Concise guide to managing behavioral health care within a managed care environment /
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| Author / Creator: | Bennett, Michael Isaiah, 1945- |
|---|---|
| Edition: | 1st ed. |
| Imprint: | Washington, DC : American Psychiatric Pub., c2002. |
| Description: | xxii, 80 p. ; 17 cm. |
| Language: | English |
| Series: | Concise guides Concise guides (American Psychiatric Publishing) |
| Subject: | |
| Format: | Print Book |
| URL for this record: | http://pi.lib.uchicago.edu/1001/cat/bib/4728627 |
Table of Contents:
- Introduction to the Concise Guides Series
- Introduction
- Tools for Managing Care
- Balancing the Needs of Patients With the Need for Resource Preservation
- Two Misunderstandings: Managed Care and Managed Care Organizations
- Tools for Managing Managed Care Organizations
- Understanding the Market
- Shaping the System
- Conclusion
- References
- Acknowledgments
- 1. Managing Care Ethically
- Defining the Ethical Goal
- Determining Benefit Eligibility: Understanding Eligibility Criteria
- DSM-IV-TR Diagnosis
- Non--DSM-IV-TR Behavioral Problems
- Likelihood of Improvement
- Benefit Exclusions
- Determining Medical Necessity
- Assessing Risk of Harm
- Assessing Treatment Effectiveness and Risk of Relapse
- Assessing Nonprofessional Support
- Comanaging With Patients
- Sharpening Personal Choices
- Obtaining Other Resources
- Working With Managed Care Organizations
- Knowing How to Obtain Special Services
- Obtaining Deserved Benefits
- Acquiring Leverage Over Contracts
- Conclusion
- References
- 2. Managing Nonacute Care
- Determining Nonacute Coverage
- Evaluating Coverage
- Comanaging With Patients
- Deciding How Much Nonacute Care Is Necessary
- Meeting the Initial Need
- Determining Treatment Amount and Length
- Comanaging With Patients
- Obtaining Outpatient Benefits From Managed Care Organizations
- Gaining Access to a Company's System of Care
- Responding to Reviews
- Changing to Unmanaged Treatment
- Understanding Denials and Making Appeals
- Conclusion
- References
- 3. Managing Acute Care
- Determining Entitlement to Acute Behavioral Health Care
- Determining Medical Necessity of Acute Care
- Choosing Levels of Care
- Changing to Lower Levels of Care
- Administering Active Treatment
- Preparing Plan A and Plan B
- Comanaging Acute Care With Patients
- Obtaining Acute Care Benefits From Managed Care Organizations
- Gaining Access to Acute Care and Aftercare
- Undergoing Review
- Appealing
- Conclusion
- References
- 4. Marketing to Managed Care Organizations
- Presenting Credentials
- Responding to an Interview
- Avoiding Profiles
- Meeting an MCO's Unadvertised Needs
- Providing Regional and Special Clinical Services
- Offering Other Special Services
- Improving Quality
- Appearing at the Hour of Need
- Demonstrating Need
- Enhancing Incentive
- Contracting as a Group
- Seeking Allies
- Conclusion
- References
- 5. Managing Utilization Review
- Advocating for Good Managed Care
- Maintaining a Clinical or Fiscal Barrier
- Reviewing Medical Necessity
- Promoting Standards of Practice
- Educating Patients
- Pinpointing Patient Influence Over Resource Decisions
- Encouraging Realistic Decisions
- Finding Support for Quality Improvement
- Closing the Seams Between Systems
- Conclusion
- References
- Index
