Concise Guide to Managing Behavioral Health Care Within a Managed Care Environment
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How can behavioral health clinicians provide managed care in an ethical, professionally satisfying way while also dealing with managed care organizations (MCOs)?
This concise yet powerful volume will jump-start clinicians in their search for effective answers. Unlike other managed care guides, which tend to view the clinician-managed care relationship as inherently adversarial, this groundbreaking pocket guide (another in American Psychiatric Publishing's Concise Guides series) views resource management as a basic function—indeed, an ally—of ethical clinical practice. True managed care both improves the quality of clinical care and protects community resources. It even stimulates patients to become more active managers of their own care.
The author, speaking from extensive first-hand experience as both network provider and MCO administrator, asserts that clinicians must know how to manage care themselves to effectively persuade insurance companies to pay for treatment. Toward that end, the author details the practical tools clinicians need in just five chapters:
- Chapter 1, Managing Care Ethically, discusses basic principles and methods for making clinical decisions about behavioral health care when resources are limited and methods for communicating these decisions to patients and MCOs.
- Chapter 2, Managing Nonacute Care, applies the principles and methods from Chapter 1 to providing non-acute, usually outpatient, services.
- Chapter 3, Managing Acute Care, applies the principles and methods from Chapter 1 to providing acute crisis or inpatient services.
- Chapter 4, Marketing to Managed Care Organizations, details strategies for negotiating contracts to often unreceptive MCOs who consider their networks full, showing how clinicians can enhance their market value by filling MCO needs.
- Chapter 5, Managing Utilization Review, offers insights on overseeing the clinical work of colleagues and shaping the health care system, assuming that care managers are professionally obligated to help patients receive the care they need and deserve without intruding on the clinician's role, and that the best management manages least, taking responsibility for efficient resource utilization and ongoing system improvement.
This practical guide is more than just a handbook for successfully navigating MCO procedures and market dynamics; it also shows that the outcome of truly managed care can be just as satisfying and effective as care provided with infinite resources.
Invaluable to clinicians in everyday practice, this remarkable guide with its unique insights, collaborative approach, and case examples will also find a wide audience among clinical administrators in private and public MCOs who train network clinicians and utilization managers.
- Introduction to the Concise Guides Series
- Chapter 1. Managing Care Ethically
- Chapter 2. Managing Nonacute Care
- Chapter 3. Managing Acute Care
- Chapter 4. Marketing to Managed Care Organizations
- Chapter 5. Managing Utilization Review
About the Authors
Michael Isaiah Bennett, M.D., is Medical Director at Mental Health CaseManagement, Plymouth, Massachusetts.
This book should be read and referred to frequently by clinicians involved in the delivery of mental health in a managed care environment.—Doody's Health Science Book Review Journal
Michael Isaiah Bennett has written a useful small book that can be read in less than two hours. Although brief, Managing Behavioral Health Care Within a Managed Care Environment is not superficial. The references are well chosen and abundant, so any major point can be followed up by an interested reader. I particularly liked the illustrations of exactly what words might be said in a given circumstance to the patient, the managed care company, or the clinician. Sometimes that author illustrates his point by providing a sentence or two demonstrating the wrong way to address the same issue. The practical approach and sound advice would be helpful to a newcomer to the confusing world of managed care.—Psychiatric Services
Bennett has done a considerable service to present a complex conceptual framework in such succinct and precise fashion. He has managed to explain in a most helpful way how to deal with one of the conundrums that confront the psychiatric clinician.—Journal of Clinical Psychiatry
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