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Healthcare Association (AMBHA), the industry membership organization founded in 1995. AMBHA member organizations currently manage mental health and substance abuse care for more than 80 million Americans (AMBHA, 1995). AMBHA works closely with the National Association of State Mental Health Program Directors in developing joint health care policy statements and other collaborative efforts (e.g., AMBHA and NASMHPD, 1995).

In 1995, AMBHA released its first report card, Performance-Based Measures for Managed Behavioral Healthcare Programs (PERMS 1.0). The measures are chosen to be “meaningful, measurable, and manageable ” and are classified into three domains: access to care, consumer satisfaction, and quality of care. Measures are based on available data systems, primarily based on existing administrative and reporting data bases. AMBHA has begun field testing of PERMS, and all AMBHA members have agreed to participate (Bartlett, 1996). In Chapter 6, PERMS measures are compared with other current performance measures for behavioral health care.

The Institute for Behavioral Healthcare (IBH) is also influential in the industry, publishing a journal, conducting conferences, and sponsoring other professional development activities in managed behavioral health care. In 1996, IBH released the results of a survey of members of its Leadership Council, a coalition of more than 170 behavioral health care organizations throughout the behavioral health care industry. The survey was completed by 47 percent of these organizations, with representation from four segments of the industry: (1) mental health facilities and integrated delivery systems, (2) community mental health centers and social and rehabilitation service agencies, (3) behavioral group practices, and (4) managed care organizations. The purpose of the survey was to evaluate the current use of a variety of performance indicators and their appropriateness and validity for measuring performance and the feasibility of using these indicators to measure performance (IBH, 1996).

The different segments of the industry, however, varied significantly in types of indicators used to measure access for their clients. For example, the availability of telephone access is frequently used to indicate access to managed care companies but is not used by other organizations that do not possess electronic telephone monitoring systems. The most frequently used indicators of outcomes were symptom reduction, improved functioning, and readmissions to treatment.

Efforts to standardize services and measure performance in managed behavioral health care organizations seem to be a priority for the industry. However, these efforts are in the preliminary stages, and it still is difficult for consumers, employers, and other purchasers of care to compare value and quality across plans.

WORKPLACE SERVICES

The workplace is a primary point of access for health care. An employee 's behavior, style, and habits become well known and recognized by coworkers. Changes



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