• Y
  • Y
  • Y
    Strategic Design
  • Y
  • Y
  • Y
    High Performance

Managed Care Impact

http://www.acgmt.com/managed-care-impact/Managed care is an umbrella term used to cover a variety of organizational structures, insurance benefits, and regulations which both provide for and control the cost of health care procedures. 

When applied to substance abuse and mental health, the term managed behavioral health care (MBHC) is most often employed.  

Like other forms of managed care, MBHC attempts to control costs of treatment. One prominent approach to cost control is achieved through limiting the utilization of services. Utilization is limited through imposing a variety of financial incentives and restrictions on which services are covered and which practitioners may be selected. An approach often used that typifies managed care is one of controlling benefits. In varying forms, benefit management is associated with annual and lifetime maximums, co-payments, gate-keeping procedures such as pre authorizations, and retrospective denials of benefits.

Managing benefit structures is but one of a number of procedures employed to contain costs effectively. Managed care organizations have broadened the way in which cost-containment may be conceptualized. Nowadays managed care organizations frequently talk of managing care in addition to managing benefits. Managing care is taken to ensure that only appropriate and necessary care is delivered in the least costly and restrictive settings.

It is more common to see the use of level of care placement criteria, standardized treatment planning methods, and the use of evidenced-based treatments. In this way, expensive treatments such as 30-day inpatient alcoholism programs are utilized more judiciously.

Nevertheless, unintended consequences of the managed care revolution has resulted in decreased value of substance abuse treatment benefits and decreased availability of appropriate care. Professional organizations have also increasingly acted to offset what are perceived to be unfair practices on the part of managed care organizations, managed care health plans and promoting a legal advocacy agenda. Thus, various state psychological associations have supported litigation aimed at eliminating potentially harmful MC strategies and procedures.