to make this "shared responsibility" manifest in the delivery and reimbursement of health services. This responsibility is seen in light of both pro fessional and legal accountability, a view noted by Gibson and Singhas (1978) and Alger (1980). Accountability, then, becomes a concentric concept that elaborates on the pure view of quality and reflects the federal government's consumer protection activities during the 1970s. The Joint Commission on Accreditation of Hospitals (JCAH), which has pro vided another primary historical leadership role in defining quality assurance, has promoted the evolution of the concept of resource limitations as a part of the defini tion of quality assurance.

Quality Improvement in Behavioral Health

Quality Improvement in Behavioral Health
Author: William O'Donohue
Publisher: Springer
Total Pages: 333
Release: 2016-06-17
Genre: Psychology
ISBN: 3319262092

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This innovative volume presents a cogent case for quality improvement (QI) in behavioral healthcare as ethical practice, solid science, and good business. Divided between foundational concepts, key QI tools and methods, and emerging applications, it offers guidelines for raising care standards while addressing ongoing issues of treatment validity, staffing and training, costs and funding, and integration with medical systems. Expert contributors review the implications and potential of QI in diverse areas such as treatment of entrenched mental disorders, in correctional facilities, and within the professional context of the American Psychological Association. The insights, examples, and strategies featured will increase in value as behavioral health becomes more prominent in integrated care and vital to large-scale health goals. Included in the coverage: Behavioral health conditions: direct treatment costs and indirect social costs. /liliQuality improvement and clinical psychological science. · Process mapping to improve quality in behavioral health service delivery. · Checklists for quality improvement and evaluation in behavioral health. · Creating a quality improvement system for an integrated care program: the why, what, and how to measure. · Feedback Informed Treatment (FIT): improving the outcome of psychotherapy one person at a time. Quality Improvement i n Behavioral Healthcare gives health psychologists, public health professionals, and health administrators a real-world framework for maintaining quality services in a rapidly evolving health landscape.