By Dr Michael Isaiah Bennett M.D.
How can behavioral well-being clinicians supply controlled care in a moral, professionally pleasant manner whereas additionally facing controlled care enterprises (MCOs)? This concise but robust quantity will jump-start clinicians of their look for powerful solutions. not like different controlled care publications, which are likely to view the clinicianAmanaged care courting as inherently antagonistic, this groundbreaking pocket consultant (another in American Psychiatric Publishing's Concise courses sequence) perspectives source administration as a uncomplicated functionAindeed, an allyAof moral medical perform. actual controlled care either improves the standard of medical care and protects neighborhood assets. It even stimulates sufferers to develop into extra energetic managers in their personal care. the writer, conversing from large first-hand adventure as either community supplier and MCO administrator, asserts that clinicians needs to understand how to regulate care themselves to successfully convince insurance firms to pay for therapy. towards that finish, the writer information the sensible instruments clinicians want in precisely 5 chapters: -Chapter 1, dealing with Care Ethically, discusses easy rules and techniques for making scientific judgements approximately behavioral overall healthiness care while assets are restricted and strategies for speaking those judgements to sufferers and MCOs. -Chapter 2, handling Nonacute Care, applies the foundations and strategies from bankruptcy 1 to offering non-acute, frequently outpatient, providers. -Chapter three, dealing with Acute Care, applies the foundations and strategies from bankruptcy 1 to offering acute predicament or inpatient prone. -Chapter four, advertising to controlled Care businesses, information recommendations for negotiating contracts to occasionally unreceptive MCOs who ponder their networks complete, displaying how clinicians can improve their marketplace price by means of filling MCO wishes. -Chapter five, coping with usage evaluate, bargains insights on overseeing the medical paintings of work-mates and shaping the future health care approach, assuming that care managers are professionally obligated to assist sufferers obtain the care they want and deserve with out intruding at the clinicianAs function, and that the simplest administration manages least, taking accountability for effective source usage and ongoing process development. This useful consultant is greater than only a instruction manual for effectively navigating MCO techniques and industry dynamics; it additionally indicates that the result of actually controlled care might be simply as pleasing and potent as care supplied with countless assets. precious to clinicians in daily perform, this amazing advisor with its detailed insights, collaborative procedure, and case examples also will discover a vast viewers between scientific directors in inner most and public MCOs who teach community clinicians and usage managers.
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Additional info for Concise Guide to Managing Behavioral Health Care Within a Managed Care Environment (Concise Guides)
34 ■ DETERMINING ENTITLEMENT TO ACUTE BEHAVIORAL HEALTH CARE We should know how to screen out problems for which acute care is usually not covered, and we should also know how to obtain other resources for the needed care. MCOs generally do not cover long-term custodial care for persistently disabled patients, acute incarceration for people who cannot live independently for reasons other than mental illness, and long-term residential treatment for children with behavioral problems. Increasingly, crisis centers perform a screening process that formerly took place after admission (Allen 1996).
California 1986). Our appeals are more likely to be successful if instead of venting frustration, we reason with care managers and the physician advisors who hear appeals (Green 1989; Task Force on Managed Care 1993). If, after appeals are completed, we continue to believe that our patients’ rights were not honored, we should advise them that MCOs are as responsive as other organizations to usual means of protest, such as seeking legal help or requesting assistance from politicians and executives who purchase insurance.
High Risk or Intense Medical Need We have but one choice—inpatient treatment—when patients are at high risk of harming themselves or others (Lyons et al. 1997) and thus require a locked setting, 24-hour care, and intensive psychiatric intervention. If in doubt, we err on the side of safety. Inpatient care is also necessary for patients who require around-theclock nursing and medical care. Patients who need this highest level of care include those who may act impulsively to harm themselves or others, have unstable medical problems, or physically resist attempts to help them.