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Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
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Index

A

Access to care

barriers to, 169-171

for children and adolescents, 152-153, 154

concerns about managed care, 168-169, 316-317

cultural competency as factor in, 174

definition, 171

gender differences, 175

measures of, 4-5, 142, 171-174, 175, 178-180

need for care and, 174-175, 178

negative effects of limiting, 170

as quality assessment component, 168

racial/ethnic considerations in, 175-176, 248

for special populations, 249

universal coverage and, 171

wraparound services, 136-138

Accountability

consensus on quality for, 199

employer coalitions for, 191

in evolution of behavioral health care, 189-190

for outcomes, 237-238

in primary care, 87

public reporting systems for, 198

quality of care and, 184-186

through credentialing and privileging, 187

Accreditation

and clinical practice guidelines, 252-253

cost issues, 214-215

effect on quality of care, 54, 186

findings, 243-244

goal of, 203

government role in, 218-219, 246

of Indian Health Service health centers, 158

for monitoring contracts, 7-8

for monitoring quality of care, 6, 186

organizations for, 32, 204, 214.

See also Accreditation organizations

process, 215-216

quality improvement program requirements, 64

recommendations for, 6-9, 244-247

requirements for, 214

scope of, 186

trends, 203-204, 214-215

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

See also Certification and licensure

Accreditation organizations

Council on Accreditation of Services for Families and Children, 23, 204-205

Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218

National Committee for Quality Assurance, 190-191, 202, 205-213

Rehabilitation Accreditation Commission, 32, 204

Utilization Review Accreditation Committee, 32, 213-214

Adverse selection, 51-52

Advocacy, consumer, 23-24

Affective disorders, 77

risk among children, 153

Agency for Health Care Policy and Research

activities, 203

recommendations for, 9, 11, 12, 14, 247, 250, 253, 254

Alcohol abuse/dependence, 77

co-occurring disorders, 176-177

detoxification, 276-277, 278

disease model, 106

drunk driving, 112

evolution of treatment system, 104-107

measures of local prevalence, 178

mortality, 157

suicide and, 78

treatment effectiveness, 84

trends in insurance coverage, 90-91

See also Substance abuse

Alcohol, Drug Abuse, and Mental Health Administration, 107, 111.

See also Substance Abuse and Mental Health Services Administration

Alcoholics Anonymous, 105, 114, 293

Alternative/innovative healing practices, 10, 248

American Managed Behavioral Healthcare Association, 141-142, 174

quality standards, 190-191

Anxiety disorders, 77, 177, 191

Auditing activities, 187-188, 245

B

Behavioral health problems among seniors, 156

co-occurring, 176-177

cost of care trends, 141

historical development of treatment system, 96, 103

negative effects of restricted access, 170

prevalence and incidence, 1, 15, 77

public perception/understanding, 20-21, 23-24, 170

risk among children, 153

service needs, 80-84

social costs, 77-78, 84

social stigma, 170

suicide and, 78

terminology, 22

underdiagnosed/underestimated, 3, 76, 78-80, 170

utilization patterns, 28

Benefits consulting, 31-32

C

Capitated payments

as barrier to access, 168, 169

definition, 46

in Medicaid, 47

prevalence, 46

role of, 46

soft, 48

Carve-in arrangements, 45, 49

Carve-outs, 45, 49, 88

Case management, 49

Center for Mental Health Services, 201-202, 247

Center for Substance Abuse Prevention, 201

Center for Substance Abuse Treatment, 85, 112-113, 201

Centers for Disease Control and Prevention, 11, 250

Certification and licensure

credentialing and privileging, 123, 187

peer review for, 186

quality of care issues, 57-58

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

state activities, 54-56, 186-187

for substance abuse counselors, 58-59, 294-295

substance abuse treatment, 57-58

transition of public services into managed care, 59

types of practitioners, 123

Child abuse, 153

Child and Adolescent Service System Program, 154

Children and adolescents

adolescent treatment issues, 155

findings, 251-252

health screening, 153

with impaired parents, 152-153

mental health care trends, 141

military health services for, 149-150, 151

prevalence of behavioral health problems, 77

principles of care for, 154

program financing, 153-154

recommendations regarding, 11-12, 252

risk for abuse, 153

risk for mental health problems, 153

school-based intervention, 153

service needs, 152-153

substance abuse, 77, 155, 177

Civilian Health and Medical Program of the Uniformed Services, 148, 149-150, 151, 152, 189

Clinical outcomes information system, 230, 233

Clinical practice

alternative/innovative techniques, 10, 248

coverage design/limitations and, 26

credentialing and privileging, 123, 187

cultural competence in, 159-162

duration of treatment, 319-320

effectiveness of, 84-85

findings, 252-253

focus of outcomes research, 84

in managed behavioral health care, 318-320

peer review, 186

prescription patterns, 320

recommendations for, 12-13, 253

standardization, 26-27

state licensure and effectiveness of, 57-58

structural measures of quality, 122

substance abuse counselors, 26, 58-59, 123, 294-295

terminology, 22

types and characteristics of practitioners, 25-26, 123

use of hospitals, 319

Clinical practice guidelines

as accreditation issue, 252-253

current extent of use, 60

current limitations, 252

outcomes research and, 235

potential effects, 60-61

role of, 60, 188-189

Cocaine, 276, 277-278

Community Mental Health Centers Act of 1963, 103, 104

Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment, and Rehabilitation Act.

See Hughes Act

Comprehensive Drug Abuse Prevention and Control Act of 1970, 110

Confidentiality, 35

in carve-outs, 88

concerns, 67-68

in substance abuse treatment, 68

Consultants

health benefits, 188

for regulatory compliance, 144-145

See also Benefits consulting

Consumer protection, 2

confidentiality rights, 67-68

government role in, 8-9, 219, 245-246

in managed care system, 241

meaning of, 21

patient autonomy, 69

recommendations for, 8-10, 245-246, 248

strategies, 241-242

structural/process models, 219

Consumers and families

advocacy efforts by, 23-24

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

definition, 21-22, 247

diversity, 25

involvement in health care system, 247-248

Consumer satisfaction

with access, 171, 175

measurement of, 9-10, 201-202

as measure of quality, 189, 245

media dissemination of findings, 189

Continuity of care/coverage, 6, 93, 245

Contracts/contracting

public sector-managed care, 48-49

quality assessment provisions, 29

quality of care and, 66

recommendations for, 7-8, 245

scope of coverage, 66-67

soft capitation, 48

Cost of care

adverse selection effects, 51-52

behavioral health problems, 77-78, 80

behavioral health trends, 141

concerns about quality of care, 16-17, 312

financing of child and adolescent programs, 153-154

indirect costs, 80-84

integration of service systems for, 146

managed care containment strategies, 42-45, 168

preventive interventions in workplace to reduce, 147

regional disparities, 176

spending trends, 28

substance abuse treatment expenditures, 28, 135

for substance-abusing criminal offenders, 113-114

Cost shifting, 53, 93

Council on Accreditation of Services for Families and Children, 32, 204-205

Coverage design/limitations

adverse selection effects, 51

benefits consultants, 31-32

competition for enrollees, 45-46

current status, 91

effect on quality of care, 54

employer-sponsored plans, 94, 184-185

historical limitations on mental health services, 313-314

legislative efforts, 24, 25

Medicaid, 128-129

Medicare, 130-131

parity, 24, 170-171, 314

private sector trends, 93-95

purchaser influence, 28-29

to restrict access, 169-170

substance abuse counseling, 26

treatment planning and, 26

trends, 90, 314

universal coverage, 171

Criminal justice system

alcoholism intervention, historical development of, 105-106

cost of behavioral health problems, 78

drug abuse intervention, historical development of, 107-109, 112

implications of limiting access to care, 170

managed care contracts, 114

public addiction treatment system and, 112

substance abuse by criminals, 112-113, 114

substance abuse treatment in, 113-114

Cultural competence

as ethical issue, 254

findings, 248

meaning of, 159

military health services, 150

models for practice, 160

need for, 159

recommendations for, 10, 248

resource networks, 162

threshold issues, 160-161

D

Data collection and management

admissions/discharge forms, 236

claims data, 217, 236

clinical outcomes information system, 230

confidentiality issues, 67-68

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

Mental Health Statistics Improvement Program, 201-202

for outcomes measurement, 233, 236-237

private sector quality standards, 191-199

public sector performance standards, 199-200

for quality improvement, 64

for quality measurement, 217-218

for report cards, 66

research priorities, 331

shortcomings of, 217-218

Defense, Department of, 4, 189

historical development of mental health care, 148-149

managed care services in, 151-152

TriCare program, 151-152

See also Military programs

Deinstitutionalization, 103

Delivery system

alcoholism intervention, historical development of, 104-107

behavioral health disability management plans, 145

challenges to, 3, 77

components of, 3, 122-123

in criminal justice system, 113-114

current functioning, 76-77

drug abuse intervention, historical development of, 107-111

employee assistance programs, 114-115

fragmented nature of, 76-77, 80, 96, 153-154, 163

historical development, 96, 103-111

Indian Health Service, 157-159

integration of public-private services, 49, 59, 115-116

managed care, 29-31

military managed care programs, 151-152

organizational interactions, 4

primary care in, 87-89

for rural areas, 162-163

service sector boundaries, 91-93

for special populations, 10

state level, 95-96

structural measures of quality, 122

wraparound services, 138-139

Demand management, 147

Depression/depressive disorders

among seniors, 156

primary care treatment, 87, 89

Disability

access to care, 249

behavioral, management of, 145

Medicare coverage, 130

substance abuse-related, 25

Drug Abuse Office and Treatment Act of 1972, 110

Drug Abuse Prevention, Treatment, and Rehabilitation Act, 68

E

Employee assistance programs, 114-115, 143-144, 146

Employee Retirement Income Security Act of 1974, 90-91

Employer-sponsored health plans

behavioral health disability management, 145

control of competition in, 45-46

cost of coverage, 46, 94

coverage design, 94

current status, 27-28

employer coalitions for quality accountability, 191

enrollment patterns, 46, 93-94

historical development, 184-185

mechanisms to restrict access in, 169-170

as purchasers of behavioral health care, 190-191

See also Workplace service systems

Enabling services.

See Wraparound services

Enrollment patterns

behavioral health care, 20-21

employee assistance programs, 115

employer-sponsored plans, 46, 93-94

health maintenance organizations, 31

indemnity insurance, 46

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

insured population, 28

managed behavioral health care, 1, 15, 45, 313

managed care, 1, 15, 31, 41-42

market influences, 45-46

Medicaid, 129, 202, 314

Medicare, 129, 131, 156-157, 202

private insurance, 31

substance abuse programs, 134-135

Ethical concerns, 71

confidentiality, 67-68

findings, 254

patient autonomy, 69

recommendations for, 13-14, 254

therapeutic relationship, 69-70

F

Families

with impaired parents, 152-153

military programs for, 149, 150

as substance abuse rehabilitation outcome factor, 290

Federal government

confidentiality regulations for substance abuse treatment, 68

consumer advocacy for behavioral health care, 24

consumer protection role for, 8, 9, 219, 245-246

current regulation of managed behavioral health care, 89-90

funding for substance abuse treatment, 135

historical development of alcoholism treatment, 104-107

historical development of delivery system, 96, 103, 104, 148

historical development of drug abuse treatment, 107-111

parity legislation, 24, 170-171, 314

recommendations for, 8, 9, 245-246

regulatory compliance by employers, consultants for, 144-145

research role, 249

role in quality assurance, 218-219

state level implementation, 95, 96

Foundation for Accountability, 191-198

G

Gender differences, 175

H

Harrison Narcotic Act, 107-108

Health Care Financing Administration, 29, 128

auditing activities, 187-188

quality management activities, 202

recommendations for, 14, 254

responsibilities and authorities, 202

Health maintenance organizations

accreditation requirements, 214

behavioral health care in, 45, 314

characteristics, 42

current regulation, 89-90

enrollment trends, 31

staff model, 45

Health Plan Employer Data and Information Set, 171-174, 198, 202, 217

Health Resources and Services Administration, 9, 11, 12, 247, 250, 252

Healthy People 2000, 200-201

Homeless mentally ill, 103

Housing, 83

Hughes Act, 57, 68, 106-107, 114-115

I

Indemnity insurance

enrollment trends, 46

in managed care system, 31

reimbursement system, 41

Independent practice associations, 42

Indian Health Service, 157-159

Infant mortality, 157

Institute for Behavioral Healthcare, 142

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

J

Job training, 83

Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218

K

Kassebaum-Kennedy bill, 24, 170-171

L

Legal issues, 188

Length of stay, 319-320

M

Managed behavioral health care

advantages of, 27, 48

adverse selection, 51

barriers to effective primary care, 88-89

choice of practitioner in, 315-316

clinical practice in, 318-320

competition, 50

conceptual approach to, 33-35

concerns about access, 169, 316-317

concerns about quality, 17, 47-48, 241, 312, 321

cost shifting, 53, 93

cultural competence issues, 160-161

current coverage, 91

current regulatory environment, 89-90

demands for quality, 53

effectiveness of, 50, 241, 242

employee assistance programs integrated with, 144, 146

enrollment, 1, 15, 313

ethical issues, 71

goals, 47

health promotion programs, 56-57, 146-147

historical growth, 31, 45, 314

integration of public-private services, 49-50, 59, 115-116

mechanisms to restrict access in, 169-170

in military health services, 151-152

See moral hazard. Adverse selection

outcomes of care, 321-324

performance measurement, 141-142

population needs assessment, 174-175

practitioner resistance to, 27

practitioners, 25-27, 123

principal issues, 19-20

quality improvement programs, 65

quality monitoring mechanisms, 41, 45

quality standards in private sector, 191-199

research priorities, 325-330

service sector boundaries, 91-93

skimming, 53

spending, 141

system trends, 41, 314

treatment planning in, 26

treatment trends, 15-16

Managed care

accreditation, 186

carve-outs, 45, 49, 88

challenges to confidentiality, 67-68

concerns about access, 168-169

consumer concerns, 24

cost management strategies, 42-45, 168

enrollment trends, 15, 28, 31, 41-42

evolution of structure, 42

financial incentives in, 46

goals, 1, 15, 40

historical growth, 42, 313

in Indian Health Service programs, 158-159

industry stakeholders, 31-32

influence on health care system, 40, 90-91

insurance industry in, 31

measuring local needs and access, 178-179

outcome studies, 229

patient autonomy and, 69

quality of care concerns, 16-17, 312

in rural areas, 162-163

structure and operations, 29-31, 41-45

terminology, 21

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

therapeutic relationship in, 69-70

See also Managed behavioral health care

Medicaid, 4, 92-93, 128

administrative structure, 129, 202

auditing activities, 188

capitated payment system in, 47

child health screening, 153

cost containment in, 129

coverage design, 128-129, 169

enrollment trends, 129

funding, 128

managed behavioral health care in, 94

managed care enrollment, 45, 128, 129, 202, 314

mental health care expenditures, 129

performance assessment, 130

recipients, 128

spending trends, 129

structure and operations, 128

in system of behavioral health care, 80, 104

Medicare, 4, 130

auditing activities, 188

benefit design, 130-131

costs, 131

disabled population, 130

enrollment, 31, 129, 131, 156-157, 202

managed care plans, 31, 129, 131, 202

mental health care provisions, 131

performance assessment, 130

quality improvement program, 64

Mental Health Statistics Improvement Program, 201-202

Methadone treatment, 109, 110

Military programs

child and adolescent services, 149-150, 151

coordination of treatment in, 149

cultural competence, 150

family services, 149

historical development, 148-149

older adult services, 150

services for chronic relapsing conditions, 150

See also Defense, Department of ;

Veterans Affairs, Department of

N

Narcotic Addict Rehabilitation Act of 1966, 109

Narcotics Anonymous, 293

National Alliance for the Mentally Ill, 246

National Association for Research on Schizophrenia and Depression , 246

National Committee for Quality Assurance, 190-191, 202, 205-213

National Depressive and Manic Depressive Association, 246

National Drug and Alcohol Treatment Utilization Survey, 131-133, 134

National Institute of Mental Health alcohol abuse research, 106, 111

Community Support Program, 103-104

drug abuse research, 110, 111

historical development, 103

recommendations for, 9, 11, 247, 250, 252

National Institute on Alcohol Abuse and Alcoholism, 106, 114-115

National Institute on Drug Abuse, 110-111, 250, 252

National Institutes of Health, 9, 11, 12, 247, 250, 252

National Mental Health Association, 246

O

Obsessive-compulsive disorder, 177

Older adults/senior citizens coordination of services for, 156

as health care consumers, 156-157

health perceptions of, 156

military health services for, 150

risk for chronic conditions, 156

risk for mental health problems, 156

substance abuse patterns, 177

Opiate addiction/detoxification, 277, 278

Outcomes measurement/research accountability for findings, 237- 238

analytical framework for, 231-232

clinical outcomes information system, 230

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

clinical practice guidelines and, 235

criteria for evaluating, 235-236

data sources, 236-237, 245

effect on quality of care, 54

efficacy/effectiveness assessments, 234

employee assistance program performance, 143-144

general measures, 230-232

indicators of access, 173-174

limitations of, 5, 84, 85, 233-234, 238-239, 249

long-term and short-term objectives, 228-229

in managed behavioral health care, 321-323

managed care research, 142, 229

as measure of quality, 3, 61, 198

multidimensional context, 226, 228

new approaches, 229-230

performance indicators for, 233

population-based, 327

practitioner characteristics, 123

process variables, 232

prospects for, 237-238

public dissemination of findings, 237

public expectations for treatment and, 227-228

quality improvement and, 234-235

quality indicators, 272-274

significance of, 5-6, 226, 232, 239, 324-325

stakeholder perspective as factor in, 20

standardized instruments for, 230, 236

structural variables, 232

substance abuse findings, 271-272

substance abuse rehabilitation indicators, 282-287

substance abuse treatment, 84-85

substance abuse treatment quality indicators, 272-273, 299-304

treatment effectiveness, current understanding of, 84-85

treatment goals and, 226-227

treatment setting as variable, 230

P

Parity, 24, 170-171, 314

Peer review, 186

Performance-Based Measures for Managed Behavioral Healthcare, 174, 217

Pharmacotherapy

prescription patterns in managed care, 320

prospects, 85

for substance abuse rehabilitation, 281-282, 295-297

Physician-patient relationship, 69-70

cultural resource networks, 162

Planning Systems Development Program, 154

Point-of-service plans, 15, 42, 44

Preferred provider organizations, 15, 42, 43

President's Commission on Mental Health, 101

Preventive intervention(s), 56-57

with children in schools, 153

cultural competence in, 160

demand management as, 147

educational, in workplace, 147

health promotion plans, 56-57, 146-147

opportunities in workplace, 142-143

Primary care

barriers to behavioral health assessment, 88, 170

child/adolescent behavioral problems in, 153

definition, 87

in delivery of behavioral health care, 3, 76, 87

diagnostic accuracy in, 87

findings, 253

in integration of services, 87, 116

practitioners, 25

quality assurance in, 89

quality of behavioral health care in, 76

recommendations for, 13, 253

utilization, 87

vs. managed care carve-outs, 88

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

Private systems of care accountability, 184-186

alcoholism intervention, historical development of, 105

coverage trends, 93-95

in delivery of behavioral health care, 3, 4

drug abuse intervention, historical development of, 109

employee assistance programs, historical development of, 115

health benefits consultants, 188

measures of quality in, 5, 184, 190-191

public sector services and, 91-93

quality standards, 191-199

strengths and limitations of, 94

Process measures of quality, 3, 5, 61

as outcome variables, 232

Provider inclusion

determinants of, 317-318

managed care practice, 46, 168

recommendations for, 9, 246-247

Public Health Service, 200-201

Public perception/understanding of behavioral health care, 20-21, 23-24

as factor in outcomes measurement, 227-228

of mental illness, 170

Public services

characteristics of substance abuse treatment programs, 133-134

for children and adolescents, 153-154

concerns with managed care contracts for, 47-48, 49-50

contracting with managed care organizations for, 47-49, 67, 94

criminal justice system and, 112

eligibility criteria for mental health services, 169

funding for, 76, 80, 111, 122, 242-243

historical development of alcoholism treatment, 104-107

historical development of delivery system, 96, 103-104

historical development of drug abuse intervention, 107-111

integration with private services, 49, 59, 115-116

measures of quality in, 5, 184

mental health care expenditures, 80

mental health treatment system, 135-136

performance measurement for, 199-200

private sector insurance boundaries, 91-93

state-federal relationship, 95, 96

substance abuse screening, 56-57

substance abuse treatment program funding, 135

in system of behavioral health care, 3, 4, 76, 80, 91

wraparound services, 138-139

Purchasers, group

adverse selection effects, 51-52

assessments of access by, 179-180

competition for enrollees, 45-46

employer coalitions, 191

influence of, 28-29

potential for savings, 48

price sensitivity, 51-52

purchasing alliances, 28

quality of care as issue for, 53

state governments as, 47

See also Employer-sponsored plans

Q

Quality assessment

access to care as measure for, 168

auditing for, 187-188, 245

challenges to, 6, 18, 19-20

conceptual variables, 3, 61

consensus on measurement of, 199

consumer involvement in, 9-10, 17-18, 189, 219, 248

contract provisions, 29

by corporate purchasers, 190-191

in Department of Defense TriCare program, 152

of employee assistance programs, 143-144

framework for, 2-3, 33, 232

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

goals of, 199

historical development in behavioral health care, 189-190

information infrastructure for, 217-218

managed care industry activities, 32-33, 141-142

managed care monitoring mechanisms, 41, 45

Medicaid, 130

Medicare, 131

methods, 186-187

participants, 6

private sector quality standards, 191-199

in public sector, 199, 202, 203

stakeholder perspective as factor in, 19-20, 21, 184

Quality assurance, 61

good program qualities, 223

government role, 218-219

limitations of, 62

in primary care, 89

Quality control, 61

Quality improvement, 72

applications in behavioral health care, 65

applications in health care, 64-65

goals, 53

outcome measurement and, 234-235

principles of, 62-64

recommendations for, 7, 245

role of, 35

tools for, 64

Quality indicators

definition, 272

good qualities of, 273-274

for substance abuse detoxification, 278-279

for substance abuse rehabilitation, 287-298

for substance abuse treatment, 272-273, 299-304

Quality of care

accountability and, 184-186

competition and, 95

components, 35-36

concerns about managed care, 16-17, 47-48, 312, 321

consumer advocacy for, 24-25

contracting and, 66-67

definition, 17

determinants of, 21

goals, 33

legal considerations, 188

management trends, 189-190

market forces, 53

measurement approaches, 2-3, 5, 17-18

in primary care settings, 76

purchaser standards, 28-29

recommendations for monitoring, 7, 244-245

responsibility for, 54

role of accreditation systems, 6

system determinants, 54

treatment setting as variable in, 87

R

Race/ethnicity

patterns of substance abuse, 175-178

See also Cultural competence

Reagan administration, 103-104

Rehabilitation Accreditation Commission, 32, 204

Rehabilitation medicine, 83

goals for substance abuse, 279-282

outcome indicators for substance abuse rehabilitation, 282-287

quality indicators for substance abuse rehabilitation, 287-298

Report cards

data collection for, 66, 331

market demands, 198

public sector initiatives, 201-202

role of, 66

standardization of, 66

Research

child and adolescent interventions, 155

choice of provider, 329

current status, 249

population-based outcomes, 327

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

priorities, 325-330

problem recognition, 328

recommendations for, 10-11, 250

strategies for, 331-333

structure of managed care, 327-328

targeting high-risk patients, 330

on treatment strategy, 329-330

See also Outcomes measurement/research

Risk sharing, 50

Rural areas, 162-163, 176

S

Screening policies

for adults, 56-57

for children, 153

Skimming, 53

Social Security Disability Income, 25

Special Action Office for Drug Abuse Prevention, 110

Special populations

access issues, 175-178, 249

cultural competence issues, 159-162

findings, 249

goals for, 35

recommendations regarding, 10, 249

rural services, 162-163

See also Children and adolescents

State government

alcoholism treatment requirements, 90

certification and licensure activities, 54-56, 186-187

current regulation of managed behavioral health care, 89-90

federal action and, 95, 96

funding for mental health treatment, 136

funding for substance abuse treatment, 135

historical development of alcoholism treatment, 106-107

historical development of behavioral health care, 104

historical development of drug abuse treatment, 110, 111

integration of public-private services, 116

Medicaid administration, 128, 129

as purchaser of managed care services, 47

recommendations for, 8-9, 246

role in quality assurance, 218-219

shortcomings of behavioral health care delivery, 96

structure of delivery system, 95

substance abuse treatment regulation, 57-58

support for purchasing alliances, 28

Structure of behavioral health care system

access to care as component of, 168

accreditation review, 214

for child and adolescent services, 153-154

components, 122-123, 232

findings, 242-243

fragmented nature of, 163

as measure of quality, 3, 61, 122

mental health treatment, 135-136

military, 148-149, 151-152

organizational linkages, 3, 76-77

as outcome variable, 232

recommendations for, 6, 243

research needs, 327-328

in rural areas, 162-163

substance abuse service systems, 131-135

workplace services, 142-148

wraparound services, 136-139

See also Delivery system

Substance abuse

among children and adolescents, 77, 177

co-occurring mental health problems, 176-177

criminal behavior and, 112-113

gender differences, 175

measures of local prevalence, 178-179

by older adults, 177

parental, 152-153

racial/ethnic differences in, 175-178

research needs, 304

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

risk among children, 153

screening policies, 56-57

social costs, 77-78

See also Alcohol abuse/dependence ;

Substance abuse treatment

Substance Abuse and Mental Health Services Administration, 18, 134-136

managed care initiatives, 201

Mental Health Statistics Improvement Program, 201-202

quality standards, 188, 190-191

recommendations for, 9, 10, 11, 12, 14, 247, 249, 250, 252, 253, 254

Substance abuse treatment

client characteristics, 134-135

confidentiality regulations for, 68

cost of, 28, 141

counselor practitioners, 26, 58-59, 123, 294-295

coverage patterns, 169

credentialing of practitioners, 123

detoxification and stabilization, 274-279

disparities in delivery, 176

effectiveness of managed care programs, 50

effectiveness research, 84

employee assistance programs, 114-115

employment-related outcome factors, 289-290

family-related outcome factors, 290

future prospects for, 85

goals, 227

historical development of system, 96, 103, 107-111

long-term and short-term goals, 228-229

military service system, 149

outcomes research findings, 271-272

patient-related outcome factors, 285, 288-289

pharmacotherapy, 281-282, 295-297

program enrollment, 134-135

program funding, 135

psychiatric problems as outcome factor, 286-287

public sector managed care initiatives, 201

quality indicators, 272-273, 299-304

rehabilitation goals, 279-282

rehabilitation outcome indicators, 282-287

rehabilitation quality indicators, 287-298

severity of abuse as outcome factor, 285-286

state regulation of, 57-58

treatment-related outcome factors, 290-298

types and characteristics of practitioners, 123

types and characteristics of service systems, 131-135

wraparound services, 138-139, 251

See also Alcohol abuse/dependence

Suicide

among seniors, 156

behavioral health problems and, 78

prevention among adolescents, 252

Supplemental Security Income, 25

Synanon, 109

U

Uniform Alcoholism and Intoxication Treatment Act, 57, 107

Uninsured individuals, 92-93

Universal coverage, 171

Utilization

estimates of, 28

gender differences, 175

measurement of, for quality assessment, 217

primary care, 87

substance abuse treatment, 133

trends in, 20-21, 23-24

Utilization effect, 50-51

Utilization management

effectiveness of, 190

as mechanism to restrict access, 169-170

role of, 46

tools of, 46

Suggested Citation:"INDEX." Institute of Medicine. 1997. Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: The National Academies Press. doi: 10.17226/5477.
×

Utilization Review Accreditation Commission, 32, 213-214

V

Veterans Affairs, Department of, 4

historical development of mental health care, 148-149

managed care services in, 151

services for chronic relapsing conditions, 150

See also Military programs

W

Workplace service systems, 4

behavioral health disability management, 145

consultants for regulatory compliance, 144-145

demand management, 147

findings, 250

health promotion plans, 146-147

health training and education, 147

recommendations for, 11, 250

significance of, 142-143, 147-148

special needs of, 145

See also Employee assistance programs;

Employer-sponsored health plans

Wraparound services

findings, 251

funding, 138-139

historical development, 136-138

recommendations for, 11-12, 245, 251

types and characteristics of, 138-139

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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 health—federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

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