The Clinician's Guide to Managed Behavioral Care

The Clinician's Guide to Managed Behavioral Care

Author: Norman Winegar

Publisher: Psychology Press

Published: 1996

Total Pages: 356

ISBN-13: 9780789060129

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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


Understanding Managed Care

Understanding Managed Care

Author: Annette U. Rickel

Publisher: Karger Medical and Scientific Publishers

Published: 2000

Total Pages: 125

ISBN-13: 3805569602

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A unique series of cases based on a fictional family selecting and using a health plan is presented and a glossary is provided which defines basic concepts frequently encountered in the managed care field.


Understanding Managed Care

Understanding Managed Care

Author: Thomas N. Wise

Publisher:

Published: 1999

Total Pages: 0

ISBN-13: 9783318004984

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Physicians and allied health care professionals are graduating with in-depth knowledge of disease states and therapeutics, but little, if any practical knowledge of managed care systems. Nevertheless, managed care is so prevalent that in 1998 85% of the US working population was in some form of managed care network and one third of the physicians in practice were enrolled in managed care panels. There are few structured educational opportunities for individuals who are entering health care fields that help in understanding the different managed care systems. Instead, the managed care environment confronts the new physician with an unknown language, a novel management structure, and an expanding scope of rules and regulations. This book is designed to rectify this situation and to serve as a resource for teaching or independent self-paced study. It provides a historical overview, basic structure and components of managed care organizations, and future challenges. A unique series of cases based on a fictional family selecting and using a health plan is presented and a glossary is provided which defines basic concepts frequently encountered in the managed care field.


Managing Managed Care

Managing Managed Care

Author: Institute of Medicine

Publisher: National Academies Press

Published: 1997-04-21

Total Pages: 394

ISBN-13: 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.


Textbook Of Behavioural Managed Care

Textbook Of Behavioural Managed Care

Author: William L. Poynter

Publisher: Routledge

Published: 2013-06-17

Total Pages: 174

ISBN-13: 1134868499

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The changing role of managed care can be a daunting challenge to both experienced clinicians and students entering into the practice for the first time. Managed care seems to have come out of nowhere and has affected the psychotherapy community so strongly that private-practice clinicians are finding that they must reinvent their practices in order to work well with managed care systems. The Textbook of Behavioral Managed Care presents, in a well organized and comprehensive manner, the basic definitions of managed care; its effects on clinicians; and most importantly, how clinicians can respond to the pressures of managed care and still maintain the quality of their practices. For experienced clinicians, the information in this volume will prove invaluable in adapting to the ever increasing role of managed care; for the student entering into practice, the book is an essential tool for understanding the forces that managed care has brought into play. The better managed care companies have two goals: to stretch behavioral health resources and, ultimately, to improve quality. In light of these two important tasks, this book demonstrates that truly effective implementation of managed care requires sophistication of experienced, knowledgeable, specialized therapists. The Textbook of Behavioral Managed Care will provide clinicians with a greater level of understanding that enables them to implement managed care in the most effective manner possible.


The Dictionary Of Managed Care

The Dictionary Of Managed Care

Author: Jodi Aronson

Publisher: Routledge

Published: 2013-06-20

Total Pages: 68

ISBN-13: 1135062447

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The idea of managed care has sparked much controversy including its impact on the insurance industry, employer providers of care, and the patients themselves. In the confusion that comes with deciphering this complex system, this book provides clear and concise definitions of the most commonly used words, phrases and abbreviations in the industry. If mental health professionals want to become a part of the managed care system, they need to understand the terminology. In addition to the easy-to-understand definitions, the author provides examples for further clarification and appendices which include: a termination summary, a treatment plan, a treatment update, and a release form for confidential information. The idea for this book came about after the author gave a lecture at a national conference and the audience repeatedly asked for definitions of basic managed care terms. Therefore, this dictionary does not contain a debate on the pros or cons of managed care or an inside look into the managed care system. Instead, the author has provided a valuable resource for the professional that will answer questions regarding the basic terms of this industry.


Mental Health Providers Guide To Managed Care

Mental Health Providers Guide To Managed Care

Author: Leonard Reich

Publisher: W. W. Norton & Company

Published: 2006

Total Pages: 252

ISBN-13: 9780393705041

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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.