Quality Assurance in Managed Mental and Behavioral Health Care
QualityAssurance in Managed Mental and Behavioral Health Care
TheNature of the Philosophy of Managed Care and Initiatives Directed atMental and Behavioral Health
Foryears, the care philosophy that is based on the systems of communityhas guided the delivery of services of the mental health for thepersons who are served by the agencies that are funded by the public(Handbookof Quality Management in Behavioral Health,2014).Such a philosophy assists the attributes of the community systemsthat encompass a wide range of services like individualized services,interagency cooperation, consumer and family involvement, andtreatment in the settings that are less restrictive. Moreover, thephilosophy ensures that the community systems offer services thatrespond to the diverse racial and ethnic needs of a populace. Theperceptions of the care systems emerged at a time when managedhealthcare was becoming popular.
Managedcare has made it easier for individuals to access services that arecommunity-based, as well as the critical behavioral health. However,access to hospital care for the inpatients has been minimized (BestMeetings, 2014). Managed care has made it difficult for the patientswho are diagnosed with severe mental diseases, and the uninsuredpersons to acquire the necessary services. Trends towards thetreatment approaches that are problem-oriented for the healthillnesses that concern a person’s behavior have been rampant underthe system of managed care. Some problems that relate to theexecution of the managed behavioral care were clarified by thesurveys of various states, as well as the Health Care Reform TrackingProject (HCRTP). To start with, there is distress that the currentefforts to enhance care systems for the people who are mentally sickare not being associated with the initiatives of managed care.Persons with behavioral health difficulties, as well as theirfamilies have raised concerns regarding the lack of cooperation withthe organizations that serve populaces in the behavioral healthsphere, as well as investment deficiencies in the creation ofservice-capacity concerning managed care. Also, the respondentscomplained of the difficult preauthorization needs, which may limitaccess to the suitable delivery of services because of managed care.
Accordingto Conner-Knox (2012), the Joint Commission on Mental Healthdiscovered in 1969 that persons with severe mental diseases werefrequently underserved, or were inappropriately served in thesettings that were extremely restrictive. The restrictive settingsincluded the psychiatric hospitals and residential facilities. Manysucceeding reports have authenticated such results. The recentreports agreed that serving such a populace through effectivecooperated systems require that a range of services be available. Assuch, the perception of the care systems that are based in thecommunity has become the prevailing ideology for the service systemsof the mental health. The philosophy’s care system emphasizes arange of services such as outpatient therapy, services that arehome-based, case management, day treatment, crisis services, and avariety of residential and non-residential options.Other services include public health, criminal justice, as well asthe services that are culturally competent and responsive to thetraits and needs of the diverse racial and ethnic populace. There hasbeen a major progress in the U.S in the financing and execution ofthe care systems, mainly in the public sector, for the individualswith severe needs. The Medicaid Programs of the State have been usedto a larger extent to fund the coherent systems of service delivery(Knopf, 2013).
Forthe persons that the private health programs fund the services oftheir mental health, the primary services are still offered in a morenonsystematic, traditional, and fragmented way (QualityDigest, 2012).However, there are problems that impede the care system developmentapproach to the service delivery for mental health within the privatesector. Traditionally, the delivery services have been offered by useof a medical model that focuses on the problems of the mental healthpathology, and fails to incorporate treatment with the care aspectsthat are supportive like family aid services and recovery services.
Arrangementsof the managed care were embraced during the period in which, thephilosophy of the care system was adopted. In the past, the managedcare use to deliver and finance the services of the substance abuseand mental health took place within the employer, or the privatehealth programs (Handbookof Quality Management in Behavioral Health,2014). Recently, nonetheless, the managed care programs for theservices for behavioral health have been executed mainly in thepublic sector, especially in the Medicaid Programs of the State.
TheSteps taken to Enhance Quality Care
Giventhe challenges that face the quality of healthcare, there are fivesteps that can be applied to improve quality care.Thesteps include communication and collaboration among the employees andthe patients, reporting of errors to the relevant offices, abolishingthe outdated regulations, stopping blame games among the healthcareworkers, and developing confidence among the healthcare workers(Knopf, 2013).
WhatWorks and What Does Not
Thereare various aspects that can work towards improving the quality ofhealthcare. Such aspects include incentives for the doctors to reportthe quality of Medicare, as well as payment for the healthcareservices that are directly proportional to quality (Niles, 2014).Moreover, programs that offer additional benefits to the healthcareagencies prioritize wellness, preventive care, and cost sharingcutbacks. On the contrary, the quality of healthcare will not improveby managing the healthcare facilities by the outdated regulations,inflicting fear in the staff members, and failing to report mistakesto the responsible personnel.
Itis imperative for the persons who have been diagnosed with behavioralhealth, as well as their families to be engaged in designing,planning, or executing the systems of managed care, as such will helpin helping the patients better.
BestMeetings. (2014). Physical & Behavioral Health Integration:Health Home Models. Journalof CommunityCare Behavioral Health Organization
Conner-Knox,J. (2012). Economic approaches to improving access to evidence-basedand recovery-oriented services for people with severe mentalillness. CanadianJournal of Psychiatry, 56(9),523-530.
Handbookof Quality Management in Behavioral Health.(2014). Boston, MA: Springer US.
Knopf,A. (2013). Medicaid expansion means more managed care. BehavioralHealthcare,33(2), 28-29.
Niles,N. J. (2014). Basicsof the U. S. Health Care System.Sudbury: Jones & Bartlett Learning, LLC.Topof Form
QualityDigest.(2012). FourSteps to Improving Healthcare Quality.Retrieved fromhttps://www.qualitydigest.com/inside/health-care-article/four-steps-improving-healthcare-quality.html#
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