These programs are also known as managed behavioral health
care, managed care, behavioral healthcare and are provided
to Taft Hartley trusts and self-insured companies.
Utilization Review: Review of cases is
conducted to assure appropriate length of stay, medical necessity
and proper level of care.
Case Management: The EAP/MAP or MMHC group
does all assessment and referral, authorizes all services,
monitors all treatment, provides concurrent review and discharge
planning for the behavioral healthcare program.
Management Information Systems: Benchmark
information such as distribution of utilization, problem
category breakdown, client satisfaction, and relapse rates
by provider allows for cost effective management.
Quality Assurance: Client is followed from
intake, assessment and referral through counseling, resolution
and follow-up to ensure that the benefit dollar is judiciously
spent and quality care is received in the managed mental
healthcare program.
Pain Management Services: A partnership
with Integrated
Pain Solutions (IPS), a multidisciplinary managed
services organization, now provides a continuum of pain management
services - call center, case management, care coaching, utilization
management, provider network, centers of excellence, and
physician education.
Managed Care Cost Effective Reports:
(Based on availability of data
from TPA, a third-party administartor)
• Cost outcome by provider
• Cost outcome by diagnosis
• Relapse statistics by provider
• Average length of stay
• Utilization rate
• Price per unit of service
• Balance between inpatient/outpatient service
Management of treatment is the best overall way to contain
costs.
The Benefits:
A managed mental health care program provides a continuum
of care which:
• Controls cost for mental health care benefits
• Provides the most cost effective treatment while ensuring
quality of service
• Holds providers accountable to the client, employers and trusts
who pay for the services
Health promotion and utilizing non-medical resources,
when appropriate, are ways to capitalize on the health
care cost containment opportunity.
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