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Index

A

Access to care

barriers to, 169-171

for children and adolescents, 152-153, 154

concerns about managed care, 168-169, 316-317

cultural competency as factor in, 174

definition, 171

gender differences, 175

measures of, 4-5, 142, 171-174, 175, 178-180

need for care and, 174-175, 178

negative effects of limiting, 170

as quality assessment component, 168

racial/ethnic considerations in, 175-176, 248

for special populations, 249

universal coverage and, 171

wraparound services, 136-138

Accountability

consensus on quality for, 199

employer coalitions for, 191

in evolution of behavioral health care, 189-190

for outcomes, 237-238

in primary care, 87

public reporting systems for, 198

quality of care and, 184-186

through credentialing and privileging, 187

Accreditation

and clinical practice guidelines, 252-253

cost issues, 214-215

effect on quality of care, 54, 186

findings, 243-244

goal of, 203

government role in, 218-219, 246

of Indian Health Service health centers, 158

for monitoring contracts, 7-8

for monitoring quality of care, 6, 186

organizations for, 32, 204, 214.

See also Accreditation organizations

process, 215-216

quality improvement program requirements, 64

recommendations for, 6-9, 244-247

requirements for, 214

scope of, 186

trends, 203-204, 214-215



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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH Index A Access to care barriers to, 169-171 for children and adolescents, 152-153, 154 concerns about managed care, 168-169, 316-317 cultural competency as factor in, 174 definition, 171 gender differences, 175 measures of, 4-5, 142, 171-174, 175, 178-180 need for care and, 174-175, 178 negative effects of limiting, 170 as quality assessment component, 168 racial/ethnic considerations in, 175-176, 248 for special populations, 249 universal coverage and, 171 wraparound services, 136-138 Accountability consensus on quality for, 199 employer coalitions for, 191 in evolution of behavioral health care, 189-190 for outcomes, 237-238 in primary care, 87 public reporting systems for, 198 quality of care and, 184-186 through credentialing and privileging, 187 Accreditation and clinical practice guidelines, 252-253 cost issues, 214-215 effect on quality of care, 54, 186 findings, 243-244 goal of, 203 government role in, 218-219, 246 of Indian Health Service health centers, 158 for monitoring contracts, 7-8 for monitoring quality of care, 6, 186 organizations for, 32, 204, 214. See also Accreditation organizations process, 215-216 quality improvement program requirements, 64 recommendations for, 6-9, 244-247 requirements for, 214 scope of, 186 trends, 203-204, 214-215

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH See also Certification and licensure Accreditation organizations Council on Accreditation of Services for Families and Children, 23, 204-205 Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218 National Committee for Quality Assurance, 190-191, 202, 205-213 Rehabilitation Accreditation Commission, 32, 204 Utilization Review Accreditation Committee, 32, 213-214 Adverse selection, 51-52 Advocacy, consumer, 23-24 Affective disorders, 77 risk among children, 153 Agency for Health Care Policy and Research activities, 203 recommendations for, 9, 11, 12, 14, 247, 250, 253, 254 Alcohol abuse/dependence, 77 co-occurring disorders, 176-177 detoxification, 276-277, 278 disease model, 106 drunk driving, 112 evolution of treatment system, 104-107 measures of local prevalence, 178 mortality, 157 suicide and, 78 treatment effectiveness, 84 trends in insurance coverage, 90-91 See also Substance abuse Alcohol, Drug Abuse, and Mental Health Administration, 107, 111. See also Substance Abuse and Mental Health Services Administration Alcoholics Anonymous, 105, 114, 293 Alternative/innovative healing practices, 10, 248 American Managed Behavioral Healthcare Association, 141-142, 174 quality standards, 190-191 Anxiety disorders, 77, 177, 191 Auditing activities, 187-188, 245 B Behavioral health problems among seniors, 156 co-occurring, 176-177 cost of care trends, 141 historical development of treatment system, 96, 103 negative effects of restricted access, 170 prevalence and incidence, 1, 15, 77 public perception/understanding, 20-21, 23-24, 170 risk among children, 153 service needs, 80-84 social costs, 77-78, 84 social stigma, 170 suicide and, 78 terminology, 22 underdiagnosed/underestimated, 3, 76, 78-80, 170 utilization patterns, 28 Benefits consulting, 31-32 C Capitated payments as barrier to access, 168, 169 definition, 46 in Medicaid, 47 prevalence, 46 role of, 46 soft, 48 Carve-in arrangements, 45, 49 Carve-outs, 45, 49, 88 Case management, 49 Center for Mental Health Services, 201-202, 247 Center for Substance Abuse Prevention, 201 Center for Substance Abuse Treatment, 85, 112-113, 201 Centers for Disease Control and Prevention, 11, 250 Certification and licensure credentialing and privileging, 123, 187 peer review for, 186 quality of care issues, 57-58

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH state activities, 54-56, 186-187 for substance abuse counselors, 58-59, 294-295 substance abuse treatment, 57-58 transition of public services into managed care, 59 types of practitioners, 123 Child abuse, 153 Child and Adolescent Service System Program, 154 Children and adolescents adolescent treatment issues, 155 findings, 251-252 health screening, 153 with impaired parents, 152-153 mental health care trends, 141 military health services for, 149-150, 151 prevalence of behavioral health problems, 77 principles of care for, 154 program financing, 153-154 recommendations regarding, 11-12, 252 risk for abuse, 153 risk for mental health problems, 153 school-based intervention, 153 service needs, 152-153 substance abuse, 77, 155, 177 Civilian Health and Medical Program of the Uniformed Services, 148, 149-150, 151, 152, 189 Clinical outcomes information system, 230, 233 Clinical practice alternative/innovative techniques, 10, 248 coverage design/limitations and, 26 credentialing and privileging, 123, 187 cultural competence in, 159-162 duration of treatment, 319-320 effectiveness of, 84-85 findings, 252-253 focus of outcomes research, 84 in managed behavioral health care, 318-320 peer review, 186 prescription patterns, 320 recommendations for, 12-13, 253 standardization, 26-27 state licensure and effectiveness of, 57-58 structural measures of quality, 122 substance abuse counselors, 26, 58-59, 123, 294-295 terminology, 22 types and characteristics of practitioners, 25-26, 123 use of hospitals, 319 Clinical practice guidelines as accreditation issue, 252-253 current extent of use, 60 current limitations, 252 outcomes research and, 235 potential effects, 60-61 role of, 60, 188-189 Cocaine, 276, 277-278 Community Mental Health Centers Act of 1963, 103, 104 Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment, and Rehabilitation Act. See Hughes Act Comprehensive Drug Abuse Prevention and Control Act of 1970, 110 Confidentiality, 35 in carve-outs, 88 concerns, 67-68 in substance abuse treatment, 68 Consultants health benefits, 188 for regulatory compliance, 144-145 See also Benefits consulting Consumer protection, 2 confidentiality rights, 67-68 government role in, 8-9, 219, 245-246 in managed care system, 241 meaning of, 21 patient autonomy, 69 recommendations for, 8-10, 245-246, 248 strategies, 241-242 structural/process models, 219 Consumers and families advocacy efforts by, 23-24

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH definition, 21-22, 247 diversity, 25 involvement in health care system, 247-248 Consumer satisfaction with access, 171, 175 measurement of, 9-10, 201-202 as measure of quality, 189, 245 media dissemination of findings, 189 Continuity of care/coverage, 6, 93, 245 Contracts/contracting public sector-managed care, 48-49 quality assessment provisions, 29 quality of care and, 66 recommendations for, 7-8, 245 scope of coverage, 66-67 soft capitation, 48 Cost of care adverse selection effects, 51-52 behavioral health problems, 77-78, 80 behavioral health trends, 141 concerns about quality of care, 16-17, 312 financing of child and adolescent programs, 153-154 indirect costs, 80-84 integration of service systems for, 146 managed care containment strategies, 42-45, 168 preventive interventions in workplace to reduce, 147 regional disparities, 176 spending trends, 28 substance abuse treatment expenditures, 28, 135 for substance-abusing criminal offenders, 113-114 Cost shifting, 53, 93 Council on Accreditation of Services for Families and Children, 32, 204-205 Coverage design/limitations adverse selection effects, 51 benefits consultants, 31-32 competition for enrollees, 45-46 current status, 91 effect on quality of care, 54 employer-sponsored plans, 94, 184-185 historical limitations on mental health services, 313-314 legislative efforts, 24, 25 Medicaid, 128-129 Medicare, 130-131 parity, 24, 170-171, 314 private sector trends, 93-95 purchaser influence, 28-29 to restrict access, 169-170 substance abuse counseling, 26 treatment planning and, 26 trends, 90, 314 universal coverage, 171 Criminal justice system alcoholism intervention, historical development of, 105-106 cost of behavioral health problems, 78 drug abuse intervention, historical development of, 107-109, 112 implications of limiting access to care, 170 managed care contracts, 114 public addiction treatment system and, 112 substance abuse by criminals, 112-113, 114 substance abuse treatment in, 113-114 Cultural competence as ethical issue, 254 findings, 248 meaning of, 159 military health services, 150 models for practice, 160 need for, 159 recommendations for, 10, 248 resource networks, 162 threshold issues, 160-161 D Data collection and management admissions/discharge forms, 236 claims data, 217, 236 clinical outcomes information system, 230 confidentiality issues, 67-68

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH Mental Health Statistics Improvement Program, 201-202 for outcomes measurement, 233, 236-237 private sector quality standards, 191-199 public sector performance standards, 199-200 for quality improvement, 64 for quality measurement, 217-218 for report cards, 66 research priorities, 331 shortcomings of, 217-218 Defense, Department of, 4, 189 historical development of mental health care, 148-149 managed care services in, 151-152 TriCare program, 151-152 See also Military programs Deinstitutionalization, 103 Delivery system alcoholism intervention, historical development of, 104-107 behavioral health disability management plans, 145 challenges to, 3, 77 components of, 3, 122-123 in criminal justice system, 113-114 current functioning, 76-77 drug abuse intervention, historical development of, 107-111 employee assistance programs, 114-115 fragmented nature of, 76-77, 80, 96, 153-154, 163 historical development, 96, 103-111 Indian Health Service, 157-159 integration of public-private services, 49, 59, 115-116 managed care, 29-31 military managed care programs, 151-152 organizational interactions, 4 primary care in, 87-89 for rural areas, 162-163 service sector boundaries, 91-93 for special populations, 10 state level, 95-96 structural measures of quality, 122 wraparound services, 138-139 Demand management, 147 Depression/depressive disorders among seniors, 156 primary care treatment, 87, 89 Disability access to care, 249 behavioral, management of, 145 Medicare coverage, 130 substance abuse-related, 25 Drug Abuse Office and Treatment Act of 1972, 110 Drug Abuse Prevention, Treatment, and Rehabilitation Act, 68 E Employee assistance programs, 114-115, 143-144, 146 Employee Retirement Income Security Act of 1974, 90-91 Employer-sponsored health plans behavioral health disability management, 145 control of competition in, 45-46 cost of coverage, 46, 94 coverage design, 94 current status, 27-28 employer coalitions for quality accountability, 191 enrollment patterns, 46, 93-94 historical development, 184-185 mechanisms to restrict access in, 169-170 as purchasers of behavioral health care, 190-191 See also Workplace service systems Enabling services. See Wraparound services Enrollment patterns behavioral health care, 20-21 employee assistance programs, 115 employer-sponsored plans, 46, 93-94 health maintenance organizations, 31 indemnity insurance, 46

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH insured population, 28 managed behavioral health care, 1, 15, 45, 313 managed care, 1, 15, 31, 41-42 market influences, 45-46 Medicaid, 129, 202, 314 Medicare, 129, 131, 156-157, 202 private insurance, 31 substance abuse programs, 134-135 Ethical concerns, 71 confidentiality, 67-68 findings, 254 patient autonomy, 69 recommendations for, 13-14, 254 therapeutic relationship, 69-70 F Families with impaired parents, 152-153 military programs for, 149, 150 as substance abuse rehabilitation outcome factor, 290 Federal government confidentiality regulations for substance abuse treatment, 68 consumer advocacy for behavioral health care, 24 consumer protection role for, 8, 9, 219, 245-246 current regulation of managed behavioral health care, 89-90 funding for substance abuse treatment, 135 historical development of alcoholism treatment, 104-107 historical development of delivery system, 96, 103, 104, 148 historical development of drug abuse treatment, 107-111 parity legislation, 24, 170-171, 314 recommendations for, 8, 9, 245-246 regulatory compliance by employers, consultants for, 144-145 research role, 249 role in quality assurance, 218-219 state level implementation, 95, 96 Foundation for Accountability, 191-198 G Gender differences, 175 H Harrison Narcotic Act, 107-108 Health Care Financing Administration, 29, 128 auditing activities, 187-188 quality management activities, 202 recommendations for, 14, 254 responsibilities and authorities, 202 Health maintenance organizations accreditation requirements, 214 behavioral health care in, 45, 314 characteristics, 42 current regulation, 89-90 enrollment trends, 31 staff model, 45 Health Plan Employer Data and Information Set, 171-174, 198, 202, 217 Health Resources and Services Administration, 9, 11, 12, 247, 250, 252 Healthy People 2000, 200-201 Homeless mentally ill, 103 Housing, 83 Hughes Act, 57, 68, 106-107, 114-115 I Indemnity insurance enrollment trends, 46 in managed care system, 31 reimbursement system, 41 Independent practice associations, 42 Indian Health Service, 157-159 Infant mortality, 157 Institute for Behavioral Healthcare, 142

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH J Job training, 83 Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218 K Kassebaum-Kennedy bill, 24, 170-171 L Legal issues, 188 Length of stay, 319-320 M Managed behavioral health care advantages of, 27, 48 adverse selection, 51 barriers to effective primary care, 88-89 choice of practitioner in, 315-316 clinical practice in, 318-320 competition, 50 conceptual approach to, 33-35 concerns about access, 169, 316-317 concerns about quality, 17, 47-48, 241, 312, 321 cost shifting, 53, 93 cultural competence issues, 160-161 current coverage, 91 current regulatory environment, 89-90 demands for quality, 53 effectiveness of, 50, 241, 242 employee assistance programs integrated with, 144, 146 enrollment, 1, 15, 313 ethical issues, 71 goals, 47 health promotion programs, 56-57, 146-147 historical growth, 31, 45, 314 integration of public-private services, 49-50, 59, 115-116 mechanisms to restrict access in, 169-170 in military health services, 151-152 See moral hazard. Adverse selection outcomes of care, 321-324 performance measurement, 141-142 population needs assessment, 174-175 practitioner resistance to, 27 practitioners, 25-27, 123 principal issues, 19-20 quality improvement programs, 65 quality monitoring mechanisms, 41, 45 quality standards in private sector, 191-199 research priorities, 325-330 service sector boundaries, 91-93 skimming, 53 spending, 141 system trends, 41, 314 treatment planning in, 26 treatment trends, 15-16 Managed care accreditation, 186 carve-outs, 45, 49, 88 challenges to confidentiality, 67-68 concerns about access, 168-169 consumer concerns, 24 cost management strategies, 42-45, 168 enrollment trends, 15, 28, 31, 41-42 evolution of structure, 42 financial incentives in, 46 goals, 1, 15, 40 historical growth, 42, 313 in Indian Health Service programs, 158-159 industry stakeholders, 31-32 influence on health care system, 40, 90-91 insurance industry in, 31 measuring local needs and access, 178-179 outcome studies, 229 patient autonomy and, 69 quality of care concerns, 16-17, 312 in rural areas, 162-163 structure and operations, 29-31, 41-45 terminology, 21

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH therapeutic relationship in, 69-70 See also Managed behavioral health care Medicaid, 4, 92-93, 128 administrative structure, 129, 202 auditing activities, 188 capitated payment system in, 47 child health screening, 153 cost containment in, 129 coverage design, 128-129, 169 enrollment trends, 129 funding, 128 managed behavioral health care in, 94 managed care enrollment, 45, 128, 129, 202, 314 mental health care expenditures, 129 performance assessment, 130 recipients, 128 spending trends, 129 structure and operations, 128 in system of behavioral health care, 80, 104 Medicare, 4, 130 auditing activities, 188 benefit design, 130-131 costs, 131 disabled population, 130 enrollment, 31, 129, 131, 156-157, 202 managed care plans, 31, 129, 131, 202 mental health care provisions, 131 performance assessment, 130 quality improvement program, 64 Mental Health Statistics Improvement Program, 201-202 Methadone treatment, 109, 110 Military programs child and adolescent services, 149-150, 151 coordination of treatment in, 149 cultural competence, 150 family services, 149 historical development, 148-149 older adult services, 150 services for chronic relapsing conditions, 150 See also Defense, Department of ; Veterans Affairs, Department of N Narcotic Addict Rehabilitation Act of 1966, 109 Narcotics Anonymous, 293 National Alliance for the Mentally Ill, 246 National Association for Research on Schizophrenia and Depression , 246 National Committee for Quality Assurance, 190-191, 202, 205-213 National Depressive and Manic Depressive Association, 246 National Drug and Alcohol Treatment Utilization Survey, 131-133, 134 National Institute of Mental Health alcohol abuse research, 106, 111 Community Support Program, 103-104 drug abuse research, 110, 111 historical development, 103 recommendations for, 9, 11, 247, 250, 252 National Institute on Alcohol Abuse and Alcoholism, 106, 114-115 National Institute on Drug Abuse, 110-111, 250, 252 National Institutes of Health, 9, 11, 12, 247, 250, 252 National Mental Health Association, 246 O Obsessive-compulsive disorder, 177 Older adults/senior citizens coordination of services for, 156 as health care consumers, 156-157 health perceptions of, 156 military health services for, 150 risk for chronic conditions, 156 risk for mental health problems, 156 substance abuse patterns, 177 Opiate addiction/detoxification, 277, 278 Outcomes measurement/research accountability for findings, 237- 238 analytical framework for, 231-232 clinical outcomes information system, 230

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH clinical practice guidelines and, 235 criteria for evaluating, 235-236 data sources, 236-237, 245 effect on quality of care, 54 efficacy/effectiveness assessments, 234 employee assistance program performance, 143-144 general measures, 230-232 indicators of access, 173-174 limitations of, 5, 84, 85, 233-234, 238-239, 249 long-term and short-term objectives, 228-229 in managed behavioral health care, 321-323 managed care research, 142, 229 as measure of quality, 3, 61, 198 multidimensional context, 226, 228 new approaches, 229-230 performance indicators for, 233 population-based, 327 practitioner characteristics, 123 process variables, 232 prospects for, 237-238 public dissemination of findings, 237 public expectations for treatment and, 227-228 quality improvement and, 234-235 quality indicators, 272-274 significance of, 5-6, 226, 232, 239, 324-325 stakeholder perspective as factor in, 20 standardized instruments for, 230, 236 structural variables, 232 substance abuse findings, 271-272 substance abuse rehabilitation indicators, 282-287 substance abuse treatment, 84-85 substance abuse treatment quality indicators, 272-273, 299-304 treatment effectiveness, current understanding of, 84-85 treatment goals and, 226-227 treatment setting as variable, 230 P Parity, 24, 170-171, 314 Peer review, 186 Performance-Based Measures for Managed Behavioral Healthcare, 174, 217 Pharmacotherapy prescription patterns in managed care, 320 prospects, 85 for substance abuse rehabilitation, 281-282, 295-297 Physician-patient relationship, 69-70 cultural resource networks, 162 Planning Systems Development Program, 154 Point-of-service plans, 15, 42, 44 Preferred provider organizations, 15, 42, 43 President's Commission on Mental Health, 101 Preventive intervention(s), 56-57 with children in schools, 153 cultural competence in, 160 demand management as, 147 educational, in workplace, 147 health promotion plans, 56-57, 146-147 opportunities in workplace, 142-143 Primary care barriers to behavioral health assessment, 88, 170 child/adolescent behavioral problems in, 153 definition, 87 in delivery of behavioral health care, 3, 76, 87 diagnostic accuracy in, 87 findings, 253 in integration of services, 87, 116 practitioners, 25 quality assurance in, 89 quality of behavioral health care in, 76 recommendations for, 13, 253 utilization, 87 vs. managed care carve-outs, 88

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH Private systems of care accountability, 184-186 alcoholism intervention, historical development of, 105 coverage trends, 93-95 in delivery of behavioral health care, 3, 4 drug abuse intervention, historical development of, 109 employee assistance programs, historical development of, 115 health benefits consultants, 188 measures of quality in, 5, 184, 190-191 public sector services and, 91-93 quality standards, 191-199 strengths and limitations of, 94 Process measures of quality, 3, 5, 61 as outcome variables, 232 Provider inclusion determinants of, 317-318 managed care practice, 46, 168 recommendations for, 9, 246-247 Public Health Service, 200-201 Public perception/understanding of behavioral health care, 20-21, 23-24 as factor in outcomes measurement, 227-228 of mental illness, 170 Public services characteristics of substance abuse treatment programs, 133-134 for children and adolescents, 153-154 concerns with managed care contracts for, 47-48, 49-50 contracting with managed care organizations for, 47-49, 67, 94 criminal justice system and, 112 eligibility criteria for mental health services, 169 funding for, 76, 80, 111, 122, 242-243 historical development of alcoholism treatment, 104-107 historical development of delivery system, 96, 103-104 historical development of drug abuse intervention, 107-111 integration with private services, 49, 59, 115-116 measures of quality in, 5, 184 mental health care expenditures, 80 mental health treatment system, 135-136 performance measurement for, 199-200 private sector insurance boundaries, 91-93 state-federal relationship, 95, 96 substance abuse screening, 56-57 substance abuse treatment program funding, 135 in system of behavioral health care, 3, 4, 76, 80, 91 wraparound services, 138-139 Purchasers, group adverse selection effects, 51-52 assessments of access by, 179-180 competition for enrollees, 45-46 employer coalitions, 191 influence of, 28-29 potential for savings, 48 price sensitivity, 51-52 purchasing alliances, 28 quality of care as issue for, 53 state governments as, 47 See also Employer-sponsored plans Q Quality assessment access to care as measure for, 168 auditing for, 187-188, 245 challenges to, 6, 18, 19-20 conceptual variables, 3, 61 consensus on measurement of, 199 consumer involvement in, 9-10, 17-18, 189, 219, 248 contract provisions, 29 by corporate purchasers, 190-191 in Department of Defense TriCare program, 152 of employee assistance programs, 143-144 framework for, 2-3, 33, 232

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH goals of, 199 historical development in behavioral health care, 189-190 information infrastructure for, 217-218 managed care industry activities, 32-33, 141-142 managed care monitoring mechanisms, 41, 45 Medicaid, 130 Medicare, 131 methods, 186-187 participants, 6 private sector quality standards, 191-199 in public sector, 199, 202, 203 stakeholder perspective as factor in, 19-20, 21, 184 Quality assurance, 61 good program qualities, 223 government role, 218-219 limitations of, 62 in primary care, 89 Quality control, 61 Quality improvement, 72 applications in behavioral health care, 65 applications in health care, 64-65 goals, 53 outcome measurement and, 234-235 principles of, 62-64 recommendations for, 7, 245 role of, 35 tools for, 64 Quality indicators definition, 272 good qualities of, 273-274 for substance abuse detoxification, 278-279 for substance abuse rehabilitation, 287-298 for substance abuse treatment, 272-273, 299-304 Quality of care accountability and, 184-186 competition and, 95 components, 35-36 concerns about managed care, 16-17, 47-48, 312, 321 consumer advocacy for, 24-25 contracting and, 66-67 definition, 17 determinants of, 21 goals, 33 legal considerations, 188 management trends, 189-190 market forces, 53 measurement approaches, 2-3, 5, 17-18 in primary care settings, 76 purchaser standards, 28-29 recommendations for monitoring, 7, 244-245 responsibility for, 54 role of accreditation systems, 6 system determinants, 54 treatment setting as variable in, 87 R Race/ethnicity patterns of substance abuse, 175-178 See also Cultural competence Reagan administration, 103-104 Rehabilitation Accreditation Commission, 32, 204 Rehabilitation medicine, 83 goals for substance abuse, 279-282 outcome indicators for substance abuse rehabilitation, 282-287 quality indicators for substance abuse rehabilitation, 287-298 Report cards data collection for, 66, 331 market demands, 198 public sector initiatives, 201-202 role of, 66 standardization of, 66 Research child and adolescent interventions, 155 choice of provider, 329 current status, 249 population-based outcomes, 327

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH priorities, 325-330 problem recognition, 328 recommendations for, 10-11, 250 strategies for, 331-333 structure of managed care, 327-328 targeting high-risk patients, 330 on treatment strategy, 329-330 See also Outcomes measurement/research Risk sharing, 50 Rural areas, 162-163, 176 S Screening policies for adults, 56-57 for children, 153 Skimming, 53 Social Security Disability Income, 25 Special Action Office for Drug Abuse Prevention, 110 Special populations access issues, 175-178, 249 cultural competence issues, 159-162 findings, 249 goals for, 35 recommendations regarding, 10, 249 rural services, 162-163 See also Children and adolescents State government alcoholism treatment requirements, 90 certification and licensure activities, 54-56, 186-187 current regulation of managed behavioral health care, 89-90 federal action and, 95, 96 funding for mental health treatment, 136 funding for substance abuse treatment, 135 historical development of alcoholism treatment, 106-107 historical development of behavioral health care, 104 historical development of drug abuse treatment, 110, 111 integration of public-private services, 116 Medicaid administration, 128, 129 as purchaser of managed care services, 47 recommendations for, 8-9, 246 role in quality assurance, 218-219 shortcomings of behavioral health care delivery, 96 structure of delivery system, 95 substance abuse treatment regulation, 57-58 support for purchasing alliances, 28 Structure of behavioral health care system access to care as component of, 168 accreditation review, 214 for child and adolescent services, 153-154 components, 122-123, 232 findings, 242-243 fragmented nature of, 163 as measure of quality, 3, 61, 122 mental health treatment, 135-136 military, 148-149, 151-152 organizational linkages, 3, 76-77 as outcome variable, 232 recommendations for, 6, 243 research needs, 327-328 in rural areas, 162-163 substance abuse service systems, 131-135 workplace services, 142-148 wraparound services, 136-139 See also Delivery system Substance abuse among children and adolescents, 77, 177 co-occurring mental health problems, 176-177 criminal behavior and, 112-113 gender differences, 175 measures of local prevalence, 178-179 by older adults, 177 parental, 152-153 racial/ethnic differences in, 175-178 research needs, 304

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH risk among children, 153 screening policies, 56-57 social costs, 77-78 See also Alcohol abuse/dependence ; Substance abuse treatment Substance Abuse and Mental Health Services Administration, 18, 134-136 managed care initiatives, 201 Mental Health Statistics Improvement Program, 201-202 quality standards, 188, 190-191 recommendations for, 9, 10, 11, 12, 14, 247, 249, 250, 252, 253, 254 Substance abuse treatment client characteristics, 134-135 confidentiality regulations for, 68 cost of, 28, 141 counselor practitioners, 26, 58-59, 123, 294-295 coverage patterns, 169 credentialing of practitioners, 123 detoxification and stabilization, 274-279 disparities in delivery, 176 effectiveness of managed care programs, 50 effectiveness research, 84 employee assistance programs, 114-115 employment-related outcome factors, 289-290 family-related outcome factors, 290 future prospects for, 85 goals, 227 historical development of system, 96, 103, 107-111 long-term and short-term goals, 228-229 military service system, 149 outcomes research findings, 271-272 patient-related outcome factors, 285, 288-289 pharmacotherapy, 281-282, 295-297 program enrollment, 134-135 program funding, 135 psychiatric problems as outcome factor, 286-287 public sector managed care initiatives, 201 quality indicators, 272-273, 299-304 rehabilitation goals, 279-282 rehabilitation outcome indicators, 282-287 rehabilitation quality indicators, 287-298 severity of abuse as outcome factor, 285-286 state regulation of, 57-58 treatment-related outcome factors, 290-298 types and characteristics of practitioners, 123 types and characteristics of service systems, 131-135 wraparound services, 138-139, 251 See also Alcohol abuse/dependence Suicide among seniors, 156 behavioral health problems and, 78 prevention among adolescents, 252 Supplemental Security Income, 25 Synanon, 109 U Uniform Alcoholism and Intoxication Treatment Act, 57, 107 Uninsured individuals, 92-93 Universal coverage, 171 Utilization estimates of, 28 gender differences, 175 measurement of, for quality assessment, 217 primary care, 87 substance abuse treatment, 133 trends in, 20-21, 23-24 Utilization effect, 50-51 Utilization management effectiveness of, 190 as mechanism to restrict access, 169-170 role of, 46 tools of, 46

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH Utilization Review Accreditation Commission, 32, 213-214 V Veterans Affairs, Department of, 4 historical development of mental health care, 148-149 managed care services in, 151 services for chronic relapsing conditions, 150 See also Military programs W Workplace service systems, 4 behavioral health disability management, 145 consultants for regulatory compliance, 144-145 demand management, 147 findings, 250 health promotion plans, 146-147 health training and education, 147 recommendations for, 11, 250 significance of, 142-143, 147-148 special needs of, 145 See also Employee assistance programs; Employer-sponsored health plans Wraparound services findings, 251 funding, 138-139 historical development, 136-138 recommendations for, 11-12, 245, 251 types and characteristics of, 138-139