Because of growing enrollment in managed care plans, psychiatrists are finding it necessary to sign contracts with managed mental health care programs in order to receive third-party payment. These contracts often lead to complications and form a key area of concern for clinicians. The Psychiatrist's Guide to Managed Care Contracting helps psychiatrists make sense of the legal issues arising from their managed care contracts. In a step-by-step manner, this useful guide develops the framework for the crucial decisions that must be made and highlights the strategies a psychiatric practice can employ to shape the contract in its favor. It reviews standard contract provisions and the issues involved so that potential problems can be identified early in the negotiating process. The Psychiatrist's Guide to Managed Care Contracting also details the essential groundwork and preparation that should be completed before a psychiatric practice enters negotiations, including practice assessment, financial planning, marketing, and the development of administrative support. Equipped with this knowledge and advice, psychiatrists can negotiate from a position of strength and develop a favorable contract that ensures the survival and prosperity of their practice.

Because an increasing number of patients are covered through managed care plans, psychiatrists need to understand the managed care system in order to answer their patients' questions and ensure the continued prosperity of their practices. To assist clinicians in these challenging times, The Psychiatrist's Managed Care Primer arms psychiatrists with the information and tools they need to flourish within the managed care environment while simultaneously delivering quality patient care. This monograph provides an overview of the evolution of this industry; detailed explanations of current managed care models, operations, and anticipated trends; and practical advice on key problem areas. It focuses on the pressing issues of utilization management and capitation as well as important regulatory, ethical, and legal issues psychiatrists confront under this system. The potential impact that managed care systems have on their patient referrals, clinical decision-making autonomy, and income is also examined closely. Equipped with the sophisticated understanding of managed care supplied by this primer, psychiatrists can make the important decisions that will ensure the survival of their practice.

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.

A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. Although many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--as well as mental health research. The authors include some of the country's most noted psychologists with extensive experience in managed care. Their tone is optimistic rather than pessimistic; as they look at developments others have only deplored, they see potential roles and opportunities for growth for psychologists. In an era of dramatic health change, all those practitioners who are concerned about how to make managed care work for them rather than against them, will find this Guide essential reading. ALTERNATE BLURB A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. While many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--and mental health research as well.

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.

You'll find the practical guidance you need to transition smoothly int o the managed care environment. You'll learn the pros and cons of prac ticing in a managed care setting, the daily life of managed care physi cians, the role of managed care in medical education and health care r eform. Discover how to take advantage of new opportunities and avoid p itfalls, balance cost consideration with clinical decision-making, and understand the case mix systems most frequently used in managed care. Written almost entirely by physicians, The Physician's Guide to Manag ed Care is a must for any physician interested in meeting future chall enges.

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