Managing Managed Care Quality Improvement in Behavioral Health (1997) / Chapter Skim
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FINDINGS AND RECOMMENDATIONS
FINDINGS AND RECOMMENDATIONS
Pages 241-254
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From page 241... ...
Furthermore, because of this rate of change and because of the unique structure of mental health and substance abuse care (e.g., the existence of substantial publicly paid systems at the state and local levels) , ensuring consumer protection and quality improvement are important challenges.
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From page 242... ...
Insurance coverage for mental health and substance abuse care has been limited and frequently has not covered the prolonged treatment that consumers and families need to address complex problems. · The separate publicly-financed health care system creates incentives for the private sector to limit benefits and thus to undermine the basic purpose of insurance; that is, to provide protection for large losses.
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From page 243... ...
Some of these functions overlap. · Accreditation of managed care plans by independent national bodies is an important and powerful tool of consumer protection and quality improvement in health care and behavioral health care.
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· Quality improvement methods have great potential but are still in preliminary stages for mental health and substance abuse services. Existing behavioral health performance measurement systems have used different strategies in their development, with varying degrees of consumer involvement.
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Contracting 2.2 Quality of care should be clearly addressed in contracts between pur' chasers and providers. 2.2.1 When plans contract or subcontract for the management and delivery of behavioral health care services (e.g., health maintenance organize' tions contracting with carved-out managed behavioral health care firms)
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From page 246... ...
. Role of State Governments 2.4 The role of state governments in consumer protection should include the following: 2.4.1 Support the development of consumer protection standards for managed behavioral health care by state mental health and substance abuse agencies, state Medicaid agencies, state insurance departments, state licensing boards, state hospitals, and state child welfare agencies.
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From page 247... ...
· Consumers and families strongly desire to participate fully in decisionmaking in treatment, setting behavioral health care standards, and developing performance measures. · Public behavioral health service systems make use of selEhelp groups, consumer~operated services, and experientially trained counselors (e.g., mental health workers and substance abuse counselors)
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From page 248... ...
4.2 Practitioners of alternative and innovative treatments without an ac' cepted research base should not arbitrarily be excluded from health plans. If these treatments are used, their electiveness should be studied so that standards of qual' ity improvement can be developed.
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· Research and practice interact too infrequently, and few incentives exist for collaboration among researchers, practitioners, and policymakers. · Outcomes research is often unresponsive to emerging problems in clinical practice and also rarely provides direction for accreditation and quality improvement efforts.
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(National Institute on Alcohol Abuse and Alcoholism [NIAAAl, National Institute on Drug Abuse [NIDAl, and the National Institute of Mental Health [NIMHi) , and Substance Abuse and Men' tat Health Services Administration (SAMHSA)
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From page 251... ...
8.2 To maximize full functioning for individuals with severe and persistent mental illness, and to optimize conditions supporting recovery for individuals with chronic substance abuse problems, wraparound services such as social welfare, housing, vocational, and rehabilitative services should be available and should be coordinated. 8.3 For children and adolescents with severe emotional disturbances, educational and home environment-family support services should be coordinated and integrated with mental health care.
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, and the Health Research and Services Administration (HRSA) should identify exemplary models of linking behavioral health treatment and prevention programs for children and adolescents to address suicide, substance abuse, and other areas.
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10.2 The Agency for Health Care Policy and Research (AHCPR) , Substance Abuse and Mental Health Services Administration (SAMHSA)
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tlon, continuous improvement protocols to promote better outcomes, and no contractual or other limitations for physicians and other practitio' nets concerning the discussion of clinically appropriate treatment options with patients and families. 12.2 A careful review of ethical issues in various settings, for example, managed care organizations, networks, and fee~for~service settings, is needed.
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