Managing Managed Care - Hurley, Linda K.

. .

Sommaire:
1. Basics of Managed Care in Psychological Services for Children and Families.- Changes in Thinking about Health Care Reimbursement.- Changes Affecting Psychological Practices.- The ABCs of Managed Care.- Managed Behavioral Health Care.- Watching Managed Care Companies.- Conclusions.- 2. Problems Posed by Managed Care for Services to Children and Families.- Need for Child and Family Services.- Accessibility of Services.- Cost Containment and Utilization.- Quality of Care Issues.- Administrative Costs of Managed Care.- Accessing Services within a Managed Care Environment.- Current Procedural Terminology Codes.- Reduced Fees for Clinician-Providers.- Gatekeepers.- Utilization Management/Utilization Review.- Treatment Protocols.- Precertification.- Concurrent Review.- Denial of Service Authorization.- Restricting Patients' Access to Specialist Providers.- Medical Necessity and Noncovered Diagnoses.- What Drives Managed Care (and Drives Psychologists Elsewhere).- 3. Legal and Ethical Issues for the Clinician in Managed Care.- Restriction of Services.- Undertreatment.- Information Disclosure.- Liability and Hold Harmless Clauses.- Appealing Adverse Coverage Decisions.- Treatment beyond Reimbursement.- Confidentiality.- Managed Care Contracts.- Concluding Remarks.- 4. Adapting to the Managed Care Environment.- Accessing Provider Panels Generally.- Accessing Panels as a Specialist or Subspecialist.- Writing Behavioral and Measurable Treatment Goals.- Outcome Measurement and Evaluation.- Consumer Satisfaction.- Clinical Problems Not Covered by Managed Care Plans.- Prioritize Problems, Prioritize Treatments.- Using Time-Limited Therapy.- Office Overhead.- Helping Consumers Make Informed Choices.- Advocating for and with Consumers.- Changing the MentalHealth Care System.- Adapting to Managed Care.- 5. Limiting Negative Impact of Managed Care on a Clinical Child/Pediatric Psychology Practice.- Advantages and Disadvantages of Practicing in a Managed Care Environment.- Diversify-Balancing Sources of Managed Care Reimbursement.- Evaluating the Business, Protecting the Practice: Lethal Pitfalls to Avoid.- Handling Insurance Claims.- Marketing.- POS Option.- Group Practice.- Types of Groups.- Capitation.- Managed Care and the Clinician.- 6. Practicing outside Managed Care.- Advantages to Fee-for-Service Clients.- Identifying and Recruiting Self-Pay (Fee-for-Service) Clientele.- Financing and Payment Options.- Goals/Standards for Practice as a Business Setting.- Marketing.- Accessibility.- Diversifying Referral Sources.- Working in Primary Care.- 7. Scientific Bases for Clinical Practice in Managed Care.- Do Psychological Treatments Work?.- Fitting the Pan to the Ham.- Medical Cost Offsets for Treatment of Children and Families.- Treatment Acceptability Findings.- Consumer Satisfaction Findings.- Referral Source Satisfaction.- Documenting What the Psychologist Does in Practice.- Epilogue.- References.