MANAGED MENTAL HEALTHCARE

Managed Mental Health Care

Managed Mental Health Care

Introduction

Mental health is a concept that aims to create stable living conditions and environments that enable individuals to maintain a normal lifestyle and share in the benefits of the state. These efforts include measures to increase the chances of more people living a normal health life with full mental well being and stability. Donahue (2010) describes mental health promotion as promoting positive mental health by increasing psychological well-being, competence and resilience and by increasing supportive living conditions and environments (Donahue 2010: 203).

Managed care is any health care delivery method in which an entity other than the health care provider actively manages both financial and medical aspects of health care. It includes a wide variety of techniques, products, and services that integrate the financing and the delivery of health care. Based on the premise that providers alter practice in response to financial incentives, managed care was created to control the costs, use, and quality of health care by increasing provider accountability to payers, promoting competition, and using practice standards. Managed mental health care (behavioural services) can coexist with or be delivered within general managed care health systems. Alternatively, they can be separated or “carved out” from standard health care plans and contracted to specialized providers who are responsible for utilization control, provider selection, finances, and quality assurance.

Managed care began as prepaid health care, the provision of a set package of services for a re-established fee. The originators intended to deliver affordable, accessible care to poor and middle-class farmers and labourers who wanted to eliminate unexpected medical bills. Today's critics of managed care say it has failed in this mission. They argue that consolidation of behavioural health care has concentrated control in the hands of a few powerful financial organizations. These organizations, say critics, place profit ahead of patient welfare, deny or delay access to necessary treatments and providers, award bonuses for reducing referrals to specialists, and arbitrarily discharge providers who use too many resources. For-profit, industrialized health care has not controlled inflationary medical costs, and over 42 million Americans are without health insurance.

Forms of Managed Health Care

Managed health care evolved swiftly from the 1980s to the present. Forms of managed care and managed mental health care are defined according to: (1) structural characteristics, (2) relationship of provider and patients to systems, and (3) financial arrangements. Methods to reduce costs include reviewing the medical necessity of services, intensive management of high-cost cases, regulation of inpatient admissions and length of stay, incentives for selecting less costly forms of care, beneficiary cost sharing, and selective contracting with health care providers. Hybrids blend the characteristics of more than one model as a function of diverse sets of local and regional requirements, state regulations, and specific statutes. The major types of managed health care are as follows: (Barker, 2009, 25)

1. Utilization review and management provides evaluation of medical necessity and appropriateness of mental health services prospectively, concurrently, or retrospectively.

2. The Staff Model Health Maintenance Organization (HMO) offers services ...